| 3-D radiotherapy plan dose-volume histograms (77295) |
$2,001.50 |
$4,003 |
1.5× |
| Abdomen 2 views (74019) |
$183.25 |
$366.50 |
1.8× |
| Acute gi blood loss imaging (78278) |
$1,030 |
$2,060 |
2.7× |
| Angiography extremity bilateral rs&i (75716) |
$1,528.50 |
$3,057 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,714 |
$3,428 |
0.6× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,253 |
$4,506 |
0.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,841.50 |
$9,683 |
0.9× |
| Ankle 2 views (73600) |
$172.50 |
$345 |
2.0× |
| Aortography abdominal serialography rs&i (75625) |
$1,407.50 |
$2,815 |
0.5× |
| Basic dosimetry (77300) |
$844.50 |
$1,689 |
6.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$842.50 |
$1,685 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$1,237.75 |
$2,475.50 |
3.2× |
| Bone age studies (77072) |
$155.75 |
$311.50 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,283.50 |
$2,567 |
3.3× |
| Bone survey complete (77075) |
$399.25 |
$798.50 |
3.9× |
| Bone survey infant (77076) |
$572 |
$1,144 |
5.7× |
| Bowel imaging (78290) |
$2,033.50 |
$4,067 |
5.3× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$662 |
$1,324 |
1.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,643.50 |
$3,287 |
1.2× |
| Brain Imaging Vascular Flow Only (78610) |
$312.50 |
$625 |
0.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$459.50 |
$919 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$741.50 |
$1,483 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$181.50 |
$363 |
2.2× |
| Chest 1 view (71045) |
$143 |
$286 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$417.25 |
$834.50 |
2.5× |
| Clavicle complete (73000) |
$180 |
$360 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| Continuing medical physics consltj pr wk (77336) |
$307 |
$614 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,842.50 |
$3,685 |
5.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,374.25 |
$2,748.50 |
6.0× |
| CT abdomen w contrast (74160) |
$1,099.50 |
$2,199 |
6.5× |
| CT abdomen w wo contrast (74170) |
$1,285 |
$2,570 |
7.6× |
| CT abdomen w/o contrast (74150) |
$810.50 |
$1,621 |
8.0× |
| CT angio hrt w/3d image (75574) |
$1,147.75 |
$2,295.50 |
3.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$435.50 |
$871 |
2.6× |
| CT angiography upper extremity lt (73206) |
$593 |
$1,186 |
3.5× |
| CT c-spine w/contrast (72126) |
$1,410 |
$2,820 |
4.2× |
| CT c-spine w/o contrast (72125) |
$900 |
$1,800 |
8.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,445.50 |
$2,891 |
8.5× |
| CT chest w contrast (71260) |
$1,058.50 |
$2,117 |
6.2× |
| CT chest w/wo contrast (71270) |
$1,304 |
$2,608 |
7.7× |
| CT head/brain with contrast (70460) |
$666.50 |
$1,333 |
3.9× |
| CT head/brain without and with contrast (70470) |
$1,237.25 |
$2,474.50 |
7.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$828 |
$1,656 |
2.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT iac w contrast (70481) |
$1,390.25 |
$2,780.50 |
8.2× |
| CT limited/localized follow up study (76380) |
$265 |
$530 |
3.1× |
| CT lower ext w/o (73700) |
$796 |
$1,592 |
7.9× |
| CT lower extremity w wo contrast (73702) |
$658.50 |
$1,317 |
3.9× |
| CT lower extremity w/contrast material (73701) |
$1,082.50 |
$2,165 |
6.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,504.75 |
$3,009.50 |
8.9× |
| CT lumbar spine w/contrast (72132) |
$1,353 |
$2,706 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$848.25 |
$1,696.50 |
8.4× |
| CT maxillofacial w contrast (70487) |
$1,096.25 |
$2,192.50 |
6.5× |
| CT maxillofacial w/wo contrast (70488) |
$955.50 |
$1,911 |
5.6× |
| CT maxillofacial wo contrast (70486) |
$830.75 |
$1,661.50 |
8.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,420 |
$2,840 |
8.4× |
| CT orbits w/o contrast (70480) |
$902.50 |
$1,805 |
8.9× |
| CT pelvis w/o contrast (72192) |
$811.50 |
$1,623 |
8.0× |
| CT pelvis w/wo contrast (72194) |
$1,207 |
$2,414 |
7.1× |
| CT scan of arm combo (73202) |
$629.50 |
$1,259 |
3.7× |
| CT soft tissue neck w contrast (70491) |
$1,119 |
$2,238 |
6.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,250.75 |
$2,501.50 |
7.4× |
| CT soft tissue neck w/o contrast (70490) |
$867.25 |
$1,734.50 |
8.6× |
| CT thoracic spine w/contrast (72129) |
$1,168 |
$2,336 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$867.50 |
$1,735 |
8.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,336 |
$2,672 |
7.9× |
| CT thorax w/o contrast (71250) |
$802.25 |
$1,604.50 |
7.9× |
| CT upper ext wo (73200) |
$772 |
$1,544 |
7.6× |
| CT upper extremity with contrast (73201) |
$1,166.50 |
$2,333 |
3.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,584.75 |
$3,169.50 |
9.3× |
| Cta Abdomen (74175) |
$1,254.50 |
$2,509 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,930.25 |
