| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,021.50 |
$2,043 |
0.8× |
| Abdomen 2 views (74019) |
$699.50 |
$1,399 |
6.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,042 |
$2,084 |
2.7× |
| Angiography extremity bilateral rs&i (75716) |
$3,103 |
$6,206 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,982 |
$7,964 |
1.3× |
| Angiography internal mammary rs&i (75756) |
$2,815 |
$5,630 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,212 |
$6,424 |
0.6× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,966 |
$5,932 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,966 |
$5,932 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$2,966 |
$5,932 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,966 |
$5,932 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$696 |
$1,392 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,800 |
$5,600 |
0.9× |
| Ankle 2 views (73600) |
$972 |
$1,944 |
11.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$2,674.50 |
$5,349 |
7.9× |
| Aortogram thoracic (75605) |
$2,998.50 |
$5,997 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,247.50 |
$6,495 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$3,103 |
$6,206 |
1.0× |
| Arthrogram elbow (73085) |
$1,583 |
$3,166 |
4.7× |
| Arthrogram hip (73525) |
$1,864.50 |
$3,729 |
5.5× |
| Arthrogram shoulder (73040) |
$1,638.50 |
$3,277 |
4.8× |
| Arthrogram wrist (73115) |
$1,937.50 |
$3,875 |
5.7× |
| Arthrography knee lt (73580) |
$1,487.50 |
$2,975 |
4.4× |
| Basic radiation dosimetry calculation (77300) |
$92 |
$184 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$2,852.50 |
$5,705 |
7.3× |
| Bone &/joint imaging whole body (78306) |
$4,881.50 |
$9,763 |
12.6× |
| Bone age studies (77072) |
$582.50 |
$1,165 |
5.7× |
| Bone Imaging 3 Phase (78315) |
$5,636.50 |
$11,273 |
14.5× |
| Bone survey complete (77075) |
$1,594.50 |
$3,189 |
15.7× |
| Brain image w/flow 4 + views (78606) |
$4,025 |
$8,050 |
7.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,550.50 |
$7,101 |
2.6× |
| Brain Imaging Vascular Flow Only (78610) |
$3,239 |
$6,478 |
6.1× |
| Cervical spine 2 or 3 views (72040) |
$675.50 |
$1,351 |
8.0× |
| Chest 1 view (71045) |
$207 |
$414 |
2.4× |
| Chest 3 views (71047) |
$289.50 |
$579 |
3.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,467.50 |
$2,935 |
8.6× |
| Cineradiography/videoradiography (76120) |
$96.50 |
$193 |
0.9× |
| Clavicle complete (73000) |
$582.50 |
$1,165 |
6.9× |
| Continuing medical physics consltj pr wk (77336) |
$268 |
$536 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$9,514 |
$19,028 |
28.1× |
| CT abdomen and pelvis without contrast (74176) |
$7,090 |
$14,180 |
30.6× |
| CT abdomen w contrast (74160) |
$3,779 |
$7,558 |
22.2× |
| CT abdomen w wo contrast (74170) |
$5,056 |
$10,112 |
29.7× |
| CT abdomen w/o contrast (74150) |
$3,078.50 |
$6,157 |
30.3× |
| CT angio hrt w/3d image (75574) |
$4,271 |
$8,542 |
12.6× |
| CT angiography upper extremity lt (73206) |
$4,443 |
$8,886 |
26.1× |
| CT c-spine w/o contrast (72125) |
$2,396 |
$4,792 |
23.6× |
| CT cervical spine w&w/o contrast (72127) |
$3,370.50 |
$6,741 |
19.8× |
| CT cervical spine with contrast (72126) |
$2,783.50 |
$5,567 |
8.2× |
| CT chest w/wo contrast (71270) |
$3,596 |
$7,192 |
21.1× |
| CT chest with contrast (71260) |
$3,596 |
$7,192 |
21.1× |
| CT head/brain with contrast (70460) |
$2,344 |
$4,688 |
13.8× |
| CT head/brain without and with contrast (70470) |
$2,504 |
$5,008 |
14.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT hrt w/3d image congen (75573) |
$4,271 |
$8,542 |
12.6× |
| CT iac w contrast (70481) |
$2,564 |
$5,128 |
15.0× |
| CT limited/localized follow up study (76380) |
$2,940.50 |
$5,881 |
34.8× |
| CT lower ext w/o (73700) |
$3,072.50 |
$6,145 |
30.2× |
| CT lower extremity w wo contrast (73702) |
$3,072.50 |
$6,145 |
18.0× |
| CT lower extremity with contrast (73701) |
$3,072.50 |
$6,145 |
18.0× |
| CT lumbar spine w & w/o contrast (72133) |
$5,056 |
$10,112 |
29.7× |
| CT lumbar spine w/o contrast (72131) |
$3,599.50 |
$7,199 |
35.4× |
| CT lumbar spine with contrast (72132) |
$3,736.50 |
$7,473 |
11.0× |
| CT maxillofacial w contrast (70487) |
$2,344 |
$4,688 |
13.8× |
| CT maxillofacial w/o contrast (70486) |
$1,960 |
