| 3-D radiotherapy plan dose-volume histograms (77295) |
$809.40 |
$1,349 |
0.6× |
| Abdomen 1 View (74018) |
$289.80 |
$483 |
3.4× |
| Abdomen 2 views (74019) |
$454.80 |
$758 |
4.4× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$445.20 |
$742 |
1.1× |
| Angio pulmonary bilat (75743) |
$2,307.60 |
$3,846 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$2,631.60 |
$4,386 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,268.60 |
$3,781 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,443.60 |
$2,406 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,035.20 |
$3,392 |
0.7× |
| Ankle 2 views (73600) |
$264.60 |
$441 |
3.1× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$1,989.60 |
$3,316 |
0.4× |
| Artery X-Rays Abdomen (75726) |
$2,999.40 |
$4,999 |
0.5× |
| Artery X-Rays Pelvis (75736) |
$5,953.20 |
$9,922 |
1.1× |
| Arthrogram hip (73525) |
$477 |
$795 |
1.4× |
| Arthrogram Wrist (73115) |
$448.20 |
$747 |
1.3× |
| Basic radiation dosimetry calculation (77300) |
$88.20 |
$147 |
0.7× |
| Bone age studies (77072) |
$133.20 |
$222 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$2,178 |
$3,630 |
5.6× |
| Bone Imaging Limited Area (78300) |
$1,128.60 |
$1,881 |
2.9× |
| Bone Imaging Whole Body (78306) |
$1,590 |
$2,650 |
4.1× |
| Bone survey infant (77076) |
$126 |
$210 |
1.2× |
| Brain Image W/Flow < 4 Views (78601) |
$400.80 |
$668 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$396 |
$660 |
4.6× |
| Cerebrospinal Fluid Scan (78630) |
$755.40 |
$1,259 |
1.4× |
| Chest 1 view (71045) |
$105.60 |
$176 |
1.2× |
| Chest 2 views (71046) |
$130.80 |
$218 |
1.5× |
| Chest 3 views (71047) |
$151.80 |
$253 |
1.8× |
| Chest 4 or more views (71048) |
$187.80 |
$313 |
1.8× |
| Cholecystography Oral Contrast (74290) |
$79.20 |
$132 |
0.5× |
| Clavicle complete (73000) |
$322.20 |
$537 |
3.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$294 |
$490 |
2.9× |
| Continuing medical physics consltj pr wk (77336) |
$88.20 |
$147 |
0.7× |
| Contrast Exam Abdominl Aorta (75625) |
$2,586 |
$4,310 |
0.8× |
| Contrast X-Ray Bladder (74430) |
$420 |
$700 |
1.2× |
| Contrast X-Ray Of Elbow (73085) |
$438 |
$730 |
1.3× |
| Contrast X-Ray Of Knee Joint (73580) |
$477 |
$795 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,612.80 |
$7,688 |
13.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,602.20 |
$4,337 |
11.1× |
| CT abdomen w contrast (74160) |
$2,697.60 |
$4,496 |
15.7× |
| CT abdomen w wo contrast (74170) |
$2,869.80 |
$4,783 |
16.7× |
| CT abdomen w/o contrast (74150) |
$1,865.40 |
$3,109 |
18.2× |
| CT Angio Abdomen and Pelvis (74174) |
$2,367.60 |
$3,946 |
6.9× |
| CT Angio Chest (71275) |
$2,343 |
$3,905 |
13.6× |
| CT Angio Head (70496) |
$870 |
$1,450 |
5.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$330.60 |
$551 |
1.9× |
| CT Angio Neck (70498) |
$978.60 |
$1,631 |
5.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,187.40 |
$1,979 |
6.9× |
| CT bone density (77078) |
$127.20 |
$212 |
1.5× |
| CT cervical spine w/ contrast (72126) |
$2,949.60 |
$4,916 |
8.6× |
| CT cervical spine w/o contrast (72125) |
$1,512.60 |
$2,521 |
14.7× |
| CT cervical spine w/wo cont (72127) |
$3,312.60 |
$5,521 |
19.3× |
| CT chest w contrast (71260) |
$1,062.60 |
$1,771 |
6.2× |
| CT chest w/wo contrast (71270) |
$1,306.80 |
$2,178 |
7.6× |
| CT head/brain with contrast (70460) |
$1,394.40 |
$2,324 |
8.1× |
| CT head/brain without and with contrast (70470) |
$1,668.60 |
$2,781 |
9.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$108.60 |
$181 |
1.3× |
| CT iac w contrast (70481) |
$582.60 |
$971 |
3.4× |
| CT l-spine w&w/o contrast (72133) |
$2,818.80 |
$4,698 |
16.4× |
| CT lower ext w/o (73700) |
$1,482.60 |
$2,471 |
14.5× |
| CT lower extremity w/contrast material (73701) |
$1,853.40 |
$3,089 |
10.8× |
| CT lumbar spine w contrast (72132) |
$2,505.60 |
$4,176 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$1,252.80 |
$2,088 |
12.2× |
