| 3-D radiotherapy plan dose-volume histograms (77295) |
$1,824 |
$2,280 |
1.5× |
| Abdomen 2 views (74019) |
$256 |
$320 |
2.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,339.20 |
$1,674 |
3.9× |
| Acute venous thrombus image (78456) |
$727.20 |
$909 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$3,280 |
$4,100 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$3,280 |
$4,100 |
1.2× |
| Angiography internal mammary rs&i (75756) |
$3,280 |
$4,100 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,280 |
$4,100 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,280 |
$4,100 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,280 |
$4,100 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,280 |
$4,100 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,344 |
$1,680 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,280 |
$4,100 |
1.2× |
| Ankle 2 views (73600) |
$172 |
$215 |
2.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$730.40 |
$913 |
2.4× |
| Aortogram thoracic (75605) |
$5,441.60 |
$6,802 |
1.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,280 |
$4,100 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,280 |
$4,100 |
1.2× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,280 |
$4,100 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$3,280 |
$4,100 |
1.2× |
| Arthrogram hip (73525) |
$752 |
$940 |
2.5× |
| Arthrogram shoulder (73040) |
$653.60 |
$817 |
2.2× |
| Arthrogram wrist (73115) |
$691.20 |
$864 |
2.3× |
| Arthrography knee lt (73580) |
$581.60 |
$727 |
1.9× |
| Basic radiation dosimetry calculation (77300) |
$202 |
$252.50 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$804.80 |
$1,006 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$1,196.80 |
$1,496 |
3.5× |
| Bone age studies (77072) |
$192 |
$240 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,364 |
$1,705 |
4.0× |
| Bone survey complete (77075) |
$490.40 |
$613 |
5.4× |
| Brain image w/flow 4 + views (78606) |
$767.20 |
$959 |
1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,912 |
$3,640 |
2.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$572.80 |
$716 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$218.40 |
$273 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$310.40 |
$388 |
2.1× |
| Clavicle complete (73000) |
$286.80 |
$358.50 |
3.8× |
| Continuing medical physics consltj pr wk (77336) |
$202 |
$252.50 |
1.7× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$291.20 |
$364 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,915.20 |
$4,894 |
13.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,891.20 |
$2,364 |
9.2× |
| CT abdomen w contrast (74160) |
$1,618.40 |
$2,023 |
10.7× |
| CT abdomen w wo contrast (74170) |
$1,779.20 |
$2,224 |
11.8× |
| CT abdomen w/o contrast (74150) |
$1,285.60 |
$1,607 |
14.3× |
| CT angiography upper extremity lt (73206) |
$1,199.20 |
$1,499 |
7.9× |
| CT c-spine w/o contrast (72125) |
$1,016.80 |
$1,271 |
11.3× |
| CT cervical spine w&w/o contrast (72127) |
$2,027.20 |
$2,534 |
13.4× |
| CT cervical spine with contrast (72126) |
$1,469.60 |
$1,837 |
4.9× |
| CT chest w/wo contrast (71270) |
$1,755.20 |
$2,194 |
11.6× |
| CT chest with contrast (71260) |
$1,148 |
$1,435 |
7.6× |
| CT head/brain with contrast (70460) |
$901.60 |
$1,127 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,696 |
$2,120 |
11.2× |
| CT iac w contrast (70481) |
$1,217.60 |
$1,522 |
8.1× |
| CT lower ext w/o (73700) |
$1,397.60 |
$1,747 |
15.5× |
| CT lower extremity w wo contrast (73702) |
$1,923.20 |
$2,404 |
12.7× |
| CT lower extremity with contrast (73701) |
$1,535.20 |
$1,919 |
10.2× |
| CT lumbar spine w & w/o contrast (72133) |
$2,648 |
$3,310 |
17.5× |
| CT lumbar spine w/o contrast (72131) |
$1,087.20 |
$1,359 |
12.1× |
| CT lumbar spine with contrast (72132) |
$1,791.20 |
$2,239 |
6.0× |
| CT maxillofacial w contrast (70487) |
$1,193.60 |
$1,492 |
7.9× |
| CT maxillofacial w/o contrast (70486) |
$708.80 |
$886 |
7.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,205.60 |
$1,507 |
8.0× |
| CT neck soft tissue w contrast (70491) |
$1,524 |
$1,905 |
10.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,727.20 |
$2,159 |
11.4× |
| CT orbits w/o contrast (70480) |
$1,159.20 |
$1,449 |
12.9× |
| CT pelvis w & w/o contrast (72194) |
$2,166.40 |
$2,708 |
14.3× |
| CT pelvis w/o contrast (72192) |
$1,463.20 |
$1,829 |
16.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,612.80 |
