| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,335.20 |
$4,169 |
2.2× |
| Abdomen 2 views (74019) |
$279.20 |
$349 |
2.4× |
| Acute gi blood loss imaging (78278) |
$1,159.20 |
$1,449 |
2.6× |
| Ankle 2 views (73600) |
$233.60 |
$292 |
2.4× |
| Arthrogram hip (73525) |
$896.80 |
$1,121 |
2.3× |
| Arthrogram shoulder (73040) |
$989.60 |
$1,237 |
2.5× |
| Arthrogram wrist (73115) |
$707.20 |
$884 |
1.8× |
| Basic dosimetry (77300) |
$351.20 |
$439 |
2.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$788.80 |
$986 |
1.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$788.80 |
$986 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$1,424 |
$1,780 |
3.2× |
| Bone age studies (77072) |
$248 |
$310 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,640 |
$2,050 |
3.7× |
| Bone survey complete (77075) |
$677.60 |
$847 |
5.8× |
| Bone survey infant (77076) |
$346.40 |
$433 |
3.0× |
| Bowel imaging (78290) |
$1,740 |
$2,175 |
3.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,920 |
$2,400 |
3.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,660 |
$5,825 |
2.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,628 |
$3,285 |
5.9× |
| Cervical spine 2 or 3 views (72040) |
$283.20 |
$354 |
2.9× |
| Chest 1 view (71045) |
$177.60 |
$222 |
1.8× |
| Chest xray 3 views (71047) |
$262.40 |
$328 |
2.7× |
| Cholecystography, oral contrast Non-Facility (74290) |
$368 |
$460 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$168 |
$210 |
0.9× |
| Clavicle complete (73000) |
$248 |
$310 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$315.20 |
$394 |
2.7× |
| Continuing medical physics consltj pr wk (77336) |
$472.80 |
$591 |
3.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,848 |
$3,560 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,655.20 |
$2,069 |
6.2× |
| CT abdomen w contrast (74160) |
$1,916 |
$2,395 |
9.8× |
| CT abdomen w wo contrast (74170) |
$2,160 |
$2,700 |
11.1× |
| CT abdomen w/o contrast (74150) |
$1,365.60 |
$1,707 |
11.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,160 |
$1,450 |
5.9× |
| CT angiography upper extremity lt (73206) |
$1,160 |
$1,450 |
5.9× |
| CT c-spine w/contrast (72126) |
$1,680 |
$2,100 |
4.3× |
| CT c-spine w/o contrast (72125) |
$1,207.20 |
$1,509 |
10.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,932 |
$2,415 |
9.9× |
| CT chest w contrast (71260) |
$1,864 |
$2,330 |
9.5× |
| CT chest w/wo contrast (71270) |
$2,000 |
$2,500 |
10.2× |
| CT head/brain with contrast (70460) |
$1,640 |
$2,050 |
8.4× |
| CT head/brain without and with contrast (70470) |
$1,912 |
$2,390 |
9.8× |
| CT iac w contrast (70481) |
$1,052 |
$1,315 |
5.4× |
| CT limited/localized follow up study (76380) |
$508.80 |
$636 |
5.2× |
| CT lower ext w/o (73700) |
$720.80 |
$901 |
6.2× |
| CT lower extremity w wo contrast (73702) |
$1,280 |
$1,600 |
6.5× |
| CT lower extremity w/contrast material (73701) |
$1,160 |
$1,450 |
5.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,932 |
$2,415 |
9.9× |
| CT lumbar spine w/contrast (72132) |
$1,680 |
$2,100 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$1,207.20 |
$1,509 |
10.4× |
| CT maxillofacial w contrast (70487) |
$1,052 |
$1,315 |
5.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,480 |
$1,850 |
7.6× |
| CT maxillofacial wo contrast (70486) |
$674.40 |
$843 |
5.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,480 |
$1,850 |
7.6× |
| CT orbits w/o contrast (70480) |
$674.40 |
$843 |
5.8× |
| CT pelvis w/o contrast (72192) |
$1,402.40 |
$1,753 |
12.0× |
| CT pelvis w/wo contrast (72194) |
$2,160 |
$2,700 |
11.1× |
| CT scan of arm combo (73202) |
$1,280 |
$1,600 |
6.5× |
| CT soft tissue neck w contrast (70491) |
$1,052 |
$1,315 |
5.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,480 |
$1,850 |
7.6× |
| CT soft tissue neck w/o contrast (70490) |
$674.40 |
$843 |
5.8× |
| CT thoracic spine w/contrast (72129) |
$1,680 |
$2,100 |
8.6× |
| CT thoracic spine w/o contrast (72128) |
$1,207.20 |
$1,509 |
10.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,860 |
$2,325 |
9.5× |
| CT thorax w/o contrast (71250) |
$817.60 |
$1,022 |
7.0× |
| CT upper ext wo (73200) |
$720.80 |
$901 |
6.2× |
| CT upper extremity with contrast (73201) |
$1,160 |
$1,450 |
3.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,680 |
$2,100 |
8.6× |
| Cta Abdomen (74175) |
$1,916 |
$2,395 |
9.8× |
| CTA abdomen pelvis (74174) |
$2,120 |
$2,650 |
5.5× |
| CTA chest (71275) |
$1,583.20 |
$1,979 |
8.1× |
| Cta Head (70496) |
$1,640 |
$2,050 |
8.4× |
| Cta Neck (70498) |
$1,052 |
$1,315 |
5.4× |
| Cta Pelvis (72191) |
$1,680 |
$2,100 |
8.6× |
| Cystography minimum 3 views rs&i (74430) |
$772 |
$965 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$420 |
$525 |
3.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$217.60 |
$272 |
2.2× |
| Esophagus (74220) |
$508 |
$635 |
2.6× |
| Facial bones min 3 views (70150) |
