| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,976.26 |
$3,040.40 |
1.4× |
| Abdomen 2 views (74019) |
$147.55 |
$227 |
1.4× |
| Angiography extremity bilateral rs&i (75716) |
$203.45 |
$313 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$182 |
$280 |
0.1× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$114.40 |
$176 |
0.0× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$206.70 |
$318 |
0.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$201.50 |
$310 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$116.35 |
$179 |
0.0× |
| Ankle 2 views (73600) |
$96.20 |
$148 |
1.1× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$117.65 |
$181 |
0.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$206.70 |
$318 |
0.1× |
| Aortography abdominal serialography rs&i (75625) |
$148.85 |
$229 |
0.0× |
| Arthrogram ankle (73615) |
$61.10 |
$94 |
0.2× |
| Arthrogram elbow (73085) |
$57.20 |
$88 |
0.2× |
| Arthrogram hip (73525) |
$63.05 |
$97 |
0.2× |
| Arthrogram knee (73580) |
$68.25 |
$105 |
0.2× |
| Arthrogram shoulder (73040) |
$59.15 |
$91 |
0.2× |
| Arthrogram wrist (73115) |
$59.80 |
$92 |
0.2× |
| Basic dosimetry (77300) |
$210.86 |
$324.41 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,388.40 |
$2,136 |
3.4× |
| Bone age studies (77072) |
$128.38 |
$197.50 |
1.2× |
| Bone survey complete (77075) |
$315.58 |
$485.50 |
2.9× |
| Bone survey infant (77076) |
$74.10 |
$114 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$121.22 |
$186.50 |
1.3× |
| Chest 1 view (71045) |
$96.85 |
$149 |
1.1× |
| Chest xray 3 views (71047) |
$29.25 |
$45 |
0.3× |
| Cholecystography, oral contrast Non-Facility (74290) |
$33.80 |
$52 |
0.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$56.55 |
$87 |
0.3× |
| Clavicle complete (73000) |
$118.30 |
$182 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$497.58 |
$765.50 |
4.6× |
| Continuing medical physics consltj pr wk (77336) |
$428.23 |
$658.82 |
3.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,818.70 |
$2,798 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,579.82 |
$2,430.50 |
6.4× |
| CT abdomen w contrast (74160) |
$853.45 |
$1,313 |
4.7× |
| CT abdomen w wo contrast (74170) |
$954.20 |
$1,468 |
5.3× |
| CT abdomen w/o contrast (74150) |
$447.52 |
$688.50 |
4.1× |
| CT angio hrt w/3d image (75574) |
$250.25 |
$385 |
0.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$820.95 |
$1,263 |
4.5× |
| CT angiography upper extremity lt (73206) |
$187.85 |
$289 |
1.0× |
| CT c-spine w/contrast (72126) |
$128.05 |
$197 |
0.4× |
| CT c-spine w/o contrast (72125) |
$780.98 |
$1,201.50 |
7.2× |
| CT cervical spine w&w/o contrast (72127) |
$133.25 |
$205 |
0.7× |
| CT chest w contrast (71260) |
$739.05 |
$1,137 |
4.1× |
| CT chest w/wo contrast (71270) |
$904.15 |
$1,391 |
5.0× |
| CT head/brain with contrast (70460) |
$673.08 |
$1,035.50 |
3.7× |
| CT head/brain without and with contrast (70470) |
$727.68 |
$1,119.50 |
4.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$182 |
$280 |
0.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$67.28 |
$103.50 |
0.7× |
| CT hrt w/3d image congen (75573) |
$265.85 |
$409 |
0.7× |
| CT iac w contrast (70481) |
$640.58 |
$985.50 |
3.5× |
| CT limited/localized follow up study (76380) |
$100.75 |
$155 |
1.1× |
| CT lower ext w/o (73700) |
$699.72 |
$1,076.50 |
6.5× |
| CT lower extremity w wo contrast (73702) |
$694.20 |
$1,068 |
3.8× |
| CT lower extremity w/contrast material (73701) |
$595.72 |
$916.50 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$871.98 |
$1,341.50 |
4.8× |
| CT lumbar spine w/contrast (72132) |
$785.85 |
$1,209 |
2.2× |
| CT lumbar spine w/o contrast (72131) |
$812.82 |
$1,250.50 |
7.5× |
| CT maxillofacial w contrast (70487) |
$736.78 |
$1,133.50 |
4.1× |
| CT maxillofacial w/wo contrast (70488) |
$133.25 |
$205 |
0.7× |
| CT maxillofacial wo contrast (70486) |
$772.85 |
$1,189 |
7.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$797.22 |
$1,226.50 |
4.4× |
| CT orbits w/o contrast (70480) |
$748.15 |
$1,151 |
6.9× |
| CT pelvis w/o contrast (72192) |
$770.25 |
$1,185 |
7.1× |
| CT pelvis w/wo contrast (72194) |
$127.40 |
$196 |
0.7× |
| CT scan of arm combo (73202) |
$127.40 |
$196 |
0.7× |
| CT soft tissue neck w contrast (70491) |
$686.40 |
$1,056 |
3.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$844.35 |
$1,299 |
4.7× |
| CT soft tissue neck w/o contrast (70490) |
$780.32 |
$1,200.50 |
7.2× |
| CT thoracic spine w/contrast (72129) |
$1,051.70 |
$1,618 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$829.72 |
$1,276.50 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$133.90 |
$206 |
0.7× |
