| Abdomen 2 views (74019) |
$232 |
$400 |
2.2× |
| Acute gi blood loss imaging (78278) |
$687.30 |
$1,185 |
1.7× |
| Angiography extremity unilateral rs&i (75710) |
$3,636.60 |
$6,270 |
1.1× |
| Ankle 2 views (73600) |
$161.24 |
$278 |
1.8× |
| Arthrogram hip (73525) |
$628.72 |
$1,084 |
1.7× |
| Arthrogram knee (73580) |
$803.30 |
$1,385 |
2.2× |
| Arthrogram shoulder (73040) |
$671.64 |
$1,158 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$672.22 |
$1,159 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$675.12 |
$1,164 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$694.84 |
$1,198 |
1.7× |
| Bone age studies (77072) |
$178.06 |
$307 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$790.54 |
$1,363 |
1.9× |
| Bone Marrow Imaging Limited Area (78102) |
$496.48 |
$856 |
1.2× |
| Bone survey complete (77075) |
$355.54 |
$613 |
3.3× |
| Bone survey infant (77076) |
$134.56 |
$232 |
1.2× |
| Bowel imaging (78290) |
$672.22 |
$1,159 |
1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$455.88 |
$786 |
0.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,450.50 |
$4,225 |
1.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$875.22 |
$1,509 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$245.92 |
$424 |
2.7× |
| Chest 1 view (71045) |
$182.70 |
$315 |
2.0× |
| Chest xray 3 views (71047) |
$241.28 |
$416 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$349.74 |
$603 |
1.9× |
| Clavicle complete (73000) |
$161.24 |
$278 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$303.34 |
$523 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,285.28 |
$2,216 |
3.6× |
| CT abdomen and pelvis without contrast (74176) |
$938.44 |
$1,618 |
3.8× |
| CT abdomen w contrast (74160) |
$1,032.98 |
$1,781 |
5.7× |
| CT abdomen w wo contrast (74170) |
$1,245.26 |
$2,147 |
6.9× |
| CT abdomen w/o contrast (74150) |
$790.54 |
$1,363 |
7.3× |
| CT angio hrt w/3d image (75574) |
$624.08 |
$1,076 |
1.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$796.34 |
$1,373 |
4.4× |
| CT angiography upper extremity lt (73206) |
$422.82 |
$729 |
2.3× |
| CT c-spine w/contrast (72126) |
$1,358.94 |
$2,343 |
3.8× |
| CT c-spine w/o contrast (72125) |
$1,031.82 |
$1,779 |
9.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,804.96 |
$3,112 |
10.0× |
| CT chest w contrast (71260) |
$1,057.92 |
$1,824 |
5.8× |
| CT chest w/wo contrast (71270) |
$1,245.26 |
$2,147 |
6.9× |
| CT colonography screening (74263) |
$1,107.22 |
$1,909 |
4.5× |
| CT colonography w/o cntrst (74261) |
$947.14 |
$1,633 |
8.8× |
| CT head/brain with contrast (70460) |
$1,121.72 |
$1,934 |
6.2× |
| CT head/brain without and with contrast (70470) |
$1,290.50 |
$2,225 |
7.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,032.98 |
$1,781 |
2.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$149.06 |
$257 |
1.7× |
| CT iac w contrast (70481) |
$1,103.16 |
$1,902 |
6.1× |
| CT limited/localized follow up study (76380) |
$435 |
$750 |
4.8× |
| CT lower ext w/o (73700) |
$773.14 |
$1,333 |
7.2× |
| CT lower extremity w wo contrast (73702) |
$1,126.94 |
$1,943 |
6.2× |
| CT lower extremity w/contrast material (73701) |
$1,001.66 |
$1,727 |
5.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,420.42 |
$2,449 |
7.8× |
| CT lumbar spine w/contrast (72132) |
$1,144.92 |
$1,974 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$851.44 |
$1,468 |
7.9× |
| CT maxillofacial w contrast (70487) |
$1,141.44 |
$1,968 |
6.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,171.60 |
$2,020 |
6.5× |
| CT maxillofacial wo contrast (70486) |
$1,102.58 |
$1,901 |
10.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,309.64 |
$2,258 |
7.2× |
| CT orbits w/o contrast (70480) |
$759.22 |
$1,309 |
7.0× |
| CT pelvis w/o contrast (72192) |
$821.28 |
$1,416 |
7.6× |
| CT pelvis w/wo contrast (72194) |
$1,126.94 |
$1,943 |
6.2× |
| CT scan of arm combo (73202) |
$1,061.98 |
$1,831 |