| CT maxillofacial w contrast (70487) |
$1,202.40 |
$2,004 |
7.0× |
| CT maxillofacial wo contrast (70486) |
$993.60 |
$1,656 |
9.7× |
| CT neck tissue combo (70492) |
$834.60 |
$1,391 |
4.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$631.80 |
$1,053 |
3.7× |
| CT orbits w/o contrast (70480) |
$493.80 |
$823 |
4.8× |
| CT pelvis w&w/o contrast (72194) |
$2,127.60 |
$3,546 |
12.4× |
| CT pelvis w/o contrast (72192) |
$941.40 |
$1,569 |
9.2× |
| CT scan of leg combo (73702) |
$1,690.20 |
$2,817 |
9.8× |
| CT scans face/jaw combo (70488) |
$1,420.80 |
$2,368 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$719.40 |
$1,199 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$590.40 |
$984 |
5.8× |
| CT thoracic spine w contrast (72129) |
$2,041.20 |
$3,402 |
11.9× |
| CT thoracic spine w/o contrast (72128) |
$1,036.20 |
$1,727 |
10.1× |
| CT thoracic spine w/wo cont (72130) |
$2,300.40 |
$3,834 |
13.4× |
| CT thorax w/o contrast (71250) |
$531.60 |
$886 |
5.2× |
| CT upper ext wo (73200) |
$1,784.40 |
$2,974 |
17.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,302.60 |
$2,171 |
7.6× |
| CT upper extremity with contrast (73201) |
$2,212.80 |
$3,688 |
6.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$245.40 |
$409 |
1.4× |
| Cta Abdomen (74175) |
$1,681.20 |
$2,802 |
9.8× |
| Discography Cerv/Thor Spine (72285) |
$2,132.40 |
$3,554 |
1.1× |
| Esophagram (74220) |
$364.80 |
$608 |
2.1× |
| Fetal Biophys Profile W/Nst (76818) |
$200.40 |
$334 |
2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$200.40 |
$334 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$490.20 |
$817 |
2.1× |
| Follow-Up Angiography (75898) |
$65.40 |
$109 |
0.0× |
| Foot 2 views (73620) |
$260.40 |
$434 |
3.1× |
| Forearm 2 views (73090) |
$327.60 |
$546 |
3.8× |
| Gastric emptying imaging study (78264) |
$1,596 |
$2,660 |
4.1× |
| Gated Heart Planar Single (78472) |
$1,303.80 |
$2,173 |
3.3× |
| Gated Heart, Multiple (78473) |
$1,642.80 |
$2,738 |
4.2× |
| Hand 2 views (73120) |
$354.60 |
$591 |
3.5× |
| Hepatobil Syst Image W/Drug (78227) |
$1,957.20 |
$3,262 |
3.7× |
| Hepatobiliary System Imaging (78226) |
$1,428.60 |
$2,381 |
3.6× |
| Ht Muscle Image Spect Sing (78451) |
$2,221.80 |
$3,703 |
1.7× |
| Hysterosalpingogram (74740) |
$486.60 |
$811 |
2.1× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$156 |
$260 |
1.8× |
| Infant hip ultrasound, limited static exam (76886) |
$146.40 |
$244 |
1.7× |
| Joint Survey Single View (77077) |
$43.20 |
$72 |
0.4× |
| K Flow/Funct Image Multiple (78709) |
$2,032.80 |
$3,388 |
3.8× |
| K Flow/Funct Image W/Drug (78708) |
$1,798.80 |
$2,998 |
3.4× |
| K Flow/Funct Image W/O Drug (78707) |
$2,410.20 |
$4,017 |
4.5× |
| Knee 3 Views (73562) |
$417.60 |
$696 |
4.9× |
| Liver & Spleen Imaging Static Only (78215) |
$351.60 |
$586 |
0.9× |
| Lung perfusion differential (78597) |
$808.20 |
$1,347 |
2.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$666.60 |
$1,111 |
1.3× |
| Lung Ventilation Imaging (78579) |
$446.40 |
$744 |
1.1× |
| Lymph System Imaging (78195) |
$1,099.20 |
$1,832 |
2.1× |
| Magnetic Image Jaw Joint (70336) |
$1,872 |
$3,120 |
8.0× |
| Mammary ductogram or galactogram multiple (77054) |
$489.60 |
$816 |
2.1× |
| Mammary ductogram or galactogram single (77053) |
$384 |
$640 |
1.6× |
| Meckels Divert Exam (78290) |
$602.40 |
$1,004 |
1.5× |
| Mlc imrt design & construction per imrt plan (77338) |
$402 |
$670 |
1.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,505.60 |
$4,176 |
7.3× |
| MRA head w/o contrast (70544) |
$1,576.20 |
$2,627 |
6.7× |
| MRA head with contrast (70545) |
$1,828.20 |
$3,047 |
5.3× |
| MRA neck w contrast (70548) |
$517.80 |
$863 |
1.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,070 |
$3,450 |
6.0× |
| MRA neck w/o contrast (70547) |
$1,304.40 |
$2,174 |
5.6× |
| MRI abdomen w contrast (74182) |
$2,510.40 |
$4,184 |
7.3× |
| MRI abdomen w/o contrast (74181) |
$2,008.80 |
$3,348 |