| CT thorax w/o contrast (71250) |
$834.28 |
$1,283.50 |
7.7× |
| CT upper ext wo (73200) |
$782.28 |
$1,203.50 |
7.3× |
| CT upper extremity with contrast (73201) |
$697.78 |
$1,073.50 |
1.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,128.72 |
$1,736.50 |
6.2× |
| Cta Abdomen (74175) |
$1,359.80 |
$2,092 |
7.5× |
| CTA abdomen pelvis (74174) |
$2,907.45 |
$4,473 |
8.1× |
| CTA chest (71275) |
$872.95 |
$1,343 |
4.8× |
| Cta Head (70496) |
$1,017.25 |
$1,565 |
5.6× |
| Cta Neck (70498) |
$1,041.95 |
$1,603 |
5.8× |
| Cta Pelvis (72191) |
$890.18 |
$1,369.50 |
4.9× |
| Cystography minimum 3 views rs&i (74430) |
$33.80 |
$52 |
0.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$86.45 |
$133 |
0.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$74.10 |
$114 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$297.05 |
$457 |
2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$21.45 |
$33 |
0.2× |
| Echo exam of eye (76529) |
$71.50 |
$110 |
0.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$87.10 |
$134 |
0.4× |
| Esophagus (74220) |
$63.05 |
$97 |
0.3× |
| Facial bones min 3 views (70150) |
$190.45 |
$293 |
1.8× |
| Fetal biophysical profile non-stress testing (76818) |
$111.15 |
$171 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$278.20 |
$428 |
2.6× |
| Fetal Echo (76825) |
$175.50 |
$270 |
0.3× |
| Fluoroscopy up to 1 hr (76000) |
$33.15 |
$51 |
0.1× |
| Foot 2 views (73620) |
$95.88 |
$147.50 |
1.1× |
| Forearm 2 views (73090) |
$117.98 |
$181.50 |
1.3× |
| Hand 2 views (73120) |
$122.20 |
$188 |
1.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$114.40 |
$176 |
0.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$114.40 |
$176 |
0.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,360.45 |
$2,093 |
2.4× |
| Hysterosalpingogram (74740) |
$40.95 |
$63 |
0.2× |
| Knee 3 views (73562) |
$149.82 |
$230.50 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$171.60 |
$264 |
0.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$608.40 |
$936 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,555.78 |
$2,393.50 |
4.3× |
| Mlc imrt design & construction per imrt plan (77338) |
$662.58 |
$1,019.36 |
1.7× |
| MRA head w & w/o contrast (70546) |
$1,229.80 |
$1,892 |
3.4× |
| MRA head w/o contrast (70544) |
$1,115.72 |
$1,716.50 |
4.5× |
| MRA head with contrast (70545) |
$126.10 |
$194 |
0.4× |
| MRA neck w contrast (70548) |
$1,295.12 |
$1,992.50 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,548.95 |
$2,383 |
4.3× |
| MRA neck w/o contrast (70547) |
$126.10 |
$194 |
0.5× |
| MRI abdomen w contrast (74182) |
$746.85 |
$1,149 |
2.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,711.45 |
$2,633 |
4.8× |
| MRI abdomen w/o contrast (74181) |
$1,098.50 |
$1,690 |
4.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,365.98 |
$2,101.50 |
1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,975.68 |
$3,039.50 |
5.5× |
| MRI c-spine with contrast (72142) |
$1,269.78 |
$1,953.50 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$1,119.30 |
$1,722 |
4.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,096.22 |
$1,686.50 |
3.0× |
| MRI chest w/o contrast (71550) |
$1,144.98 |
$1,761.50 |
4.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,310.72 |
$2,016.50 |
3.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,898.32 |
$2,920.50 |
5.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,048.78 |
$1,613.50 |
4.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$818.35 |
$1,259 |
3.3× |
| MRI orbit face neck w contrast (70542) |
$170.30 |
$262 |
0.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,852.18 |
$2,849.50 |
5.1× |
| MRI pelvis w/contrast (72196) |
$842.40 |
$1,296 |
2.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,404.65 |
$2,161 |
3.9× |
| MRI pelvis w/o contrast (72195) |
$1,116.38 |
$1,717.50 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,437.80 |
$2,212 |
4.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$187.85 |
$289 |
0.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,828.12 |
$2,812.50 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,080.30 |
$1,662 |
3.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,452.10 |
$2,234 |
4.0× |
| MRI temporomandibular joint (70336) |
$1,137.50 |
$1,750 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,161.88 |
$1,787.50 |
4.7× |
| MRI up ext w/o contrast (73218) |
$973.05 |
$1,497 |
4.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,050.08 |
$1,615.50 |
4.3× |
| MRI, joint upper extrem combo (73223) |
$1,636.05 |
$2,517 |
4.5× |
| Myelogram Cervical (72240) |
$96.85 |
$149 |
0.1× |
| Myelogram thoracic (72255) |
$96.20 |
$148 |
