| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,184.40 |
$5,640 |
0.9× |
| Abdomen 2 views (74019) |
$55.86 |
$266 |
0.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$419.37 |
$1,997 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$2,148.30 |
$10,230 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$1,947.12 |
$9,272 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,110.06 |
$5,286 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,479.47 |
$11,807 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,781.43 |
$8,483 |
0.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,133.58 |
$5,398 |
0.4× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,001.70 |
$4,770 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$1,781.43 |
$8,483 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$876.54 |
$4,174 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,168.44 |
$5,564 |
0.4× |
| Ankle 2 views (73600) |
$67.41 |
$321 |
0.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$483.84 |
$2,304 |
1.5× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,842.12 |
$8,772 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,947.12 |
$9,272 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,947.12 |
$9,272 |
0.7× |
| Arthrogram elbow (73085) |
$175.14 |
$834 |
0.6× |
| Arthrogram hip (73525) |
$175.14 |
$834 |
0.6× |
| Arthrogram shoulder (73040) |
$262.71 |
$1,251 |
0.8× |
| Arthrogram wrist (73115) |
$306.60 |
$1,460 |
1.0× |
| Basic radiation dosimetry calculation (77300) |
$105 |
$500 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$265.65 |
$1,265 |
0.7× |
| Bone &/joint imaging whole body (78306) |
$248.64 |
$1,184 |
0.7× |
| Bone age studies (77072) |
$77.70 |
$370 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$271.95 |
$1,295 |
0.8× |
| Bone survey complete (77075) |
$177.87 |
$847 |
1.9× |
| Brachytx isodose complex (77318) |
$228.50 |
$965.50 |
0.7× |
| Brachytx isodose intermed (77317) |
$315.42 |
$1,502 |
0.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$481.95 |
$2,295 |
1.4× |
| Brain image w/flow 4 + views (78606) |
$328.44 |
$1,564 |
0.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,350.51 |
$6,431 |
1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$187.11 |
$891 |
0.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$244.02 |
$1,162 |
0.5× |
| Cervical spine 2 or 3 views (72040) |
$36.51 |
$161 |
0.5× |
| Chest 1 view (71045) |
$27.74 |
$123.50 |
0.4× |
| Chest 3 views (71047) |
$52.50 |
$250 |
0.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$177.66 |
$846 |
1.1× |
| Cineradiography/videoradiography (76120) |
$76.44 |
$364 |
0.8× |
| Cisternography Positive Contrast Rs&I (70015) |
$719.67 |
$3,427 |
1.0× |
| Clavicle complete (73000) |
$66.46 |
$316.50 |
0.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$95.13 |
$453 |
1.0× |
| Continuing medical physics consltj pr wk (77336) |
$158.13 |
$753 |
1.3× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$88.62 |
$422 |
0.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$689.01 |
$3,281 |
2.2× |
| CT abdomen and pelvis without contrast (74176) |
$515.76 |
$2,456 |
2.4× |
| CT abdomen w contrast (74160) |
$401.94 |
$1,914 |
2.5× |
| CT abdomen w wo contrast (74170) |
$459.48 |
$2,188 |
2.9× |
| CT abdomen w/o contrast (74150) |
$343.98 |
$1,638 |
3.6× |
| CT angiography upper extremity lt (73206) |
$492.24 |
$2,344 |
3.1× |
| CT c-spine w/o contrast (72125) |
$377.58 |
$1,798 |
4.0× |
| CT cervical spine w&w/o contrast (72127) |
$455.28 |
$2,168 |
2.9× |
| CT cervical spine with contrast (72126) |
$393.54 |
$1,874 |
1.2× |
| CT chest w/wo contrast (71270) |
$492.24 |
$2,344 |
3.1× |
| CT chest with contrast (71260) |
$399.42 |
$1,902 |
2.5× |
| CT head/brain with contrast (70460) |
$349.86 |
$1,666 |
2.2× |
| CT head/brain without and with contrast (70470) |
$409.71 |
$1,951 |
2.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$42.21 |
$201 |
0.5× |
| CT iac w contrast (70481) |
$445.83 |
$2,123 |
2.8× |
| CT limited/localized follow up study (76380) |
$63.63 |
$303 |
0.8× |
| CT lower ext w/o (73700) |
$515.97 |
$2,457 |
5.5× |
| CT lower extremity w wo contrast (73702) |
$614.56 |
$2,926.50 |
3.9× |
| CT lower extremity with contrast (73701) |
$558.81 |
$2,661 |
3.5× |
| CT lumbar spine w & w/o contrast (72133) |
$455.28 |
$2,168 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$383.46 |
$1,826 |
4.1× |
| CT lumbar spine with contrast (72132) |
$393.54 |
$1,874 |