8.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,624.40 |
$4,374 |
3.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,624.40 |
$4,374 |
7.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,249.40 |
$3,749 |
2.9× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,371.20 |
$3,952 |
10.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,185.60 |
$1,976 |
5.1× |
| MRI cervical spine w contrast (72142) |
$2,624.40 |
$4,374 |
7.7× |
| MRI cervical spine w/o cont (72141) |
$2,099.40 |
$3,499 |
9.0× |
| MRI chest w/o contrast (71550) |
$1,185.60 |
$1,976 |
5.1× |
| MRI chest wo w contrast (71552) |
$1,872 |
$3,120 |
5.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,282.40 |
$3,804 |
6.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,282.40 |
$3,804 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,438.20 |
$2,397 |
6.1× |
| MRI lumbar spine w contrast (72149) |
$2,624.40 |
$4,374 |
7.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,624.40 |
$4,374 |
7.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,417.20 |
$2,362 |
6.1× |
| MRI orbit face neck w contrast (70542) |
$765 |
$1,275 |
2.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,249.40 |
$3,749 |
6.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,249.40 |
$3,749 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,417.20 |
$2,362 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,825.80 |
$3,043 |
7.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,860 |
$3,100 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,233.60 |
$2,056 |
5.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,957.80 |
$3,263 |
5.7× |
| MRI, abdomen, combo (74183) |
$2,510.40 |
$4,184 |
7.3× |
| MRI, dorsal spine combo (72157) |
$2,282.40 |
$3,804 |
6.7× |
| MRI, dorsal spine contrast (72147) |
$2,282.40 |
$3,804 |
6.7× |
| MRI, joint upper extrem (73221) |
$1,799.40 |
$2,999 |
7.7× |
| MRI, joint upper extrem combo (73223) |
$2,249.40 |
$3,749 |
6.6× |
| MRI, lumbar spine combo (72158) |
$2,624.40 |
$4,374 |
7.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,677.20 |
$4,462 |
2.1× |
| Neck soft tissue (70360) |
$287.40 |
$479 |
3.4× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1,487.40 |
$2,479 |
1.1× |
| Nuclear Rx Oral Admin (79005) |
$621 |
$1,035 |
2.7× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$97.80 |
$163 |
1.0× |
| Optic foramina (70190) |
$208.80 |
$348 |
2.4× |
| Panoramic X-ray of jaws (70355) |
$214.80 |
$358 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$877.80 |
$1,463 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$190.80 |
$318 |
1.9× |
| Perineogram (74775) |
$201 |
$335 |
0.9× |
| Peritoneogram Rs&I (74190) |
$197.40 |
$329 |
0.4× |
| PET image w/CT, full body (78816) |
$3,388.80 |
$5,648 |
2.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$3,322.20 |
$5,537 |
2.4× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$534 |
$890 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$473.40 |
$789 |
1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$547.80 |
$913 |
5.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$253.80 |
$423 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$348 |
$580 |
4.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$142.80 |
$238 |
1.7× |
| Radex elbow complete minimum 3 views (73080) |
$303 |
$505 |
3.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$339 |
$565 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$313.80 |
$523 |
3.7× |
| Radex foot complete minimum 3 views (73630) |
$321.60 |
$536 |
3.8× |
| Radex Hand Minimum 3 Views (73130) |
$422.40 |
$704 |
4.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$103.80 |
$173 |
1.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$43.20 |
$72 |
0.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$123 |
$205 |
1.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$476.40 |
$794 |
5.6× |
| Radex shoulder complete minimum 2 views (73030) |
$327 |
