| 3-D radiotherapy plan dose-volume histograms (77295) |
$6,060.60 |
$20,202 |
4.7× |
| Abdomen 2 views (74019) |
$195.60 |
$652 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$534 |
$1,780 |
1.4× |
| Angiography extremity bilateral rs&i (75716) |
$1,745.40 |
$5,818 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,745.40 |
$5,818 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$2,743.50 |
$9,145 |
0.9× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,955.70 |
$6,519 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,864.90 |
$12,883 |
1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,955.70 |
$6,519 |
0.7× |
| Angiography Spinal Selective Rs&I (75705) |
$4,274.70 |
$14,249 |
0.8× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,064.10 |
$13,547 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,029 |
$3,430 |
0.3× |
| Ankle 2 views (73600) |
$182.10 |
$607 |
2.2× |
| Aortogram thoracic (75605) |
$4,560.60 |
$15,202 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,007.90 |
$6,693 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,745.40 |
$5,818 |
0.6× |
| Arthrogram elbow (73085) |
$525.90 |
$1,753 |
1.6× |
| Arthrogram shoulder (73040) |
$825.30 |
$2,751 |
2.5× |
| Arthrography knee lt (73580) |
$859.20 |
$2,864 |
2.6× |
| Basic radiation dosimetry calculation (77300) |
$756.90 |
$2,523 |
6.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$585.90 |
$1,953 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$944.70 |
$3,149 |
2.5× |
| Bone age studies (77072) |
$168 |
$560 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$1,081.80 |
$3,606 |
2.9× |
| Bone survey complete (77075) |
$262.20 |
$874 |
2.7× |
| Brachytx isodose complex (77318) |
$681.30 |
$2,271 |
1.9× |
| Brachytx isodose intermed (77317) |
$681.30 |
$2,271 |
1.9× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$245.70 |
$819 |
0.7× |
| Brain imaging < 4 static views w vascular flow (78601) |
$373.20 |
$1,244 |
1.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,077.40 |
$10,258 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$798.30 |
$2,661 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$201 |
$670 |
2.5× |
| Chest 1 view (71045) |
$136.50 |
$455 |
1.7× |
| Chest 3 views (71047) |
$240.30 |
$801 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$195 |
$650 |
1.2× |
| Clavicle complete (73000) |
$130.80 |
$436 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$70.50 |
$235 |
0.7× |
| Continuing medical physics consltj pr wk (77336) |
$688.20 |
$2,294 |
5.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,963.70 |
$9,879 |
9.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,693.50 |
$5,645 |
7.6× |
| CT abdomen w contrast (74160) |
$1,059.60 |
$3,532 |
6.4× |
| CT abdomen w wo contrast (74170) |
$1,481.70 |
$4,939 |
9.0× |
| CT abdomen w/o contrast (74150) |
$846.90 |
$2,823 |
8.6× |
| CT angio hrt w/3d image (75574) |
$393.60 |
$1,312 |
1.2× |
| CT angiography upper extremity lt (73206) |
$1,402.20 |
$4,674 |
8.5× |
| CT c-spine w/o contrast (72125) |
$698.40 |
$2,328 |
7.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,124.70 |
$3,749 |
6.8× |
| CT cervical spine with contrast (72126) |
$821.40 |
$2,738 |
2.5× |
| CT chest w/wo contrast (71270) |
$1,786.80 |
$5,956 |
10.9× |
| CT chest with contrast (71260) |
$1,034.70 |
$3,449 |
6.3× |
| CT head/brain with contrast (70460) |
$867.30 |
$2,891 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,330.50 |
$4,435 |
8.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$302.10 |
$1,007 |
0.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$250.20 |
$834 |
3.1× |
| CT iac w contrast (70481) |
$1,285.80 |
$4,286 |
7.8× |
| CT limited/localized follow up study (76380) |
$564 |
$1,880 |
6.9× |
| CT lower ext w/o (73700) |
$311.40 |
$1,038 |
3.2× |
| CT lower extremity w wo contrast (73702) |
$1,323.60 |
$4,412 |
8.0× |
| CT lower extremity with contrast (73701) |
$839.10 |
$2,797 |
5.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,014 |
$3,380 |
6.2× |
| CT lumbar spine w/o contrast (72131) |
$846.90 |
$2,823 |
8.6× |
| CT lumbar spine with contrast (72132) |
$945.90 |
$3,153 |
2.9× |
| CT maxillofacial w contrast (70487) |
$932.10 |
$3,107 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$864.60 |
$2,882 |
8.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,395.90 |
$4,653 |
8.5× |