5.9× |
| CT soft tissue neck w contrast (70491) |
$1,103.16 |
$1,902 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,350.82 |
$2,329 |
7.5× |
| CT soft tissue neck w/o contrast (70490) |
$832.88 |
$1,436 |
7.7× |
| CT thoracic spine w/contrast (72129) |
$1,175.66 |
$2,027 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$1,062.56 |
$1,832 |
9.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,738.84 |
$2,998 |
9.6× |
| CT thorax w/o contrast (71250) |
$939.60 |
$1,620 |
8.7× |
| CT upper ext wo (73200) |
$744.14 |
$1,283 |
6.9× |
| CT upper extremity with contrast (73201) |
$923.36 |
$1,592 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$796.34 |
$1,373 |
4.4× |
| Cta Abdomen (74175) |
$796.34 |
$1,373 |
4.4× |
| CTA abdomen pelvis (74174) |
$939.60 |
$1,620 |
2.6× |
| CTA chest (71275) |
$1,032.98 |
$1,781 |
5.7× |
| Cta Head (70496) |
$937.28 |
$1,616 |
5.2× |
| Cta Neck (70498) |
$937.28 |
$1,616 |
5.2× |
| Cta Pelvis (72191) |
$1,042.26 |
$1,797 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$575.36 |
$992 |
1.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,633.86 |
$2,817 |
0.8× |
| Diskogram cervical (72285) |
$1,987.08 |
$3,426 |
1.0× |
| Diskography lumbar (72295) |
$2,291 |
$3,950 |
1.1× |
| Esophagus (74220) |
$437.90 |
$755 |
2.4× |
| Facial bones min 3 views (70150) |
$313.78 |
$541 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$179.22 |
$309 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$435 |
$750 |
1.8× |
| Foot 2 views (73620) |
$143.26 |
$247 |
1.6× |
| Forearm 2 views (73090) |
$169.94 |
$293 |
1.9× |
| Hand 2 views (73120) |
$169.94 |
$293 |
1.6× |
| Heart Infarct Image (78466) |
$529.54 |
$913 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$859.56 |
$1,482 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$758.06 |
$1,307 |
1.8× |
| Hysterosalpingogram (74740) |
$584.64 |
$1,008 |
2.4× |
| Interstitial radiation source applic complex (77778) |
$546.36 |
$942 |
0.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$179.22 |
$309 |
1.7× |
| Kidney imaging morphology (78700) |
$451.24 |
$778 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$730.80 |
$1,260 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$749.94 |
$1,293 |
1.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$820.70 |
$1,415 |
1.5× |
| Knee 3 views (73562) |
$232.58 |
$401 |
2.6× |
| Liver & spleen imaging static only (78215) |
$654.82 |
$1,129 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$710.50 |
$1,225 |
1.7× |
| Liver imaging static only (78201) |
$1,147.24 |
$1,978 |
2.0× |
| Liver imaging w/vascular flow (78202) |
$1,295.72 |
$2,234 |
2.3× |
| Lung ventilation imaging (78579) |
$475.02 |
$819 |
1.2× |
| Lymphoscintigraphy (78195) |
$790.54 |
$1,363 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,851.94 |
$3,193 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,662.86 |
$2,867 |
4.6× |
| Mammary ductogram or galactogram multiple (77054) |
$522 |
$900 |
2.1× |
| Mammary ductogram or galactogram single (77053) |
$233.74 |
$403 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,662.86 |
$2,867 |
4.6× |
| MRA head w/o contrast (70544) |
$1,647.78 |
$2,841 |
6.7× |
| MRA neck w contrast (70548) |
$1,647.78 |
$2,841 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,662.86 |
$2,867 |
4.6× |
| MRA neck w/o contrast (70547) |
$1,575.86 |
$2,717 |
6.4× |
| MRI abdomen w contrast (74182) |
$1,662.86 |
$2,867 |
4.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,750.44 |
$3,018 |
4.9× |
| MRI abdomen w/o contrast (74181) |
$1,647.78 |
$2,841 |
6.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,851.94 |
$3,193 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,150.64 |
$3,708 |
6.0× |
| MRI breast w/o contrast bilateral (77047) |
$1,869.34 |
$3,223 |
7.6× |
| MRI c-spine with contrast (72142) |
$1,662.86 |
$2,867 |
4.6× |
| MRI cervical spine w/o contrast (72141) |
$1,615.88 |