$3,860.50 |
5.7× |
| CTA chest (71275) |
$1,321.50 |
$2,643 |
7.8× |
| Cta Head (70496) |
$1,327 |
$2,654 |
7.8× |
| Cta Neck (70498) |
$1,291.50 |
$2,583 |
7.6× |
| Cystography minimum 3 views rs&i (74430) |
$221.50 |
$443 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$92.50 |
$185 |
0.9× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$97 |
$194 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$91.50 |
$183 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$340 |
$680 |
3.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$83.50 |
$167 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$122.50 |
$245 |
1.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$195.50 |
$391 |
0.8× |
| Esophagus (74220) |
$332.25 |
$664.50 |
2.0× |
| Facial bones min 3 views (70150) |
$380 |
$760 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$441.50 |
$883 |
4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$304.50 |
$609 |
3.0× |
| Fetal Echo (76825) |
$429.50 |
$859 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$294 |
$588 |
1.3× |
| Foot 2 views (73620) |
$228.75 |
$457.50 |
2.7× |
| Forearm 2 views (73090) |
$159.25 |
$318.50 |
1.9× |
| Hand 2 views (73120) |
$281 |
$562 |
2.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,706 |
$3,412 |
2.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,179 |
$2,358 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,054.25 |
$2,108.50 |
2.7× |
| Hysterosalpingogram (74740) |
$1,856 |
$3,712 |
8.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$277.50 |
$555 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,109 |
$2,218 |
2.1× |
| Knee 3 views (73562) |
$234 |
$468 |
2.8× |
| Lung perf&ventilat diferentl (78598) |
$829 |
$1,658 |
1.6× |
| Lung perfusion differential (78597) |
$998.50 |
$1,997 |
2.6× |
| Lymphoscintigraphy (78195) |
$862.25 |
$1,724.50 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,706 |
$3,412 |
2.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,994.25 |
$5,988.50 |
8.9× |
| Mlc imrt design & construction per imrt plan (77338) |
$800.75 |
$1,601.50 |
2.2× |
| Mr safety determination physician/other qhp (76016) |
$272 |
$544 |
3.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$27.50 |
$55 |
1.0× |
| Mr safety implt pos&/immoblj (76019) |
$67 |
$134 |
1.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$122 |
$244 |
0.5× |
| MRA head w & w/o contrast (70546) |
$2,299 |
$4,598 |
6.8× |
| MRA head w/o contrast (70544) |
$1,441.25 |
$2,882.50 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,858 |
$3,716 |
5.5× |
| MRA neck w/o contrast (70547) |
$1,498.25 |
$2,996.50 |
6.5× |
| MRI abdomen w contrast (74182) |
$910 |
$1,820 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,825.75 |
$3,651.50 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$1,427 |
$2,854 |
6.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,794 |
$3,588 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,446 |
$6,892 |
10.2× |
| MRI breast w/o contrast bilateral (77047) |
$934.50 |
$1,869 |
4.0× |
| MRI c-spine with contrast (72142) |
$2,028 |
$4,056 |
6.0× |
| MRI cardiac w/o contrast (75557) |
$334.50 |
$669 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$1,524.75 |
$3,049.50 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,168.50 |
$4,337 |
6.4× |
| MRI chest w/o contrast (71550) |
$1,607.50 |
$3,215 |
7.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,760 |
$3,520 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,376 |
$2,752 |
6.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,735.50 |
$3,471 |
7.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,155.75 |
$4,311.50 |
6.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,591.25 |
$5,182.50 |
7.7× |
| MRI pelvis w/o contrast (72195) |
$1,893 |
$3,786 |
8.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,689.25 |
$3,378.50 |
5.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,522 |
$3,044 |
4.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,956.25 |
$3,912.50 |
5.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,126.50 |
$4,253 |
6.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,111 |
$4,222 |
6.3× |
| MRI temporomandibular joint (70336) |
$2,198 |
$4,396 |
9.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,499.50 |
$2,999 |
6.5× |
| MRI up ext w/o contrast (73218) |
$1,242.50 |
$2,485 |
5.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,474 |
$2,948 |
6.4× |
| MRI, joint upper extrem combo (73223) |
$2,813.25 |
$5,626.50 |
8.3× |
| Myocardial Spect Multiple Studies (78452) |
$3,011 |
$6,022 |
2.4× |
| N-invas est c ffr sw aly CTA (75580) |
$3,296 |
$6,592 |
4.0× |
| Neck soft tissue (70360) |
$172 |
$344 |
2.0× |
| Nm gastric emptying study (78264) |
$1,074.25 |
$2,148.50 |
