| 3-D radiotherapy plan dose-volume histograms (77295) |
$3,483.50 |
$6,967 |
2.2× |
| Abdomen 2 views (74019) |
$156.50 |
$313 |
1.3× |
| Acute gi blood loss imaging (78278) |
$779.50 |
$1,559 |
1.7× |
| Angiography extremity bilateral rs&i (75716) |
$2,842.50 |
$5,685 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,402.50 |
$4,805 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,245.78 |
$2,491.55 |
0.3× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,874.50 |
$5,749 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,825 |
$5,650 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,704 |
$3,408 |
0.5× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,657 |
$3,314 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$2,550 |
$5,100 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$447 |
$894 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,113.50 |
$2,227 |
0.3× |
| Ankle 2 views (73600) |
$179.25 |
$358.50 |
1.8× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,753 |
$5,506 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,856.50 |
$5,713 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,746.50 |
$5,493 |
0.7× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,512 |
$3,024 |
0.4× |
| Arthrogram hip (73525) |
$567 |
$1,134 |
1.4× |
| Arthrogram shoulder (73040) |
$477.50 |
$955 |
1.2× |
| Arthrogram wrist (73115) |
$469 |
$938 |
1.2× |
| Basic dosimetry (77300) |
$301 |
$602 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$285 |
$570 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$857.50 |
$1,715 |
1.8× |
| Bone age studies (77072) |
$150.15 |
$300.30 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$952 |
$1,904 |
2.1× |
| Bone survey complete (77075) |
$278 |
$556 |
2.3× |
| Bone survey infant (77076) |
$156 |
$312 |
1.3× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$754.50 |
$1,509 |
1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,270.50 |
$2,541 |
0.8× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,035 |
$2,070 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,172 |
$2,344 |
2.9× |
| Cervical spine 2 or 3 views (72040) |
$168 |
$336 |
1.7× |
| Chest 1 view (71045) |
$103.50 |
$207 |
1.0× |
| Chest xray 3 views (71047) |
$125.50 |
$251 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$283.50 |
$567 |
1.4× |
| Clavicle complete (73000) |
$180.75 |
$361.50 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$216 |
$432 |
1.8× |
| Continuing medical physics consltj pr wk (77336) |
$457.50 |
$915 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,823.50 |
$3,647 |
4.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,221 |
$2,442 |
4.4× |
| CT abdomen w contrast (74160) |
$823.50 |
$1,647 |
4.0× |
| CT abdomen w wo contrast (74170) |
$972 |
$1,944 |
4.8× |
| CT abdomen w/o contrast (74150) |
$631.50 |
$1,263 |
5.2× |
| CT angio hrt w/3d image (75574) |
$497.50 |
$995 |
1.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$440.75 |
$881.50 |
2.2× |
| CT angiography upper extremity lt (73206) |
$599.50 |
$1,199 |
2.9× |
| CT c-spine w/contrast (72126) |
$687.50 |
$1,375 |
1.7× |
| CT c-spine w/o contrast (72125) |
$651.50 |
$1,303 |
5.4× |
| CT cervical spine w&w/o contrast (72127) |
$696 |
$1,392 |
3.4× |
| CT chest w contrast (71260) |
$827.50 |
$1,655 |
4.1× |
| CT chest w/wo contrast (71270) |
$1,059.88 |
$2,119.75 |
5.2× |
| CT colonography screening (74263) |
$213.50 |
$427 |
0.8× |
| CT colonography w/o cntrst (74261) |
$598.42 |
$1,196.85 |
4.9× |
| CT head/brain with contrast (70460) |
$656 |
$1,312 |
3.2× |
| CT head/brain without and with contrast (70470) |
$835 |
$1,670 |
4.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$326.50 |
$653 |
0.8× |
| CT iac w contrast (70481) |
$573 |
$1,146 |
2.8× |
| CT limited/localized follow up study (76380) |
$229.50 |
$459 |
2.3× |
| CT lower ext w/o (73700) |
$820.25 |
$1,640.50 |
6.8× |
| CT lower extremity w wo contrast (73702) |
$663.50 |
$1,327 |
3.3× |
| CT lower extremity w/contrast material (73701) |
$933.50 |
$1,867 |
4.6× |
| CT lumbar spine w & w/o contrast (72133) |
$757.50 |
$1,515 |
3.7× |
| CT lumbar spine w/contrast (72132) |
$723.50 |
$1,447 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$651.50 |
$1,303 |
5.4× |
| CT maxillofacial w contrast (70487) |
$688.50 |
$1,377 |
3.4× |
| CT maxillofacial w/wo contrast (70488) |
$786 |
$1,572 |
3.9× |
| CT maxillofacial wo contrast (70486) |
$462.50 |
$925 |
3.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$634.50 |
$1,269 |
3.1× |
| CT orbits w/o contrast (70480) |
$497 |
$994 |
4.1× |
| CT pelvis w/o contrast (72192) |
$589.50 |
$1,179 |
4.9× |
| CT pelvis w/wo contrast (72194) |
$870 |
$1,740 |
4.3× |
