| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,609 |
$3,218 |
1.3× |
| Abdomen 2 views (74019) |
$318 |
$636 |
3.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$760 |
$1,520 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$5,162.50 |
$10,325 |
1.8× |
| Angiography extremity unilateral rs&i (75710) |
$4,430.50 |
$8,861 |
1.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,586 |
$7,172 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,966 |
$9,932 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,028 |
$8,056 |
1.4× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$2,008.50 |
$4,017 |
0.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,503 |
$7,006 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$547 |
$1,094 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,007.50 |
$2,015 |
0.4× |
| Ankle 2 views (73600) |
$157 |
$314 |
2.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$586 |
$1,172 |
1.9× |
| Aortogram thoracic (75605) |
$3,503 |
$7,006 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,944 |
$7,888 |
1.4× |
| Aortography abdominal serialography rs&i (75625) |
$3,503 |
$7,006 |
1.2× |
| Arthrogram hip (73525) |
$448 |
$896 |
1.4× |
| Arthrogram shoulder (73040) |
$484 |
$968 |
1.5× |
| Arthrogram wrist (73115) |
$528.50 |
$1,057 |
1.7× |
| Arthrography knee lt (73580) |
$622.50 |
$1,245 |
2.0× |
| Basic radiation dosimetry calculation (77300) |
$220 |
$440 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$623.50 |
$1,247 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$886.50 |
$1,773 |
2.4× |
| Bone age studies (77072) |
$237.50 |
$475 |
2.5× |
| Bone Imaging 3 Phase (78315) |
$941 |
$1,882 |
2.6× |
| Bone survey complete (77075) |
$1,014.50 |
$2,029 |
10.7× |
| Brachytx isodose complex (77318) |
$523.50 |
$1,047 |
1.5× |
| Brachytx isodose intermed (77317) |
$276.50 |
$553 |
0.8× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$242 |
$484 |
0.7× |
| Brain image w/flow 4 + views (78606) |
$1,717.50 |
$3,435 |
3.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,125 |
$4,250 |
1.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$910 |
$1,820 |
2.9× |
| Cervical spine 2 or 3 views (72040) |
$276 |
$552 |
3.5× |
| Chest 1 view (71045) |
$232 |
$464 |
2.9× |
| Chest 3 views (71047) |
$275 |
$550 |
3.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$588 |
$1,176 |
3.7× |
| Clavicle complete (73000) |
$214 |
$428 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$242 |
$484 |
2.6× |
| Continuing medical physics consltj pr wk (77336) |
$204 |
$408 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,660.50 |
$5,321 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,893.50 |
$3,787 |
8.8× |
| CT abdomen w contrast (74160) |
$1,888.50 |
$3,777 |
11.9× |
| CT abdomen w wo contrast (74170) |
$1,971 |
$3,942 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,606 |
$3,212 |
17.0× |
| CT angio hrt w/3d image (75574) |
$900 |
$1,800 |
2.8× |
| CT angiography upper extremity lt (73206) |
$1,055 |
$2,110 |
6.6× |
| CT c-spine w/o contrast (72125) |
$1,925.50 |
$3,851 |
20.3× |
| CT cervical spine w&w/o contrast (72127) |
$2,324 |
$4,648 |
14.6× |
| CT cervical spine with contrast (72126) |
$2,181 |
$4,362 |
6.9× |
| CT chest w/wo contrast (71270) |
$2,187.50 |
$4,375 |
13.8× |
| CT chest with contrast (71260) |
$1,900.50 |
$3,801 |
12.0× |
| CT head/brain with contrast (70460) |
$1,027.50 |
$2,055 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,417 |
$2,834 |
8.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,158 |
$2,316 |
3.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$125 |
$250 |
1.6× |
| CT iac w contrast (70481) |
$1,271 |
$2,542 |
8.0× |
| CT limited/localized follow up study (76380) |
$604 |
$1,208 |
7.7× |
| CT lower ext w/o (73700) |
$1,399 |
$2,798 |
14.8× |
| CT lower extremity w wo contrast (73702) |
$1,886.50 |
$3,773 |
11.9× |
| CT lower extremity with contrast (73701) |
$1,667 |
$3,334 |
10.5× |
| CT lumbar spine w/o contrast (72131) |
$1,852.50 |
$3,705 |
19.6× |
| CT lumbar spine with contrast (72132) |
$2,513.50 |
$5,027 |
8.0× |
| CT maxillofacial w contrast (70487) |
$2,259.50 |
$4,519 |
14.2× |
| CT maxillofacial w/o contrast (70486) |
$1,893.50 |
$3,787 |
20.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,578 |
$5,156 |
16.2× |