| CT neck soft tissue w contrast (70491) |
$1,047 |
$3,490 |
6.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,395.90 |
$4,653 |
8.5× |
| CT orbits w/o contrast (70480) |
$1,118.10 |
$3,727 |
11.4× |
| CT pelvis w & w/o contrast (72194) |
$1,289.10 |
$4,297 |
7.8× |
| CT pelvis w/o contrast (72192) |
$846.90 |
$2,823 |
8.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,724.70 |
$5,749 |
10.5× |
| CT soft tissue neck w/o contrast (70490) |
$988.50 |
$3,295 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$869.70 |
$2,899 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$698.40 |
$2,328 |
7.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,165.50 |
$3,885 |
7.1× |
| CT thorax w/o contrast (71250) |
$713.10 |
$2,377 |
7.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,289.10 |
$4,297 |
7.8× |
| CT upper extremity w/o contrast rt (73200) |
$839.10 |
$2,797 |
8.6× |
| CT upper extremity with contrast (73201) |
$1,064.70 |
$3,549 |
3.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,108.50 |
$3,695 |
6.7× |
| Cta Abdomen (74175) |
$1,447.50 |
$4,825 |
8.8× |
| CTA abdomen pelvis (74174) |
$658.50 |
$2,195 |
2.0× |
| CTA chest (71275) |
$1,819.20 |
$6,064 |
11.1× |
| Cta Head (70496) |
$1,367.10 |
$4,557 |
8.3× |
| Cta Neck (70498) |
$1,539.60 |
$5,132 |
9.4× |
| Cta Pelvis (72191) |
$1,275.30 |
$4,251 |
7.7× |
| Cystography minimum 3 views rs&i (74430) |
$310.80 |
$1,036 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$452.70 |
$1,509 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$244.20 |
$814 |
3.0× |
| Echoencephalography real time imaging (76506) |
$381.90 |
$1,273 |
3.9× |
| Esophagus (74220) |
$447.90 |
$1,493 |
2.7× |
| Fetal biophysical profile non-stress testing (76818) |
$118.50 |
$395 |
1.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$118.50 |
$395 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$399.60 |
$1,332 |
1.8× |
| Foot 2 views (73620) |
$163.50 |
$545 |
2.0× |
| Forearm 2 views (73090) |
$195.60 |
$652 |
2.4× |
| Gated Heart Planar Single (78472) |
$632.70 |
$2,109 |
1.7× |
| Hand 2 views (73120) |
$163.50 |
$545 |
1.7× |
| Hand 3 views (73130) |
$195.60 |
$652 |
2.4× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,293.60 |
$4,312 |
2.0× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,293.60 |
$4,312 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,369.80 |
$4,566 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,369.80 |
$4,566 |
3.7× |
| Ht muscle image spect sing (78451) |
$842.40 |
$2,808 |
0.7× |
| Humerus Min 2 Views Left (73060) |
$195.60 |
$652 |
2.4× |
| Hysterosalpingogram (74740) |
$244.20 |
$814 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$276.90 |
$923 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$645.30 |
$2,151 |
1.3× |
| Knee 3 views (73562) |
$235.20 |
$784 |
2.9× |
| Liver & spleen imaging static only (78215) |
$825 |
$2,750 |
2.2× |
| Lung perf&ventilat diferentl (78598) |
$1,591.50 |
$5,305 |
3.1× |
| Lung perfusion differential (78597) |
$1,019.40 |
$3,398 |
2.7× |
| Meckels Diverticulum (78290) |
$916.50 |
$3,055 |
2.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$625.50 |
$2,085 |
1.8× |
| MRA head w & w/o contrast (70546) |
$1,050.60 |
$3,502 |
3.2× |
| MRA head w/o contrast (70544) |
$919.80 |
$3,066 |
4.1× |
| MRA head with contrast (70545) |
$930.90 |
$3,103 |
2.8× |
| MRA neck w contrast (70548) |
$820.80 |
$2,736 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$826.20 |
$2,754 |
2.5× |
| MRA neck w/o contrast (70547) |
$778.80 |
$2,596 |
3.5× |
| MRI abdomen w contrast (74182) |
$1,058.10 |
$3,527 |
3.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,345.20 |
$4,484 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$920.10 |
$3,067 |
4.1× |
| MRI any jnt lwr ext with con lt (73722) |
$1,879.50 |
$6,265 |
2.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,543.80 |
$5,146 |
2.1× |
| MRI breast w/o contrast bilateral (77047) |
$654.60 |
$2,182 |
2.9× |
| MRI c-spine with contrast (72142) |
$1,326.30 |
$4,421 |
4.1× |
| MRI cardiac w/o contrast (75557) |
$798.30 |
$2,661 |
3.6× |
| MRI cervical spine w/o contrast (72141) |
$1,255.80 |
$4,186 |
5.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,660.80 |
$5,536 |
5.1× |
| MRI chest w/o contrast (71550) |
$1,255.80 |
$4,186 |
5.6× |
| MRI chest with contrast (71551) |
$1,444.20 |
$4,814 |