| CT soft tissue neck w contrast (70491) |
$733.50 |
$1,467 |
3.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$821 |
$1,642 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$650.45 |
$1,300.90 |
5.4× |
| CT thoracic spine w/contrast (72129) |
$687.50 |
$1,375 |
3.4× |
| CT thoracic spine w/o contrast (72128) |
$651.50 |
$1,303 |
5.4× |
| CT thoracic spine w/wo contrast (72130) |
$702.50 |
$1,405 |
3.4× |
| CT thorax w/o contrast (71250) |
$700.50 |
$1,401 |
5.8× |
| CT upper ext wo (73200) |
$485 |
$970 |
4.0× |
| CT upper extremity with contrast (73201) |
$583.50 |
$1,167 |
1.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$668 |
$1,336 |
3.3× |
| Cta Abdomen (74175) |
$1,045.50 |
$2,091 |
5.1× |
| CTA abdomen pelvis (74174) |
$1,946 |
$3,892 |
4.8× |
| CTA chest (71275) |
$944 |
$1,888 |
4.6× |
| Cta Head (70496) |
$872.50 |
$1,745 |
4.3× |
| Cta Neck (70498) |
$872.50 |
$1,745 |
4.3× |
| Cta Pelvis (72191) |
$989 |
$1,978 |
4.9× |
| Cystography minimum 3 views rs&i (74430) |
$419 |
$838 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$246 |
$492 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$212 |
$424 |
1.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$65.50 |
$131 |
0.6× |
| Esophagus (74220) |
$261.50 |
$523 |
1.3× |
| Facial bones min 3 views (70150) |
$217.50 |
$435 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$235 |
$470 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$286 |
$572 |
1.0× |
| Foot 2 views (73620) |
$113.50 |
$227 |
1.1× |
| Forearm 2 views (73090) |
$188 |
$376 |
1.9× |
| Hand 2 views (73120) |
$180.75 |
$361.50 |
1.5× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$952.50 |
$1,905 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,132 |
$4,264 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$904 |
$1,808 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$755.50 |
$1,511 |
1.6× |
| Hysterosalpingogram (74740) |
$558.50 |
$1,117 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$901.50 |
$1,803 |
1.4× |
| Knee 3 views (73562) |
$196.75 |
$393.50 |
1.9× |
| Liver & spleen imaging static only (78215) |
$618 |
$1,236 |
1.3× |
| Lymphoscintigraphy (78195) |
$762 |
$1,524 |
1.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,035.50 |
$2,071 |
1.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,171 |
$2,342 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,281.50 |
$2,563 |
3.2× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$145.75 |
$291.50 |
1.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$909 |
$1,818 |
2.1× |
| MRA head w & w/o contrast (70546) |
$1,415 |
$2,830 |
3.5× |
| MRA head w/o contrast (70544) |
$1,004.50 |
$2,009 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,279 |
$2,558 |
3.2× |
| MRA neck w/o contrast (70547) |
$1,004.50 |
$2,009 |
3.6× |
| MRI abdomen w contrast (74182) |
$1,263.50 |
$2,527 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,259 |
$2,518 |
3.1× |
| MRI abdomen w/o contrast (74181) |
$986 |
$1,972 |
3.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,035.50 |
$2,071 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,281.50 |
$2,563 |
3.2× |
| MRI bone marrow blood supply (77084) |
$625.50 |
$1,251 |
2.3× |
| MRI breast w/o contrast bilateral (77047) |
$620.50 |
$1,241 |
2.2× |
| MRI breast wo contrast unilateral (77046) |
$462.50 |
$925 |
1.7× |
| MRI c-spine with contrast (72142) |
$1,064 |
$2,128 |
2.6× |
| MRI cardiac w/o contrast (75557) |
$637 |
$1,274 |
2.3× |
| MRI cervical spine w/o contrast (72141) |
$979 |
$1,958 |
3.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,202.50 |
$2,405 |
3.0× |
| MRI chest w/o contrast (71550) |
$937.50 |
$1,875 |
3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,025 |
$2,050 |
2.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,281.50 |
$2,563 |
3.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$938.50 |
$1,877 |
3.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$913 |
$1,826 |
3.3× |
| MRI orbit face neck w contrast (70542) |
$947 |
$1,894 |
2.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,208.50 |
$2,417 |
3.0× |
| MRI pelvis w/contrast (72196) |
$1,212.25 |
$2,424.50 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,212.50 |
$2,425 |
3.0× |
| MRI pelvis w/o contrast (72195) |
$942 |
$1,884 |
3.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,140 |
$2,280 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,251.98 |
$2,503.95 |
3.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,140 |
$2,280 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,064 |
$2,128 |
2.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,140 |
$2,280 |
2.8× |
| MRI temporomandibular joint (70336) |
$582 |
$1,164 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$979 |
