| 3-D radiotherapy plan dose-volume histograms (77295) |
$859.70 |
$1,754.50 |
0.6× |
| Abdomen 2 views (74019) |
— |
$90 |
— |
| Acute gi blood loss imaging (78278) |
$977.55 |
$1,995 |
2.3× |
| Angiography extremity bilateral rs&i (75716) |
$153.37 |
$313 |
0.0× |
| Angiography extremity unilateral rs&i (75710) |
$137.20 |
$280 |
0.0× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,077.76 |
$352 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$155.82 |
$318 |
0.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$151.90 |
$310 |
0.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$114.17 |
$233 |
0.0× |
| Ankle 2 views (73600) |
— |
$86 |
— |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$102.16 |
$208.50 |
0.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,463.38 |
$318 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,157.14 |
$229 |
0.3× |
| Arthrogram ankle (73615) |
$108.54 |
$94 |
0.3× |
| Arthrogram elbow (73085) |
$84.77 |
$173 |
0.2× |
| Arthrogram hip (73525) |
$171.01 |
$223 |
0.5× |
| Arthrogram knee (73580) |
$136.22 |
$278 |
0.4× |
| Arthrogram shoulder (73040) |
$178.36 |
$227.50 |
0.5× |
| Arthrogram wrist (73115) |
$183.26 |
$233 |
0.5× |
| Basic dosimetry (77300) |
$75.22 |
$153.50 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$684.04 |
$1,396 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$975.10 |
$1,063 |
2.3× |
| Bone age studies (77072) |
$28.91 |
$45.50 |
0.3× |
| Bone Imaging 3 Phase (78315) |
$1,315.65 |
$1,424 |
3.1× |
| Bone survey complete (77075) |
$124.95 |
$172.50 |
1.1× |
| Bone survey infant (77076) |
$174.20 |
$114 |
1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,293.20 |
$4,680 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,112.79 |
$2,271 |
2.7× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$428.26 |
$874 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
— |
$101 |
— |
| Chest 1 view (71045) |
— |
$60 |
— |
| Chest xray 3 views (71047) |
$36.02 |
$73.50 |
0.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$72.03 |
$147 |
0.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$168.56 |
$215.50 |
0.9× |
| Clavicle complete (73000) |
— |
$86 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$152.88 |
$243.50 |
1.4× |
| Continuing medical physics consltj pr wk (77336) |
$249.90 |
$510 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$432.67 |
$603.50 |
1.2× |
| CT abdomen and pelvis without contrast (74176) |
$179.83 |
$324 |
0.7× |
| CT abdomen w contrast (74160) |
$303.80 |
$413 |
1.7× |
| CT abdomen w wo contrast (74170) |
$344.47 |
$464.50 |
1.9× |
| CT abdomen w/o contrast (74150) |
$142.59 |
$242 |
1.3× |
| CT angio hrt w/3d image (75574) |
$369.95 |
$755 |
1.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$411.60 |
$572 |
2.2× |
| CT angiography upper extremity lt (73206) |
$373.87 |
$526 |
2.0× |
| CT c-spine w/contrast (72126) |
$196.49 |
$299 |
0.5× |
| CT c-spine w/o contrast (72125) |
$146.51 |
$230 |
1.3× |
| CT cervical spine w&w/o contrast (72127) |
$496.86 |
$1,014 |
2.7× |
| CT chest w contrast (71260) |
$197.47 |
$296 |
1.1× |
| CT chest w/wo contrast (71270) |
$242.06 |
$348 |
1.3× |
| CT head/brain with contrast (70460) |
$167.58 |
$262.50 |
0.9× |
| CT head/brain without and with contrast (70470) |
$200.41 |
$307.50 |
1.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$257.74 |
$526 |
0.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$63.70 |
$100 |
0.7× |
| CT hrt w/3d image congen (75573) |
$263.38 |
$537.50 |
0.7× |
| CT iac w contrast (70481) |
$223.93 |
$320 |
1.2× |
| CT limited/localized follow up study (76380) |
$113.68 |
$232 |
1.2× |
| CT lower ext w/o (73700) |
$145.53 |
$229 |
1.3× |
| CT lower extremity w wo contrast (73702) |
$243.04 |
$496 |
1.3× |
| CT lower extremity w/contrast material (73701) |
$197.47 |
$295.50 |
1.1× |
| CT lumbar spine w & w/o contrast (72133) |
$681.84 |
$205 |
3.7× |
| CT lumbar spine w/contrast (72132) |
$196.98 |
$299.50 |
0.5× |
| CT lumbar spine w/o contrast (72131) |
$145.04 |
$228.50 |
1.3× |