0.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,798.55 |
$2,767 |
1.3× |
| Neck soft tissue (70360) |
$70.52 |
$108.50 |
0.8× |
| Nonvascular shunt X-ray (75809) |
$50.70 |
$78 |
0.5× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,922.40 |
$2,957.53 |
1.3× |
| Ob us nuchal meas 1 gest (76813) |
$124.15 |
$191 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$118.62 |
$182.50 |
1.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$143.65 |
$221 |
0.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$54.60 |
$84 |
0.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$118.62 |
$182.50 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$117.98 |
$181.50 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$118.62 |
$182.50 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$142.35 |
$219 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$204.42 |
$314.50 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$94.90 |
$146 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$118.30 |
$182 |
1.3× |
| Radex Hand Minimum 3 Views (73130) |
$118.62 |
$182.50 |
1.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$97.82 |
$150.50 |
1.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$29.25 |
$45 |
0.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$204.10 |
$314 |
1.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$282.10 |
$434 |
2.6× |
| Radex Humerus Minimum 2 Views (73060) |
$144.62 |
$222.50 |
1.6× |
| Radex Kne 1/2 Views (73560) |
$118.30 |
$182 |
1.3× |
| Radex Kne Compl 4/More Views (73564) |
$149.18 |
$229.50 |
1.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$26.65 |
$41 |
0.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$134.88 |
$207.50 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$199.22 |
$306.50 |
1.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$142.02 |
$218.50 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$94.58 |
$145.50 |
1.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$131.95 |
$203 |
1.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$26 |
$40 |
0.3× |
| Radex Toe Minimum 2 Views (73660) |
$114.72 |
$176.50 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$17.55 |
$27 |
0.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$118.62 |
$182.50 |
1.3× |
| Radiation treatment delivery level 1 (77402) |
$295.15 |
$454.07 |
2.8× |
| Radiation treatment delivery level 3 (77412) |
$506.84 |
$779.76 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$97.18 |
$149.50 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$28.60 |
$44 |
0.3× |
| Radiologic exam chest 2 views (71046) |
$151.12 |
$232.50 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$108.55 |
$167 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$94.25 |
$145 |
0.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$84.50 |
$130 |
0.5× |
| Radiologic examination femur 1 view (73551) |
$18.20 |
$28 |
0.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$117.98 |
$181.50 |
1.3× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$38.35 |
$59 |
0.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$36.40 |
$56 |
0.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$19.50 |
$30 |
0.2× |
| Radiological examination surgical specimen (76098) |
$33.80 |
$52 |
0.1× |
| Ribs bilateral 3 views (71110) |
$31.20 |
$48 |
0.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$68.25 |
$105 |
0.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$148.20 |
$228 |
0.1× |
| Sacroiliac Joints < 3 Views (72200) |
$18.20 |
$28 |
0.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$76.70 |
$118 |
0.3× |
| Scapula (73010) |
$118.95 |
$183 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$90.35 |
$139 |
3.9× |
| Shoulder 1 view (73020) |
$16.90 |
$26 |
0.2× |
| Small bowel series (74250) |
$84.50 |
$130 |
0.5× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$781.30 |
$1,202 |
2.0× |
| Special Physics Consult (77370) |
$551.67 |
$848.72 |
4.0× |
| Special treatment procedure (77470) |
$809.92 |
$1,246.02 |
1.4× |
| Spine thoracic 3 views (72072) |
$149.18 |
$229.50 |
1.4× |
| Stereotactic Body Radiation Delivery (77373) |
$21,983.03 |
$33,820.05 |
11.9× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,769.16 |
$2,721.79 |
4.6× |
| Ther rad simulaj-aided field setting complex (77290) |
$632.28 |
$972.74 |
1.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$331.55 |
$510.08 |
2.4× |
| Thoracolumbar 2 views (72080) |
$22.75 |
$35 |
0.3× |
| Tmj unilateral (70328) |
$19.50 |
$30 |
0.2× |
| Treatment device complex (77334) |
$899.91 |
$1,384.47 |
2.3× |
| Treatment device intermediate (77333) |
$244.88 |
$376.75 |
1.8× |
| Treatment devices simple (77332) |