$1,958 |
3.5× |
| MRI up ext w/o contrast (73218) |
$938.50 |
$1,877 |
3.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,104.15 |
$2,208.30 |
4.0× |
| MRI, joint upper extrem combo (73223) |
$1,281.50 |
$2,563 |
3.2× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$1,459 |
$2,918 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,227 |
$4,454 |
1.5× |
| Myocardial spect single study at rest or stress (78451) |
$812.50 |
$1,625 |
0.5× |
| Neck soft tissue (70360) |
$152 |
$304 |
1.5× |
| Nm gastric emptying study (78264) |
$854 |
$1,708 |
1.8× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$4,088 |
$8,176 |
2.5× |
| Nuclear Rx Oral Admin (79005) |
$731 |
$1,462 |
2.7× |
| Ob us nuchal meas 1 gest (76813) |
$152 |
$304 |
1.3× |
| Parathyrd planar w/spect&CT (78072) |
$762 |
$1,524 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$762 |
$1,524 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$129 |
$258 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$1,979.50 |
$3,959 |
1.2× |
| PET imaging for CT attenuation whole body (78816) |
$1,979.50 |
$3,959 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$508 |
$1,016 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$851.50 |
$1,703 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$361.50 |
$723 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$204 |
$408 |
2.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$164.75 |
$329.50 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$239.52 |
$479.05 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$62 |
$124 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$103 |
$206 |
0.8× |
| Radex fingr minimum 2 views (73140) |
$148.50 |
$297 |
1.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$183.75 |
$367.50 |
1.8× |
| Radex Hand Minimum 3 Views (73130) |
$197.25 |
$394.50 |
2.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$120.50 |
$241 |
1.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$105 |
$210 |
0.9× |
| Radex Humerus Minimum 2 Views (73060) |
$184.50 |
$369 |
1.8× |
| Radex Kne 1/2 Views (73560) |
$180.75 |
$361.50 |
1.8× |
| Radex Kne Compl 4/More Views (73564) |
$251.25 |
$502.50 |
2.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$202 |
$404 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$153 |
$306 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$148 |
$296 |
1.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$218.50 |
$437 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$127.50 |
$255 |
1.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$185 |
$370 |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$217.50 |
$435 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$104 |
$208 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$179.45 |
$358.90 |
1.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$201 |
$402 |
2.0× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$6,056 |
$12,112 |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$544.50 |
$1,089 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$139 |
$278 |
1.4× |
| Radiologic exam chest 2 views (71046) |
$116.50 |
$233 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$306.50 |
$613 |
1.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$261.50 |
$523 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$347.50 |
$695 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$300.50 |
$601 |
1.5× |
| Radiologic examination femur 1 view (73551) |
$97.50 |
$195 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$189.25 |
$378.50 |
1.9× |
| Radiological examination surgical specimen (76098) |
$124.50 |
$249 |
0.2× |
| Ribs bilateral 3 views (71110) |
$140 |
$280 |
1.2× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$545.50 |
$1,091 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,345.50 |
$2,691 |
2.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,468 |
$2,936 |
0.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,294 |
$2,588 |
0.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$494 |
$988 |
1.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$209.50 |
$419 |
0.8× |
| Scapula (73010) |
$128 |
$256 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$35.50 |
$71 |
1.5× |
| Shoulder 1 view (73020) |
$120.50 |
$241 |
1.2× |
| Small bowel series (74250) |
$346.50 |
$693 |
1.7× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$863 |
$1,726 |
2.0× |
| Special dosimetry (77331) |
$261 |
$522 |
1.7× |
| Special Physics Consult (77370) |
$480 |
$960 |
3.1× |
| Special treatment procedure (77470) |
$1,749.50 |
$3,499 |
2.7× |
| Spine thoracic 3 views (72072) |
$189.50 |
$379 |
1.6× |
| Stereotactic Body Radiation Delivery (77373) |
