| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,539.20 |
$8,464 |
1.8× |
| Abdomen 2 views (74019) |
$150 |
$500 |
1.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$501.30 |
$1,671 |
1.3× |
| Angiography extremity bilateral rs&i (75716) |
$2,032.20 |
$6,774 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,935.60 |
$6,452 |
0.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,581.40 |
$11,938 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,330.80 |
$4,436 |
0.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,175.10 |
$3,917 |
0.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,581.40 |
$11,938 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,032.20 |
$6,774 |
0.6× |
| Ankle 2 views (73600) |
$134.10 |
$447 |
1.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$248.10 |
$827 |
0.7× |
| Aortogram thoracic (75605) |
$3,581.40 |
$11,938 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,468.70 |
$8,229 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$1,935.60 |
$6,452 |
0.6× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,050 |
$3,500 |
0.3× |
| Arthrogram shoulder (73040) |
$408.60 |
$1,362 |
1.2× |
| Basic radiation dosimetry calculation (77300) |
$256.50 |
$855 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$445.80 |
$1,486 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$767.70 |
$2,559 |
1.9× |
| Bone age studies (77072) |
$106.50 |
$355 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$668.70 |
$2,229 |
1.7× |
| Bone survey complete (77075) |
$192.60 |
$642 |
1.8× |
| Brain image w/flow 4 + views (78606) |
$575.70 |
$1,919 |
1.1× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,721.70 |
$5,739 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$150.30 |
$501 |
1.7× |
| Chest 1 view (71045) |
$105.30 |
$351 |
1.2× |
| Chest 3 views (71047) |
$148.50 |
$495 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$255.60 |
$852 |
1.5× |
| Clavicle complete (73000) |
$123 |
$410 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$213 |
$710 |
2.0× |
| Continuing medical physics consltj pr wk (77336) |
$314.40 |
$1,048 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,770 |
$5,900 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,350 |
$4,500 |
5.6× |
| CT abdomen w contrast (74160) |
$748.80 |
$2,496 |
4.3× |
| CT abdomen w wo contrast (74170) |
$981 |
$3,270 |
5.6× |
| CT abdomen w/o contrast (74150) |
$594.90 |
$1,983 |
5.7× |
| CT angio hrt w/3d image (75574) |
$887.40 |
$2,958 |
2.5× |
| CT angiography upper extremity lt (73206) |
$809.10 |
$2,697 |
4.6× |
| CT c-spine w/o contrast (72125) |
$765.60 |
$2,552 |
7.3× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$134.40 |
$448 |
0.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,012.50 |
$3,375 |
5.8× |
| CT cervical spine with contrast (72126) |
$707.70 |
$2,359 |
2.0× |
| CT chest w/wo contrast (71270) |
$825 |
$2,750 |
4.7× |
| CT chest with contrast (71260) |
$780 |
$2,600 |
4.4× |
| CT head/brain with contrast (70460) |
$773.40 |
$2,578 |
4.4× |
| CT head/brain without and with contrast (70470) |
$980.70 |
$3,269 |
5.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$177.30 |
$591 |
2.0× |
| CT iac w contrast (70481) |
$633.60 |
$2,112 |
3.6× |
| CT limited/localized follow up study (76380) |
$371.40 |
$1,238 |
4.3× |
| CT lower ext w/o (73700) |
$553.50 |
$1,845 |
5.3× |
| CT lower extremity w wo contrast (73702) |
$683.40 |
$2,278 |
3.9× |
| CT lower extremity with contrast (73701) |
$652.20 |
$2,174 |
3.7× |
| CT lumbar spine w & w/o contrast (72133) |
$990 |
$3,300 |
5.6× |
| CT lumbar spine w/o contrast (72131) |
$810 |
$2,700 |
7.7× |
| CT lumbar spine with contrast (72132) |
$900 |
$3,000 |
2.6× |
| CT maxillofacial w contrast (70487) |
$845.40 |
$2,818 |
4.8× |
| CT maxillofacial w/o contrast (70486) |
$690.90 |
$2,303 |
6.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,012.20 |
$3,374 |
5.8× |
| CT neck soft tissue w contrast (70491) |
$779.70 |
$2,599 |
4.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$806.70 |
$2,689 |
4.6× |
| CT orbits w/o contrast (70480) |
$607.50 |
$2,025 |
5.8× |
| CT pelvis w & w/o contrast (72194) |
$978.90 |
$3,263 |
5.6× |
| CT pelvis w/o contrast (72192) |
$822.30 |
$2,741 |
7.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$794.40 |
$2,648 |
4.5× |
| CT soft tissue neck w/o contrast (70490) |
$599.70 |
$1,999 |
5.7× |
| CT thoracic spine w/contrast (72129) |
$805.80 |
$2,686 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$728.70 |
$2,429 |
7.0× |
| CT thoracic spine w/wo contrast (72130) |
$837.90 |
$2,793 |
4.8× |
| CT thorax w/o contrast (71250) |
$767.40 |
$2,558 |
7.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$704.70 |
$2,349 |
4.0× |
| CT upper extremity w/o contrast rt (73200) |
$624 |
$2,080 |
6.0× |
| CT upper extremity with contrast (73201) |
$678 |
$2,260 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,069.50 |
$3,565 |
6.1× |
| Cta Abdomen (74175) |
$1,095 |
$3,650 |
6.2× |
| CTA abdomen pelvis (74174) |
$1,584.90 |