$2,786 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,851.94 |
$3,193 |
5.1× |
| MRI chest w/o contrast (71550) |
$1,662.86 |
$2,867 |
6.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,672.72 |
$2,884 |
4.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,851.94 |
$3,193 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,568.90 |
$2,705 |
6.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$986 |
$1,700 |
4.0× |
| MRI orbit face neck w contrast (70542) |
$1,353.72 |
$2,334 |
3.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,530.04 |
$2,638 |
4.2× |
| MRI pelvis w/contrast (72196) |
$1,732.46 |
$2,987 |
4.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,911.68 |
$3,296 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,615.88 |
$2,786 |
6.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,750.44 |
$3,018 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,732.46 |
$2,987 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,911.68 |
$3,296 |
5.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,662.86 |
$2,867 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,858.90 |
$3,205 |
5.2× |
| MRI temporomandibular joint (70336) |
$1,606.02 |
$2,769 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,615.88 |
$2,786 |
6.6× |
| MRI up ext w/o contrast (73218) |
$1,568.90 |
$2,705 |
6.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,537 |
$2,650 |
6.2× |
| MRI, joint upper extrem combo (73223) |
$2,150.64 |
$3,708 |
6.0× |
| Myelogram Cervical (72240) |
$1,272.52 |
$2,194 |
1.6× |
| Myelogram Lumbar (72265) |
$1,256.28 |
$2,166 |
1.6× |
| Myelogram thoracic (72255) |
$1,266.14 |
$2,183 |
1.6× |
| Myelography 2 or more regions (72270) |
$1,602.54 |
$2,763 |
2.0× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$975.56 |
$1,682 |
0.7× |
| Myocardial infarct spect (78469) |
$1,211.04 |
$2,088 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,103.66 |
$3,627 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$1,292.24 |
$2,228 |
1.0× |
| Neck soft tissue (70360) |
$153.12 |
$264 |
1.7× |
| Nm bone marrow multi (78103) |
$561.44 |
$968 |
1.4× |
| Nm bone marrow wb (78104) |
$654.82 |
$1,129 |
1.6× |
| Nm cisternogram (78630) |
$1,025.44 |
$1,768 |
1.8× |
| Nm gastric emptying study (78264) |
$687.30 |
$1,185 |
1.7× |
| Nm kidney scan w/flow (78701) |
$679.76 |
$1,172 |
1.6× |
| Noncardiac Vascular Flow Imaging (78445) |
$676.28 |
$1,166 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$647.28 |
$1,116 |
2.7× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$176.03 |
$303.50 |
1.6× |
| Osseous survey limited (77074) |
$196.62 |
$339 |
1.8× |
| Parathyrd planar w/spect&CT (78072) |
$744.14 |
$1,283 |
1.3× |
| Parathyroid Planar Imaging (78070) |
$664.68 |
$1,146 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$687.30 |
$1,185 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$194.30 |
$335 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$4,179.48 |
$7,206 |
2.8× |
| PET imaging for CT attenuation whole body (78816) |
$4,307.66 |
$7,427 |
2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$467.48 |
$806 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,135.06 |
$1,957 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$495.90 |
$855 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$189.66 |
$327 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$143.26 |
$247 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$215.18 |
$371 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$153.12 |
$264 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$194.30 |
$335 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$241.28 |
$416 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$133.40 |
$230 |
1.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$161.24 |
$278 |
1.8× |
| Radex Hand Minimum 3 Views (73130) |
$184.44 |
$318 |
2.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$134.56 |
