| 3-D radiotherapy plan dose-volume histograms (77295) |
$539.70 |
$771 |
0.4× |
| Abdomen 2 views (74019) |
$206.15 |
$294.50 |
1.9× |
| Angiography extremity bilateral rs&i (75716) |
$196.70 |
$281 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$181.65 |
$259.50 |
0.1× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$173.25 |
$247.50 |
0.0× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$205.10 |
$293 |
0.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$217 |
$310 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$163.10 |
$233 |
0.0× |
| Ankle 2 views (73600) |
$133.70 |
$191 |
1.5× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$145.95 |
$208.50 |
0.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$189.70 |
$271 |
0.1× |
| Aortography abdominal serialography rs&i (75625) |
$152.60 |
$218 |
0.0× |
| Arthrogram ankle (73615) |
$155.05 |
$221.50 |
0.4× |
| Arthrogram elbow (73085) |
$121.10 |
$173 |
0.3× |
| Arthrogram hip (73525) |
$156.10 |
$223 |
0.4× |
| Arthrogram knee (73580) |
$134.05 |
$191.50 |
0.4× |
| Arthrogram shoulder (73040) |
$159.25 |
$227.50 |
0.4× |
| Arthrogram wrist (73115) |
$163.10 |
$233 |
0.4× |
| Basic dosimetry (77300) |
$78.40 |
$112 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$1,581.30 |
$2,259 |
3.8× |
| Bone age studies (77072) |
$143.50 |
$205 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,953.70 |
$2,791 |
4.7× |
| Bone survey complete (77075) |
$383.25 |
$547.50 |
3.5× |
| Bone survey infant (77076) |
$79.80 |
$114 |
0.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$611.80 |
$874 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$177.45 |
$253.50 |
1.9× |
| Chest 1 view (71045) |
$139.30 |
$199 |
1.5× |
| Chest xray 3 views (71047) |
$51.45 |
$73.50 |
0.6× |
| Cholecystography, oral contrast Non-Facility (74290) |
$102.90 |
$147 |
0.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$150.85 |
$215.50 |
0.8× |
| Clavicle complete (73000) |
$140 |
$200 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$170.45 |
$243.50 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,557.45 |
$3,653.50 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,087.05 |
$2,981.50 |
8.4× |
| CT abdomen w contrast (74160) |
$1,292.20 |
$1,846 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,389.15 |
$1,984.50 |
7.6× |
| CT abdomen w/o contrast (74150) |
$1,106.70 |
$1,581 |
10.1× |
| CT angio hrt w/3d image (75574) |
$399 |
$570 |
1.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$884.10 |
$1,263 |
4.8× |
| CT angiography upper extremity lt (73206) |
$368.20 |
$526 |
2.0× |
| CT c-spine w/contrast (72126) |
$209.30 |
$299 |
0.6× |
| CT c-spine w/o contrast (72125) |
$1,180.55 |
$1,686.50 |
10.8× |
| CT cervical spine w&w/o contrast (72127) |
$143.50 |
$205 |
0.8× |
| CT chest w contrast (71260) |
$1,093.40 |
$1,562 |
6.0× |
| CT chest w/wo contrast (71270) |
$1,221.15 |
$1,744.50 |
6.6× |
| CT head/brain with contrast (70460) |
$917.70 |
$1,311 |
5.0× |
| CT head/brain without and with contrast (70470) |
$1,190.70 |
$1,701 |
6.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$282.10 |
$403 |
0.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$123.90 |
$177 |
1.4× |
| CT hrt w/3d image congen (75573) |
$376.25 |
$537.50 |
1.0× |
| CT iac w contrast (70481) |
$1,017.10 |
$1,453 |
5.5× |
| CT limited/localized follow up study (76380) |
$162.40 |
$232 |
1.8× |
| CT lower ext w/o (73700) |
$829.50 |
$1,185 |
7.6× |
| CT lower extremity w wo contrast (73702) |
$242.20 |
$346 |
1.3× |
| CT lower extremity w/contrast material (73701) |
$641.55 |
$916.50 |
3.5× |
| CT lumbar spine w & w/o contrast (72133) |
$143.50 |
$205 |
0.8× |
| CT lumbar spine w/contrast (72132) |
$1,306.20 |
$1,866 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,180.55 |
$1,686.50 |
10.8× |
| CT maxillofacial w contrast (70487) |
$1,012.20 |
$1,446 |
5.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,100.75 |
$1,572.50 |
6.0× |
| CT maxillofacial wo contrast (70486) |
$824.95 |
$1,178.50 |
7.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$261.45 |
$373.50 |
1.4× |
| CT orbits w/o contrast (70480) |
$1,015.35 |
$1,450.50 |
9.3× |
| CT pelvis w/o contrast (72192) |
$1,003.80 |
$1,434 |
9.2× |
| CT pelvis w/wo contrast (72194) |
$313.60 |
$448 |
1.7× |
| CT scan of arm combo (73202) |
$480.20 |
$686 |
2.6× |
| CT soft tissue neck w contrast (70491) |
$1,279.25 |
$1,827.50 |
7.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,412.25 |
$2,017.50 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$996.80 |
$1,424 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$1,132.60 |
$1,618 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$1,180.55 |
$1,686.50 |
10.8× |