$5,283 |
4.5× |
| CTA chest (71275) |
$1,164 |
$3,880 |
6.6× |
| Cta Head (70496) |
$946.50 |
$3,155 |
5.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,651.20 |
$5,504 |
4.7× |
| Cta Neck (70498) |
$1,187.10 |
$3,957 |
6.8× |
| Cta Pelvis (72191) |
$689.40 |
$2,298 |
3.9× |
| Cystography minimum 3 views rs&i (74430) |
$326.40 |
$1,088 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$158.10 |
$527 |
1.5× |
| Esophageal motility (78258) |
$330 |
$1,100 |
0.8× |
| Esophagus (74220) |
$241.80 |
$806 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$321.60 |
$1,072 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$197.40 |
$658 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$230.10 |
$767 |
1.0× |
| Foot 2 views (73620) |
$109.80 |
$366 |
1.3× |
| Forearm 2 views (73090) |
$127.50 |
$425 |
1.5× |
| Functional MRI brain by tech (70554) |
$946.20 |
$3,154 |
4.0× |
| Gated Heart Planar Single (78472) |
$697.20 |
$2,324 |
1.7× |
| Hand 2 views (73120) |
$96 |
$320 |
0.9× |
| Hand 3 views (73130) |
$118.20 |
$394 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$823.80 |
$2,746 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$716.10 |
$2,387 |
1.8× |
| Ht muscle image spect sing (78451) |
$719.10 |
$2,397 |
0.6× |
| Humerus Min 2 Views Left (73060) |
$129.30 |
$431 |
1.5× |
| Hysterosalpingogram (74740) |
$421.50 |
$1,405 |
1.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$126 |
$420 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$700.50 |
$2,335 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$830.70 |
$2,769 |
1.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$624.30 |
$2,081 |
1.1× |
| Knee 3 views (73562) |
$145.80 |
$486 |
1.7× |
| Liver & spleen imaging static only (78215) |
$663.90 |
$2,213 |
1.7× |
| Lung perfusion differential (78597) |
$597.90 |
$1,993 |
1.5× |
| Lymphoscintigraphy (78195) |
$617.70 |
$2,059 |
1.1× |
| Mammary ductogram or galactogram multiple (77054) |
$251.10 |
$837 |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$198.60 |
$662 |
0.8× |
| Meckels Diverticulum (78290) |
$480 |
$1,600 |
1.2× |
| Mlc imrt design & construction per imrt plan (77338) |
$690 |
$2,300 |
1.8× |
| MRA head w/o contrast (70544) |
$753.30 |
$2,511 |
3.2× |
| MRA neck w contrast (70548) |
$772.50 |
$2,575 |
2.2× |
| MRA neck w/o contrast (70547) |
$926.40 |
$3,088 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,206 |
$4,020 |
3.5× |
| MRI abdomen w/o contrast (74181) |
$930 |
$3,100 |
3.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,087.50 |
$3,625 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,087.50 |
$3,625 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$702.60 |
$2,342 |
2.9× |
| MRI breast w/o contrast unilat (77046) |
$856.80 |
$2,856 |
3.6× |
| MRI cervical spine w/o contrast (72141) |
$884.70 |
$2,949 |
3.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,263.90 |
$4,213 |
3.6× |
| MRI chest w/o contrast (71550) |
$812.40 |
$2,708 |
3.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$834.30 |
$2,781 |
3.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$888.90 |
$2,963 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,346.40 |
$4,488 |
3.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,313.70 |
$4,379 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$877.80 |
$2,926 |
3.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,478.70 |
$4,929 |
4.2× |
| MRI scan of leg joint before and after contrast (73723) |
$1,206 |
$4,020 |
3.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,346.40 |
$4,488 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,278.60 |
$4,262 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,278.60 |
$4,262 |
3.7× |
| MRI thoracic spine w/o contrast (72146) |
$895.50 |
$2,985 |
3.7× |
| MRI tmj (70336) |
$596.10 |
$1,987 |
2.5× |
| MRI upper ext joint w/o contrast (73221) |
$860.40 |
$2,868 |
3.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,206 |
$4,020 |
3.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,084.80 |
$3,616 |
4.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,771.20 |
$5,904 |
1.4× |
| Neck soft tissue (70360) |
$119.40 |
$398 |
1.4× |
| Nm gastric emptying study (78264) |
$597.90 |
$1,993 |
1.5× |
| Nm red cell sequestration (78140) |
$402.30 |
$1,341 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,196.80 |
$10,656 |
2.3× |
| Nuclear medicine study of digestive tracts (78299) |
$176.10 |
$587 |
0.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$207.30 |
$691 |
2.0× |
| Osseous survey infant (77076) |
$108.60 |
$362 |
1.0× |
| Osseous survey limited (77074) |
$221.70 |
$739 |
2.1× |
| Parathyroid imaging (78070) |
$408.90 |
$1,363 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$108.30 |
$361 |
1.0× |
| PET image w/CT, skull-thigh (78815) |
$1,926.90 |
$6,423 |
1.3× |
| PET imaging CT for attenuation limited area (78814) |
$1,926.90 |
$6,423 |
1.3× |
| PET imaging for CT attenuation whole body (78816) |
$1,926.90 |
$6,423 |
1.3× |
| PET imaging limited area chest head/neck (78811) |