1.2× |
| CT maxillofacial w contrast (70487) |
$360.78 |
$1,718 |
2.3× |
| CT maxillofacial w/o contrast (70486) |
$395.01 |
$1,881 |
4.2× |
| CT maxillofacial w/wo contrast (70488) |
$408.87 |
$1,947 |
2.6× |
| CT neck soft tissue w contrast (70491) |
$349.86 |
$1,666 |
2.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$481.53 |
$2,293 |
3.0× |
| CT orbits w/o contrast (70480) |
$409.71 |
$1,951 |
4.3× |
| CT pelvis w & w/o contrast (72194) |
$459.48 |
$2,188 |
2.9× |
| CT pelvis w/o contrast (72192) |
$343.98 |
$1,638 |
3.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$481.53 |
$2,293 |
3.0× |
| CT soft tissue neck w/o contrast (70490) |
$343.98 |
$1,638 |
3.6× |
| CT thoracic spine w/contrast (72129) |
$391.44 |
$1,864 |
2.5× |
| CT thoracic spine w/o contrast (72128) |
$364.14 |
$1,734 |
3.8× |
| CT thoracic spine w/wo contrast (72130) |
$455.28 |
$2,168 |
2.9× |
| CT thorax w/o contrast (71250) |
$355.74 |
$1,694 |
3.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$614.56 |
$2,926.50 |
3.9× |
| CT upper extremity w/o contrast rt (73200) |
$515.97 |
$2,457 |
5.5× |
| CT upper extremity with contrast (73201) |
$558.81 |
$2,661 |
1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$430.08 |
$2,048 |
2.7× |
| Cta Abdomen (74175) |
$492.24 |
$2,344 |
3.1× |
| CTA abdomen pelvis (74174) |
$193.41 |
$921 |
0.6× |
| CTA chest (71275) |
$492.24 |
$2,344 |
3.1× |
| Cta Head (70496) |
$492.24 |
$2,344 |
3.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,107.54 |
$5,274 |
7.0× |
| Cta Neck (70498) |
$492.24 |
$2,344 |
3.1× |
| Cta Pelvis (72191) |
$492.24 |
$2,344 |
3.1× |
| Cystography minimum 3 views rs&i (74430) |
$161.07 |
$767 |
0.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$26.67 |
$127 |
0.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$33.33 |
$101 |
0.4× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$28.05 |
$85 |
0.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$97.86 |
$466 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$59.64 |
$284 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$53.97 |
$257 |
0.6× |
| Echo exam of fetal heart (76825) |
$114.66 |
$546 |
0.2× |
| Echoencephalography real time imaging (76506) |
$161.07 |
$767 |
1.7× |
| Esophagus (74220) |
$102.06 |
$486 |
0.6× |
| Fetal biophysical profile non-stress testing (76818) |
$109.71 |
$485 |
1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$83.25 |
$369 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$111.30 |
$530 |
0.5× |
| Foot 2 views (73620) |
$67.41 |
$321 |
0.9× |
| Forearm 2 views (73090) |
$67.41 |
$321 |
0.9× |
| Gated Heart Planar Single (78472) |
$386.82 |
$1,842 |
1.1× |
| Hand 2 views (73120) |
$67.41 |
$321 |
0.7× |
| Hand 3 views (73130) |
$67.41 |
$321 |
0.9× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$364.77 |
$1,737 |
0.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,798.65 |
$8,565 |
2.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,330.98 |
$6,338 |
0.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$289.80 |
$1,380 |
0.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$518.91 |
$2,471 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$44.94 |
$214 |
0.6× |
| Hysterosalpingogram (74740) |
$212.52 |
$1,012 |
1.0× |
| Interstitial radiation source applic complex (77778) |
$686.07 |
$3,267 |
1.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$56.70 |
$270 |
0.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$244.02 |
$1,162 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$289.80 |
$1,380 |
0.6× |
| Knee 3 views (73562) |
$55.86 |
$266 |
0.7× |
| Liver & spleen imaging static only (78215) |
$289.80 |
$1,380 |
0.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$196.14 |
$934 |
0.5× |
| Liver imaging static only (78201) |
$84.21 |
$401 |
0.2× |
| Lung perfusion differential (78597) |
$351.75 |
$1,675 |
1.0× |
| Lung Ventilation Imaging (78579) |
$248.43 |
$1,183 |
0.7× |
| Lymphoscintigraphy (78195) |
$244.02 |
$1,162 |
0.5× |
| Meckels Diverticulum (78290) |
$259.14 |
$1,234 |
0.7× |
| Mlc imrt design & construction per imrt plan (77338) |
$218.19 |
$1,039 |
0.6× |
| MRA head w & w/o contrast (70546) |
$916.44 |
$4,364 |
2.9× |
| MRA head w/o contrast (70544) |
$588.63 |
$2,803 |
2.7× |
| MRA head with contrast (70545) |
$679.98 |
$3,238 |
2.2× |
| MRA neck w contrast (70548) |
$588.63 |
$2,803 |
1.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,145.97 |
$5,457 |
3.6× |
| MRA neck w/o contrast (70547) |
$588.63 |