$4,782.50 |
$9,565 |
2.3× |
| Superior sagittal sinus venogram (75870) |
$365 |
$730 |
0.1× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,373 |
$2,746 |
3.2× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,152 |
$2,304 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$605 |
$1,210 |
3.9× |
| Thoracolumbar 2 views (72080) |
$173 |
$346 |
1.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$949 |
$1,898 |
1.5× |
| Thyroid uptake measurement (78012) |
$229.50 |
$459 |
0.5× |
| Treatment device complex (77334) |
$639.50 |
$1,279 |
1.5× |
| Treatment device intermediate (77333) |
$449.50 |
$899 |
2.9× |
| Ultrasound breast complete (76641) |
$466.75 |
$933.50 |
3.8× |
| Ultrasound Exam Aaa Screen (76706) |
$86 |
$172 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$242.50 |
$485 |
2.0× |
| Umbilical-artery Doppler (OB) (76820) |
$246 |
$492 |
2.0× |
| Unlisted magnetic resonance procedure (76498) |
$647.50 |
$1,295 |
6.4× |
| Urethrocystogram voiding (74455) |
$365.12 |
$730.25 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$416 |
$832 |
1.5× |
| Us breast unilateral limited (76642) |
$247.04 |
$494.09 |
2.4× |
| Us chest (76604) |
$188.50 |
$377 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$214 |
$428 |
1.8× |
| Us elastography parenchyma (76981) |
$114.50 |
$229 |
0.9× |
| Us encephalogram (76506) |
$245 |
$490 |
2.0× |
| Us infant hips w manipulation (76885) |
$340.50 |
$681 |
3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$138.50 |
$277 |
1.1× |
| Us ob detailed single fetus (76811) |
$353.50 |
$707 |
1.3× |
| Us ob limited (76815) |
$153 |
$306 |
1.3× |
| Us ob transvaginal (76817) |
$161.50 |
$323 |
1.3× |
| Us pelvic non ob complete (76856) |
$300.50 |
$601 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$190 |
$380 |
1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$176 |
$352 |
1.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$156.50 |
$313 |
1.3× |
| Us retroperitoneal complete (76770) |
$277 |
$554 |
2.3× |
| Us retroperitoneal limited (76775) |
$170.50 |
$341 |
1.4× |
| Us scrotum and contents (76870) |
$258.50 |
$517 |
2.1× |
| Us soft tissue head/neck (76536) |
$251.50 |
$503 |
2.1× |
| Us spinal canal and contents (76800) |
$167 |
$334 |
1.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$210 |
$420 |
1.7× |
| Venogram extremity bilateral (75822) |
$1,129 |
$2,258 |
0.6× |
| Venogram Extremity Unilateral (75820) |
$711.50 |
$1,423 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,020 |
$4,040 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,488.50 |
$2,977 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$977 |
$1,954 |
0.3× |
| Wrist 2 views (73100) |
$210.78 |
$421.58 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$200 |
$400 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$165 |
$330 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$488 |
$976 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$200.28 |
$400.55 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$136 |
$272 |
1.3× |
| X-ray exam of femur 2/> (73552) |
$93.25 |
$186.50 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$156 |
$312 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$170.50 |
$341 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$116 |
$232 |
1.1× |
| X-ray leg, infant (73592) |
$115.75 |
$231.50 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$169 |
$338 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$297.50 |
$595 |
2.5× |
| X-ray nose-rectum child f.b. (76010) |
$76 |
$152 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$199 |
$398 |
1.6× |
| X-ray retrograde pyelogram (74420) |
$424.50 |
$849 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$127.50 |
$255 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$156.50 |
$313 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$189 |
$378 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$144 |
$288 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$144 |
$288 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$211 |
$422 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$245.50 |
$491 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$127.50 |
$255 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$127.50 |
$255 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$135 |
$270 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$150.50 |
$301 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$159.50 |
$319 |
1.3× |
| Xr bone length studies (77073) |
$173.50 |
$347 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$208 |
$416 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$253 |
$506 |
2.1× |
| Xr chest 4+ views (71048) |
$150 |
$300 |
1.2× |