$372 |
$465 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$668.80 |
$836 |
5.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$667.20 |
$834 |
5.7× |
| Foot 2 views (73620) |
$233.60 |
$292 |
2.4× |
| Forearm 2 views (73090) |
$248 |
$310 |
2.6× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,391.20 |
$1,739 |
3.1× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$1,739.20 |
$2,174 |
2.9× |
| Hand 2 views (73120) |
$233.60 |
$292 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,344 |
$1,680 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$835.60 |
$1,044.50 |
1.9× |
| Hysterosalpingogram (74740) |
$613.60 |
$767 |
2.3× |
| Image fusion (77399) |
$522.40 |
$653 |
3.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$354.40 |
$443 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,275.20 |
$1,594 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,396 |
$2,995 |
4.0× |
| Knee 3 views (73562) |
$268.80 |
$336 |
2.8× |
| Liver & spleen imaging static only (78215) |
$692.80 |
$866 |
1.6× |
| Lung perf&ventilat diferentl (78598) |
$1,101.60 |
$1,377 |
1.8× |
| Lung perfusion differential (78597) |
$927.20 |
$1,159 |
2.1× |
| Lymphoscintigraphy (78195) |
$2,216 |
$2,770 |
3.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,332 |
$2,915 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,240 |
$2,800 |
5.8× |
| Mammary ductogram or galactogram multiple (77054) |
$1,110.40 |
$1,388 |
4.2× |
| Mammary ductogram or galactogram single (77053) |
$495.20 |
$619 |
1.9× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$220.80 |
$276 |
0.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$723.20 |
$904 |
1.7× |
| MRA head w & w/o contrast (70546) |
$2,832 |
$3,540 |
7.3× |
| MRA head w/o contrast (70544) |
$1,797.60 |
$2,247 |
6.8× |
| MRA head with contrast (70545) |
$1,904 |
$2,380 |
4.9× |
| MRA neck w contrast (70548) |
$1,740 |
$2,175 |
4.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,200 |
$2,750 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,113.60 |
$1,392 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,680 |
$3,350 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,676 |
$2,095 |
6.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,332 |
$2,915 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,548 |
$3,185 |
6.6× |
| MRI bone marrow blood supply (77084) |
$546.40 |
$683 |
2.1× |
| MRI breast w/o contrast bilateral (77047) |
$1,680 |
$2,100 |
6.3× |
| MRI breast wo contrast unilateral (77046) |
$1,176 |
$1,470 |
4.4× |
| MRI c-spine with contrast (72142) |
$2,672 |
$3,340 |
6.9× |
| MRI cervical spine w/o contrast (72141) |
$2,012.80 |
$2,516 |
7.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,548 |
$3,185 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,676 |
$2,095 |
6.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,904 |
$2,380 |
4.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,240 |
$2,800 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,096.80 |
$1,371 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,096.80 |
$1,371 |
4.1× |
| MRI orbit face neck w contrast (70542) |
$1,584 |
$1,980 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,820 |
$2,275 |
4.7× |
| MRI pelvis w/contrast (72196) |
$2,160 |
$2,700 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,548 |
$3,185 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,676 |
$2,095 |
6.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,752 |
$3,440 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,672 |
$3,340 |
6.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,752 |
$3,440 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,672 |
$3,340 |
6.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,752 |
$3,440 |
7.1× |
| MRI temporomandibular joint (70336) |
$1,008 |
$1,260 |
3.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,012.80 |
$2,516 |
7.6× |
| MRI up ext w/o contrast (73218) |
$1,096.80 |
$1,371 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,676 |
$2,095 |
6.3× |
| MRI, joint upper extrem combo (73223) |
$2,680 |
$3,350 |
6.9× |
| Myelogram Cervical (72240) |
$2,233.60 |
$2,792 |
2.6× |
| Myelogram Lumbar (72265) |
$1,918.40 |
$2,398 |
2.2× |
| Myelogram thoracic (72255) |
$2,233.60 |
$2,792 |
2.6× |
| Myelography 2 or more regions (72270) |
$1,804 |
$2,255 |
2.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,440 |
$4,300 |
2.4× |
| Myocardial spect single study at rest or stress (78451) |
$3,280 |
$4,100 |
2.3× |
| Neck soft tissue (70360) |
$198.40 |
$248 |
2.0× |
| Nm cardiac blood pool multiple (78473) |
$2,947.20 |
$3,684 |
6.6× |
| Nm cisternogram (78630) |
$1,275.20 |
$1,594 |
2.1× |
| Nm gastric emptying study (78264) |
$1,760 |
$2,200 |
4.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$3,836.80 |
$4,796 |
2.5× |
| Nuclear Rx Oral Admin (79005) |
$936 |
$1,170 |
3.6× |
| Osseous survey limited (77074) |