$545 |
3.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$219 |
$365 |
2.6× |
| Radex Spine 1 View Specify Level (72020) |
$361.20 |
$602 |
4.2× |
| Radex Sternum Minimum 2 Views (71120) |
$159 |
$265 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$43.20 |
$72 |
0.5× |
| Radex Toe Minimum 2 Views (73660) |
$167.40 |
$279 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$72 |
$120 |
0.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$409.80 |
$683 |
4.8× |
| Radiation treatment delivery level 3 (77412) |
$150.60 |
$251 |
0.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$182.40 |
$304 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$443.40 |
$739 |
4.3× |
| Radiologic exam colon double contrast study (74280) |
$465 |
$775 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$331.80 |
$553 |
1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$205.80 |
$343 |
1.2× |
| Radiologic exam knee complete 4/more views (73564) |
$480 |
$800 |
4.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$261.60 |
$436 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$274.20 |
$457 |
1.6× |
| Radiologic exam swallow function contrast study (74230) |
$87 |
$145 |
0.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$388.80 |
$648 |
2.3× |
| Radiologic examination femur 1 view (73551) |
$106.80 |
$178 |
1.3× |
| Radiologic examination femur minimum 2 views (73552) |
$106.80 |
$178 |
1.3× |
| Radiologic examination knee 1/2 views (73560) |
$355.20 |
$592 |
4.2× |
| Radiologic Examination Osseous Survey Limited (77074) |
$128.40 |
$214 |
1.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$45 |
$75 |
0.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$274.20 |
$457 |
3.2× |
| Radiopharmaceutical therapy, by intracavitary administration Non-Facility (79200) |
$225 |
$375 |
1.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$534 |
$890 |
1.0× |
| Ribs bilateral 3 views (71110) |
$619.20 |
$1,032 |
6.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$904.20 |
$1,507 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,482.60 |
$2,471 |
2.8× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$904.20 |
$1,507 |
1.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$72.60 |
$121 |
0.1× |
| Rp Therapy Intravenous Administration (79101) |
$334.20 |
$557 |
1.5× |
| Scapula (73010) |
$187.80 |
$313 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$13.80 |
$23 |
0.6× |
| Sella turcica (70240) |
$43.20 |
$72 |
0.5× |
| Shoulder 1 view (73020) |
$336.60 |
$561 |
3.9× |
| Shoulder Arthrography (73040) |
$788.40 |
$1,314 |
2.3× |
| Sialogram (70390) |
$116.40 |
$194 |
0.5× |
Skull less than 4 views (70250)
range across 2 matching MRF lines |
$281.40–$302.40 |
$469–$504 |
varies |
| Special dosimetry (77331) |
$89.40 |
$149 |
0.7× |
| Special treatment procedure (77470) |
$395.40 |
$659 |
0.7× |
| Sternoclavicular joints (71130) |
$190.80 |
$318 |
2.2× |
| Ther Rad Simulaj-Aided Field Setting Complex (77290) |
$757.80 |
$1,263 |
2.1× |
| Ther rad simulaj-aided field setting simple (77280) |
$363.60 |
$606 |
2.8× |
| Thoracic spine 2 views (72070) |
$278.40 |
$464 |
2.7× |
| Thoracic spine 3 views (72072) |
$343.20 |
$572 |
3.3× |
| Thoracolumbar 2 views (72080) |
$324.60 |
$541 |
3.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$753 |
$1,255 |
1.9× |
| Thyroid Met Imaging Body (78018) |
$1,709.40 |
$2,849 |
3.2× |
| Thyroid Uptake Measurement (78012) |
$433.20 |
$722 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$952.80 |
$1,588 |
2.4× |
| Tx Devices Design & Construction Complex (77334) |
$168 |
$280 |
0.5× |
| Ultrasound Breast Limited (76642) |
$363.60 |
$606 |
4.3× |
| Ultrasound Exam Aaa Screen (76706) |
$358.20 |
$597 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$913.80 |
$1,523 |
8.9× |
| Unlisted Dx Radiographic Procedure (76499) |
$61.80 |
$103 |
0.7× |
| Upper gi w/o kub (74240) |
$375.60 |
$626 |
2.2× |
| Urethrocystogram voiding (74455) |