2.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,254.90 |
$4,183 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,125.30 |
$3,751 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,278.90 |
$4,263 |
5.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,691.40 |
$5,638 |
5.2× |
| MRI orbit/face/neck w/contrast (70542) |
$1,471.20 |
$4,904 |
4.5× |
| MRI pelvis w contrast (72196) |
$1,307.10 |
$4,357 |
4.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,345.20 |
$4,484 |
4.1× |
| MRI pelvis w/o contrast (72195) |
$945 |
$3,150 |
4.2× |
| MRI scan of arm joint before and after contrast (73223) |
$1,774.80 |
$5,916 |
5.4× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$665.10 |
$2,217 |
0.9× |
| MRI scan of leg joint before and after contrast (73723) |
$2,255.40 |
$7,518 |
6.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,525.20 |
$5,084 |
4.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,525.20 |
$5,084 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,660.80 |
$5,536 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,444.20 |
$4,814 |
4.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,660.80 |
$5,536 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,255.80 |
$4,186 |
5.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,342.50 |
$4,475 |
6.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,342.50 |
$4,475 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,167.30 |
$3,891 |
5.2× |
| Myelogram Cervical (72240) |
$538.20 |
$1,794 |
0.7× |
| Myelogram Lumbar (72265) |
$483.30 |
$1,611 |
0.7× |
| Myelogram thoracic (72255) |
$520.50 |
$1,735 |
0.7× |
| Myelography 2 or more regions (72270) |
$696 |
$2,320 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,934.10 |
$6,447 |
1.6× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,158 |
$3,860 |
1.4× |
| Neck soft tissue (70360) |
$204.30 |
$681 |
2.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$307.20 |
$1,024 |
0.8× |
| Nm gastric emptying study (78264) |
$1,129.50 |
$3,765 |
3.0× |
| Nm peritoneal-venous shunt patency (78291) |
$401.10 |
$1,337 |
1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$5,320.50 |
$17,735 |
4.1× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$2,675.40 |
$8,918 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$2,045.40 |
$6,818 |
9.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$67.80 |
$226 |
0.7× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$111.90 |
$373 |
1.1× |
| Orthopantogram (70355) |
$64.80 |
$216 |
0.8× |
| Osseous survey infant (77076) |
$99 |
$330 |
1.0× |
| Osseous survey limited (77074) |
$165 |
$550 |
1.7× |
| Parathyroid imaging (78070) |
$664.80 |
$2,216 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$201 |
$670 |
2.0× |
| Peritoneogram rs&i (74190) |
$844.50 |
$2,815 |
1.6× |
| PET image w/CT, skull-thigh (78815) |
$3,077.40 |
$10,258 |
2.3× |
| PET imaging CT for attenuation limited area (78814) |
$3,077.40 |
$10,258 |
2.3× |
| PET imaging for CT attenuation whole body (78816) |
$3,077.40 |
$10,258 |
2.3× |
| PET imaging limited area chest head/neck (78811) |
$2,654.40 |
$8,848 |
2.2× |
| PET whole body (78813) |
$3,077.40 |
$10,258 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,342.50 |
$4,475 |
4.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,284.60 |
$4,282 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$738.30 |
$2,461 |
2.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,591.50 |
$5,305 |
3.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$318.60 |
$1,062 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$52.50 |
$175 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$86.70 |
$289 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$86.70 |
$289 |
0.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$190.80 |
$636 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$165.30 |
$551 |
1.7× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$20,605.80 |
$68,686 |
3.0× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$419.40 |
$1,398 |
0.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$216.90 |
$723 |
2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$195.60 |
$652 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$176.70 |
$589 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$214.50 |
$715 |
2.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$219 |