| CT thoracic spine w/wo contrast (72130) |
$144.20 |
$206 |
0.8× |
| CT thorax w/o contrast (71250) |
$1,003.45 |
$1,433.50 |
9.2× |
| CT upper ext wo (73200) |
$842.45 |
$1,203.50 |
7.7× |
| CT upper extremity with contrast (73201) |
$249.20 |
$356 |
0.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,484.35 |
$2,120.50 |
8.1× |
| Cta Abdomen (74175) |
$1,464.40 |
$2,092 |
8.0× |
| CTA abdomen pelvis (74174) |
$4,015.20 |
$5,736 |
11.0× |
| CTA chest (71275) |
$1,271.20 |
$1,816 |
6.9× |
| Cta Head (70496) |
$1,200.85 |
$1,715.50 |
6.5× |
| Cta Neck (70498) |
$1,179.50 |
$1,685 |
6.4× |
| Cta Pelvis (72191) |
$958.65 |
$1,369.50 |
5.2× |
| Cystography minimum 3 views rs&i (74430) |
$50.05 |
$71.50 |
0.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$144.55 |
$206.50 |
0.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$107.80 |
$154 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$72.10 |
$103 |
0.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$38.85 |
$55.50 |
0.4× |
| Echo exam of eye (76529) |
$77 |
$110 |
0.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$189.70 |
$271 |
0.8× |
| Esophagus (74220) |
$117.95 |
$168.50 |
0.6× |
| Facial bones min 3 views (70150) |
$205.10 |
$293 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$143.85 |
$205.50 |
1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$299.60 |
$428 |
2.7× |
| Fetal Echo (76825) |
$316.40 |
$452 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$51.80 |
$74 |
0.2× |
| Foot 2 views (73620) |
$130.90 |
$187 |
1.4× |
| Forearm 2 views (73090) |
$143.15 |
$204.50 |
1.6× |
| Hand 2 views (73120) |
$131.60 |
$188 |
1.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$149.10 |
$213 |
0.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$149.80 |
$214 |
0.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,703.10 |
$2,433 |
3.0× |
| Hysterosalpingogram (74740) |
$113.75 |
$162.50 |
0.5× |
| Knee 3 views (73562) |
$168.70 |
$241 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$389.55 |
$556.50 |
0.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$412.30 |
$589 |
1.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,675.45 |
$2,393.50 |
4.6× |
| Mlc imrt design & construction per imrt plan (77338) |
$540.40 |
$772 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,324.40 |
$1,892 |
3.6× |
| MRA head w/o contrast (70544) |
$1,201.55 |
$1,716.50 |
4.8× |
| MRA head with contrast (70545) |
$1,222.20 |
$1,746 |
3.3× |
| MRA neck w contrast (70548) |
$1,394.75 |
$1,992.50 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,668.10 |
$2,383 |
4.6× |
| MRA neck w/o contrast (70547) |
$268.45 |
$383.50 |
1.1× |
| MRI abdomen w contrast (74182) |
$804.30 |
$1,149 |
2.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,843.10 |
$2,633 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,316.35 |
$1,880.50 |
5.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,471.05 |
$2,101.50 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,127.65 |
$3,039.50 |
5.8× |
| MRI breast w/o contrast bilateral (77047) |
$363.30 |
$519 |
1.5× |
| MRI c-spine with contrast (72142) |
$1,367.45 |
$1,953.50 |
3.7× |
| MRI cardiac w/o contrast (75557) |
$428.40 |
$612 |
1.7× |
| MRI cervical spine w/o contrast (72141) |
$1,331.40 |
$1,902 |
5.3× |
| MRI chest w/o & w/contrast material (71552) |
$585.90 |
$837 |
1.6× |
| MRI chest w/o contrast (71550) |
$1,233.05 |
$1,761.50 |
4.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,411.55 |
$2,016.50 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,044.35 |
$2,920.50 |
5.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,745.80 |
$2,494 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$881.30 |
$1,259 |
3.5× |
| MRI orbit face neck w contrast (70542) |
$333.90 |
$477 |
0.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,994.65 |
$2,849.50 |
5.5× |
| MRI pelvis w/contrast (72196) |
$471.80 |
$674 |
1.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,726.20 |
$2,466 |
4.7× |
| MRI pelvis w/o contrast (72195) |
$1,212.40 |
$1,732 |
4.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,938.65 |
$2,769.50 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,562.40 |
$2,232 |
4.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,968.75 |
$2,812.50 |
5.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,163.40 |
$1,662 |
3.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,921.50 |
$2,745 |
5.3× |
| MRI temporomandibular joint (70336) |
$1,225 |
$1,750 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,370.25 |
$1,957.50 |
5.5× |
| MRI up ext w/o contrast (73218) |
$1,225 |
$1,750 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,319.50 |
$1,885 |
5.3× |
| MRI, joint upper extrem combo (73223) |
$1,761.90 |