$3,920 |
19.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,839 |
$5,678 |
16.7× |
| CT neck soft tissue w contrast (70491) |
$2,344 |
$4,688 |
13.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,204.50 |
$6,409 |
18.8× |
| CT orbits w/o contrast (70480) |
$2,218.50 |
$4,437 |
21.8× |
| CT pelvis w & w/o contrast (72194) |
$4,458 |
$8,916 |
26.2× |
| CT pelvis w/o contrast (72192) |
$3,599.50 |
$7,199 |
35.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,839 |
$5,678 |
16.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,960 |
$3,920 |
19.3× |
| CT thoracic spine w/contrast (72129) |
$3,525 |
$7,050 |
20.7× |
| CT thoracic spine w/o contrast (72128) |
$3,395.50 |
$6,791 |
33.4× |
| CT thoracic spine w/wo contrast (72130) |
$4,769.50 |
$9,539 |
28.0× |
| CT thorax w/o contrast (71250) |
$3,105 |
$6,210 |
30.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$3,072.50 |
$6,145 |
18.0× |
| CT upper extremity w/o contrast rt (73200) |
$2,793 |
$5,586 |
27.5× |
| CT upper extremity with contrast (73201) |
$3,351.50 |
$6,703 |
9.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$9,108.50 |
$18,217 |
53.4× |
| Cta Abdomen (74175) |
$4,919 |
$9,838 |
28.9× |
| CTA abdomen pelvis (74174) |
$9,109 |
$18,218 |
26.9× |
| CTA chest (71275) |
$4,919 |
$9,838 |
28.9× |
| Cta Head (70496) |
$2,750.50 |
$5,501 |
16.1× |
| CTA lwr ext w&w/o contrast (73706) |
$4,443 |
$8,886 |
26.1× |
| Cta Neck (70498) |
$3,279.50 |
$6,559 |
19.2× |
| Cta Pelvis (72191) |
$4,919 |
$9,838 |
28.9× |
| Cystography minimum 3 views rs&i (74430) |
$1,237 |
$2,474 |
3.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$1,555 |
$3,110 |
15.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$1,189 |
$2,378 |
14.1× |
| Esophagus (74220) |
$1,467.50 |
$2,935 |
8.6× |
| Fetal biophysical profile non-stress testing (76818) |
$1,451 |
$2,902 |
14.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$273.50 |
$547 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$678 |
$1,356 |
2.9× |
| Foot 2 views (73620) |
$1,107 |
$2,214 |
13.1× |
| Forearm 2 views (73090) |
$582.50 |
$1,165 |
6.9× |
| Gated Heart Planar Single (78472) |
$3,076 |
$6,152 |
7.9× |
| Hand 2 views (73120) |
$972 |
$1,944 |
9.6× |
| Hand 3 views (73130) |
$1,107 |
$2,214 |
13.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,870 |
$7,740 |
7.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$3,870 |
$7,740 |
10.0× |
| Ht muscle image spect sing (78451) |
$3,927 |
$7,854 |
3.1× |
| Humerus Min 2 Views Left (73060) |
$652.50 |
$1,305 |
7.7× |
| Hysterosalpingogram (74740) |
$1,405 |
$2,810 |
6.1× |
| Kidney imaging morphology (78700) |
$2,499 |
$4,998 |
6.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$4,344 |
$8,688 |
8.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$4,717.50 |
$9,435 |
8.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$4,717.50 |
$9,435 |
8.9× |
| Knee 3 views (73562) |
$681.50 |
$1,363 |
8.1× |
| Liver & spleen imaging static only (78215) |
$3,689 |
$7,378 |
9.5× |
| Lung perf&ventilat diferentl (78598) |
$3,804 |
$7,608 |
7.2× |
| Lung Ventilation Imaging (78579) |
$2,253 |
$4,506 |
5.8× |
| Lymphoscintigraphy (78195) |
$2,904.50 |
$5,809 |
5.5× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.2× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Meckels Diverticulum (78290) |
$3,470.50 |
$6,941 |
8.9× |
| MRA head w & w/o contrast (70546) |
$3,850.50 |
$7,701 |
11.4× |
| MRA head w/o contrast (70544) |
$2,866 |
$5,732 |
12.4× |
| MRA head with contrast (70545) |
$3,615.50 |
$7,231 |
10.7× |
| MRA neck w contrast (70548) |
$3,615.50 |
$7,231 |
10.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,366.50 |
$8,733 |
12.9× |
| MRA neck w/o contrast (70547) |
$3,009.50 |
$6,019 |
13.0× |
| MRI abdomen w contrast (74182) |
$3,824 |
$7,648 |
11.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,824 |
$7,648 |
11.3× |
| MRI abdomen w/o contrast (74181) |
$3,009.50 |
$6,019 |
13.0× |
| MRI any jnt lwr ext with con lt (73722) |
$3,287 |
$6,574 |
4.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,287 |
$6,574 |
4.3× |
| MRI breast w/o contrast bilateral (77047) |
$3,615.50 |
$7,231 |
15.6× |
| MRI c-spine with contrast (72142) |
$4,019 |
$8,038 |
11.9× |
| MRI cardiac w/o contrast (75557) |
$2,605.50 |