$2,803 |
2.7× |
| MRI abdomen w contrast (74182) |
$711.69 |
$3,389 |
2.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,054.62 |
$5,022 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$560.91 |
$2,671 |
2.6× |
| MRI any jnt lwr ext with con lt (73722) |
$1,067.54 |
$5,083.50 |
1.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,067.54 |
$5,083.50 |
1.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,629.18 |
$7,758 |
7.5× |
| MRI c-spine with contrast (72142) |
$711.69 |
$3,389 |
2.3× |
| MRI cervical spine w/o contrast (72141) |
$560.91 |
$2,671 |
2.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,054.62 |
$5,022 |
3.3× |
| MRI chest w/o contrast (71550) |
$560.91 |
$2,671 |
2.6× |
| MRI fetal sngl/1st gestation (74712) |
$315 |
$1,500 |
1.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$472.50 |
$2,250 |
1.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$472.50 |
$2,250 |
1.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$870.98 |
$4,147.50 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$580.65 |
$2,765 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,086.12 |
$5,172 |
3.4× |
| MRI orbit/face/neck w/contrast (70542) |
$711.69 |
$3,389 |
2.3× |
| MRI pelvis w contrast (72196) |
$315 |
$1,500 |
1.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$658.35 |
$3,135 |
2.1× |
| MRI pelvis w/o contrast (72195) |
$560.91 |
$2,671 |
2.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,340.64 |
$6,384 |
4.2× |
| MRI scan of leg joint before and after contrast (73723) |
$1,340.64 |
$6,384 |
4.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,256.01 |
$5,981 |
4.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$711.69 |
$3,389 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,256.01 |
$5,981 |
4.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$711.69 |
$3,389 |
2.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,256.01 |
$5,981 |
4.0× |
| MRI thoracic spine w/o contrast (72146) |
$560.91 |
$2,671 |
2.6× |
| MRI tmj (70336) |
$580.65 |
$2,765 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$580.65 |
$2,765 |
2.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$580.65 |
$2,765 |
1.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,340.64 |
$6,384 |
6.2× |
| Myelogram Lumbar (72265) |
$719.67 |
$3,427 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$210.42 |
$1,002 |
0.2× |
| Neck soft tissue (70360) |
$44.94 |
$214 |
0.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$26.46 |
$126 |
0.1× |
| Nm cisternogram (78630) |
$299.04 |
$1,424 |
0.6× |
| Nm gastric emptying study (78264) |
$294.84 |
$1,404 |
0.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,041.60 |
$4,960 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$92.30 |
$403.50 |
1.0× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$26.07 |
$79 |
0.2× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$17.49 |
$53 |
0.2× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$21.12 |
$64 |
0.2× |
| Osseous survey infant (77076) |
$102.90 |
$490 |
1.1× |
| Osseous survey limited (77074) |
$69.30 |
$330 |
0.7× |
| Parathyrd planar w/wo subtrj (78071) |
$163.59 |
$779 |
0.5× |
| Parathyroid imaging (78070) |
$358.05 |
$1,705 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$45.57 |
$217 |
0.5× |
| PET image w/CT, skull-thigh (78815) |
$1,889.79 |
$8,999 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$1,889.79 |
$8,999 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$893.76 |
$4,256 |
2.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$727.23 |
$3,463 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$212.10 |
$1,010 |
0.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$315.42 |
$1,502 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$121.17 |
$577 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$25.41 |
$121 |
0.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$58.17 |
$277 |
0.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$35.79 |
$157 |
0.4× |
Radiation Delivery Stereotactic Cranial Linear (77372)
likely a partial charge, not the full procedure |
$467.67 |
$2,227 |
0.1× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$481.95 |
$2,295 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$62.58 |
$298 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$196.35 |
$935 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$34.36 |
$152.50 |
0.4× |
| Radiologic exam colon single contrast study (74270) |
$129.15 |
$615 |
