| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,086.08 |
$5,088 |
1.6× |
| Abdomen 2 views (74019) |
$196.39 |
$479 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$392.78 |
$958 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$272.65 |
$665 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$266.91 |
$651 |
0.1× |
| Angiography internal mammary rs&i (75756) |
$1,141.85 |
$2,785 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,039.34 |
$4,974 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$277.98 |
$678 |
0.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$274.29 |
$669 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$296.43 |
$723 |
0.1× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$571.13 |
$1,393 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$305.86 |
$746 |
0.1× |
| Ankle 2 views (73600) |
$134.48 |
$328 |
1.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$231.65 |
$565 |
0.7× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$258.71 |
$631 |
0.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$250.10 |
$610 |
0.1× |
| Aortography abdominal serialography rs&i (75625) |
$236.57 |
$577 |
0.1× |
| Arthrogram elbow (73085) |
$226.73 |
$553 |
0.7× |
| Arthrogram hip (73525) |
$186.55 |
$455 |
0.6× |
| Arthrogram shoulder (73040) |
$319.80 |
$780 |
1.0× |
| Arthrogram wrist (73115) |
$289.05 |
$705 |
0.9× |
| Arthrography knee lt (73580) |
$184.09 |
$449 |
0.6× |
| Basic radiation dosimetry calculation (77300) |
$227.14 |
$554 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$449.77 |
$1,097 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$595.32 |
$1,452 |
1.6× |
| Bone age studies (77072) |
$116.03 |
$283 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$753.58 |
$1,838 |
2.0× |
| Bone survey complete (77075) |
$231.65 |
$565 |
2.3× |
| Brachytx isodose complex (77318) |
$577.28 |
$1,408 |
1.6× |
| Brachytx isodose intermed (77317) |
$507.17 |
$1,237 |
1.4× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$348.50 |
$850 |
1.0× |
| Brain image w/flow 4 + views (78606) |
$619.51 |
$1,511 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$175.07 |
$427 |
2.1× |
| Chest 1 view (71045) |
$170.56 |
$416 |
2.0× |
| Chest 3 views (71047) |
$93.89 |
$229 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$354.24 |
$864 |
2.1× |
| Clavicle complete (73000) |
$132.02 |
$322 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$758.09 |
$1,849 |
7.6× |
| Continuing medical physics consltj pr wk (77336) |
$313.65 |
$765 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,751.11 |
$4,271 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,564.97 |
$3,817 |
6.8× |
| CT abdomen w contrast (74160) |
$736.36 |
$1,796 |
4.4× |
| CT abdomen w wo contrast (74170) |
$906.10 |
$2,210 |
5.4× |
| CT abdomen w/o contrast (74150) |
$674.45 |
$1,645 |
6.7× |
| CT angio hrt w/3d image (75574) |
$1,002.45 |
$2,445 |
3.0× |
| CT angiography upper extremity lt (73206) |
$749.89 |
$1,829 |
4.5× |
| CT c-spine w/o contrast (72125) |
$971.29 |
$2,369 |
9.7× |
| CT cervical spine w&w/o contrast (72127) |
$925.37 |
$2,257 |
5.5× |
| CT cervical spine with contrast (72126) |
$821.23 |
$2,003 |
2.5× |
| CT chest w/wo contrast (71270) |
$905.28 |
$2,208 |
5.4× |
| CT chest with contrast (71260) |
$1,026.23 |
$2,503 |
6.1× |
| CT head/brain with contrast (70460) |
$854.03 |
$2,083 |
5.1× |
| CT head/brain without and with contrast (70470) |
$1,002.45 |
$2,445 |
6.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$840.50 |
$2,050 |
2.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$379.25 |
$925 |
4.5× |
| CT iac w contrast (70481) |
$666.25 |
$1,625 |
4.0× |
| CT lower ext w/o (73700) |
$639.19 |
$1,559 |
6.4× |
| CT lower extremity w wo contrast (73702) |
$975.39 |
$2,379 |
5.8× |
| CT lower extremity with contrast (73701) |
$710.53 |
$1,733 |
4.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,034.02 |
$2,522 |
6.1× |
| CT lumbar spine w/o contrast (72131) |
$772.85 |
$1,885 |
7.7× |
| CT lumbar spine with contrast (72132) |
$881.50 |
$2,150 |
2.6× |
| CT maxillofacial w contrast (70487) |
$733.08 |
$1,788 |
4.4× |
| CT maxillofacial w/o contrast (70486) |
$783.10 |
$1,910 |
7.8× |
| CT maxillofacial w/wo contrast (70488) |
$764.65 |
$1,865 |
4.5× |
| CT neck soft tissue w contrast (70491) |
$740.05 |
$1,805 |
4.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$824.92 |
$2,012 |
4.9× |