$5,211 |
11.2× |
| MRI cervical spine w/o contrast (72141) |
$3,349 |
$6,698 |
14.4× |
| MRI chest w/o & w/contrast material (71552) |
$4,366.50 |
$8,733 |
12.9× |
| MRI chest w/o contrast (71550) |
$2,605.50 |
$5,211 |
11.2× |
| MRI chest with contrast (71551) |
$3,615.50 |
$7,231 |
4.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,287 |
$6,574 |
9.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,287 |
$6,574 |
9.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,009.50 |
$6,019 |
13.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,735.50 |
$5,471 |
11.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,969.50 |
$7,939 |
11.7× |
| MRI orbit/face/neck w/contrast (70542) |
$3,287 |
$6,574 |
9.7× |
| MRI pelvis w contrast (72196) |
$4,236 |
$8,472 |
12.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,236 |
$8,472 |
12.5× |
| MRI pelvis w/o contrast (72195) |
$3,009.50 |
$6,019 |
13.0× |
| MRI scan of arm joint before and after contrast (73223) |
$3,615.50 |
$7,231 |
10.7× |
| MRI scan of leg joint before and after contrast (73723) |
$3,615.50 |
$7,231 |
10.7× |
| MRI spectroscopy (76390) |
$3,615.50 |
$7,231 |
42.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,019 |
$8,038 |
11.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,615.50 |
$7,231 |
10.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,366.50 |
$8,733 |
12.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,615.50 |
$7,231 |
10.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,366.50 |
$8,733 |
12.9× |
| MRI thoracic spine w/o contrast (72146) |
$3,009.50 |
$6,019 |
13.0× |
| MRI tmj (70336) |
$2,517.50 |
$5,035 |
10.9× |
| MRI upper ext joint w/o contrast (73221) |
$3,009.50 |
$6,019 |
13.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,287 |
$6,574 |
9.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,009.50 |
$6,019 |
13.0× |
| Myocardial Spect Multiple Studies (78452) |
$5,610 |
$11,220 |
4.5× |
| Neck soft tissue (70360) |
$466 |
$932 |
5.5× |
| Nm adrenal scan (78075) |
$4,881.50 |
$9,763 |
3.9× |
| Nm cisternogram (78630) |
$1,124.50 |
$2,249 |
2.1× |
| Nm gastric emptying study (78264) |
$4,488 |
$8,976 |
11.6× |
| Nm peritoneal-venous shunt patency (78291) |
$347 |
$694 |
0.9× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$5,370.50 |
$10,741 |
4.3× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$3,927 |
$7,854 |
3.1× |
| Nuclear medicine study of kidney and blood flow (78701) |
$2,499 |
$4,998 |
6.4× |
| Nuclear Rx Oral Admin (79005) |
$2,708 |
$5,416 |
11.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$559 |
$1,118 |
5.5× |
| Osseous survey infant (77076) |
$799 |
$1,598 |
7.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,168 |
$4,336 |
4.1× |
| Parathyrd planar w/wo subtrj (78071) |
$1,629 |
$3,258 |
4.2× |
| Parathyroid imaging (78070) |
$1,629 |
$3,258 |
4.2× |
| Pelvis 1 or 2 views (72170) |
$541.50 |
$1,083 |
5.3× |
| PET image w/CT, skull-thigh (78815) |
$1,467.50 |
$2,935 |
1.1× |
| PET imaging CT for attenuation limited area (78814) |
$1,467.50 |
$2,935 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,043.50 |
$2,087 |
0.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,615.50 |
$7,231 |
10.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,084 |
$4,168 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$3,804 |
$7,608 |
9.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$4,108 |
$8,216 |
7.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$296 |
$592 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$347 |
$694 |
4.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$757 |
$1,514 |
7.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$757 |
$1,514 |
7.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$342.50 |
$685 |
3.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$730 |
$1,460 |
7.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$653 |
$1,306 |
7.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$699.50 |
$1,399 |
6.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$248 |
$496 |
2.9× |
| Radiologic exam colon single contrast study (74270) |
$1,821.50 |
$3,643 |
10.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,467.50 |
$2,935 |
8.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$410 |