$730 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$285 |
$950 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$489.30 |
$1,631 |
3.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$390.60 |
$1,302 |
2.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$52.50 |
$175 |
0.6× |
| Radiological examination surgical specimen (76098) |
$206.40 |
$688 |
0.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,844.80 |
$12,816 |
1.3× |
| Ribs bilateral 3 views (71110) |
$235.20 |
$784 |
2.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$803.40 |
$2,678 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,407.90 |
$4,693 |
2.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,407.90 |
$4,693 |
1.2× |
| Rp Therapy Intravenous Administration (79101) |
$331.20 |
$1,104 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$63.30 |
$211 |
0.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$188.70 |
$629 |
0.8× |
| Scanogram (77073) |
$186 |
$620 |
1.9× |
| Scapula complete (73010) |
$190.80 |
$636 |
1.9× |
| Screening digital breast tomosynthesis (77063) |
$42.60 |
$142 |
1.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$144.90 |
$483 |
1.5× |
| Simulation intermediate (77285) |
$1,356.60 |
$4,522 |
3.9× |
| Small bowel series (74250) |
$244.20 |
$814 |
1.5× |
| Spec medical radj physics consltj (77370) |
$524.10 |
$1,747 |
4.2× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$1,680.60 |
$5,602 |
4.8× |
| Special dosimetry (77331) |
$740.40 |
$2,468 |
5.9× |
| Special treatment procedure (77470) |
$912.90 |
$3,043 |
1.8× |
| Stereotactic body radiation delivery (77373) |
$4,014.90 |
$13,383 |
2.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$680.40 |
$2,268 |
1.9× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$382.20 |
$1,274 |
1.1× |
| Ther rad simulaj-aided field setting complex (77290) |
$2,398.50 |
$7,995 |
6.8× |
| Ther rad simulaj-aided field setting simple (77280) |
$1,345.80 |
$4,486 |
10.7× |
| Therapeutic Enema (74283) |
$563.10 |
$1,877 |
3.4× |
| Thoracolumbar 2 views (72080) |
$78.60 |
$262 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,846.80 |
$6,156 |
3.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$842.40 |
$2,808 |
2.2× |
| Thyroid uptake measurement (78012) |
$202.80 |
$676 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,001.10 |
$3,337 |
2.7× |
| Treatment device intermediate (77333) |
$362.10 |
$1,207 |
2.9× |
| Treatment devices simple (77332) |
$230.10 |
$767 |
1.8× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$534 |
$1,780 |
1.4× |
| Tx devices design & construction complex (77334) |
$668.70 |
$2,229 |
1.9× |
| Ultrasound elastography first target lesion (76982) |
$320.40 |
$1,068 |
3.3× |
| Ultrasound scan of cornea to determine thickness (76514) |
$32.70 |
$109 |
1.2× |
| Ultrasound scan to determine eye length and lens power (76519) |
$115.50 |
$385 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$245.10 |
$817 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$121.80 |
$406 |
1.2× |
| Unlisted fluoroscopic procedure (76496) |
$165 |
$550 |
2.0× |
| Upper Extremity Infant (73092) |
$195.60 |
$652 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$327 |
$1,090 |
1.5× |
| Urethrocystography voiding (74455) |
$327 |
$1,090 |
1.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$692.70 |
$2,309 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$111.90 |
$373 |
1.1× |
| Us breast unilateral complete (76641) |
$118.80 |
$396 |
1.2× |
| Us breast unilateral limited (76642) |
$118.80 |
$396 |
1.5× |
| Us chest (76604) |
$140.40 |
$468 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$196.50 |
$655 |
2.0× |
| Us elastography parenchyma (76981) |
$320.40 |
$1,068 |
3.3× |
| Us guided compression repair (76936) |
$370.80 |
$1,236 |
1.8× |
| Us infant hips limited static (76886) |
$167.70 |
$559 |
2.1× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$106.50 |
$355 |
1.1× |
| Us ob detailed single fetus (76811) |
$290.40 |
$968 |
1.3× |
| Us ob transvaginal (76817) |
$424.50 |
$1,415 |
4.3× |
| Us pelvic non ob complete (76856) |
$435.90 |
$1,453 |
4.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$401.70 |
$1,339 |
4.1× |
| Us pregnancy ltd (76815) |
$168.30 |
$561 |
1.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$118.50 |
$395 |
1.2× |
| Us retroperitoneal complete (76770) |
$897.60 |
$2,992 |
9.2× |