| CT neck soft tissue w contrast (70491) |
$1,161 |
$2,322 |
7.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,448 |
$2,896 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,059 |
$2,118 |
11.2× |
| CT pelvis w & w/o contrast (72194) |
$1,861.50 |
$3,723 |
11.7× |
| CT pelvis w/o contrast (72192) |
$1,564 |
$3,128 |
16.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,525 |
$3,050 |
9.6× |
| CT soft tissue neck w/o contrast (70490) |
$925.50 |
$1,851 |
9.8× |
| CT thoracic spine w/contrast (72129) |
$1,879 |
$3,758 |
11.8× |
| CT thoracic spine w/o contrast (72128) |
$1,644 |
$3,288 |
17.4× |
| CT thoracic spine w/wo contrast (72130) |
$2,217.50 |
$4,435 |
14.0× |
| CT thorax w/o contrast (71250) |
$1,484.50 |
$2,969 |
15.7× |
| CT upper extremity w/o contrast rt (73200) |
$762.50 |
$1,525 |
8.1× |
| CT upper extremity with contrast (73201) |
$1,079.50 |
$2,159 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$972 |
$1,944 |
6.1× |
| Cta Abdomen (74175) |
$907 |
$1,814 |
5.7× |
| CTA abdomen pelvis (74174) |
$1,391.50 |
$2,783 |
4.4× |
| CTA chest (71275) |
$972 |
$1,944 |
6.1× |
| Cta Head (70496) |
$749.50 |
$1,499 |
4.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,055 |
$2,110 |
6.6× |
| Cta Neck (70498) |
$749.50 |
$1,499 |
4.7× |
| Cta Pelvis (72191) |
$2,525.50 |
$5,051 |
15.9× |
| Cystography minimum 3 views rs&i (74430) |
$609.50 |
$1,219 |
1.9× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$391 |
$782 |
4.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$311.50 |
$623 |
3.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$125.25 |
$250.50 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$403 |
$806 |
4.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$359 |
$718 |
4.6× |
| Echo exam of fetal heart (76825) |
$353.25 |
$706.50 |
0.7× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$448.50 |
$897 |
2.1× |
| Echoencephalography real time imaging (76506) |
$380 |
$760 |
4.0× |
| Esophagus (74220) |
$327 |
$654 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$211.50 |
$423 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$144.75 |
$289.50 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$202 |
$404 |
0.9× |
| Foot 2 views (73620) |
$186.50 |
$373 |
2.4× |
| Forearm 2 views (73090) |
$206 |
$412 |
2.6× |
| Gated Heart Planar Single (78472) |
$976 |
$1,952 |
2.7× |
| Hand 2 views (73120) |
$157 |
$314 |
1.7× |
| Hand 3 views (73130) |
$208 |
$416 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$627 |
$1,254 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$627 |
$1,254 |
1.7× |
| Ht muscle image spect sing (78451) |
$2,786.50 |
$5,573 |
2.4× |
| Humerus Min 2 Views Left (73060) |
$197.50 |
$395 |
2.5× |
| Hysterosalpingogram (74740) |
$700 |
$1,400 |
3.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$100 |
$200 |
1.1× |
| Kidney imaging morphology (78700) |
$359.50 |
$719 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$454 |
$908 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$488.50 |
$977 |
1.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$557.50 |
$1,115 |
1.1× |
| Knee 3 views (73562) |
$239.50 |
$479 |
3.0× |
| Liver & spleen imaging static only (78215) |
$828 |
$1,656 |
2.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$860 |
$1,720 |
2.4× |
| Liver imaging w/vascular flow (78202) |
$738 |
$1,476 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$1,917.50 |
$3,835 |
3.9× |
| Lung perfusion differential (78597) |
$400.50 |
$801 |
1.1× |
| Lymphoscintigraphy (78195) |
$1,151.50 |
$2,303 |
2.3× |
| Meckels Diverticulum (78290) |
$760 |
$1,520 |
2.1× |
| Mlc imrt design & construction per imrt plan (77338) |
$229.50 |
$459 |
0.7× |
| Mr elastography (76391) |
$862.50 |
$1,725 |
4.0× |
| MRA head w & w/o contrast (70546) |
$3,091 |
$6,182 |
9.8× |
| MRA head w/o contrast (70544) |
$2,269 |
$4,538 |
10.5× |
| MRA head with contrast (70545) |
$2,427.50 |
$4,855 |
7.7× |
| MRA neck w contrast (70548) |
$1,848 |
$3,696 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,094.50 |
$4,189 |
6.6× |
| MRA neck w/o contrast (70547) |
$1,601.50 |
$3,203 |
7.4× |
| MRI abdomen w contrast (74182) |
$1,971 |
$3,942 |
6.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,464 |
$4,928 |
7.8× |
| MRI abdomen w/o contrast (74181) |
$1,848 |
$3,696 |
8.6× |
| MRI any jnt lwr ext with con lt (73722) |