$2,517 |
4.8× |
| Myelogram Cervical (72240) |
$135.80 |
$194 |
0.2× |
| Myelogram thoracic (72255) |
$130.55 |
$186.50 |
0.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,936.90 |
$2,767 |
1.4× |
| Neck soft tissue (70360) |
$135.10 |
$193 |
1.5× |
| Nm peritoneal-venous shunt patency (78291) |
$485.80 |
$694 |
1.2× |
| Nonvascular shunt X-ray (75809) |
$99.05 |
$141.50 |
0.9× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,005.90 |
$1,437 |
0.7× |
| Ob us nuchal meas 1 gest (76813) |
$140 |
$200 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$138.25 |
$197.50 |
1.3× |
| PET image w/CT, skull-thigh (78815) |
$3,637.20 |
$5,196 |
2.4× |
| PET imaging CT for attenuation limited area (78814) |
$3,122 |
$4,460 |
2.1× |
| PET imaging for CT attenuation whole body (78816) |
$3,637.20 |
$5,196 |
2.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$164.85 |
$235.50 |
0.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$72.10 |
$103 |
0.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$154 |
$220 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$135.10 |
$193 |
1.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$208.25 |
$297.50 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$153.30 |
$219 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$220.15 |
$314.50 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$124.95 |
$178.50 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$151.55 |
$216.50 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$152.95 |
$218.50 |
1.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$117.95 |
$168.50 |
1.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$193.55 |
$276.50 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$248.50 |
$355 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$253.75 |
$362.50 |
2.3× |
| Radex Humerus Minimum 2 Views (73060) |
$148.05 |
$211.50 |
1.6× |
| Radex Kne 1/2 Views (73560) |
$146.30 |
$209 |
1.6× |
| Radex Kne Compl 4/More Views (73564) |
$88.20 |
$126 |
0.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$105.70 |
$151 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$196.70 |
$281 |
2.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$214.55 |
$306.50 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$212.10 |
$303 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$127.05 |
$181.50 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$49.35 |
$70.50 |
0.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$64.40 |
$92 |
0.7× |
| Radex Toe Minimum 2 Views (73660) |
$123.55 |
$176.50 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$38.50 |
$55 |
0.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$163.80 |
$234 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$152.25 |
$217.50 |
1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$52.15 |
$74.50 |
0.5× |
| Radiologic exam chest 2 views (71046) |
$166.25 |
$237.50 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$185.50 |
$265 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$101.50 |
$145 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$148.40 |
$212 |
0.8× |
| Radiologic examination femur 1 view (73551) |
$35.70 |
$51 |
0.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$147.70 |
$211 |
1.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$75.25 |
$107.50 |
0.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$75.25 |
$107.50 |
0.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$46.55 |
$66.50 |
0.4× |
| Radiological examination surgical specimen (76098) |
$51.80 |
$74 |
0.1× |
| Ribs bilateral 3 views (71110) |
$53.55 |
$76.50 |
0.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$73.50 |
$105 |
0.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$159.60 |
$228 |
0.1× |
| Sacroiliac Joints < 3 Views (72200) |
$40.60 |
$58 |
0.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$141.05 |
$201.50 |
0.6× |
| Scapula (73010) |
$162.05 |
$231.50 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$97.30 |
$139 |
4.2× |
| Shoulder 1 view (73020) |
$120.75 |
$172.50 |
1.3× |
| Small bowel series (74250) |
$147 |
$210 |
0.8× |
| Special treatment procedure (77470) |
$256.20 |
$366 |
0.4× |
| Spine thoracic 3 views (72072) |
$222.60 |
$318 |
2.0× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$364.70 |
$521 |
0.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$197.40 |
$282 |
0.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$90.30 |
$129 |
0.6× |
| Thoracolumbar 2 views (72080) |
$42.35 |
$60.50 |
0.5× |
| Tmj unilateral (70328) |
$42 |
$60 |
0.5× |
| Treatment device complex (77334) |
$144.90 |
$207 |
0.4× |
| Treatment device intermediate (77333) |
$94.50 |
$135 |
0.7× |
| Treatment devices simple (77332) |
$57.40 |