| CT maxillofacial w contrast (70487) |
$174.93 |
$269.50 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
$219.52 |
$448 |
1.2× |
| CT maxillofacial wo contrast (70486) |
$154.84 |
$227 |
1.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$265.58 |
$373.50 |
1.4× |
| CT orbits w/o contrast (70480) |
$173.95 |
$282 |
1.6× |
| CT pelvis w/o contrast (72192) |
$144.55 |
$235.50 |
1.3× |
| CT pelvis w/wo contrast (72194) |
$343 |
$448 |
1.9× |
| CT scan of arm combo (73202) |
$336.14 |
$686 |
1.8× |
| CT soft tissue neck w contrast (70491) |
$210.21 |
$326.50 |
1.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$256.27 |
$391.50 |
1.4× |
| CT soft tissue neck w/o contrast (70490) |
$158.76 |
$265.50 |
1.4× |
| CT thoracic spine w/contrast (72129) |
$484.86 |
$198 |
2.6× |
| CT thoracic spine w/o contrast (72128) |
$146.02 |
$229.50 |
1.3× |
| CT thoracic spine w/wo contrast (72130) |
$528.96 |
$1,079.50 |
2.9× |
| CT thorax w/o contrast (71250) |
$145.04 |
$235.50 |
1.3× |
| CT upper ext wo (73200) |
$200.90 |
$285.50 |
1.8× |
| CT upper extremity with contrast (73201) |
$256.76 |
$356 |
0.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$525.28 |
$727 |
2.9× |
| Cta Abdomen (74175) |
$387.59 |
$542 |
2.1× |
| CTA abdomen pelvis (74174) |
$1,063.79 |
$994 |
2.9× |
| CTA chest (71275) |
$344.47 |
$498.50 |
1.9× |
| Cta Head (70496) |
$340.55 |
$488.50 |
1.9× |
| Cta Neck (70498) |
$340.06 |
$488 |
1.9× |
| Cta Pelvis (72191) |
$386.61 |
$539 |
2.1× |
| Cystography minimum 3 views rs&i (74430) |
$44.59 |
$71.50 |
0.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$101.18 |
$206.50 |
0.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$95.06 |
$194 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$165.13 |
$103 |
1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$27.20 |
$55.50 |
0.3× |
| Echo exam of eye (76529) |
$107.31 |
$219 |
1.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$132.79 |
$271 |
0.5× |
| Esophagus (74220) |
$117.60 |
$168.50 |
0.6× |
| Facial bones min 3 views (70150) |
— |
$121 |
— |
| Fetal biophysical profile non-stress testing (76818) |
$117.60 |
$240 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$84.28 |
$148.50 |
0.8× |
| Fetal Echo (76825) |
$310.66 |
$452 |
0.5× |
| Fluoroscopy up to 1 hr (76000) |
$47.53 |
$74 |
0.2× |
| Foot 2 views (73620) |
— |
$86 |
— |
| Forearm 2 views (73090) |
— |
$75 |
— |
| Hand 2 views (73120) |
— |
$82 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$104.37 |
$213 |
0.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$104.86 |
$214 |
0.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,081.68 |
$1,231 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,329.86 |
$1,416.50 |
3.2× |
| Hysterosalpingogram (74740) |
$128.38 |
$162.50 |
0.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,164.73 |
$2,377 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$735.49 |
$845.50 |
1.3× |
| Knee 3 views (73562) |
— |
$101 |
— |
| Lung perf&ventilat diferentl (78598) |
$1,759.59 |
$3,591 |
3.1× |
| Lung perfusion differential (78597) |
$655.62 |
$1,338 |
1.6× |
| Lymphoscintigraphy (78195) |
$1,080.45 |
$1,197 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$416.01 |
$556.50 |
0.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$448.35 |
$589 |
1.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$542.92 |
$728 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$620.69 |
$1,266.71 |
1.6× |
| MRA head w & w/o contrast (70546) |
$456.68 |
$586 |
1.2× |
| MRA head w/o contrast (70544) |
$280.28 |
$383 |
1.1× |
| MRA head with contrast (70545) |
$300.37 |
$403.50 |
0.8× |
| MRA neck w contrast (70548) |
$309.19 |
$437 |
0.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$459.13 |
$613.50 |
1.3× |
| MRA neck w/o contrast (70547) |
$280.77 |
$383.50 |
1.1× |
| MRI abdomen w contrast (74182) |
$389.55 |
$537 |
1.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$414.54 |
$846 |
1.1× |
| MRI abdomen w/o contrast (74181) |
$224.91 |
$347.50 |
0.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$416.99 |
$557 |