$820 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,628.50 |
$3,257 |
9.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$652.50 |
$1,305 |
7.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$79.50 |
$159 |
0.9× |
| Radiological examination surgical specimen (76098) |
$496 |
$992 |
0.9× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,775 |
$5,550 |
0.9× |
| Ribs bilateral 3 views (71110) |
$873.50 |
$1,747 |
8.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,019.50 |
$4,039 |
5.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,423 |
$4,846 |
4.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,423 |
$4,846 |
4.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,423 |
$4,846 |
1.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,423 |
$4,846 |
1.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,423 |
$4,846 |
1.9× |
| Sacroiliac Joints < 3 Views (72200) |
$675 |
$1,350 |
6.6× |
| Salivary gland imaging serial images (78231) |
$387.50 |
$775 |
1.0× |
| Scanogram (77073) |
$767 |
$1,534 |
7.5× |
| Scapula complete (73010) |
$563 |
$1,126 |
5.5× |
| Screening digital breast tomosynthesis (77063) |
$358 |
$716 |
15.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$766.50 |
$1,533 |
7.5× |
| Small bowel series (74250) |
$1,405 |
$2,810 |
8.2× |
| Special treatment procedure (77470) |
$270 |
$540 |
0.5× |
| Spine thoracic 3 views (72072) |
$721.50 |
$1,443 |
7.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$848.50 |
$1,697 |
2.3× |
| Testicular Imaging With Vascular Flow (78761) |
$3,308 |
$6,616 |
8.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$848.50 |
$1,697 |
2.3× |
| Ther rad simulaj-aided field setting simple (77280) |
$212 |
$424 |
1.6× |
| Thoracolumbar 2 views (72080) |
$155 |
$310 |
1.8× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,695 |
$3,390 |
3.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,003.50 |
$2,007 |
2.6× |
| Thyroid uptake measurement (78012) |
$1,150 |
$2,300 |
3.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,150 |
$2,300 |
3.0× |
| Tmj unilateral (70328) |
$911.50 |
$1,823 |
10.8× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,423 |
$4,846 |
4.6× |
| Tx devices design & construction complex (77334) |
$219 |
$438 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$2,272 |
$4,544 |
22.4× |
| Umbilical-artery Doppler (OB) (76820) |
$170 |
$340 |
1.7× |
| Unlisted magnetic resonance procedure (76498) |
$368.50 |
$737 |
4.4× |
| Upper Extremity Infant (73092) |
$652.50 |
$1,305 |
6.4× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$90 |
$180 |
1.0× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$2,423 |
$4,846 |
6.2× |
| Urethrocystography voiding (74455) |
$969.50 |
$1,939 |
4.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,798.50 |
$3,597 |
10.6× |
| Us abdl aorta screen aaa (76706) |
$218 |
$436 |
2.1× |
| Us breast unilateral complete (76641) |
$852.50 |
$1,705 |
8.4× |
| Us breast unilateral limited (76642) |
$745 |
$1,490 |
8.8× |
| Us chest (76604) |
$366.50 |
$733 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$1,414.50 |
$2,829 |
13.9× |
| Us elastography parenchyma (76981) |
$92.50 |
$185 |
0.9× |
| Us guided compression repair (76936) |
$1,245 |
$2,490 |
5.9× |
| Us infant hips dynamic (76885) |
$1,414.50 |
$2,829 |
16.7× |
| Us infant hips limited static (76886) |
$707.50 |
$1,415 |
8.4× |
| Us kidney transplant (76776) |
$192.50 |
$385 |
1.9× |
| Us ob detailed single fetus (76811) |
$276.50 |
$553 |
1.2× |
| Us ob transvaginal (76817) |
$1,496.50 |
$2,993 |
14.7× |
| Us pelvic non ob complete (76856) |
$1,862.50 |
$3,725 |
18.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$432.50 |
$865 |
4.3× |
| Us pregnancy ltd (76815) |
$1,106.50 |
$2,213 |
10.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$2,570.50 |
$5,141 |
25.3× |
| Us retroperitoneal complete (76770) |
$2,404.50 |
$4,809 |
23.7× |
| Us retroperitoneal limited (76775) |
$471.50 |
$943 |
4.6× |
| Us scrotum and contents (76870) |
$1,496.50 |
$2,993 |
14.7× |
| Us soft tissue head/neck (76536) |
$1,740 |
$3,480 |
17.1× |
| Us spinal canal and contents (76800) |
$521.50 |
$1,043 |
5.1× |
| Us xtr non-vasc lmtd (76882) |
$861 |
$1,722 |
8.5× |
| Venogram extremity bilateral (75822) |