$2,197.80 |
$7,326 |
1.7× |
| PET whole body (78813) |
$2,197.80 |
$7,326 |
1.5× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$937.50 |
$3,125 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,206 |
$4,020 |
3.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$557.10 |
$1,857 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$474.30 |
$1,581 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$250.80 |
$836 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$131.10 |
$437 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$183.90 |
$613 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$132.90 |
$443 |
1.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$165.30 |
$551 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$243.60 |
$812 |
2.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$444.60 |
$1,482 |
0.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$186 |
$620 |
1.8× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$310.20 |
$1,034 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$154.20 |
$514 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$132.30 |
$441 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$180 |
$600 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$126 |
$420 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$351.60 |
$1,172 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$310.20 |
$1,034 |
1.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$320.10 |
$1,067 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$126.60 |
$422 |
1.5× |
| Radiological examination surgical specimen (76098) |
$351.60 |
$1,172 |
0.6× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$1,071 |
$3,570 |
2.7× |
| Ribs bilateral 3 views (71110) |
$156.60 |
$522 |
1.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$873.60 |
$2,912 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$914.10 |
$3,047 |
1.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,131.30 |
$3,771 |
0.9× |
| Salivary gland function study (78232) |
$425.40 |
$1,418 |
1.1× |
| Salivary gland imaging (78230) |
$320.40 |
$1,068 |
0.8× |
| Scanogram (77073) |
$120 |
$400 |
1.1× |
| Scapula complete (73010) |
$139.50 |
$465 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$48.90 |
$163 |
2.1× |
| Sella turcica (70240) |
$89.40 |
$298 |
1.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$148.50 |
$495 |
1.4× |
| Simulation intermediate (77285) |
$646.20 |
$2,154 |
1.7× |
| Small bowel series (74250) |
$310.80 |
$1,036 |
1.8× |
| Spec medical radj physics consltj (77370) |
$471.90 |
$1,573 |
3.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$362.70 |
$1,209 |
1.0× |
| Special dosimetry (77331) |
$128.10 |
$427 |
1.0× |
| Special treatment procedure (77470) |
$1,082.40 |
$3,608 |
2.0× |
| Spine thoracic 3 views (72072) |
$156.60 |
$522 |
1.5× |
| Stereotactic body radiation delivery (77373) |
$3,780 |
$12,600 |
2.1× |
| Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction 2nd-5th Sessions (77438) |
$82.20 |
$274 |
0.8× |
| Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting 2nd-5th… (77436) |
$30 |
$100 |
0.8× |
| Surface radiation therapy; superficial, delivery, </=150 kV, per fraction (eg, electronic brachytherapy) 2nd-5th… (77437) |
$82.20 |
$274 |
0.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,102.20 |
$3,674 |
2.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$303.30 |
$1,011 |
0.8× |
| Testicular Imaging With Vascular Flow (78761) |
$348.60 |
$1,162 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,044.60 |
$3,482 |
2.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$434.10 |
$1,447 |
3.2× |
| Therapeutic Enema (74283) |
$247.80 |
$826 |
1.4× |
| Thoracolumbar 2 views (72080) |
$126 |
$420 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$340.80 |
$1,136 |
0.9× |
| Thyroid uptake measurement (78012) |
$282.30 |
$941 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$539.70 |
$1,799 |
1.3× |
| Tmj unilateral (70328) |
$70.50 |
$235 |
0.8× |
| Tomogram (76100) |
$328.80 |
$1,096 |
3.1× |
| Treatment device intermediate (77333) |
$406.80 |
$1,356 |
3.0× |
| Treatment devices simple (77332) |
$263.40 |
$878 |
2.0× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,005.30 |
$3,351 |
1.8× |
| Tx devices design & construction complex (77334) |
$650.70 |
$2,169 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$294 |
$980 |
2.8× |
| Umbilical-artery Doppler (OB) (76820) |
$97.80 |
$326 |
0.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$179.10 |
$597 |
2.1× |
| Unlisted fluoroscopic procedure (76496) |
$62.10 |
$207 |
0.7× |
| Upper Extremity Infant (73092) |
$108 |
$360 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$237 |
$790 |
1.0× |
| Urethrocystography voiding (74455) |
$282.30 |
$941 |
1.2× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$530.70 |
$1,769 |
3.0× |
| Us abdl aorta screen aaa (76706) |
$157.80 |
$526 |
1.5× |
| Us breast unilateral complete (76641) |
$314.40 |
$1,048 |
3.0× |
| Us breast unilateral limited (76642) |
$172.50 |