2.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$224.50 |
$449 |
0.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$2,753.50 |
$5,507 |
2.1× |
| Nuclear Rx Oral Admin (79005) |
$554.75 |
$1,109.50 |
2.5× |
| Ob us nuchal meas 1 gest (76813) |
$461.50 |
$923 |
4.6× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$238 |
$476 |
2.4× |
| Orthopantogram (70355) |
$186 |
$372 |
2.2× |
| Parathyrd planar w/spect&CT (78072) |
$883 |
$1,766 |
1.7× |
| Parathyroid Planar Imaging (78070) |
$849.75 |
$1,699.50 |
2.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$494 |
$988 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$171 |
$342 |
1.7× |
| PET image w/CT, skull-thigh (78815) |
$5,010.25 |
$10,020.50 |
3.6× |
| PET imaging for CT attenuation whole body (78816) |
$5,511 |
$11,022 |
4.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$816.50 |
$1,633 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,253 |
$2,506 |
2.4× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,069.50 |
$2,139 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$277.25 |
$554.50 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$193 |
$386 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$172 |
$344 |
2.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$183.50 |
$367 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$257.25 |
$514.50 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$324.75 |
$649.50 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$158.50 |
$317 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$186.50 |
$373 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$245.50 |
$491 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$160.50 |
$321 |
1.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$125.75 |
$251.50 |
1.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$415 |
$830 |
4.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$365 |
$730 |
3.6× |
| Radex Humerus Minimum 2 Views (73060) |
$238 |
$476 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$161 |
$322 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$420.25 |
$840.50 |
4.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$232.75 |
$465.50 |
2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$189.75 |
$379.50 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$214.75 |
$429.50 |
2.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$175 |
$350 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$137.75 |
$275.50 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$250.50 |
$501 |
2.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$417 |
$834 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$151 |
$302 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$246 |
$492 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$173.50 |
$347 |
2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$370 |
$740 |
3.7× |
| Radiation treatment delivery level 1 (77402) |
$1,347 |
$2,694 |
13.6× |
| Radiation treatment delivery level 2 (77407) |
$2,020.50 |
$4,041 |
5.4× |
| Radiation treatment delivery level 3 (77412) |
$1,051.25 |
$2,102.50 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$198.50 |
$397 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$182.50 |
$365 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$180 |
$360 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$437.25 |
$874.50 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$209 |
$418 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,670.50 |
$3,341 |
9.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$417.50 |
$835 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$123.75 |
$247.50 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$170 |
$340 |
2.0× |
| Radiological examination surgical specimen (76098) |
$382.50 |
$765 |
0.7× |
| Ribs bilateral 3 views (71110) |
$324 |
$648 |
3.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,919 |
$3,838 |
3.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,063 |
$2,126 |
2.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,410 |
$4,820 |
1.9× |
| Scapula (73010) |
$214.25 |
$428.50 |
2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$52 |
$104 |
2.2× |
| Shoulder 1 view (73020) |
$151.75 |
$303.50 |
1.8× |
| Small bowel series (74250) |
$364 |
$728 |
2.1× |
| Special dosimetry (77331) |
$436 |
$872 |
3.4× |
| Special Physics Consult (77370) |
$398.25 |
$796.50 |
3.1× |
| Special treatment procedure (77470) |
$1,040 |
$2,080 |
1.9× |
| Spine thoracic 3 views (72072) |
$226.25 |
$452.50 |
2.2× |
| Stereotactic Body Radiation Delivery (77373) |
$2,443.75 |
$4,887.50 |
1.4× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$1,348.50 |
$2,697 |
3.7× |
| Ther rad simulaj-aided field setting complex (77290) |
$984.75 |
$1,969.50 |
2.7× |