| CT orbits w/o contrast (70480) |
$652.72 |
$1,592 |
6.5× |
| CT pelvis w & w/o contrast (72194) |
$845.01 |
$2,061 |
5.0× |
| CT pelvis w/o contrast (72192) |
$629.35 |
$1,535 |
6.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$778.59 |
$1,899 |
4.6× |
| CT soft tissue neck w/o contrast (70490) |
$620.33 |
$1,513 |
6.2× |
| CT thoracic spine w/contrast (72129) |
$737.18 |
$1,798 |
4.4× |
| CT thoracic spine w/o contrast (72128) |
$684.70 |
$1,670 |
6.8× |
| CT thoracic spine w/wo contrast (72130) |
$833.53 |
$2,033 |
5.0× |
| CT thorax w/o contrast (71250) |
$715.04 |
$1,744 |
7.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$887.24 |
$2,164 |
5.3× |
| CT upper extremity w/o contrast rt (73200) |
$638.78 |
$1,558 |
6.4× |
| CT upper extremity with contrast (73201) |
$710.53 |
$1,733 |
2.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$921.68 |
$2,248 |
5.5× |
| Cta Abdomen (74175) |
$889.70 |
$2,170 |
5.3× |
| CTA abdomen pelvis (74174) |
$1,848.28 |
$4,508 |
5.5× |
| CTA chest (71275) |
$821.23 |
$2,003 |
4.9× |
| Cta Head (70496) |
$821.23 |
$2,003 |
4.9× |
| CTA lwr ext w&w/o contrast (73706) |
$1,039.76 |
$2,536 |
6.2× |
| Cta Neck (70498) |
$821.23 |
$2,003 |
4.9× |
| Cta Pelvis (72191) |
$848.29 |
$2,069 |
5.0× |
| Cystography minimum 3 views rs&i (74430) |
$232.06 |
$566 |
0.7× |
| Diskography lumbar (72295) |
$660.51 |
$1,611 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$116.03 |
$283 |
1.2× |
| Dxa bone density study axial skeleton (77085) |
$132.02 |
$322 |
1.3× |
| Echoencephalography real time imaging (76506) |
$286.59 |
$699 |
2.9× |
| Esophagus (74220) |
$134.48 |
$328 |
0.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$166.46 |
$406 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$90.20 |
$220 |
0.4× |
| Foot 2 views (73620) |
$116.03 |
$283 |
1.4× |
| Forearm 2 views (73090) |
$152.11 |
$371 |
1.8× |
| Gated Heart Planar Single (78472) |
$561.29 |
$1,369 |
1.5× |
| Hand 2 views (73120) |
$134.48 |
$328 |
1.3× |
| Hand 3 views (73130) |
$189.83 |
$463 |
2.3× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,132 |
$5,200 |
3.2× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,449.34 |
$5,974 |
3.7× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$656.41 |
$1,601 |
0.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$861.82 |
$2,102 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$694.95 |
$1,695 |
1.8× |
| Ht muscle image spect sing (78451) |
$874.53 |
$2,133 |
0.7× |
| Humerus Min 2 Views Left (73060) |
$127.51 |
$311 |
1.5× |
| Hysterosalpingogram (74740) |
$245.18 |
$598 |
1.1× |
| Interstitial radiation source applic complex (77778) |
$2,019.25 |
$4,925 |
3.0× |
| Intracavitary Radiation Source Applic Complex (77763) |
$790.89 |
$1,929 |
1.2× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$574.41 |
$1,401 |
1.1× |
| Intracavitary radiation source applic simple (77761) |
$501.02 |
$1,222 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$482.57 |
$1,177 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$578.92 |
$1,412 |
1.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$708.48 |
$1,728 |
1.4× |
| Knee 3 views (73562) |
$202.95 |
$495 |
2.4× |
| Liver & spleen imaging static only (78215) |
$536.28 |
$1,308 |
1.4× |
| Lung perfusion differential (78597) |
$439.93 |
$1,073 |
1.1× |
| Lung Ventilation Imaging (78579) |
$377.20 |
$920 |
1.0× |
| Lymphoscintigraphy (78195) |
$525.62 |
$1,282 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$248.05 |
$605 |
1.1× |
| Mammary ductogram or galactogram single (77053) |
$201.31 |
$491 |
0.9× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$70.52 |
$172 |
0.8× |
| Meckels Diverticulum (78290) |
$373.51 |
$911 |
1.0× |
| Mlc imrt design & construction per imrt plan (77338) |
$393.60 |
$960 |
1.1× |
| MRA head w & w/o contrast (70546) |
$1,211.96 |
$2,956 |
3.6× |
| MRA head w/o contrast (70544) |
$839.68 |
$2,048 |
3.7× |
| MRA head with contrast (70545) |
$990.56 |
$2,416 |
3.0× |
| MRA neck w contrast (70548) |
$922.91 |
$2,251 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,211.96 |
$2,956 |
3.6× |
| MRA neck w/o contrast (70547) |
$786.79 |
$1,919 |
3.4× |
| MRI abdomen w contrast (74182) |
$1,100.03 |
$2,683 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,284.12 |
$3,132 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$922.09 |
$2,249 |
4.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,039.76 |
