| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,716.50 |
$5,433 |
1.9× |
| Abdomen 2 views (74019) |
$201.50 |
$403 |
1.9× |
| Acute gi blood loss imaging (78278) |
$397 |
$794 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$2,110.50 |
$4,221 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$2,110.50 |
$4,221 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$3,800.50 |
$7,601 |
1.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,862.50 |
$3,725 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,110.50 |
$4,221 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,110.50 |
$4,221 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$7,146 |
$14,292 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,155.50 |
$10,311 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$661.50 |
$1,323 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,755.50 |
$7,511 |
1.1× |
| Ankle 2 views (73600) |
$206.50 |
$413 |
2.3× |
| Aortogram thoracic (75605) |
$5,155.50 |
$10,311 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,194.50 |
$4,389 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$5,938 |
$11,876 |
1.8× |
| Artery X-Rays Adrenal Gland (75731) |
$2,237 |
$4,474 |
0.7× |
| Arthrogram hip (73525) |
$619.50 |
$1,239 |
1.7× |
| Arthrogram shoulder (73040) |
$387 |
$774 |
1.1× |
| Basic dosimetry (77300) |
$306 |
$612 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$634.50 |
$1,269 |
1.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$779.50 |
$1,559 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$996.50 |
$1,993 |
2.4× |
| Bone age studies (77072) |
$198 |
$396 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$996.50 |
$1,993 |
2.4× |
| Bone Marrow Imaging Limited Area (78102) |
$668.50 |
$1,337 |
1.6× |
| Bone survey complete (77075) |
$345.50 |
$691 |
3.2× |
| Bone survey infant (77076) |
$172.50 |
$345 |
1.6× |
| Bowel imaging (78290) |
$715 |
$1,430 |
1.7× |
| Brachytx isodose complex (77318) |
$433.50 |
$867 |
1.1× |
| Brachytx isodose intermed (77317) |
$433.50 |
$867 |
1.1× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$156 |
$312 |
0.4× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$208.50 |
$417 |
0.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$540.50 |
$1,081 |
1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,844.50 |
$3,689 |
5.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$414.50 |
$829 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$157 |
$314 |
1.7× |
| Chest 1 view (71045) |
$106 |
$212 |
1.2× |
| Chest xray 3 views (71047) |
$106 |
$212 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$304.50 |
$609 |
1.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$598 |
$1,196 |
0.7× |
| Clavicle complete (73000) |
$235 |
$470 |
2.6× |
| Continuing medical physics consltj pr wk (77336) |
$303.50 |
$607 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,588 |
$5,176 |
7.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,068.50 |
$2,137 |
4.3× |
| CT abdomen w contrast (74160) |
$1,110.50 |
$2,221 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,802 |
$3,604 |
9.9× |
| CT abdomen w/o contrast (74150) |
$1,020.50 |
$2,041 |
9.4× |
| CT angio hrt w/3d image (75574) |
$800.50 |
$1,601 |
2.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,520.50 |
$3,041 |
8.4× |
| CT angiography upper extremity lt (73206) |
$2,162.50 |
$4,325 |
11.9× |
| CT c-spine w/contrast (72126) |
$1,115.50 |
$2,231 |
3.1× |
| CT c-spine w/o contrast (72125) |
$1,094 |
$2,188 |
10.1× |
| CT chest w contrast (71260) |
$1,151 |
$2,302 |
6.3× |
| CT chest w/wo contrast (71270) |
$1,221 |
$2,442 |
6.7× |
| CT head/brain with contrast (70460) |
$1,097.50 |
$2,195 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,230 |
$2,460 |
6.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$539 |
$1,078 |
1.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$199 |
$398 |
2.2× |
| CT iac w contrast (70481) |
$1,279 |
$2,558 |
7.0× |
| CT limited/localized follow up study (76380) |
$467.50 |
$935 |
5.2× |
| CT lower ext w/o (73700) |
$983.50 |
$1,967 |
9.1× |
| CT lower extremity w/contrast material (73701) |