$191.80 |
$295.08 |
1.4× |
| Ultrasound breast complete (76641) |
$77.35 |
$119 |
0.7× |
| Ultrasound Exam Aaa Screen (76706) |
$183.30 |
$282 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$238.88 |
$367.50 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$52.65 |
$81 |
0.5× |
| Urethrocystogram voiding (74455) |
$34.45 |
$53 |
0.1× |
| Urethrocystography retrograde rs&i (74450) |
$34.45 |
$53 |
0.1× |
| Us breast unilateral limited (76642) |
$72.15 |
$111 |
0.8× |
| Us chest (76604) |
$209.62 |
$322.50 |
1.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$206.70 |
$318 |
0.9× |
| Us compl joint r-t w/image documentation (76881) |
$246.35 |
$379 |
2.3× |
| Us encephalogram (76506) |
$68.90 |
$106 |
0.6× |
| Us hips infant static (76886) |
$65.65 |
$101 |
0.7× |
| Us infant hips w manipulation (76885) |
$78 |
$120 |
0.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$310.70 |
$478 |
2.9× |
| Us ob limited (76815) |
$203.45 |
$313 |
1.9× |
| Us ob transvaginal (76817) |
$368.55 |
$567 |
3.4× |
| Us pelvic non ob complete (76856) |
$321.42 |
$494.50 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$205.72 |
$316.50 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$221.32 |
$340.50 |
2.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$221.65 |
$341 |
2.1× |
| Us retroperitoneal complete (76770) |
$339.95 |
$523 |
3.2× |
| Us retroperitoneal limited (76775) |
$477.75 |
$735 |
4.4× |
| Us scrotum and contents (76870) |
$283.72 |
$436.50 |
2.6× |
| Us soft tissue head/neck (76536) |
$279.82 |
$430.50 |
2.6× |
| Us spinal canal and contents (76800) |
$137.80 |
$212 |
1.3× |
| Us transrectal (76872) |
$72.15 |
$111 |
0.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$79.30 |
$122 |
0.7× |
| Venogram extremity bilateral (75822) |
$152.10 |
$234 |
0.1× |
| Venogram Extremity Unilateral (75820) |
$108.55 |
$167 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$117.65 |
$181 |
0.0× |
| Venography caval superior serialography rs&i (75827) |
$118.30 |
$182 |
0.1× |
| Venography Renal Bilateral (75833) |
$154.05 |
$237 |
0.0× |
| Venography renal unilateral selective rs&i (75831) |
$113.75 |
$175 |
0.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$117.65 |
$181 |
0.0× |
| Wrist 2 views (73100) |
$96.52 |
$148.50 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$176.15 |
$271 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$20.80 |
$32 |
0.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$132.60 |
$204 |
0.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$121.22 |
$186.50 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$151.45 |
$233 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$31.85 |
$49 |
0.3× |
| X-ray exam of femur 2/> (73552) |
$161.85 |
$249 |
1.8× |
| X-ray eye for foreign body (70030) |
$64.02 |
$98.50 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$21.45 |
$33 |
0.2× |
| X-ray IV pyelogram (ivp) (74400) |
$52 |
$80 |
0.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$157.95 |
$243 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$126.10 |
$194 |
1.4× |
| X-ray leg, infant (73592) |
$108.22 |
$166.50 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$151.45 |
$233 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$32.50 |
$50 |
0.3× |
| X-ray nose-rectum child f.b. (76010) |
$121.22 |
$186.50 |
1.3× |
| X-ray optic foramen (70190) |
$24.05 |
$37 |
0.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$29.90 |
$46 |
0.3× |
| X-ray retrograde pyelogram (74420) |
$53.95 |
$83 |
0.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$120.90 |
$186 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$123.50 |
$190 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$126.42 |
$194.50 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$180.05 |
$277 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$148.85 |
$229 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$143 |
$220 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$29.90 |
$46 |
0.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$170.30 |
$262 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$178.10 |
$274 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$144.95 |
$223 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$21.45 |
$33 |
0.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$117.65 |
$181 |
1.1× |
| Xr bone length studies (77073) |
$29.25 |
$45 |
0.3× |
| Xr c-spine 4 or 5 views (72050) |
$190.78 |
$293.50 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$32.50 |
$50 |
0.3× |
| Xr chest 4+ views (71048) |
$32.50 |
$50 |
0.3× |
| Xr urogram antegrade (74425) |
$52.65 |
$81 |
0.1× |