0.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$500.78 |
$685 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,034.64 |
$519 |
4.1× |
| MRI c-spine with contrast (72142) |
$337.12 |
$489 |
0.9× |
| MRI cardiac w/o contrast (75557) |
$299.88 |
$612 |
1.2× |
| MRI cervical spine w/o contrast (72141) |
$214.13 |
$338.50 |
0.9× |
| MRI chest w/o & w/contrast material (71552) |
$641.41 |
$837 |
1.8× |
| MRI chest w/o contrast (71550) |
$472.36 |
$600 |
1.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$329.77 |
$467.50 |
0.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$416.50 |
$598.50 |
1.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$281.75 |
$396.50 |
1.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$287.14 |
$402 |
1.1× |
| MRI orbit face neck w contrast (70542) |
$339.08 |
$477 |
0.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$419.44 |
$601.50 |
1.1× |
| MRI pelvis w/contrast (72196) |
$330.26 |
$476.50 |
0.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$412.09 |
$598 |
1.1× |
| MRI pelvis w/o contrast (72195) |
$282.73 |
$407 |
1.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$374.85 |
$568 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$329.28 |
$480.50 |
0.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$373.87 |
$567 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$333.69 |
$484.50 |
0.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$376.32 |
$569.50 |
1.0× |
| MRI temporomandibular joint (70336) |
$343 |
$469.50 |
1.4× |
| MRI thoracic spine w/o contrast (72146) |
$213.64 |
$338 |
0.9× |
| MRI up ext w/o contrast (73218) |
$420.42 |
$539 |
1.7× |
| MRI upper ext joint w/o contrast (73221) |
$245.49 |
$360.50 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$502.74 |
$687.50 |
1.4× |
| Myelogram Cervical (72240) |
$95.06 |
$194 |
0.1× |
| Myelogram thoracic (72255) |
$91.38 |
$186.50 |
0.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,115.98 |
$257 |
0.8× |
| Myocardial spect single study at rest or stress (78451) |
$1,947.26 |
$2,096 |
1.4× |
| Neck soft tissue (70360) |
— |
$79 |
— |
| Nm gastric emptying study (78264) |
$524.30 |
$598 |
1.3× |
| Nm kidney scan w/flow (78701) |
$795.27 |
$1,623 |
1.9× |
| Nm peritoneal-venous shunt patency (78291) |
$340.06 |
$694 |
0.8× |
| Nonvascular shunt X-ray (75809) |
$69.34 |
$141.50 |
0.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,290.42 |
$2,633.50 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$685.02 |
$841.50 |
2.8× |
| Ob us nuchal meas 1 gest (76813) |
$98 |
$200 |
0.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,373.47 |
$1,526 |
2.4× |
| Pelvis 1 or 2 views (72170) |
— |
$68 |
— |
| PET image w/CT, skull-thigh (78815) |
$3,645.60 |
$5,196 |
2.4× |
| PET imaging CT for attenuation limited area (78814) |
$2,975.52 |
$6,072.50 |
2.0× |
| PET imaging for CT attenuation whole body (78816) |
$2,664.86 |
$5,196 |
1.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$115.40 |
$235.50 |
0.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$799.68 |
$1,632 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$894.25 |
$997.50 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$59.78 |
$122 |
0.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
— |
$98 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$73 |
— |
| Radex Elbw Compl Minimum 3 Views (73080) |
— |
$86 |
— |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$36.26 |
$43 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
— |
$191 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$110 |
— |
| Radex Foot Compl Minimum 3 Views (73630) |
— |
$91 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$101 |
— |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$40.67 |
$57.50 |
0.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$79.87 |
$104 |
0.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$51.94 |
$106 |
0.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$79.87 |
$107.50 |
0.7× |
| Radex Humerus Minimum 2 Views (73060) |
— |
$84 |
— |
| Radex Kne 1/2 Views (73560) |