$2,053.50 |
$4,107 |
2.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,153 |
$4,306 |
3.0× |
| MRI breast w/o contrast bilateral (77047) |
$1,499.50 |
$2,999 |
6.9× |
| MRI breast w/o contrast unilat (77046) |
$862.50 |
$1,725 |
4.0× |
| MRI c-spine with contrast (72142) |
$2,020.50 |
$4,041 |
6.4× |
| MRI cardiac w/o contrast (75557) |
$597 |
$1,194 |
2.8× |
| MRI cervical spine w/o contrast (72141) |
$1,786.50 |
$3,573 |
8.3× |
| MRI chest w/o & w/contrast material (71552) |
$2,188 |
$4,376 |
6.9× |
| MRI chest w/o contrast (71550) |
$1,440.50 |
$2,881 |
6.7× |
| MRI chest with contrast (71551) |
$1,573 |
$3,146 |
2.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,591 |
$5,182 |
8.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,043.50 |
$4,087 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,848 |
$3,696 |
8.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,565 |
$3,130 |
7.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,791.50 |
$5,583 |
8.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,912 |
$3,824 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,935 |
$3,870 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,786.50 |
$3,573 |
8.3× |
| MRI scan of arm joint before and after contrast (73223) |
$2,468 |
$4,936 |
7.8× |
| MRI scan of leg joint before and after contrast (73723) |
$2,489 |
$4,978 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,555.50 |
$5,111 |
8.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,909.50 |
$3,819 |
6.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,156 |
$4,312 |
6.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,972 |
$3,944 |
6.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,543 |
$5,086 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,786.50 |
$3,573 |
8.3× |
| MRI tmj (70336) |
$1,278 |
$2,556 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,848 |
$3,696 |
8.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,079 |
$6,158 |
9.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,285 |
$4,570 |
10.6× |
| Myelogram Cervical (72240) |
$834 |
$1,668 |
1.2× |
| Myelogram Lumbar (72265) |
$834 |
$1,668 |
1.2× |
| Myelogram thoracic (72255) |
$772 |
$1,544 |
1.1× |
| Myelography 2 or more regions (72270) |
$1,314.50 |
$2,629 |
1.9× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,043 |
$4,086 |
1.7× |
| Myocardial Spect Multiple Studies (78452) |
$3,962.50 |
$7,925 |
3.4× |
| Neck soft tissue (70360) |
$239 |
$478 |
3.0× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$575.50 |
$1,151 |
1.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$575.50 |
$1,151 |
1.6× |
| Nm cisternogram (78630) |
$1,651.50 |
$3,303 |
3.4× |
| Nm gastric emptying study (78264) |
$917 |
$1,834 |
2.5× |
| Nm gastroesophageal reflux study (78262) |
$1,151 |
$2,302 |
3.2× |
| Nm peritoneal-venous shunt patency (78291) |
$356 |
$712 |
1.0× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,887.50 |
$3,775 |
1.5× |
| Nuclear Rx Oral Admin (79005) |
$732 |
$1,464 |
3.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$156 |
$312 |
1.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$512.50 |
$1,025 |
5.4× |
| Orthopantogram (70355) |
$173.50 |
$347 |
2.2× |
| Osseous survey infant (77076) |
$387 |
$774 |
4.1× |
| Osseous survey limited (77074) |
$470.50 |
$941 |
5.0× |
| Parathyrd planar w/wo subtrj (78071) |
$1,132.50 |
$2,265 |
3.1× |
| Parathyroid imaging (78070) |
$877 |
$1,754 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$171 |
$342 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$3,912 |
$7,824 |
3.0× |
| PET imaging CT for attenuation limited area (78814) |
$2,932 |
$5,864 |
2.3× |
| PET imaging for CT attenuation whole body (78816) |
$3,912 |
$7,824 |
3.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,518.50 |
$5,037 |
8.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$760 |
$1,520 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,408 |
$2,816 |
2.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$731 |
$1,462 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$80.50 |
$161 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$134.50 |
$269 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$134.50 |
$269 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$289 |
$578 |
3.1× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$3,527 |