$575 |
2.0× |
| Us chest (76604) |
$217.50 |
$725 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$191.40 |
$638 |
1.8× |
| Us infant hips dynamic (76885) |
$254.40 |
$848 |
2.9× |
| Us ob detailed single fetus (76811) |
$348.30 |
$1,161 |
1.5× |
| Us ob transvaginal (76817) |
$175.80 |
$586 |
1.7× |
| Us pelvic non ob complete (76856) |
$373.50 |
$1,245 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$198 |
$660 |
1.9× |
| Us pregnancy ltd (76815) |
$198 |
$660 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$306.90 |
$1,023 |
2.9× |
| Us retroperitoneal complete (76770) |
$378.60 |
$1,262 |
3.6× |
| Us retroperitoneal limited (76775) |
$264.30 |
$881 |
2.5× |
| Us scrotum and contents (76870) |
$304.20 |
$1,014 |
2.9× |
| Us soft tissue head/neck (76536) |
$315.90 |
$1,053 |
3.0× |
| Us spinal canal and contents (76800) |
$282.90 |
$943 |
2.7× |
| Us transrectal (76872) |
$162.30 |
$541 |
1.5× |
| Us xtr non-vasc lmtd (76882) |
$172.20 |
$574 |
1.6× |
| Vasogram (74440) |
$187.20 |
$624 |
0.8× |
| Venogram extremity bilateral (75822) |
$1,519.80 |
$5,066 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$2,032.20 |
$6,774 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$693.90 |
$2,313 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$900 |
$3,000 |
0.6× |
| Venography Renal Bilateral (75833) |
$3,505.50 |
$11,685 |
1.1× |
| Vertebral fracture assessment via dxa (77086) |
$97.20 |
$324 |
1.1× |
| Wrist 2 views (73100) |
$130.50 |
$435 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$119.10 |
$397 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$165.60 |
$552 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$460.50 |
$1,535 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$137.40 |
$458 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$158.70 |
$529 |
1.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$163.20 |
$544 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$104.10 |
$347 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$114 |
$380 |
1.3× |
| X-ray exam hip uni 4/> views (73503) |
$131.10 |
$437 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$177.90 |
$593 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$189.60 |
$632 |
1.8× |
| X-ray exam of femur 1 (73551) |
$104.10 |
$347 |
1.2× |
| X-ray eye for foreign body (70030) |
$71.40 |
$238 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$171.90 |
$573 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$157.20 |
$524 |
1.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$120 |
$400 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$90 |
$300 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$137.70 |
$459 |
1.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$167.70 |
$559 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$60.30 |
$201 |
0.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$60.30 |
$201 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$176.10 |
$587 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$302.40 |
$1,008 |
2.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$131.10 |
$437 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$161.70 |
$539 |
1.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$132.90 |
$443 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$238.20 |
$794 |
2.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$149.10 |
$497 |
1.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$369.30 |
$1,231 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$132 |
$440 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$170.40 |
$568 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$190.50 |
$635 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$115.50 |
$385 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$146.40 |
$488 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$158.40 |
$528 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$159.90 |
$533 |
1.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$126 |
$420 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$170.40 |
$568 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$113.10 |
$377 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$129.60 |
$432 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$85.20 |
$284 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$133.20 |
$444 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$150 |
$500 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$105 |
$350 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$139.50 |
$465 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$240 |
$800 |
2.3× |
| Xr chest 4+ views (71048) |
$152.10 |
$507 |
1.5× |
| Xr finger(s) 2+ views (73140) |
$117.60 |
$392 |
1.3× |
| Xr shoulder 1 view (73020) |
$113.40 |
$378 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$203.70 |
$679 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$150.90 |
$503 |
1.7× |
| Xr tmj bilateral (70330) |
$148.20 |
$494 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$126.90 |
$423 |
1.5× |