| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,171.90 |
$8,817 |
4.3× |
| Abdomen 2 views (74019) |
$325.80 |
$465.43 |
3.0× |
| Acute gi blood loss imaging (78278) |
$1,306.90 |
$1,867 |
3.1× |
| Angiography extremity bilateral rs&i (75716) |
$3,605 |
$5,150 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$1,596.35 |
$2,280.50 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$355.60 |
$508 |
0.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,411.40 |
$6,302 |
1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,691.50 |
$3,845 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,603.90 |
$6,577 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$711.90 |
$1,017 |
0.2× |
| Ankle 2 views (73600) |
$651.70 |
$931 |
7.2× |
| Aortogram thoracic (75605) |
$4,603.90 |
$6,577 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$844.20 |
$1,206 |
0.3× |
| Aortography abdominal serialography rs&i (75625) |
$2,724.05 |
$3,891.50 |
0.8× |
| Basic dosimetry (77300) |
$2,035.60 |
$2,908 |
14.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$751.80 |
$1,074 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$2,150.40 |
$3,072 |
5.2× |
| Bone age studies (77072) |
$219.80 |
$314 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$1,385.48 |
$1,979.26 |
3.3× |
| Bone survey complete (77075) |
$1,017.10 |
$1,453 |
9.3× |
| Bowel imaging (78290) |
$807.10 |
$1,153 |
1.9× |
| Brachytx isodose complex (77318) |
$2,340.80 |
$3,344 |
6.0× |
| Brachytx isodose intermed (77317) |
$2,209.90 |
$3,157 |
5.7× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$2,013.90 |
$2,877 |
5.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,130.15 |
$1,614.50 |
2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,728.50 |
$6,755 |
3.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,970.50 |
$2,815 |
4.7× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$1,507.10 |
$2,153 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$689.50 |
$985 |
7.6× |
| Chest 1 view (71045) |
$203.38 |
$290.54 |
2.2× |
| Chest xray 3 views (71047) |
$342.30 |
$489 |
3.8× |
| Cholecystography, oral contrast Non-Facility (74290) |
$324.10 |
$463 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$455.02 |
$650.02 |
2.5× |
| Clavicle complete (73000) |
$659.05 |
$941.50 |
7.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,465.80 |
$6,379.70 |
12.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,841.13 |
$4,058.76 |
11.4× |
| CT abdomen w contrast (74160) |
$3,412.50 |
$4,875 |
18.6× |
| CT abdomen w wo contrast (74170) |
$4,277 |
$6,110 |
23.3× |
| CT abdomen w/o contrast (74150) |
$3,007.20 |
$4,296 |
27.5× |
| CT angio hrt w/3d image (75574) |
$1,029.70 |
$1,471 |
2.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,438.92 |
$2,055.60 |
7.9× |
| CT angiography upper extremity lt (73206) |
$2,595.60 |
$3,708 |
14.2× |
| CT c-spine w/contrast (72126) |
$3,385.20 |
$4,836 |
9.3× |
| CT c-spine w/o contrast (72125) |
$372.57 |
$532.24 |
3.4× |
| CT cervical spine w&w/o contrast (72127) |
$4,025.70 |
$5,751 |
22.0× |
| CT chest w contrast (71260) |
$1,805.92 |
$2,579.89 |
9.9× |
| CT chest w/wo contrast (71270) |
$2,077.38 |
$2,967.68 |
11.3× |
| CT head/brain with contrast (70460) |
$1,771.30 |
$2,530.42 |
9.7× |
| CT head/brain without and with contrast (70470) |
$530.60 |
$758 |
2.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$234.50 |
$335 |
2.6× |
| CT iac w contrast (70481) |
$2,140.22 |
$3,057.46 |
11.7× |
| CT lower ext w/o (73700) |
$2,463.30 |
$3,519 |
22.6× |
| CT lower extremity w wo contrast (73702) |
$1,262.10 |
$1,803 |
6.9× |
| CT lower extremity w/contrast material (73701) |
$3,327.45 |
$4,753.50 |
18.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,659.88 |
$2,371.26 |
9.1× |
| CT lumbar spine w/contrast (72132) |
$2,999.50 |
$4,285 |
8.2× |
| CT lumbar spine w/o contrast (72131) |
$375.20 |
$536 |
3.4× |
| CT maxillofacial w contrast (70487) |
$3,551.10 |
$5,073 |
19.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,949.33 |
$2,784.76 |
10.6× |
| CT maxillofacial wo contrast (70486) |
$391.30 |
$559 |
3.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,909.50 |
$5,585 |
21.3× |
| CT orbits w/o contrast (70480) |
$1,940.72 |
$2,772.46 |
17.8× |
| CT pelvis w/o contrast (72192) |
$382.06 |
$545.80 |
3.5× |
| CT pelvis w/wo contrast (72194) |
$3,816.40 |
$5,452 |
20.8× |
| CT scan of arm combo (73202) |
$3,358.60 |
$4,798 |
18.3× |
| CT soft tissue neck w contrast (70491) |
$1,634.99 |
$2,335.70 |
8.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,006.90 |
$2,867 |
11.0× |
| CT soft tissue neck w/o contrast (70490) |
$459.20 |
$656 |
4.2× |
| CT thoracic spine w/contrast (72129) |
$3,448.20 |
$4,926 |