0.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$102.06 |
$486 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$185.01 |
$881 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$107.31 |
$511 |
0.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$76.23 |
$363 |
1.0× |
| Radiological examination surgical specimen (76098) |
$119.28 |
$568 |
0.2× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,686.93 |
$8,033 |
0.6× |
| Ribs bilateral 3 views (71110) |
$40.74 |
$194 |
0.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$317.73 |
$1,513 |
0.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$289.80 |
$1,380 |
0.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$431.76 |
$2,056 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,458.87 |
$6,947 |
1.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$730.17 |
$3,477 |
3.5× |
| Rp Therapy Intravenous Administration (79101) |
$271.95 |
$1,295 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$132.72 |
$632 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$43.89 |
$133 |
0.2× |
| Scanogram (77073) |
$73.71 |
$351 |
0.8× |
| Scapula complete (73010) |
$67.41 |
$321 |
0.7× |
| Screening digital breast tomosynthesis (77063) |
$46.62 |
$222 |
2.0× |
| Simulation intermediate (77285) |
$304.29 |
$1,449 |
0.9× |
| Small bowel series (74250) |
$102.06 |
$486 |
0.6× |
| Spec medical radj physics consltj (77370) |
$212.10 |
$1,010 |
1.7× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$217.35 |
$1,035 |
0.6× |
| Special treatment procedure (77470) |
$454.65 |
$2,165 |
0.9× |
| Spine thoracic 3 views (72072) |
$184.80 |
$880 |
2.0× |
| Splenoportograpy rs&i (75810) |
$727.23 |
$3,463 |
0.3× |
| Stereotactic body radiation delivery (77373) |
$747.39 |
$3,559 |
0.5× |
| Superior sagittal sinus venogram (75870) |
$1,487.43 |
$7,083 |
0.5× |
| Tbs Technical Calculation Only (77091) |
$88.20 |
$420 |
1.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$225.12 |
$1,072 |
0.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$153.93 |
$733 |
0.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$360.78 |
$1,718 |
1.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$183.75 |
$875 |
1.5× |
| Thoracolumbar 2 views (72080) |
$50.19 |
$239 |
0.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$244.02 |
$1,162 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$228.69 |
$1,089 |
0.6× |
| Tmj unilateral (70328) |
$58.38 |
$278 |
0.7× |
| Treatment device intermediate (77333) |
$197.61 |
$941 |
1.6× |
| Treatment devices simple (77332) |
$182.70 |
$870 |
1.5× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$758.73 |
$3,613 |
1.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$196.14 |
$934 |
0.5× |
| Tx devices design & construction complex (77334) |
$218.19 |
$1,039 |
0.6× |
| Ultrasound scan of cornea to determine thickness (76514) |
$4.62 |
$14 |
0.2× |
| Ultrasound scan to determine eye length and lens power (76519) |
$25.08 |
$76 |
0.3× |
| Ultrasound, abdomen limited (76705) |
$95.02 |
$412.50 |
1.0× |
| Umbilical-artery Doppler (OB) (76820) |
$22.02 |
$90 |
0.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$1,487.43 |
$7,083 |
18.9× |
| Unlisted fluoroscopic procedure (76496) |
$1,487.43 |
$7,083 |
18.9× |
| Unlisted Ultrasound Procedure (76999) |
$26.25 |
$125 |
0.3× |
| Upper Extremity Infant (73092) |
$80.32 |
$382.50 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$161.07 |
$767 |
0.7× |
| Urethrocystography voiding (74455) |
$161.07 |
$767 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$161.07 |
$767 |
1.0× |
| Us abdl aorta screen aaa (76706) |
$85.52 |
$335.50 |
0.9× |
| Us breast unilateral complete (76641) |
$95.13 |
$453 |
1.0× |
| Us breast unilateral limited (76642) |
$132.82 |
$632.50 |
1.7× |
| Us chest (76604) |
$116.55 |
$555 |
1.2× |
| Us compl joint r-t w/image documentation (76881) |
$55.86 |
$266 |
0.6× |
| Us fetal nuchal translucency 1st gestation (76813) |
$44.55 |
$135 |
0.5× |
| Us infant hips dynamic (76885) |
$26.25 |
$125 |
0.3× |
| Us infant hips limited static (76886) |
$36.54 |
$174 |
0.5× |
| Us kidney transplant (76776) |
$58.59 |
$279 |
0.6× |
| Us ob detailed single fetus (76811) |
$114.80 |
$489.50 |
0.5× |
| Us ob transvaginal (76817) |
$92.73 |
$411 |
1.0× |
| Us pelvic non ob complete (76856) |
$94.41 |
$415 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$70.92 |
$322 |
0.7× |
| Us pregnancy ltd (76815) |
$83.44 |
$370.50 |
0.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$93.62 |