$1,330.50 |
$2,661 |
7.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,250 |
$4,500 |
12.4× |
| CT lumbar spine w/contrast (72132) |
$1,227 |
$2,454 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$1,113.50 |
$2,227 |
10.3× |
| CT maxillofacial w contrast (70487) |
$953 |
$1,906 |
5.3× |
| CT maxillofacial wo contrast (70486) |
$942.50 |
$1,885 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$983.50 |
$1,967 |
5.4× |
| CT orbits w/o contrast (70480) |
$1,162.50 |
$2,325 |
10.7× |
| CT pelvis w/o contrast (72192) |
$942 |
$1,884 |
8.7× |
| CT pelvis w/wo contrast (72194) |
$1,509.50 |
$3,019 |
8.3× |
| CT scan of arm combo (73202) |
$654.50 |
$1,309 |
3.6× |
| CT soft tissue neck w contrast (70491) |
$1,049 |
$2,098 |
5.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$641.50 |
$1,283 |
3.5× |
| CT soft tissue neck w/o contrast (70490) |
$770 |
$1,540 |
7.1× |
| CT thoracic spine w/contrast (72129) |
$1,115.50 |
$2,231 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$944 |
$1,888 |
8.7× |
| CT thorax w/o contrast (71250) |
$565.50 |
$1,131 |
5.2× |
| CT upper ext wo (73200) |
$1,056.50 |
$2,113 |
9.8× |
| CT upper extremity with contrast (73201) |
$1,082.50 |
$2,165 |
3.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,233 |
$4,466 |
12.3× |
| Cta Abdomen (74175) |
$2,641 |
$5,282 |
14.6× |
| CTA abdomen pelvis (74174) |
$1,727 |
$3,454 |
4.8× |
| CTA chest (71275) |
$1,290.50 |
$2,581 |
7.1× |
| Cta Head (70496) |
$1,322 |
$2,644 |
7.3× |
| Cta Neck (70498) |
$1,241 |
$2,482 |
6.8× |
| Cta Pelvis (72191) |
$1,891.50 |
$3,783 |
10.4× |
| Cystography minimum 3 views rs&i (74430) |
$644 |
$1,288 |
1.8× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,275.50 |
$2,551 |
0.6× |
| Diskography lumbar (72295) |
$2,738 |
$5,476 |
1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$286.50 |
$573 |
2.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$180 |
$360 |
1.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$358.50 |
$717 |
3.3× |
| Esophagus (74220) |
$682 |
$1,364 |
3.8× |
| Facial bones min 3 views (70150) |
$409 |
$818 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$529.50 |
$1,059 |
4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$310 |
$620 |
2.9× |
| Fetal Echo (76825) |
$629.50 |
$1,259 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$469 |
$938 |
1.9× |
| Foot 2 views (73620) |
$206.50 |
$413 |
2.3× |
| Forearm 2 views (73090) |
$294 |
$588 |
3.3× |
| Hand 2 views (73120) |
$206.50 |
$413 |
1.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$896.50 |
$1,793 |
1.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,291 |
$2,582 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$1,450.50 |
$2,901 |
0.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,800.50 |
$7,601 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$835 |
$1,670 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$835 |
$1,670 |
2.0× |
| Hysterosalpingogram (74740) |
$1,008 |
$2,016 |
4.1× |
| Image fusion (77399) |
$159 |
$318 |
1.1× |
| Interstitial radiation source applic complex (77778) |
$857 |
$1,714 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$647.50 |
$1,295 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,129.50 |
$2,259 |
2.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$668 |
$1,336 |
1.2× |
| Knee 3 views (73562) |
$411.50 |
$823 |
4.6× |
| Liver & spleen imaging static only (78215) |
$529.50 |
$1,059 |
1.3× |
| Lung ventilation imaging (78579) |
$258 |
$516 |
0.6× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,492.50 |
$2,985 |
0.5× |
| Lymphoscintigraphy (78195) |
$418.50 |
$837 |
0.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,687.50 |
$3,375 |
2.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,731.50 |
$3,463 |
4.8× |
| Mlc imrt design & construction per imrt plan (77338) |
$750.50 |
$1,501 |
1.9× |
| MRA head w & w/o contrast (70546) |
$2,110.50 |
$4,221 |
5.8× |
| MRA head w/o contrast (70544) |
$1,919 |
$3,838 |
7.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,499 |
$2,998 |
4.2× |
| MRA neck w/o contrast (70547) |
$1,212.50 |
$2,425 |
4.9× |