| Ther rad simulaj-aided field setting simple (77280) |
$650 |
$1,300 |
5.0× |
| Thoracolumbar 2 views (72080) |
$214.50 |
$429 |
2.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,120.50 |
$2,241 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$843.75 |
$1,687.50 |
2.2× |
| Treatment device complex (77334) |
$846 |
$1,692 |
2.3× |
| Treatment device intermediate (77333) |
$615.50 |
$1,231 |
4.7× |
| Treatment devices simple (77332) |
$551.50 |
$1,103 |
4.2× |
| Ultrasound breast complete (76641) |
$488 |
$976 |
4.8× |
| Ultrasound Exam Aaa Screen (76706) |
$348 |
$696 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$405.50 |
$811 |
4.0× |
| Umbilical-artery Doppler (OB) (76820) |
$187 |
$374 |
1.8× |
| Urethrocystogram voiding (74455) |
$666 |
$1,332 |
2.9× |
| Us breast unilateral limited (76642) |
$231.50 |
$463 |
2.8× |
| Us chest (76604) |
$220.50 |
$441 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$201.50 |
$403 |
2.0× |
| Us elastography parenchyma (76981) |
$131 |
$262 |
1.3× |
| Us encephalogram (76506) |
$462 |
$924 |
4.6× |
| Us infant hips w manipulation (76885) |
$305.50 |
$611 |
3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$369.75 |
$739.50 |
3.7× |
| Us ob detailed single fetus (76811) |
$224.25 |
$448.50 |
1.0× |
| Us ob limited (76815) |
$253.50 |
$507 |
2.5× |
| Us ob transvaginal (76817) |
$250.50 |
$501 |
2.5× |
| Us pelvic non ob complete (76856) |
$490.25 |
$980.50 |
4.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$326 |
$652 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$284 |
$568 |
2.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$367.50 |
$735 |
3.6× |
| Us retroperitoneal complete (76770) |
$529 |
$1,058 |
5.2× |
| Us retroperitoneal limited (76775) |
$429 |
$858 |
4.2× |
| Us scrotum and contents (76870) |
$491 |
$982 |
4.9× |
| Us soft tissue head/neck (76536) |
$610 |
$1,220 |
6.0× |
| Us spinal canal and contents (76800) |
$124.75 |
$249.50 |
1.2× |
| Us transrectal (76872) |
$155.50 |
$311 |
1.5× |
| Us, eye b-scan (76512) |
$292.50 |
$585 |
2.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$328 |
$656 |
3.2× |
| Venogram extremity bilateral (75822) |
$804.50 |
$1,609 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$669.25 |
$1,338.50 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,273.50 |
$2,547 |
0.4× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,629 |
$7,258 |
1.2× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$1,761.50 |
$3,523 |
0.3× |
| Wrist 2 views (73100) |
$163 |
$326 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$324.75 |
$649.50 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$211.75 |
$423.50 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$567.50 |
$1,135 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$172 |
$344 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$212.50 |
$425 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$397.50 |
$795 |
3.9× |
| X-ray exam of femur 2/> (73552) |
$225 |
$450 |
2.7× |
| X-ray eye for foreign body (70030) |
$191.50 |
$383 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$287.75 |
$575.50 |
3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$190.75 |
$381.50 |
2.3× |
| X-ray leg, infant (73592) |
$201 |
$402 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$241.50 |
$483 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$337.50 |
$675 |
3.3× |
| X-ray nose-rectum child f.b. (76010) |
$827.75 |
$1,655.50 |
9.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$305.50 |
$611 |
3.0× |
| X-ray retrograde pyelogram (74420) |
$551.50 |
$1,103 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$166.25 |
$332.50 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$255.75 |
$511.50 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$349.25 |
$698.50 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$165.50 |
$331 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$193.50 |
$387 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$240 |
$480 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$346.50 |
$693 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$171.75 |
$343.50 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$145.50 |
$291 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$124.50 |
$249 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$175 |
$350 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$222.75 |
$445.50 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$357.75 |
$715.50 |
3.5× |
| Xr bone length studies (77073) |
$271.50 |
$543 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$295.25 |
$590.50 |
2.9× |
| Xr c-spine 6 or more views (72052) |
$339 |
$678 |
3.4× |
| Xr chest 4+ views (71048) |
$120 |
$240 |
1.2× |
| Xr urogram antegrade (74425) |
$389.50 |
$779 |
1.2× |