18.8× |
| CT thoracic spine w/o contrast (72128) |
$371.64 |
$530.92 |
3.4× |
| CT thoracic spine w/wo contrast (72130) |
$3,620.40 |
$5,172 |
19.8× |
| CT thorax w/o contrast (71250) |
$1,426.92 |
$2,038.45 |
13.1× |
| CT upper ext wo (73200) |
$2,436.70 |
$3,481 |
22.3× |
| CT upper extremity with contrast (73201) |
$2,558.50 |
$3,655 |
7.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,786.70 |
$3,981 |
15.2× |
| Cta Abdomen (74175) |
$3,038.70 |
$4,341 |
16.6× |
| CTA chest (71275) |
$1,835.69 |
$2,622.42 |
10.0× |
| Cta Head (70496) |
$802.90 |
$1,147 |
4.4× |
| Cta Neck (70498) |
$1,883.92 |
$2,691.32 |
10.3× |
| Cta Pelvis (72191) |
$2,974.30 |
$4,249 |
16.2× |
| Cystography minimum 3 views rs&i (74430) |
$625.10 |
$893 |
1.7× |
| Diskography lumbar (72295) |
$1,738.10 |
$2,483 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$632.80 |
$904 |
5.8× |
| Esophagus (74220) |
$681.10 |
$973 |
3.7× |
| Facial bones min 3 views (70150) |
$574.70 |
$821 |
5.3× |
| Fetal biophysical profile non-stress testing (76818) |
$307.30 |
$439 |
2.8× |
| Fluoroscopy up to 1 hr (76000) |
$759.50 |
$1,085 |
3.0× |
| Foot 2 views (73620) |
$473.90 |
$677 |
5.2× |
| Forearm 2 views (73090) |
$573.30 |
$819 |
6.3× |
| Functional MRI brain by tech (70554) |
$2,396.80 |
$3,424 |
9.6× |
| Hand 2 views (73120) |
$420 |
$600 |
3.8× |
| Heart Infarct Image (78466) |
$940.10 |
$1,343 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,161.60 |
$3,088 |
3.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,817.20 |
$2,596 |
4.4× |
| Interstitial radiation source applic complex (77778) |
$1,404.20 |
$2,006 |
1.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,836.10 |
$2,623 |
3.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,072.70 |
$2,961 |
3.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$807.10 |
$1,153 |
1.4× |
| Knee 3 views (73562) |
$372.05 |
$531.50 |
4.1× |
| Liver & spleen imaging static only (78215) |
$2,076.20 |
$2,966 |
5.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,009.40 |
$1,442 |
2.4× |
| Lung ventilation imaging (78579) |
$1,460.90 |
$2,087 |
3.5× |
| Lymphoscintigraphy (78195) |
$1,703.10 |
$2,433 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,239.30 |
$3,199 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,470.90 |
$6,387 |
12.3× |
| MRA head w & w/o contrast (70546) |
$2,383.30 |
$3,404.72 |
6.5× |
| MRA head w/o contrast (70544) |
$637 |
$910 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,332.75 |
$3,332.50 |
6.4× |
| MRA neck w/o contrast (70547) |
$2,265.90 |
$3,237 |
9.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,040.38 |
$2,914.84 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$3,616.90 |
$5,167 |
14.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,939.55 |
$7,056.50 |
13.6× |
| MRI c-spine with contrast (72142) |
$4,038.30 |
$5,769 |
11.1× |
| MRI cervical spine w/o contrast (72141) |
$2,200.10 |
$3,143 |
8.8× |
| MRI chest w/o & w/contrast material (71552) |
$4,386.90 |
$6,267 |
12.0× |
| MRI chest w/o contrast (71550) |
$3,869.60 |
$5,528 |
15.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,445.40 |
$4,922 |
9.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,316.90 |
$6,167 |
11.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,234 |
$4,620 |
13.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,105.04 |
$3,007.20 |
8.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,682.40 |
$3,832 |
7.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,105.48 |
$3,007.84 |
5.8× |
| MRI pelvis w/o contrast (72195) |
$3,250.10 |
$4,643 |
13.0× |
| MRI spectroscopy (76390) |
$3,370.50 |
$4,815 |
37.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,450.34 |
$4,929.06 |
9.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,735.55 |
$5,336.50 |
10.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,697.40 |
$5,282 |
10.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,457.40 |
$2,082 |
5.8× |
| MRI up ext w/o contrast (73218) |
$3,124.10 |
$4,463 |
12.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,939.70 |
$2,771 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$4,084.50 |
$5,835 |
11.2× |
| Myelogram Cervical (72240) |
$1,590.40 |
$2,272 |
1.9× |
| Myelogram Lumbar (72265) |
$1,590.40 |
$2,272 |
1.9× |
| Myelogram thoracic (72255) |
$2,100.70 |
$3,001 |
2.6× |
| Myelography 2 or more regions (72270) |
$1,827 |
$2,610 |
2.2× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,320.10 |
$4,743 |
2.5× |
| Myocardial Spect Multiple Studies (78452) |
$3,727.50 |
$5,325 |
2.8× |
| Neck soft tissue (70360) |
$490 |
$700 |
5.4× |
| Nm cisternogram (78630) |
$1,463.70 |
$2,091 |
2.6× |
| Nm csf leak detection (78650) |
$1,297.80 |
$1,854 |