| Us retroperitoneal limited (76775) |
$448.80 |
$1,496 |
4.6× |
| Us scrotum and contents (76870) |
$218.70 |
$729 |
2.2× |
| Us soft tissue head/neck (76536) |
$381.90 |
$1,273 |
3.9× |
| Us spinal canal and contents (76800) |
$209.10 |
$697 |
2.1× |
| Us transrectal (76872) |
$170.10 |
$567 |
1.7× |
| Us xtr non-vasc lmtd (76882) |
$196.50 |
$655 |
2.0× |
| Us, eye b-scan (76512) |
$170.10 |
$567 |
1.7× |
| Venogram extremity bilateral (75822) |
$1,074 |
$3,580 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$3,864.90 |
$12,883 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$1,074 |
$3,580 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$625.20 |
$2,084 |
0.4× |
| Venography Renal Bilateral (75833) |
$3,864.90 |
$12,883 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,559.50 |
$11,865 |
1.2× |
| Wrist 2 views (73100) |
$163.50 |
$545 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$327 |
$1,090 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$269.70 |
$899 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$229.20 |
$764 |
2.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$894 |
$2,980 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$195.60 |
$652 |
2.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$229.20 |
$764 |
2.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$165.30 |
$551 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$52.50 |
$175 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$52.50 |
$175 |
0.6× |
| X-ray exam hip uni 4/> views (73503) |
$86.70 |
$289 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$86.70 |
$289 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$165.30 |
$551 |
1.7× |
| X-ray exam of femur 1 (73551) |
$52.50 |
$175 |
0.6× |
| X-ray eye for foreign body (70030) |
$158.70 |
$529 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$235.20 |
$784 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$130.80 |
$436 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$195.60 |
$652 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$163.50 |
$545 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161.10 |
$537 |
2.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$262.20 |
$874 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$75 |
$250 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$47.70 |
$159 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$201 |
$670 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$335.70 |
$1,119 |
3.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$102 |
$340 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$168 |
$560 |
2.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$190.20 |
$634 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$201 |
$670 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$203.40 |
$678 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$195.60 |
$652 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$231.60 |
$772 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$251.70 |
$839 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$168 |
$560 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$201 |
$670 |
2.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$290.70 |
$969 |
3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$269.70 |
$899 |
3.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$62.10 |
$207 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$269.70 |
$899 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$87 |
$290 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$201 |
$670 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$128.40 |
$428 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$168 |
$560 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$269.70 |
$899 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$72 |
$240 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$195.60 |
$652 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$335.70 |
$1,119 |
3.4× |
| Xr chest 4+ views (71048) |
$283.80 |
$946 |
2.9× |
| Xr finger(s) 2+ views (73140) |
$72 |
$240 |
0.9× |
| Xr shoulder 1 view (73020) |
$130.80 |
$436 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$335.70 |
$1,119 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$195.60 |
$652 |
2.4× |
| Xr tmj bilateral (70330) |
$201 |
$670 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$195.60 |
$652 |
2.4× |