$2,536 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,042.22 |
$2,542 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,054.93 |
$2,573 |
4.6× |
| MRI breast w/o contrast unilat (77046) |
$966.78 |
$2,358 |
4.2× |
| MRI c-spine with contrast (72142) |
$1,223.03 |
$2,983 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$1,002.45 |
$2,445 |
4.4× |
| MRI chest w/o & w/contrast material (71552) |
$1,121.76 |
$2,736 |
3.4× |
| MRI chest w/o contrast (71550) |
$872.89 |
$2,129 |
3.8× |
| MRI chest with contrast (71551) |
$1,033.61 |
$2,521 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,086.50 |
$2,650 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,204.17 |
$2,937 |
3.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$910.20 |
$2,220 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$973.75 |
$2,375 |
4.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,228.77 |
$2,997 |
3.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,271.82 |
$3,102 |
3.8× |
| MRI pelvis w contrast (72196) |
$969.65 |
$2,365 |
2.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,367.35 |
$3,335 |
4.1× |
| MRI pelvis w/o contrast (72195) |
$819.18 |
$1,998 |
3.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,476.41 |
$3,601 |
4.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,257.47 |
$3,067 |
3.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,429.26 |
$3,486 |
4.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,115.61 |
$2,721 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,380.47 |
$3,367 |
4.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,055.34 |
$2,574 |
3.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,422.29 |
$3,469 |
4.2× |
| MRI thoracic spine w/o contrast (72146) |
$969.65 |
$2,365 |
4.2× |
| MRI tmj (70336) |
$1,020.08 |
$2,488 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$913.89 |
$2,229 |
4.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,120.94 |
$2,734 |
3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$932.34 |
$2,274 |
4.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,023.36 |
$2,496 |
0.8× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$3,451.38 |
$8,418 |
4.2× |
| Neck soft tissue (70360) |
$144.73 |
$353 |
1.7× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$186.55 |
$455 |
0.5× |
| Nm cisternogram (78630) |
$771.62 |
$1,882 |
1.5× |
| Nm gastric emptying study (78264) |
$568.67 |
$1,387 |
1.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,642.04 |
$6,444 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$460.02 |
$1,122 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$139.40 |
$340 |
1.4× |
| Osseous survey infant (77076) |
$234.11 |
$571 |
2.3× |
| Osseous survey limited (77074) |
$114.80 |
$280 |
1.1× |
| Parathyroid imaging (78070) |
$491.18 |
$1,198 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$116.03 |
$283 |
1.2× |
| Peritoneogram rs&i (74190) |
$210.74 |
$514 |
0.4× |
| PET image w/CT, skull-thigh (78815) |
$2,503.05 |
$6,105 |
1.8× |
| PET imaging CT for attenuation limited area (78814) |
$2,367.34 |
$5,774 |
1.7× |
| PET imaging for CT attenuation whole body (78816) |
$2,503.05 |
$6,105 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,320.20 |
$3,220 |
3.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$279.21 |
$681 |
0.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$377.20 |
$920 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$577.69 |
$1,409 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$113.57 |
$277 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$116.03 |
$283 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$176.30 |
$430 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$129.56 |
$316 |
1.3× |
Radiation Delivery Stereotactic Cranial Linear (77372)
unusually low: confirm this is the full procedure |
$2,628.10 |
$6,410 |
0.4× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$430.91 |
$1,051 |
0.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$276.75 |
$675 |
2.8× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$384.17 |
$937 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$184.50 |
$450 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$169.74 |
$414 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$218.12 |
$532 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$351.78 |
$858 |
2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$253.79 |
$619 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$321.03 |