$7,054 |
0.5× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$292.50 |
$585 |
0.6× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$167 |
$334 |
1.8× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$167 |
$334 |
0.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$293.50 |
$587 |
3.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$253.50 |
$507 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$349.50 |
$699 |
3.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$274.50 |
$549 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$475 |
$950 |
3.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$344.50 |
$689 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$500 |
$1,000 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$407 |
$814 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$80.50 |
$161 |
1.0× |
| Radiological examination surgical specimen (76098) |
$913 |
$1,826 |
1.8× |
| Ribs bilateral 3 views (71110) |
$221 |
$442 |
2.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,577 |
$3,154 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,480.50 |
$2,961 |
3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,925.50 |
$3,851 |
1.6× |
| Rp Therapy Intravenous Administration (79101) |
$658 |
$1,316 |
3.1× |
| Sacroiliac Joints < 3 Views (72200) |
$129.50 |
$259 |
1.4× |
| Scanogram (77073) |
$331 |
$662 |
3.5× |
| Scapula complete (73010) |
$251.50 |
$503 |
2.7× |
| Screening digital breast tomosynthesis (77063) |
$55 |
$110 |
2.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$574.50 |
$1,149 |
6.1× |
| Sialogram (70390) |
$384 |
$768 |
1.8× |
| Simulation intermediate (77285) |
$437.50 |
$875 |
1.3× |
| Small bowel series (74250) |
$460 |
$920 |
2.9× |
| Spec medical radj physics consltj (77370) |
$222.50 |
$445 |
1.8× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$461 |
$922 |
1.4× |
| Special dosimetry (77331) |
$204 |
$408 |
1.7× |
| Special treatment procedure (77470) |
$578.50 |
$1,157 |
1.2× |
| Spine thoracic 3 views (72072) |
$469.50 |
$939 |
5.0× |
| Stereotactic body radiation delivery (77373) |
$920.50 |
$1,841 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$455 |
$910 |
1.3× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$163 |
$326 |
0.5× |
| Ther rad simulaj-aided field setting complex (77290) |
$491.50 |
$983 |
1.4× |
| Ther rad simulaj-aided field setting simple (77280) |
$221 |
$442 |
1.8× |
| Thoracolumbar 2 views (72080) |
$446 |
$892 |
5.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,515 |
$3,030 |
3.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,043 |
$2,086 |
2.9× |
| Tmj unilateral (70328) |
$143.50 |
$287 |
1.8× |
| Tomogram (76100) |
$216 |
$432 |
2.3× |
| Treatment device intermediate (77333) |
$187 |
$374 |
1.5× |
| Treatment devices simple (77332) |
$155.50 |
$311 |
1.3× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,126.50 |
$4,253 |
4.3× |
| Tx devices design & construction complex (77334) |
$318 |
$636 |
0.9× |
| Ultrasound elastography first target lesion (76982) |
$4,743 |
$9,486 |
50.1× |
| Ultrasound, abdomen limited (76705) |
$568 |
$1,136 |
6.0× |
| Umbilical-artery Doppler (OB) (76820) |
$187 |
$374 |
2.0× |
| Upper Extremity Infant (73092) |
$206 |
$412 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$764.50 |
$1,529 |
3.5× |
| Urethrocystography voiding (74455) |
$609.50 |
$1,219 |
2.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$647 |
$1,294 |
4.1× |
| Us abdl aorta screen aaa (76706) |
$185 |
$370 |
2.0× |
| Us breast unilateral complete (76641) |
$199.50 |
$399 |
2.1× |
| Us breast unilateral limited (76642) |
$154 |
$308 |
2.0× |
| Us chest (76604) |
$262.50 |
$525 |
2.8× |
| Us compl joint r-t w/image documentation (76881) |
$390.50 |
$781 |
4.1× |
| Us elastography parenchyma (76981) |
$474.50 |
$949 |
5.0× |
| Us fetal nuchal translucency 1st gestation (76813) |
$109.50 |
$219 |
1.2× |
| Us guided compression repair (76936) |
$441 |
$882 |
2.3× |
| Us infant hips dynamic (76885) |
$505 |
$1,010 |
6.4× |
| Us kidney transplant (76776) |
$484.50 |
$969 |
5.1× |
| Us ob detailed single fetus (76811) |
$317.25 |
$634.50 |
1.5× |
| Us ob transvaginal (76817) |
$177.75 |
$355.50 |
1.9× |
| Us pelvic non ob complete (76856) |
$538 |
$1,076 |
5.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$538 |
$1,076 |
5.7× |