1.0× |
| Nm gastric emptying study (78264) |
$1,750 |
$2,500 |
4.2× |
| Nm gastroesophageal reflux study (78262) |
$1,345.40 |
$1,922 |
3.2× |
| Nm peritoneal-venous shunt patency (78291) |
$807.10 |
$1,153 |
1.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$807.10 |
$1,153 |
1.9× |
| Nuclear Rx Oral Admin (79005) |
$1,915.20 |
$2,736 |
7.9× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$76.30 |
$109 |
0.7× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$21 |
$30 |
0.7× |
| Osseous survey limited (77074) |
$394.80 |
$564 |
3.6× |
| Parathyroid Planar Imaging (78070) |
$1,523.90 |
$2,177 |
3.7× |
| Pelvis 1 or 2 views (72170) |
$264.24 |
$377.48 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$5,433.75 |
$7,762.50 |
3.6× |
| PET imaging CT for attenuation limited area (78814) |
$4,346.65 |
$6,209.50 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$5,696.60 |
$8,138 |
3.8× |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
$2,853.20 |
$4,076 |
2.1× |
| PET whole body (78813) |
$5,132.40 |
$7,332 |
3.4× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Non-Facility (78812) |
$3,804.50 |
$5,435 |
2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,704.50 |
$2,435 |
4.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,870.70 |
$4,101 |
5.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$478.80 |
$684 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$536.20 |
$766 |
5.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$609.70 |
$871 |
6.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$817.60 |
$1,168 |
9.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$219.80 |
$314 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$574 |
$820 |
5.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$344.40 |
$492 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$624.40 |
$892 |
6.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$710.50 |
$1,015 |
7.8× |
| Radex Hand Minimum 3 Views (73130) |
$841.75 |
$1,202.50 |
9.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$383.95 |
$548.50 |
4.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$749 |
$1,070 |
6.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$400.88 |
$572.68 |
3.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,170.40 |
$1,672 |
10.7× |
| Radex Humerus Minimum 2 Views (73060) |
$578.90 |
$827 |
6.4× |
| Radex Kne 1/2 Views (73560) |
$540.40 |
$772 |
5.9× |
| Radex Kne Compl 4/More Views (73564) |
$773.50 |
$1,105 |
7.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$672.70 |
$961 |
6.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$609 |
$870 |
6.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$723.80 |
$1,034 |
6.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$938 |
$1,340 |
10.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$309.40 |
$442 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$630.70 |
$901 |
6.9× |
| Radex Toe Minimum 2 Views (73660) |
$599.55 |
$856.50 |
6.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$831.25 |
$1,187.50 |
9.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$421.40 |
$602 |
3.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$231.86 |
$331.22 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$318.50 |
$455 |
2.9× |
| Radiologic exam chest 2 views (71046) |
$253.70 |
$362.44 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$604.10 |
$863 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,047.90 |
$1,497 |
5.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,232 |
$1,760 |
6.7× |
| Radiologic examination femur 1 view (73551) |
$597.45 |
$853.50 |
6.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$219.80 |
$314 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$797.65 |
$1,139.50 |
8.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$296.10 |
$423 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$235.90 |
$337 |
2.2× |
| Radiological examination surgical specimen (76098) |
$656.60 |
$938 |
1.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,024.80 |
$1,464 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,056.60 |
$2,938 |
4.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,867.50 |
$5,525 |
6.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,724.40 |
$3,892 |
4.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,683.15 |
$2,404.50 |
3.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,009 |
$2,870 |
1.5× |
| Scapula (73010) |
$827.05 |
$1,181.50 |
7.6× |
| Sella turcica (70240) |
$219.80 |
$314 |
2.4× |
| Shoulder 1 view (73020) |
$202.82 |
$289.74 |
2.2× |
| Small bowel series (74250) |
$970.90 |
$1,387 |
5.3× |
| Special Physics Consult (77370) |
$998.90 |
$1,427 |
7.1× |
| Special treatment procedure (77470) |