$444 |
$740 |
1.9× |
| Urethrocystography retrograde (74450) |
$433.80 |
$723 |
1.9× |
| Us breast unilateral complete (76641) |
$443.40 |
$739 |
4.3× |
| Us chest (76604) |
$220.20 |
$367 |
2.1× |
| Us exam, pelvic, limited (76857) |
$549.60 |
$916 |
5.4× |
| Us head (76506) |
$248.40 |
$414 |
2.4× |
| Us kidney transplant (76776) |
$440.40 |
$734 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$414 |
$690 |
4.0× |
| Us ob detailed single fetus (76811) |
$600 |
$1,000 |
2.6× |
| Us ob limited 1 or more fetuses (76815) |
$516 |
$860 |
5.0× |
| Us ob transvaginal (76817) |
$593.40 |
$989 |
5.8× |
| Us pelvic non ob complete (76856) |
$808.80 |
$1,348 |
7.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$634.80 |
$1,058 |
6.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$195.60 |
$326 |
1.9× |
| Us retroperitoneal complete (76770) |
$986.40 |
$1,644 |
9.6× |
| Us retroperitoneal limited (76775) |
$502.80 |
$838 |
4.9× |
| Us scrotum and contents (76870) |
$690 |
$1,150 |
6.7× |
| Us spinal canal and contents (76800) |
$200.40 |
$334 |
2.0× |
| Us thyroid (76536) |
$667.80 |
$1,113 |
6.5× |
| Vein X-Ray Chest (75827) |
$636.60 |
$1,061 |
0.4× |
| Venogram Sinus/Jugular (75860) |
$638.40 |
$1,064 |
0.2× |
| Venography caval inferior serialography rs&i (75825) |
$1,989.60 |
$3,316 |
0.6× |
| Venography extremity bilateral rs&i (75822) |
$1,149 |
$1,915 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$820.80 |
$1,368 |
0.5× |
| Wrist 2 views (73100) |
$262.20 |
$437 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$219.60 |
$366 |
2.6× |
| X-ray antegrade pyelogram tube (74425) |
$1,590 |
$2,650 |
4.6× |
| X-Ray Aorta Leg Arteries (75630) |
$3,206.40 |
$5,344 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$469.20 |
$782 |
4.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$273 |
$455 |
3.2× |
| X-Ray Exam Breast Specimen (76098) |
$410.40 |
$684 |
0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$152.40 |
$254 |
1.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$230.40 |
$384 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$81 |
$135 |
0.9× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$89.40 |
$149 |
0.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$81 |
$135 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$86.40 |
$144 |
0.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$170.40 |
$284 |
1.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$726 |
$1,210 |
7.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$544.20 |
$907 |
6.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$680.40 |
$1,134 |
6.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$476.40 |
$794 |
4.6× |
| X-ray eye for foreign body (70030) |
$44.40 |
$74 |
0.5× |
| X-ray humerus (73060) |
$228 |
$380 |
2.7× |
| X-ray IV pyelogram (ivp) (74400) |
$3,163.80 |
$5,273 |
18.4× |
| X-ray IV pyelogram+tomography (74415) |
$957 |
$1,595 |
5.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$159 |
$265 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$392.40 |
$654 |
4.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$408 |
$680 |
4.0× |
| X-ray nose-rectum child f.b. (76010) |
$72 |
$120 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$619.20 |
$1,032 |
6.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$307.20 |
$512 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$265.20 |
$442 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$273.60 |
$456 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$381 |
$635 |
3.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,622.40 |
$2,704 |
4.7× |
| X-Rays Bone Length Studies (77073) |
$44.40 |
$74 |
0.4× |
| X-Rays Bone Survey Complete (77075) |
$253.20 |
$422 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$533.40 |
$889 |
5.2× |
| Xr facial bones less than 3 views (70140) |
$264.60 |
$441 |
3.1× |
| Xr orbits complete 4 views (70200) |
$253.80 |
$423 |
2.5× |