$469.60 |
$587 |
4.0× |
| Parathyroid Planar Imaging (78070) |
$1,120 |
$1,400 |
2.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,420 |
$1,775 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$248 |
$310 |
2.1× |
| PET image w/CT, skull-thigh (78815) |
$5,172.80 |
$6,466 |
3.2× |
| PET imaging for CT attenuation whole body (78816) |
$5,172.80 |
$6,466 |
3.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$855.20 |
$1,069 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,560 |
$3,200 |
4.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$518.40 |
$648 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$252 |
$315 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$222.40 |
$278 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$268.80 |
$336 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$256.80 |
$321 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$359.20 |
$449 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$464 |
$580 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$199.20 |
$249 |
2.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$252 |
$315 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$252 |
$315 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$256.80 |
$321 |
2.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$464 |
$580 |
4.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$367.20 |
$459 |
3.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$496.80 |
$621 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$268.80 |
$336 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$248 |
$310 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$292 |
$365 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$292 |
$365 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$248 |
$310 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$346.40 |
$433 |
3.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$268.80 |
$336 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$292 |
$365 |
3.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$401.60 |
$502 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$376.80 |
$471 |
3.9× |
| Radex Toe Minimum 2 Views (73660) |
$199.20 |
$249 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$233.60 |
$292 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$252 |
$315 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$521.60 |
$652 |
4.5× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$10,804.80 |
$13,506 |
1.3× |
| Radiation treatment delivery level 1 (77402) |
$298.40 |
$373 |
2.6× |
| Radiation treatment delivery level 2 (77407) |
$347.20 |
$434 |
0.8× |
| Radiation treatment delivery level 3 (77412) |
$545.60 |
$682 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$236.80 |
$296 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$329.60 |
$412 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$227.20 |
$284 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$801.60 |
$1,002 |
4.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$533.60 |
$667 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$778.40 |
$973 |
4.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$687.20 |
$859 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$256.80 |
$321 |
2.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$248 |
$310 |
2.6× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$222.40 |
$278 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$376.80 |
$471 |
3.9× |
| Radiological examination surgical specimen (76098) |
$636 |
$795 |
1.0× |
| Ribs bilateral 3 views (71110) |
$372 |
$465 |
3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,188.80 |
$3,986 |
5.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,739.20 |
$2,174 |
2.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,563.20 |
$3,204 |
4.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,087.20 |
$2,609 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$936 |
$1,170 |
3.6× |
| Sacroiliac Joints < 3 Views (72200) |
$248 |
$310 |
2.1× |
| Scapula (73010) |
$248 |
$310 |
2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$44 |
$55 |
1.9× |
| Shoulder 1 view (73020) |
$268.80 |
$336 |
2.8× |
| Simulation intermediate (77285) |
$669.60 |
$837 |
1.6× |
| Small bowel series (74250) |
$613.60 |
$767 |
3.1× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$872 |
$1,090 |
2.1× |
| Special dosimetry (77331) |
$388.80 |
$486 |
2.6× |
| Special Physics Consult (77370) |
$557.60 |
$697 |
3.7× |
| Special treatment procedure (77470) |
$1,092 |
$1,365 |
1.8× |
| Spine thoracic 3 views (72072) |
$346.40 |
$433 |
3.0× |
| Stereotactic Body Radiation Delivery (77373) |
$3,475.20 |
$4,344 |
1.7× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$257.60 |
$322 |
2.3× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$760.80 |
$951 |
1.8× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$669.60 |