$2,016 |
10.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,094.40 |
$1,368 |
12.1× |
| CT thoracic spine w/contrast (72129) |
$1,896 |
$2,370 |
12.5× |
| CT thoracic spine w/o contrast (72128) |
$1,478.40 |
$1,848 |
16.4× |
| CT thoracic spine w/wo contrast (72130) |
$2,328 |
$2,910 |
15.4× |
| CT thorax w/o contrast (71250) |
$976 |
$1,220 |
10.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,284 |
$1,605 |
8.5× |
| CT upper extremity w/o contrast rt (73200) |
$1,177.60 |
$1,472 |
13.1× |
| CT upper extremity with contrast (73201) |
$1,218.40 |
$1,523 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,297.60 |
$2,872 |
15.2× |
| Cta Abdomen (74175) |
$2,082.40 |
$2,603 |
13.8× |
| CTA abdomen pelvis (74174) |
$2,032 |
$2,540 |
6.8× |
| CTA chest (71275) |
$2,140 |
$2,675 |
14.2× |
| Cta Head (70496) |
$2,130.40 |
$2,663 |
14.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,258.40 |
$1,573 |
8.3× |
| Cta Neck (70498) |
$2,116.80 |
$2,646 |
14.0× |
| Cta Pelvis (72191) |
$1,732 |
$2,165 |
11.5× |
| Cystography minimum 3 views rs&i (74430) |
$349.60 |
$437 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$449.60 |
$562 |
5.0× |
| Echoencephalography real time imaging (76506) |
$237.60 |
$297 |
2.6× |
| Esophagus (74220) |
$352 |
$440 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$344.80 |
$431 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$544 |
$680 |
6.0× |
| Fluoroscopy up to 1 hr (76000) |
$380 |
$475 |
1.8× |
| Foot 2 views (73620) |
$148 |
$185 |
2.0× |
| Forearm 2 views (73090) |
$168.80 |
$211 |
2.2× |
| Gated Heart Planar Single (78472) |
$1,134.40 |
$1,418 |
3.3× |
| Hand 2 views (73120) |
$171.20 |
$214 |
1.9× |
| Hand 3 views (73130) |
$333.60 |
$417 |
4.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,280 |
$4,100 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,110.40 |
$1,388 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,110.40 |
$1,388 |
3.2× |
| Ht muscle image spect sing (78451) |
$1,505.60 |
$1,882 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$174.40 |
$218 |
2.3× |
| Hysterosalpingogram (74740) |
$909.60 |
$1,137 |
4.4× |
| Interstitial radiation source applic complex (77778) |
$7,860 |
$9,825 |
13.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$141.60 |
$177 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,263.20 |
$1,579 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,127.20 |
$1,409 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$947.20 |
$1,184 |
2.0× |
| Liver & spleen imaging static only (78215) |
$689.60 |
$862 |
2.0× |
| Liver imaging static only (78201) |
$555.20 |
$694 |
1.2× |
| Liver imaging w/vascular flow (78202) |
$561.60 |
$702 |
1.2× |
| Lung perfusion differential (78597) |
$467.20 |
$584 |
1.4× |
| Lung Ventilation Imaging (78579) |
$467.20 |
$584 |
1.4× |
| Lymphoscintigraphy (78195) |
$1,333.60 |
$1,667 |
2.8× |
| Mammary ductogram or galactogram single (77053) |
$954.80 |
$1,193.50 |
4.6× |
| Meckels Diverticulum (78290) |
$824 |
$1,030 |
2.4× |
| Mlc imrt design & construction per imrt plan (77338) |
$548 |
$685 |
1.7× |
| MRA head w & w/o contrast (70546) |
$2,568 |
$3,210 |
8.5× |
| MRA head w/o contrast (70544) |
$1,981.60 |
$2,477 |
9.6× |
| MRA head with contrast (70545) |
$2,119.20 |
$2,649 |
7.0× |
| MRA neck w contrast (70548) |
$2,240 |
$2,800 |
7.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,403.20 |
$3,004 |
8.0× |
| MRA neck w/o contrast (70547) |
$2,089.60 |
$2,612 |
10.2× |
| MRI abdomen w contrast (74182) |
$2,077.60 |
$2,597 |
6.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,811.20 |
$3,514 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$2,191.20 |
$2,739 |
10.7× |
| MRI any jnt lwr ext with con lt (73722) |
$2,564.80 |
$3,206 |
3.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,168 |
$2,710 |
3.2× |
| MRI breast w/o contrast bilateral (77047) |
$2,408.80 |
$3,011 |
11.7× |
| MRI breast w/o contrast unilat (77046) |
$1,054.40 |
$1,318 |
5.1× |
| MRI c-spine with contrast (72142) |
$2,479.20 |
$3,099 |
8.2× |
| MRI cervical spine w/o contrast (72141) |
$1,596 |
$1,995 |
7.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,396.80 |
$2,996 |
8.0× |
| MRI chest w/o contrast (71550) |
$1,639.20 |
$2,049 |
8.0× |
| MRI chest with contrast (71551) |
$2,238.40 |
$2,798 |
3.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,094.40 |
$2,618 |
7.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,640 |