$407.50 |
1.0× |
| Us retroperitoneal complete (76770) |
$139.86 |
$666 |
1.5× |
| Us retroperitoneal limited (76775) |
$93.03 |
$443 |
1.0× |
| Us scrotum and contents (76870) |
$126 |
$600 |
1.3× |
| Us soft tissue head/neck (76536) |
$120.75 |
$575 |
1.3× |
| Us spinal canal and contents (76800) |
$156.87 |
$747 |
1.7× |
| Us transrectal (76872) |
$75.57 |
$229 |
0.8× |
| Us xtr non-vasc lmtd (76882) |
$63.18 |
$290 |
0.7× |
| Us, eye b-scan (76512) |
$18.15 |
$55 |
0.2× |
| Venogram extremity bilateral (75822) |
$1,131.69 |
$5,389 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$1,313.55 |
$6,255 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$1,256.85 |
$5,985 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$1,487.43 |
$7,083 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,373.40 |
$6,540 |
0.5× |
| Wrist 2 views (73100) |
$67.41 |
$321 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$77.70 |
$370 |
0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$52.92 |
$252 |
0.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$67.41 |
$321 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$153.93 |
$733 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$67.41 |
$321 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$70.88 |
$337.50 |
0.9× |
| X-ray exam hip uni 1 view (73501) |
$46.83 |
$223 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$51.03 |
$243 |
0.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$53.97 |
$257 |
0.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$74.97 |
$357 |
0.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$92.82 |
$442 |
0.6× |
| X-ray eye for foreign body (70030) |
$85.05 |
$405 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$51.24 |
$244 |
0.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$48.72 |
$232 |
0.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$67.41 |
$321 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$67.41 |
$321 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$16.17 |
$77 |
0.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$114.03 |
$543 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$92.61 |
$441 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$76.86 |
$366 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$36.99 |
$163 |
0.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$78.54 |
$374 |
0.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$59.22 |
$282 |
0.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$44.31 |
$211 |
0.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$42.21 |
$201 |
0.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$56.70 |
$270 |
0.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$58.17 |
$277 |
0.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$161.07 |
$767 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$50.82 |
$242 |
0.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$66.36 |
$316 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$102.48 |
$488 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$55.86 |
$266 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$44.94 |
$214 |
0.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$76.23 |
$363 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$58.80 |
$280 |
0.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$44.94 |
$214 |
0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$77.70 |
$370 |
0.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$44.31 |
$211 |
0.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$49.77 |
$237 |
0.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$50.82 |
$242 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$55.86 |
$266 |
0.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$21.60 |
$92 |
0.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$58.17 |
$277 |
0.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$44.94 |
$214 |
0.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$67.41 |
$321 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$73.71 |
$351 |
0.8× |
| Xr chest 4+ views (71048) |
$58.80 |
$280 |
0.6× |
| Xr finger(s) 2+ views (73140) |
$44.94 |
$214 |
0.6× |
| Xr shoulder 1 view (73020) |
$71.82 |
$342 |
0.9× |
| Xr spine cervical 4 or 5 views (72050) |
$77.70 |
$370 |
0.8× |
| Xr tibia/fibula 2 views (73590) |
$67.41 |
$321 |
0.9× |
| Xr tmj bilateral (70330) |
$71.61 |
$341 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$69.93 |
$333 |
0.9× |