| MRI abdomen w contrast (74182) |
$979 |
$1,958 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,886 |
$3,772 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$1,494.50 |
$2,989 |
6.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,618 |
$3,236 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,147 |
$4,294 |
5.9× |
| MRI cardiac w/o contrast (75557) |
$867 |
$1,734 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$1,499 |
$2,998 |
6.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,984 |
$3,968 |
5.5× |
| MRI chest w/o contrast (71550) |
$1,354 |
$2,708 |
5.5× |
| MRI fetal sngl/1st gestation (74712) |
$540.50 |
$1,081 |
2.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,844.50 |
$3,689 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,530.50 |
$3,061 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$989.50 |
$1,979 |
4.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,333 |
$2,666 |
3.7× |
| MRI pelvis w/contrast (72196) |
$1,190 |
$2,380 |
3.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,736 |
$3,472 |
4.8× |
| MRI pelvis w/o contrast (72195) |
$1,205.50 |
$2,411 |
4.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,773 |
$3,546 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,416 |
$2,832 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,319 |
$4,638 |
6.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,525.50 |
$5,051 |
7.0× |
| MRI temporomandibular joint (70336) |
$939.50 |
$1,879 |
3.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,844.50 |
$3,689 |
7.5× |
| MRI up ext w/o contrast (73218) |
$1,014.50 |
$2,029 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,697 |
$3,394 |
6.9× |
| MRI, joint upper extrem combo (73223) |
$1,975.50 |
$3,951 |
5.5× |
| Myelogram Lumbar (72265) |
$619.50 |
$1,239 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,161 |
$4,322 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,079.50 |
$4,159 |
1.6× |
| N-invas est c ffr sw aly CTA (75580) |
$1,361.50 |
$2,723 |
1.5× |
| Neck soft tissue (70360) |
$149 |
$298 |
1.7× |
| Nm cardiac blood pool multiple (78473) |
$847 |
$1,694 |
2.0× |
| Nm gastric emptying study (78264) |
$1,390 |
$2,780 |
3.4× |
| Nm peritoneal-venous shunt patency (78291) |
$334.50 |
$669 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,878 |
$5,756 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$655.50 |
$1,311 |
2.7× |
| Ob us nuchal meas 1 gest (76813) |
$217.50 |
$435 |
2.0× |
| Orthopantogram (70355) |
$73 |
$146 |
0.8× |
| Parathyrd planar w/spect&CT (78072) |
$871.50 |
$1,743 |
1.6× |
| Parathyroid Planar Imaging (78070) |
$673.50 |
$1,347 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$575 |
$1,150 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$178 |
$356 |
1.6× |
| Peritoneogram after injection (74190) |
$748 |
$1,496 |
1.3× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,003.50 |
$2,007 |
0.3× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,130.50 |
$2,261 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$416.50 |
$833 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$900.50 |
$1,801 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$828 |
$1,656 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$278 |
$556 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$142 |
$284 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$334.50 |
$669 |
3.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$196 |
$392 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$199.50 |
$399 |
2.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$281.50 |
$563 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$247.50 |
$495 |
2.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$160 |
$320 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$270 |
$540 |
2.5× |
| Radex Humerus Minimum 2 Views (73060) |
$210 |
$420 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$243.50 |
$487 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$549 |
$1,098 |
5.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$346 |
$692 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$224 |
$448 |