$2,672.50 |
$5,345 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$3,103 |
$6,206 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$831.50 |
$1,663 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$1,781.50 |
$3,563 |
1.2× |
| Venography Renal Bilateral (75833) |
$2,434 |
$4,868 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$1,930.50 |
$3,861 |
0.6× |
| Wrist 2 views (73100) |
$528 |
$1,056 |
6.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$856 |
$1,712 |
8.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$783.50 |
$1,567 |
9.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$1,107 |
$2,214 |
13.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$519 |
$1,038 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$1,066.50 |
$2,133 |
12.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$1,188 |
$2,376 |
14.0× |
| X-ray exam hip uni 1 view (73501) |
$580.50 |
$1,161 |
6.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$652.50 |
$1,305 |
7.7× |
| X-ray exam hip uni 4/> views (73503) |
$1,403 |
$2,806 |
13.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$2,194.50 |
$4,389 |
21.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$3,028.50 |
$6,057 |
29.8× |
| X-ray exam of femur 1 (73551) |
$630.50 |
$1,261 |
7.5× |
| X-ray eye for foreign body (70030) |
$56 |
$112 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$873.50 |
$1,747 |
8.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$275.50 |
$551 |
3.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$1,107 |
$2,214 |
13.1× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,150 |
$2,300 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$984.50 |
$1,969 |
11.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$364.50 |
$729 |
4.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$1,188 |
$2,376 |
11.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$484 |
$968 |
5.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$652.50 |
$1,305 |
7.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$757 |
$1,514 |
7.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$243 |
$486 |
2.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$677.50 |
$1,355 |
6.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$582.50 |
$1,165 |
6.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$1,160 |
$2,320 |
11.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$541.50 |
$1,083 |
5.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$2,897 |
$5,794 |
8.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$671.50 |
$1,343 |
7.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$873.50 |
$1,747 |
8.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$873.50 |
$1,747 |
8.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$675 |
$1,350 |
6.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$652.50 |
$1,305 |
7.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$1,188 |
$2,376 |
14.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$873.50 |
$1,747 |
10.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$675 |
$1,350 |
8.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$990 |
$1,980 |
9.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$812 |
$1,624 |
8.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$466 |
$932 |
5.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$719.50 |
$1,439 |
8.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$697 |
$1,394 |
8.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$721.50 |
$1,443 |
7.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$1,013 |
$2,026 |
10.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$466 |
$932 |
5.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$1,107 |
$2,214 |
13.1× |
| Xr arthrogram ankle (73615) |
$1,937.50 |
$3,875 |
5.7× |
| Xr c-spine 6 or more views (72052) |
$1,257 |
$2,514 |
12.4× |
| Xr chest 4+ views (71048) |
$344.50 |
$689 |
3.4× |
| Xr finger(s) 2+ views (73140) |
$466 |
$932 |
5.5× |
| Xr shoulder 1 view (73020) |
$535.50 |
$1,071 |
6.3× |
| Xr spine cervical 4 or 5 views (72050) |
$990 |
$1,980 |
9.7× |
| Xr tibia/fibula 2 views (73590) |
$582.50 |
$1,165 |
6.9× |
| Xr tmj bilateral (70330) |
$911.50 |
$1,823 |
10.8× |
| Xray knee 1 or 2 views rt (73560) |
$681.50 |
$1,363 |
8.1× |