$3,300 |
8.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,027.20 |
$2,534 |
9.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,376.80 |
$1,721 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,609.60 |
$3,262 |
8.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,608.80 |
$2,011 |
5.3× |
| MRI pelvis w contrast (72196) |
$2,583.20 |
$3,229 |
8.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,910.40 |
$3,638 |
9.7× |
| MRI pelvis w/o contrast (72195) |
$2,256.80 |
$2,821 |
11.0× |
| MRI scan of arm joint before and after contrast (73223) |
$2,932 |
$3,665 |
9.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,928 |
$2,410 |
6.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,441.60 |
$3,052 |
8.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,444.80 |
$4,306 |
11.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,756.80 |
$3,446 |
9.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,040 |
$3,800 |
10.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,704.80 |
$4,631 |
12.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,704.80 |
$2,131 |
8.3× |
| MRI tmj (70336) |
$1,055.20 |
$1,319 |
5.1× |
| MRI upper ext joint w/o contrast (73221) |
$2,101.60 |
$2,627 |
10.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,767.20 |
$3,459 |
9.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,172.80 |
$2,716 |
10.6× |
| Myelogram Cervical (72240) |
$2,584 |
$3,230 |
3.8× |
| Myelogram Lumbar (72265) |
$2,202.40 |
$2,753 |
3.3× |
| Myelogram thoracic (72255) |
$816 |
$1,020 |
1.2× |
| Myelography 2 or more regions (72270) |
$2,329.60 |
$2,912 |
3.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,941.60 |
$7,427 |
5.3× |
| Myocardial Spect Multiple Studies (78452) |
$3,011.20 |
$3,764 |
2.7× |
| Neck soft tissue (70360) |
$167.20 |
$209 |
2.2× |
| Nm cisternogram (78630) |
$929.60 |
$1,162 |
2.0× |
| Nm csf leak detection (78650) |
$1,290.40 |
$1,613 |
1.2× |
| Nm gastric emptying study (78264) |
$1,296.80 |
$1,621 |
3.8× |
| Nm peritoneal-venous shunt patency (78291) |
$387.20 |
$484 |
1.1× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,824 |
$2,280 |
1.5× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$3,706.40 |
$4,633 |
3.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,002.40 |
$1,253 |
2.9× |
| Nuclear Rx Oral Admin (79005) |
$1,018.40 |
$1,273 |
5.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$281.60 |
$352 |
3.1× |
| Osseous survey infant (77076) |
$208 |
$260 |
2.3× |
| Osseous survey limited (77074) |
$245.60 |
$307 |
2.7× |
| Parathyroid imaging (78070) |
$732 |
$915 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$195.20 |
$244 |
2.2× |
| Perineogram (74775) |
$885.60 |
$1,107 |
4.3× |
| Peritoneogram rs&i (74190) |
$383.20 |
$479 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$4,863.20 |
$6,079 |
3.9× |
| PET imaging CT for attenuation limited area (78814) |
$3,024.80 |
$3,781 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,327.20 |
$6,659 |
4.3× |
| PET imaging limited area chest head/neck (78811) |
$2,587.20 |
$3,234 |
2.3× |
| PET whole body (78813) |
$3,728 |
$4,660 |
3.0× |
| Pr csf ventriculography (78635) |
$1,130.40 |
$1,413 |
2.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,929.60 |
$3,662 |
9.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,280 |
$4,100 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,048.80 |
$1,311 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,215.20 |
$1,519 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$568 |
$710 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$121.60 |
$152 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$201.60 |
$252 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$201.60 |
$252 |
2.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$206.40 |
$258 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$384 |
$480 |
4.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$386.40 |
$483 |
0.8× |
| Radiation treatment delivery 1 mev >= simple (77402) |
$200 |
$250 |
2.3× |
| Radiation tx delivery 1 mev >= intermediate (77407) |
$240 |
$300 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$232 |
$290 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$252.80 |
$316 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$481.60 |
$602 |
3.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$364.80 |
$456 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$478.40 |