$82 |
0.4× |
| Ultrasound breast complete (76641) |
$124.25 |
$177.50 |
1.1× |
| Ultrasound Exam Aaa Screen (76706) |
$303.80 |
$434 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$330.40 |
$472 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$54.25 |
$77.50 |
0.5× |
| Urethrocystogram voiding (74455) |
$125.65 |
$179.50 |
0.5× |
| Urethrocystography retrograde rs&i (74450) |
$37.10 |
$53 |
0.1× |
| Us breast unilateral limited (76642) |
$102.90 |
$147 |
1.1× |
| Us chest (76604) |
$281.75 |
$402.50 |
2.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$314.65 |
$449.50 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$103.60 |
$148 |
0.9× |
| Us encephalogram (76506) |
$136.85 |
$195.50 |
1.2× |
| Us hips infant static (76886) |
$120.75 |
$172.50 |
1.3× |
| Us infant hips w manipulation (76885) |
$164.15 |
$234.50 |
1.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$206.50 |
$295 |
1.9× |
| Us ob detailed single fetus (76811) |
$686 |
$980 |
2.7× |
| Us ob limited (76815) |
$122.50 |
$175 |
1.1× |
| Us ob transvaginal (76817) |
$476.70 |
$681 |
4.4× |
| Us pelvic non ob complete (76856) |
$347.90 |
$497 |
3.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$242.20 |
$346 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$312.55 |
$446.50 |
2.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$238.70 |
$341 |
2.2× |
| Us retroperitoneal complete (76770) |
$366.10 |
$523 |
3.3× |
| Us retroperitoneal limited (76775) |
$314.30 |
$449 |
2.9× |
| Us scrotum and contents (76870) |
$320.60 |
$458 |
2.9× |
| Us soft tissue head/neck (76536) |
$203 |
$290 |
1.9× |
| Us spinal canal and contents (76800) |
$209.30 |
$299 |
1.9× |
| Us transrectal (76872) |
$77.70 |
$111 |
0.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$178.15 |
$254.50 |
1.6× |
| Venogram extremity bilateral (75822) |
$161.35 |
$230.50 |
0.1× |
| Venogram Extremity Unilateral (75820) |
$130.20 |
$186 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$137.90 |
$197 |
0.0× |
| Venography caval superior serialography rs&i (75827) |
$143.50 |
$205 |
0.1× |
| Venography Renal Bilateral (75833) |
$178.85 |
$255.50 |
0.1× |
| Venography renal unilateral selective rs&i (75831) |
$144.20 |
$206 |
0.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$151.55 |
$216.50 |
0.0× |
| Wrist 2 views (73100) |
$129.15 |
$184.50 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$231 |
$330 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$158.90 |
$227 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$142.80 |
$204 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.55 |
$186.50 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$165.90 |
$237 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$65.45 |
$93.50 |
0.6× |
| X-ray exam of femur 2/> (73552) |
$157.85 |
$225.50 |
1.7× |
| X-ray eye for foreign body (70030) |
$144.55 |
$206.50 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$39.20 |
$56 |
0.4× |
| X-ray IV pyelogram (ivp) (74400) |
$56 |
$80 |
0.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$170.10 |
$243 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$135.80 |
$194 |
1.5× |
| X-ray leg, infant (73592) |
$94.85 |
$135.50 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$217 |
$310 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$74.55 |
$106.50 |
0.7× |
| X-ray nose-rectum child f.b. (76010) |
$130.55 |
$186.50 |
1.4× |
| X-ray optic foramen (70190) |
$45.85 |
$65.50 |
0.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$58.10 |
$83 |
0.5× |
| X-ray retrograde pyelogram (74420) |
$58.10 |
$83 |
0.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$192.85 |
$275.50 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$208.60 |
$298 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$261.80 |
$374 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$193.90 |
$277 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$188.30 |
$269 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$202.65 |
$289.50 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$54.25 |
$77.50 |
0.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$183.40 |
$262 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$191.80 |
$274 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$50.05 |
$71.50 |
0.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$164.85 |
$235.50 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$126.70 |
$181 |
1.2× |
| Xr bone length studies (77073) |
$31.50 |
$45 |
0.3× |
| Xr c-spine 4 or 5 views (72050) |
$255.50 |
$365 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$75.95 |
$108.50 |
0.7× |
| Xr chest 4+ views (71048) |
$55.65 |
$79.50 |
0.5× |
| Xr urogram antegrade (74425) |
$164.15 |
$234.50 |
0.4× |