$837 |
1.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,078.40 |
$1,348 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$491.20 |
$614 |
3.3× |
| Thoracolumbar 2 views (72080) |
$316.80 |
$396 |
3.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,520 |
$1,900 |
2.5× |
| Thyroid imaging w/blood flow (78013) |
$1,356 |
$1,695 |
3.0× |
| Thyroid uptake measurement (78012) |
$1,356 |
$1,695 |
3.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,356 |
$1,695 |
3.0× |
| Tmj unilateral (70328) |
$173.60 |
$217 |
1.8× |
| Treatment device complex (77334) |
$723.20 |
$904 |
1.7× |
| Treatment device intermediate (77333) |
$541.60 |
$677 |
3.6× |
| Treatment devices simple (77332) |
$258.40 |
$323 |
1.7× |
| Ultrasound breast complete (76641) |
$428.80 |
$536 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$590.40 |
$738 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$628 |
$785 |
5.4× |
| Umbilical-artery Doppler (OB) (76820) |
$614.40 |
$768 |
5.3× |
| Urethrocystogram voiding (74455) |
$755.20 |
$944 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$700.80 |
$876 |
2.6× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$382.40 |
$478 |
2.0× |
| Us breast unilateral limited (76642) |
$340 |
$425 |
3.5× |
| Us chest (76604) |
$658.40 |
$823 |
5.7× |
| Us compl joint r-t w/image documentation (76881) |
$430.40 |
$538 |
3.7× |
| Us encephalogram (76506) |
$220.80 |
$276 |
1.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$281.60 |
$352 |
2.4× |
| Us ob limited (76815) |
$561.60 |
$702 |
4.8× |
| Us ob transvaginal (76817) |
$417.60 |
$522 |
3.6× |
| Us pelvic non ob complete (76856) |
$432 |
$540 |
3.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$460.80 |
$576 |
4.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$436 |
$545 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$464 |
$580 |
4.0× |
| Us retroperitoneal complete (76770) |
$921.60 |
$1,152 |
7.9× |
| Us retroperitoneal limited (76775) |
$589.60 |
$737 |
5.1× |
| Us scrotum and contents (76870) |
$666.40 |
$833 |
5.7× |
| Us soft tissue head/neck (76536) |
$589.60 |
$737 |
5.1× |
| Us spinal canal and contents (76800) |
$536.80 |
$671 |
4.6× |
| Us transrectal (76872) |
$206.40 |
$258 |
1.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$620 |
$775 |
5.3× |
| Venogram Extremity Unilateral (75820) |
$1,111.20 |
$1,389 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$3,473.60 |
$4,342 |
1.0× |
| Wrist 2 views (73100) |
$233.60 |
$292 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$346.40 |
$433 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$316.80 |
$396 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,053.60 |
$1,317 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$255.20 |
$319 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$342.40 |
$428 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$400.80 |
$501 |
3.4× |
| X-ray exam of femur 2/> (73552) |
$256.80 |
$321 |
2.6× |
| X-ray eye for foreign body (70030) |
$216 |
$270 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$292 |
$365 |
3.0× |
| X-ray IV pyelogram (ivp) (74400) |
$807.20 |
$1,009 |
4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$248 |
$310 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$191.20 |
$239 |
2.0× |
| X-ray leg, infant (73592) |
$233.60 |
$292 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$316.80 |
$396 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$560 |
$700 |
4.8× |
| X-ray nose-rectum child f.b. (76010) |
$248 |
$310 |
2.6× |
| X-ray optic foramen (70190) |
$278.40 |
$348 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$372 |
$465 |
3.2× |
| X-ray retrograde pyelogram (74420) |
$1,258.40 |
$1,573 |
3.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$268 |
$335 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$268 |
$335 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$372 |
$465 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$248 |
$310 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$268.80 |
$336 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$372 |
$465 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$421.60 |
$527 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$292 |
$365 |
2.5× |
| X-Ray Small Bowel Enteroclysis (74251) |
$613.60 |
$767 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$198.40 |
$248 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$357.60 |
$447 |
3.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$307.20 |
$384 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$308 |
$385 |
2.6× |
| Xr bone length studies (77073) |
$372 |
$465 |
3.2× |
| Xr c-spine 4 or 5 views (72050) |
$421.60 |
$527 |
3.6× |
| Xr c-spine 6 or more views (72052) |
$533.60 |
$667 |
4.6× |
| Xr chest 4+ views (71048) |
$391.20 |
$489 |
3.4× |
| Xr urogram antegrade (74425) |
$855.20 |
$1,069 |
2.2× |