2.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$183 |
$366 |
1.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$376 |
$752 |
4.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$189.50 |
$379 |
1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$383 |
$766 |
4.3× |
| Radex Toe Minimum 2 Views (73660) |
$210 |
$420 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$223 |
$446 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$260 |
$520 |
2.9× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$8,144 |
$16,288 |
1.1× |
| Radiation treatment delivery level 1 (77402) |
$145 |
$290 |
1.4× |
| Radiation treatment delivery level 2 (77407) |
$145 |
$290 |
0.4× |
| Radiation treatment delivery level 3 (77412) |
$480.50 |
$961 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$106 |
$212 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$201.50 |
$403 |
1.9× |
| Radiologic exam chest 2 views (71046) |
$106 |
$212 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$253 |
$506 |
1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$307.50 |
$615 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$307.50 |
$615 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$307.50 |
$615 |
1.7× |
| Radiologic examination femur 1 view (73551) |
$103.50 |
$207 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$288.50 |
$577 |
3.2× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77768) |
$423.50 |
$847 |
1.1× |
| Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed;… (77767) |
$340 |
$680 |
0.9× |
| Renal Cyst Study (74470) |
$745 |
$1,490 |
1.3× |
| Ribs bilateral 3 views (71110) |
$191 |
$382 |
1.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$504.50 |
$1,009 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$504.50 |
$1,009 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,744.50 |
$3,489 |
3.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,253.50 |
$2,507 |
2.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,744.50 |
$3,489 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,979 |
$3,958 |
1.3× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,744.50 |
$3,489 |
1.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$655.50 |
$1,311 |
2.7× |
| Rp Therapy Intravenous Administration (79101) |
$336 |
$672 |
1.4× |
| Sacroiliac Joints < 3 Views (72200) |
$178 |
$356 |
1.6× |
| Scapula (73010) |
$264 |
$528 |
2.4× |
| Shoulder 1 view (73020) |
$196.50 |
$393 |
2.2× |
| Simulation intermediate (77285) |
$530 |
$1,060 |
1.4× |
| Small bowel series (74250) |
$162 |
$324 |
0.9× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$750.50 |
$1,501 |
1.9× |
| Special dosimetry (77331) |
$322 |
$644 |
2.3× |
| Special Physics Consult (77370) |
$317.50 |
$635 |
2.3× |
| Special treatment procedure (77470) |
$1,122.50 |
$2,245 |
2.0× |
| Spine thoracic 3 views (72072) |
$430.50 |
$861 |
4.0× |
| Stereotactic Body Radiation Delivery (77373) |
$5,817 |
$11,634 |
3.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$346.50 |
$693 |
0.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$156 |
$312 |
0.4× |
| Ther rad simulaj-aided field setting complex (77290) |
$883 |
$1,766 |
2.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$591.50 |
$1,183 |
4.3× |
| Thoracolumbar 2 views (72080) |
$414.50 |
$829 |
4.6× |
| Thyroid imaging w/blood flow (78013) |
$210 |
$420 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$560 |
$1,120 |
1.4× |
| Treatment device complex (77334) |
$496.50 |
$993 |
1.3× |
| Treatment devices simple (77332) |
$569.50 |
$1,139 |
4.1× |
| Ultrasound breast complete (76641) |
$120.50 |
$241 |
1.1× |
| Ultrasound Exam Aaa Screen (76706) |
$155 |
$310 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$341 |
$682 |
3.2× |
| Umbilical-artery Doppler (OB) (76820) |
$177.50 |
$355 |
1.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$114 |
$228 |
1.3× |
| Unlisted fluoroscopic procedure (76496) |
$122 |
$244 |
1.4× |
| Urethrocystogram voiding (74455) |
$644 |
$1,288 |
2.6× |
| Urethrocystography retrograde rs&i (74450) |
$117 |
$234 |
0.5× |
| Us breast unilateral limited (76642) |
$120.50 |
$241 |
1.3× |