— |
$91 |
— |
| Radex Kne Compl 4/More Views (73564) |
$61.74 |
$126 |
0.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$54.39 |
$76 |
0.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$103 |
— |
| Radex Pelvis Compl Minimum 3 Views (72190) |
— |
$105 |
— |
| Radex Sho Compl Minimum 2 Views (73030) |
— |
$90 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$83 |
— |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
— |
$104 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$70.56 |
$92 |
0.8× |
| Radex Toe Minimum 2 Views (73660) |
— |
$80 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
$40.67 |
$55 |
0.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
— |
$114 |
— |
| Radiation treatment delivery level 1 (77402) |
$88.69 |
$181 |
0.8× |
| Radiation treatment delivery level 3 (77412) |
$398.31 |
$812.88 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
— |
$75 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$36.50 |
$74.50 |
0.3× |
| Radiologic exam chest 2 views (71046) |
— |
$81 |
— |
| Radiologic exam colon single contrast study (74270) |
$177.87 |
$265 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$193.80 |
$395.50 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$144.06 |
$212 |
0.8× |
| Radiologic examination femur 1 view (73551) |
$24.99 |
$51 |
0.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$83 |
— |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$52.68 |
$107.50 |
0.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$52.68 |
$107.50 |
0.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$32.58 |
$66.50 |
0.3× |
| Radiological examination surgical specimen (76098) |
$47.04 |
$74 |
0.1× |
| Ribs bilateral 3 views (71110) |
$51.45 |
$76.50 |
0.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$263.13 |
$537 |
0.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,631.70 |
$3,330 |
2.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,469.51 |
$1,585 |
2.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$861.42 |
$228 |
0.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$691.88 |
$1,412 |
2.8× |
| Sacroiliac Joints < 3 Views (72200) |
$28.42 |
$58 |
0.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$98.74 |
$201.50 |
0.4× |
| Scapula (73010) |
— |
$53 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$47.53 |
$97 |
2.0× |
| Shoulder 1 view (73020) |
$24.50 |
$38 |
0.3× |
| Simulation intermediate (77285) |
$366.03 |
$747 |
0.9× |
| Small bowel series (74250) |
$142.10 |
$210 |
0.8× |
| Special Physics Consult (77370) |
$241.08 |
$492 |
1.7× |
| Special treatment procedure (77470) |
$404.74 |
$826 |
0.7× |
| Spine thoracic 3 views (72072) |
— |
$101 |
— |
| Stereotactic Body Radiation Delivery (77373) |
$5,424.79 |
$11,071 |
2.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$676.44 |
$1,380.50 |
1.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$759.01 |
$1,549 |
1.9× |
| Ther rad simulaj-aided field setting complex (77290) |
$291.30 |
$594.50 |
0.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$145.53 |
$297 |
1.0× |
| Thoracolumbar 2 views (72080) |
$29.64 |
$60.50 |
0.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$896.70 |
$981 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$596.33 |
$648 |
1.4× |
| Tmj unilateral (70328) |
$29.40 |
$60 |
0.3× |
| Treatment device complex (77334) |
$161.94 |
$330.50 |
0.4× |
| Treatment device intermediate (77333) |
$99.22 |
$202.50 |
0.7× |
| Treatment devices simple (77332) |
$67.86 |
$138.50 |
0.5× |
| Ultrasound breast complete (76641) |
$115.64 |
$236 |
1.1× |
| Ultrasound Exam Aaa Screen (76706) |
$137.20 |
$184.50 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$100.94 |
$150.50 |
0.9× |
| Umbilical-artery Doppler (OB) (76820) |
$39.69 |
$81 |
0.4× |
| Urethrocystogram voiding (74455) |
$149.94 |
$306 |
0.6× |
| Urethrocystography retrograde rs&i (74450) |
$288.86 |
$53 |
1.2× |
| Us breast unilateral limited (76642) |
$89.67 |
$183 |
1.0× |
| Us chest (76604) |
$51.45 |
$98.50 |
0.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$284.69 |