$2,814.70 |
$4,021 |
4.9× |
| Testicular Imaging With Vascular Flow (78761) |
$751.80 |
$1,074 |
1.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,208.90 |
$1,727 |
3.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,644.30 |
$2,349 |
2.9× |
| Thyroid imaging w/blood flow (78013) |
$1,100.40 |
$1,572 |
2.6× |
| Thyroid uptake measurement (78012) |
$1,009.40 |
$1,442 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,009.40 |
$1,442 |
2.4× |
| Treatment device complex (77334) |
$1,614.20 |
$2,306 |
4.1× |
| Treatment devices simple (77332) |
$1,990.80 |
$2,844 |
14.2× |
| Ultrasound breast complete (76641) |
$670.25 |
$957.50 |
6.1× |
| Ultrasound, abdomen limited (76705) |
$498.31 |
$711.87 |
4.6× |
| Unlisted magnetic resonance procedure (76498) |
$2,387 |
$3,410 |
26.3× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$1,086.40 |
$1,552 |
10.2× |
| Urethrocystogram voiding (74455) |
$984.90 |
$1,407 |
4.0× |
| Urethrocystography retrograde rs&i (74450) |
$987.70 |
$1,411 |
4.0× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,025.50 |
$1,465 |
5.6× |
| Us breast unilateral limited (76642) |
$599.20 |
$856 |
6.6× |
| Us chest (76604) |
$518 |
$740 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$731.50 |
$1,045 |
6.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$620.20 |
$886 |
5.7× |
| Us ob detailed single fetus (76811) |
$475.30 |
$679 |
1.9× |
| Us ob limited (76815) |
$171.50 |
$245 |
1.6× |
| Us pelvic non ob complete (76856) |
$567.90 |
$811.29 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$767.20 |
$1,096 |
7.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$623.70 |
$891 |
5.7× |
| Us retroperitoneal complete (76770) |
$337.84 |
$482.64 |
3.1× |
| Us retroperitoneal limited (76775) |
$983.50 |
$1,405 |
9.0× |
| Us scrotum and contents (76870) |
$801.50 |
$1,145 |
7.3× |
| Us soft tissue head/neck (76536) |
$411.35 |
$587.64 |
3.8× |
| Us spinal canal and contents (76800) |
$307.30 |
$439 |
2.8× |
| Us transrectal (76872) |
$893.55 |
$1,276.50 |
8.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$412.30 |
$589 |
3.8× |
| Venogram extremity bilateral (75822) |
$1,820 |
$2,600 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$1,213.10 |
$1,733 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$616.70 |
$881 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$616.70 |
$881 |
0.4× |
| Venography Renal Bilateral (75833) |
$3,791.90 |
$5,417 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$2,527.70 |
$3,611 |
0.8× |
| Venous sampling by catheter (75893) |
$4,603.90 |
$6,577 |
0.8× |
| Wrist 2 views (73100) |
$564.55 |
$806.50 |
6.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$287.70 |
$411 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,454.60 |
$2,078 |
7.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$442.40 |
$632 |
4.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$553 |
$790 |
6.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$1,029.70 |
$1,471 |
9.4× |
| X-ray exam of femur 2/> (73552) |
$682.85 |
$975.50 |
7.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$406 |
$580 |
4.5× |
| X-ray IV pyelogram (ivp) (74400) |
$478.10 |
$683 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$634.20 |
$906 |
7.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$869.40 |
$1,242 |
8.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$713.64 |
$1,019.48 |
6.5× |
| X-ray optic foramen (70190) |
$219.80 |
$314 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$1,168.30 |
$1,669 |
10.7× |
| X-ray retrograde pyelogram (74420) |
$1,115.10 |
$1,593 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$669.90 |
$957 |
7.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$877.10 |
$1,253 |
8.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$506.80 |
$724 |
4.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$679 |
$970 |
7.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,029.70 |
$1,471 |
11.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,082.90 |
$1,547 |
9.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$650.30 |
$929 |
6.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$482.30 |
$689 |
5.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$219.80 |
$314 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$613.90 |
$877 |
6.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$696.50 |
$995 |
6.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$912.10 |
$1,303 |
8.4× |
| Xr bone length studies (77073) |
$452.20 |
$646 |
4.1× |
| Xr c-spine 4 or 5 views (72050) |
$847 |
$1,210 |
7.8× |
| Xr c-spine 6 or more views (72052) |
$527.62 |
$753.74 |
4.8× |
| Xr urogram antegrade (74425) |
$887.60 |
$1,268 |
2.4× |