$598 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$396.80 |
$496 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$121.60 |
$152 |
1.6× |
| Radiological examination surgical specimen (76098) |
$388 |
$485 |
0.8× |
| Ribs bilateral 3 views (71110) |
$314.40 |
$393 |
3.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$992.80 |
$1,241 |
2.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$969.60 |
$1,212 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,544.80 |
$3,181 |
5.4× |
| Rp Therapy Intravenous Administration (79101) |
$749.60 |
$937 |
3.7× |
| Sacroiliac Joints < 3 Views (72200) |
$219.20 |
$274 |
2.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$585.60 |
$732 |
2.8× |
| Scanogram (77073) |
$253.60 |
$317 |
2.8× |
| Scapula complete (73010) |
$278.40 |
$348 |
3.1× |
| Screening digital breast tomosynthesis (77063) |
$51.20 |
$64 |
2.2× |
| Sella turcica (70240) |
$157.60 |
$197 |
2.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$755.20 |
$944 |
8.4× |
| Sialogram (70390) |
$738.40 |
$923 |
3.6× |
| Simulation intermediate (77285) |
$548 |
$685 |
1.7× |
| Small bowel series (74250) |
$327.20 |
$409 |
2.2× |
| Spec medical radj physics consltj (77370) |
$202 |
$252.50 |
1.7× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$548 |
$685 |
1.7× |
| Special dosimetry (77331) |
$202 |
$252.50 |
1.7× |
| Special treatment procedure (77470) |
$728 |
$910 |
1.5× |
| Spine thoracic 3 views (72072) |
$226.40 |
$283 |
2.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$337.60 |
$422 |
3.8× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$240 |
$300 |
0.7× |
| Telethx isodose pln smpl w/dosimetry calculation (77306) |
$226.40 |
$283 |
0.7× |
| Testicular Imaging With Vascular Flow (78761) |
$598.40 |
$748 |
1.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$548 |
$685 |
1.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$202 |
$252.50 |
1.7× |
| Therapeutic Enema (74283) |
$796.80 |
$996 |
5.3× |
| Thoracolumbar 2 views (72080) |
$190.40 |
$238 |
2.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,165.60 |
$1,457 |
2.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$629.60 |
$787 |
1.8× |
| Thyroid uptake measurement (78012) |
$536 |
$670 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$766.40 |
$958 |
2.2× |
| Treatment device intermediate (77333) |
$376 |
$470 |
3.2× |
| Treatment devices simple (77332) |
$627.20 |
$784 |
5.4× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$3,029.60 |
$3,787 |
6.5× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,356.80 |
$1,696 |
3.9× |
| Tx devices design & construction complex (77334) |
$376 |
$470 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$445.60 |
$557 |
4.9× |
| Unlisted Ultrasound Procedure (76999) |
$299.20 |
$374 |
4.0× |
| Upper Extremity Infant (73092) |
$111.20 |
$139 |
1.2× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,409.60 |
$1,762 |
4.1× |
| Urethrocystography retrograde rs&i (74450) |
$500 |
$625 |
2.4× |
| Urethrocystography voiding (74455) |
$592.80 |
$741 |
2.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$696.80 |
$871 |
4.6× |
| Us abdl aorta screen aaa (76706) |
$225.60 |
$282 |
2.5× |
| Us breast unilateral complete (76641) |
$358.80 |
$448.50 |
4.0× |
| Us breast unilateral limited (76642) |
$184 |
$230 |
2.5× |
| Us chest (76604) |
$280 |
$350 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$378.40 |
$473 |
4.2× |
| Us elastography parenchyma (76981) |
$120 |
$150 |
1.3× |
| Us guided compression repair (76936) |
$264 |
$330 |
1.4× |
| Us infant hips limited static (76886) |
$122.40 |
$153 |
1.6× |
| Us kidney transplant (76776) |
$422.40 |
$528 |
4.7× |
| Us ob detailed single fetus (76811) |
$741.60 |
$927 |
3.6× |
| Us ob transvaginal (76817) |
$429.60 |
$537 |
4.8× |
| Us pelvic non ob complete (76856) |
$540.80 |
$676 |
6.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$447.20 |
$559 |
5.0× |
| Us pregnancy ltd (76815) |
$658.40 |
$823 |
7.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$396.80 |
$496 |
4.4× |
| Us retroperitoneal complete (76770) |
$500.80 |
$626 |
5.6× |
| Us retroperitoneal limited (76775) |
$403.20 |
$504 |
4.5× |
| Us scrotum and contents (76870) |
$401.60 |
$502 |
4.5× |
| Us soft tissue head/neck (76536) |
$440 |
$550 |
4.9× |
| Us spinal canal and contents (76800) |
$237.60 |
$297 |
2.6× |
| Us transrectal (76872) |
$377.60 |
$472 |
4.2× |
| Us transrectal prostate volume (76873) |