$783 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$274.29 |
$669 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$161.54 |
$394 |
1.9× |
| Radiological examination surgical specimen (76098) |
$92.66 |
$226 |
0.2× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,225.90 |
$2,990 |
0.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$656.41 |
$1,601 |
0.2× |
| Ribs bilateral 3 views (71110) |
$116.03 |
$283 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$782.69 |
$1,909 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$717.91 |
$1,751 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$269.78 |
$658 |
1.2× |
| Scanogram (77073) |
$265.48 |
$647.50 |
2.6× |
| Scapula complete (73010) |
$159.08 |
$388 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$45.92 |
$112 |
2.0× |
| Sella turcica (70240) |
$68.88 |
$168 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$332.92 |
$812 |
3.3× |
| Sialogram (70390) |
$321.03 |
$783 |
1.4× |
| Simulation intermediate (77285) |
$483.39 |
$1,179 |
1.3× |
| Small bowel series (74250) |
$275.52 |
$672 |
1.6× |
| Spec medical radj physics consltj (77370) |
$330.87 |
$807 |
2.6× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$438.70 |
$1,070 |
1.2× |
| Special dosimetry (77331) |
$206.64 |
$504 |
1.6× |
| Special treatment procedure (77470) |
$744.15 |
$1,815 |
1.4× |
| Spine thoracic 3 views (72072) |
$207.87 |
$507 |
2.1× |
| Stereotactic body radiation delivery (77373) |
$2,733.47 |
$6,667 |
1.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,273.87 |
$3,107 |
3.5× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$682.65 |
$1,665 |
1.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$693.31 |
$1,691 |
1.9× |
| Ther rad simulaj-aided field setting simple (77280) |
$423.12 |
$1,032 |
3.3× |
| Therapeutic Enema (74283) |
$151.29 |
$369 |
0.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$653.13 |
$1,593 |
1.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$306.68 |
$748 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$467.40 |
$1,140 |
1.2× |
| Tmj unilateral (70328) |
$82.82 |
$202 |
1.0× |
| Tomogram (76100) |
$229.19 |
$559 |
2.3× |
| Treatment device intermediate (77333) |
$322.26 |
$786 |
2.5× |
| Treatment devices simple (77332) |
$268.55 |
$655 |
2.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,047.14 |
$2,554 |
2.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$622.79 |
$1,519 |
1.6× |
| Tx devices design & construction complex (77334) |
$475.60 |
$1,160 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$336.61 |
$821 |
3.4× |
| Umbilical-artery Doppler (OB) (76820) |
$74.21 |
$181 |
0.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$225.91 |
$551 |
2.7× |
| Unlisted fluoroscopic procedure (76496) |
$134.48 |
$328 |
1.6× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$125.46 |
$306 |
1.3× |
| Upper Extremity Infant (73092) |
$116.03 |
$283 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$184.91 |
$451 |
0.8× |
| Urethrocystography voiding (74455) |
$279.21 |
$681 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$356.70 |
$870 |
2.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$440.34 |
$1,074 |
2.6× |
| Us abdl aorta screen aaa (76706) |
$297.66 |
$726 |
3.0× |
| Us breast unilateral complete (76641) |
$243.95 |
$595 |
2.4× |
| Us breast unilateral limited (76642) |
$184.91 |
$451 |
2.2× |
| Us chest (76604) |
$172.61 |
$421 |
1.7× |
| Us compl joint r-t w/image documentation (76881) |
$191.06 |
$466 |
1.9× |
| Us elastography parenchyma (76981) |
$241.08 |
$588 |
2.4× |
| Us infant hips dynamic (76885) |
$367.77 |
$897 |
4.4× |
| Us infant hips limited static (76886) |
$256.25 |
$625 |
3.1× |
| Us kidney transplant (76776) |
$406.72 |
$992 |
4.1× |
| Us ob transvaginal (76817) |
$287.41 |
$701 |
2.9× |
| Us pelvic non ob complete (76856) |
$317.75 |
$775 |
3.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$252.97 |
$617 |
2.5× |
| Us pregnancy ltd (76815) |
$213.20 |
$520 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$704.79 |
$1,719 |
7.0× |
| Us retroperitoneal complete (76770) |
$226.32 |
$552 |
2.3× |
| Us retroperitoneal limited (76775) |
$139.40 |
$340 |
1.4× |
| Us scrotum and contents (76870) |
$252.15 |
$615 |
2.5× |
| Us soft tissue head/neck (76536) |
$302.58 |
$738 |
3.0× |
| Us spinal canal and contents (76800) |
$291.51 |
$711 |
2.9× |
| Us transrectal (76872) |
$280.44 |
$684 |