$581 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$150.18 |
$148 |
1.4× |
| Us encephalogram (76506) |
$139.65 |
$195.50 |
1.3× |
| Us hips infant static (76886) |
$119.56 |
$172.50 |
1.3× |
| Us infant hips w manipulation (76885) |
$171.01 |
$349 |
1.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$224 |
$112 |
2.0× |
| Us ob detailed single fetus (76811) |
$464.28 |
$308 |
1.9× |
| Us ob limited (76815) |
$85.75 |
$175 |
0.8× |
| Us ob transvaginal (76817) |
$208.98 |
$198 |
1.9× |
| Us pelvic non ob complete (76856) |
$123.97 |
$182 |
1.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$44.59 |
$85.50 |
0.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$120.05 |
$202.50 |
1.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$118.58 |
$190 |
1.1× |
| Us retroperitoneal complete (76770) |
$124.95 |
$187.50 |
1.1× |
| Us retroperitoneal limited (76775) |
$203.60 |
$113 |
1.9× |
| Us scrotum and contents (76870) |
$119.07 |
$173 |
1.1× |
| Us soft tissue head/neck (76536) |
$142.10 |
$190.50 |
1.3× |
| Us spinal canal and contents (76800) |
$200.57 |
$299 |
1.8× |
| Us transrectal (76872) |
$169.30 |
$345.50 |
1.5× |
| Us, eye b-scan (76512) |
$219.52 |
$208 |
2.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$189.63 |
$254.50 |
1.7× |
| Venogram extremity bilateral (75822) |
$114.66 |
$234 |
0.1× |
| Venogram Extremity Unilateral (75820) |
$100.45 |
$186 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$4,084.64 |
$213 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$111.72 |
$228 |
0.1× |
| Venography Renal Bilateral (75833) |
$125.20 |
$255.50 |
0.0× |
| Venography renal unilateral selective rs&i (75831) |
$2,793.98 |
$206 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$106.08 |
$216.50 |
0.0× |
| Wrist 2 views (73100) |
— |
$90 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$121 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$33.81 |
$50.50 |
0.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$209.72 |
$428 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$36.26 |
$51 |
0.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$128 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$45.82 |
$93.50 |
0.4× |
| X-ray exam of femur 2/> (73552) |
— |
$73 |
— |
| X-ray eye for foreign body (70030) |
$41.16 |
$56.50 |
0.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$27.44 |
$56 |
0.3× |
| X-ray IV pyelogram (ivp) (74400) |
$297.43 |
$607 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$105 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$111 |
— |
| X-ray leg, infant (73592) |
$40.67 |
$55 |
0.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$102 |
— |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$52.18 |
$106.50 |
0.5× |
| X-ray nose-rectum child f.b. (76010) |
— |
$73 |
— |
| X-ray optic foramen (70190) |
$32.10 |
$65.50 |
0.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$40.67 |
$83 |
0.4× |
| X-ray retrograde pyelogram (74420) |
$274.16 |
$83 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
— |
$91 |
— |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$103 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$129 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$48.51 |
$68 |
0.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$84 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$46.55 |
$65.50 |
0.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$37.98 |
$77.50 |
0.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$95 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
$28.42 |
$42.50 |
0.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$52.43 |
$107 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$84 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
— |
$81 |
— |
| Xr bone length studies (77073) |
$22.05 |
$45 |
0.2× |
| Xr c-spine 4 or 5 views (72050) |
— |
$142 |
— |
| Xr c-spine 6 or more views (72052) |
$53.16 |
$108.50 |
0.5× |
| Xr chest 4+ views (71048) |
$38.96 |
$79.50 |
0.4× |
| Xr urogram antegrade (74425) |
$114.90 |
$234.50 |
0.3× |