$420.80 |
$526 |
4.7× |
| Us xtr non-vasc lmtd (76882) |
$346.40 |
$433 |
3.8× |
| Vascular flow imaging (78445) |
$445.60 |
$557 |
1.3× |
| Venogram extremity bilateral (75822) |
$1,536 |
$1,920 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$3,280 |
$4,100 |
1.2× |
| Venography caval superior serialography rs&i (75827) |
$1,835.20 |
$2,294 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$1,280 |
$1,600 |
0.9× |
| Venography Renal Bilateral (75833) |
$3,280 |
$4,100 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$3,280 |
$4,100 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,280 |
$4,100 |
1.2× |
| Wrist 2 views (73100) |
$164 |
$205 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$148.80 |
$186 |
2.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$291.60 |
$364.50 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$522.40 |
$653 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168.80 |
$211 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$268.80 |
$336 |
3.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$384 |
$480 |
4.3× |
| X-ray exam hip uni 1 view (73501) |
$121.60 |
$152 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$121.60 |
$152 |
1.6× |
| X-ray exam hip uni 4/> views (73503) |
$201.60 |
$252 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$201.60 |
$252 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$384 |
$480 |
4.3× |
| X-ray exam of femur 1 (73551) |
$121.60 |
$152 |
1.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$384 |
$480 |
2.5× |
| X-ray eye for foreign body (70030) |
$130.40 |
$163 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$289.60 |
$362 |
3.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$169.60 |
$212 |
2.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$213.60 |
$267 |
2.8× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,418.40 |
$3,023 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$240 |
$300 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$150.40 |
$188 |
2.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$346.80 |
$433.50 |
3.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$112.80 |
$141 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$111.20 |
$139 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$215.20 |
$269 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$478.40 |
$598 |
5.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$204 |
$255 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$187.20 |
$234 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$131.20 |
$164 |
1.7× |
| X-ray of voice box or throat (70370) |
$383.20 |
$479 |
5.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$208.80 |
$261 |
2.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$384.80 |
$481 |
4.3× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$572.80 |
$716 |
1.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$469.60 |
$587 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$238.40 |
$298 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$175.20 |
$219 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$204.80 |
$256 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$325.20 |
$406.50 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$246.40 |
$308 |
3.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$149.60 |
$187 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$297.60 |
$372 |
3.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$204 |
$255 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$192 |
$240 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$247.20 |
$309 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$239.20 |
$299 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$230.40 |
$288 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$160 |
$200 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$241.60 |
$302 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$276 |
$345 |
3.1× |
| Xr finger(s) 2+ views (73140) |
$165.60 |
$207 |
2.2× |
| Xr internal auditory meati complete (70134) |
$217.60 |
$272 |
0.5× |
| Xr optic foramina (70190) |
$200.80 |
$251 |
2.7× |
| Xr shoulder 1 view (73020) |
$199.20 |
$249 |
2.7× |
| Xr spine cervical 4 or 5 views (72050) |
$360.80 |
$451 |
4.0× |
| Xr tibia/fibula 2 views (73590) |
$179.20 |
$224 |
2.4× |
| Xr tmj bilateral (70330) |
$215.20 |
$269 |
2.9× |
| Xray knee 1 or 2 views rt (73560) |
$250 |
$312.50 |
3.3× |