| Us chest (76604) |
$311 |
$622 |
2.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$369 |
$738 |
1.7× |
| Us compl joint r-t w/image documentation (76881) |
$323.50 |
$647 |
3.0× |
| Us encephalogram (76506) |
$440.50 |
$881 |
4.1× |
| Us infant hips w manipulation (76885) |
$189.50 |
$379 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$179.50 |
$359 |
1.7× |
| Us ob detailed single fetus (76811) |
$772 |
$1,544 |
3.1× |
| Us ob limited (76815) |
$584.50 |
$1,169 |
5.4× |
| Us ob transvaginal (76817) |
$572 |
$1,144 |
5.3× |
| Us pelvic non ob complete (76856) |
$297 |
$594 |
2.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$272.50 |
$545 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$274 |
$548 |
2.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$513.50 |
$1,027 |
4.7× |
| Us retroperitoneal complete (76770) |
$274 |
$548 |
2.5× |
| Us retroperitoneal limited (76775) |
$126 |
$252 |
1.2× |
| Us scrotum and contents (76870) |
$274 |
$548 |
2.5× |
| Us soft tissue head/neck (76536) |
$406.50 |
$813 |
3.8× |
| Us spinal canal and contents (76800) |
$285.50 |
$571 |
2.6× |
| Us transrectal (76872) |
$238 |
$476 |
2.2× |
| Us transrectal prostate volume (76873) |
$274 |
$548 |
2.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$187 |
$374 |
1.7× |
| Venogram adrenal unilat (75840) |
$3,605.50 |
$7,211 |
1.1× |
| Venogram extremity bilateral (75822) |
$620.50 |
$1,241 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$1,877 |
$3,754 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$2,216 |
$4,432 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,049 |
$2,098 |
0.6× |
| Venography Renal Bilateral (75833) |
$2,005 |
$4,010 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$2,216 |
$4,432 |
0.7× |
| Venography venous sinus/jugular cath rs&i (75860) |
$711.50 |
$1,423 |
0.2× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,155 |
$2,310 |
0.2× |
| Wrist 2 views (73100) |
$206.50 |
$413 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$298.50 |
$597 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$142 |
$284 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$468 |
$936 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$206.50 |
$413 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$179 |
$358 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$183 |
$366 |
1.7× |
| X-ray exam of femur 2/> (73552) |
$252 |
$504 |
2.8× |
| X-ray eye for foreign body (70030) |
$136 |
$272 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$136 |
$272 |
1.5× |
| X-ray IV pyelogram (ivp) (74400) |
$840 |
$1,680 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$136 |
$272 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$136 |
$272 |
1.5× |
| X-ray leg, infant (73592) |
$147.50 |
$295 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$288.50 |
$577 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$493 |
$986 |
4.6× |
| X-ray nose-rectum child f.b. (76010) |
$143.50 |
$287 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$194.50 |
$389 |
1.8× |
| X-ray retrograde pyelogram (74420) |
$672 |
$1,344 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$101.50 |
$203 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$252 |
$504 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$260.50 |
$521 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$196 |
$392 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$154.50 |
$309 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$308 |
$616 |
3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$559.50 |
$1,119 |
5.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$285 |
$570 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$285.50 |
$571 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$183 |
$366 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$183 |
$366 |
1.7× |
| Xr bone length studies (77073) |
$335.50 |
$671 |
3.1× |
| Xr c-spine 4 or 5 views (72050) |
$466.50 |
$933 |
4.3× |
| Xr c-spine 6 or more views (72052) |
$466 |
$932 |
4.3× |
| Xr chest 4+ views (71048) |
$201.50 |
$403 |
1.9× |
| Xr urogram antegrade (74425) |
$392 |
$784 |
1.1× |