| Us pregnancy ltd (76815) |
$177.50 |
$355 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$194.50 |
$389 |
2.1× |
| Us retroperitoneal complete (76770) |
$633 |
$1,266 |
6.7× |
| Us retroperitoneal limited (76775) |
$503.50 |
$1,007 |
5.3× |
| Us scrotum and contents (76870) |
$554.50 |
$1,109 |
5.9× |
| Us soft tissue head/neck (76536) |
$512.50 |
$1,025 |
5.4× |
| Us spinal canal and contents (76800) |
$186 |
$372 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$342.50 |
$685 |
3.6× |
| Venogram extremity bilateral (75822) |
$1,345.50 |
$2,691 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,503 |
$7,006 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$1,177 |
$2,354 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$905.50 |
$1,811 |
0.6× |
| Venography Renal Bilateral (75833) |
$1,259 |
$2,518 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$870.50 |
$1,741 |
0.3× |
| Wrist 2 views (73100) |
$204.50 |
$409 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$441.50 |
$883 |
4.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$263 |
$526 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$225 |
$450 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$624 |
$1,248 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$157 |
$314 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$210.50 |
$421 |
2.7× |
| X-ray exam hip uni 1 view (73501) |
$72 |
$144 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$80.50 |
$161 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$134.50 |
$269 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$145.50 |
$291 |
1.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$176 |
$352 |
1.9× |
| X-ray exam of femur 1 (73551) |
$80.50 |
$161 |
1.0× |
| X-ray eye for foreign body (70030) |
$134.50 |
$269 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$349 |
$698 |
3.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$222 |
$444 |
2.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$181 |
$362 |
2.3× |
| X-ray IV pyelogram+drip infusn (74410) |
$311.50 |
$623 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$151 |
$302 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$285.50 |
$571 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$157 |
$314 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$206 |
$412 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$293.50 |
$587 |
3.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$607 |
$1,214 |
6.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$261 |
$522 |
2.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$206 |
$412 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$336 |
$672 |
3.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$733 |
$1,466 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$157 |
$314 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$263 |
$526 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$396 |
$792 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$227.50 |
$455 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$224 |
$448 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$242.50 |
$485 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$336 |
$672 |
4.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$208.50 |
$417 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$382.50 |
$765 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$208.50 |
$417 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$213.50 |
$427 |
2.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$134.50 |
$269 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$285.50 |
$571 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$387 |
$774 |
4.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$162 |
$324 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$206 |
$412 |
2.6× |
| Xr arthrogram ankle (73615) |
$251 |
$502 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$522 |
$1,044 |
5.5× |
| Xr chest 4+ views (71048) |
$335 |
$670 |
3.5× |
| Xr finger(s) 2+ views (73140) |
$157 |
$314 |
2.0× |
| Xr shoulder 1 view (73020) |
$209.50 |
$419 |
2.7× |
| Xr spine cervical 4 or 5 views (72050) |
$372 |
$744 |
3.9× |
| Xr tibia/fibula 2 views (73590) |
$206 |
$412 |
2.6× |
| Xr tmj bilateral (70330) |
$307.50 |
$615 |
3.9× |
| Xray knee 1 or 2 views rt (73560) |
$199.50 |
$399 |
2.5× |