2.8× |
| Us transrectal prostate volume (76873) |
$254.20 |
$620 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$191.06 |
$466 |
1.9× |
| Venogram extremity bilateral (75822) |
$720.37 |
$1,757 |
0.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,189 |
$2,900 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$499.79 |
$1,219 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$560.88 |
$1,368 |
0.4× |
| Venography Renal Bilateral (75833) |
$1,225.90 |
$2,990 |
0.4× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$590.40 |
$1,440 |
0.1× |
| Wrist 2 views (73100) |
$82.82 |
$202 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$291.92 |
$712 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$90.20 |
$220 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$194.34 |
$474 |
2.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$546.94 |
$1,334 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$139.40 |
$340 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$149.24 |
$364 |
1.8× |
| X-ray exam hip uni 1 view (73501) |
$134.48 |
$328 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$139.40 |
$340 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$152.52 |
$372 |
1.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$177.53 |
$433 |
1.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,184.08 |
$2,888 |
7.0× |
| X-ray eye for foreign body (70030) |
$72.98 |
$178 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$184.50 |
$450 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$116.03 |
$283 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$189.42 |
$462 |
2.3× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$251.33 |
$613 |
0.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$116.03 |
$283 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$93.89 |
$229 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$215.25 |
$525 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$116.03 |
$283 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$116.03 |
$283 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$234.11 |
$571 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$287 |
$700 |
2.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$116.03 |
$283 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$116.03 |
$283 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$116.03 |
$283 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$135.71 |
$331 |
1.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$95.12 |
$232 |
0.9× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$199.26 |
$486 |
0.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$166.46 |
$406 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$116.03 |
$283 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$149.24 |
$364 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$143.50 |
$350 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$116.03 |
$283 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$116.03 |
$283 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$174.66 |
$426 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86.51 |
$211 |
1.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$116.03 |
$283 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$170.15 |
$415 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$116.03 |
$283 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$116.03 |
$283 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$97.58 |
$238 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$76.67 |
$187 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$145.96 |
$356 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$139.40 |
$340 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$179.17 |
$437 |
2.1× |
| Xr arthrogram ankle (73615) |
$168.51 |
$411 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$151.70 |
$370 |
1.5× |
| Xr chest 4+ views (71048) |
$97.58 |
$238 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$139.40 |
$340 |
1.7× |
| Xr internal auditory meati complete (70134) |
$210.74 |
$514 |
0.4× |
| Xr optic foramina (70190) |
$63.14 |
$154 |
0.8× |
| Xr shoulder 1 view (73020) |
$116.03 |
$283 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$212.79 |
$519 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$173.02 |
$422 |
2.1× |
| Xr tmj bilateral (70330) |
$134.48 |
$328 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$139.40 |
$340 |
1.7× |