$232 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$325.38 |
$561 |
3.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$176.90 |
$305 |
1.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$318.42 |
$549 |
3.0× |
| Radex Humerus Minimum 2 Views (73060) |
$187.92 |
$324 |
2.1× |
| Radex Kne 1/2 Views (73560) |
$161.24 |
$278 |
1.8× |
| Radex Kne Compl 4/More Views (73564) |
$267.96 |
$462 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$302.18 |
$521 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$236.64 |
$408 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$207.64 |
$358 |
1.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$187.92 |
$324 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$185.60 |
$320 |
2.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$178.06 |
$307 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$273.18 |
$471 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$137.46 |
$237 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$143.55 |
$247.50 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$179.22 |
$309 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$267.96 |
$462 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$169.94 |
$293 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$308.56 |
$532 |
2.9× |
| Radiologic exam chest 2 views (71046) |
$214.02 |
$369 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$495.90 |
$855 |
2.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$437.90 |
$755 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$587.54 |
$1,013 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$540.56 |
$932 |
3.0× |
| Radiologic examination femur 1 view (73551) |
$147.32 |
$254 |
1.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$187.92 |
$324 |
2.1× |
| Radiological examination surgical specimen (76098) |
$491.84 |
$848 |
0.9× |
| Ribs bilateral 3 views (71110) |
$178.06 |
$307 |
1.7× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$989.48 |
$1,706 |
2.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,031.16 |
$3,502 |
3.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,914 |
$3,300 |
3.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,957.50 |
$3,375 |
3.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,239.38 |
$3,861 |
1.7× |
| Rp Therapy Intravenous Administration (79101) |
$640.90 |
$1,105 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$205.90 |
$355 |
1.9× |
| Scapula (73010) |
$196.62 |
$339 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$87 |
$150 |
3.7× |
| Shoulder 1 view (73020) |
$176.32 |
$304 |
2.0× |
| Small bowel series (74250) |
$451.82 |
$779 |
2.5× |
| Special dosimetry (77331) |
$136.88 |
$236 |
1.0× |
| Special Physics Consult (77370) |
$120.64 |
$208 |
0.9× |
| Special treatment procedure (77470) |
$710.50 |
$1,225 |
1.2× |
| Spine thoracic 3 views (72072) |
$217.50 |
$375 |
2.0× |
| Thoracolumbar 2 views (72080) |
$256.36 |
$442 |
2.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$852.02 |
$1,469 |
1.5× |
| Thyroid imaging w/blood flow (78013) |
$343.36 |
$592 |
0.8× |
| Thyroid uptake measurement (78012) |
$285.94 |
$493 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$870.58 |
$1,501 |
2.1× |
| Tmj unilateral (70328) |
$193.14 |
$333 |
2.2× |
| Tomogram (76100) |
$328.86 |
$567 |
3.0× |
| Treatment devices simple (77332) |
$254.04 |
$438 |
1.8× |
| Ultrasound breast complete (76641) |
$302.18 |
$521 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$194.01 |
$334.50 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$234.32 |
$404 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$161.24 |
$278 |
1.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$143.26 |
$247 |
1.6× |
| Unlisted ultrasound procedure (76999) |
$248.82 |
$429 |
2.8× |
| Ureteral reflux study (78740) |
$480.82 |
$829 |
1.2× |
| Urethrocystogram voiding (74455) |
$646.12 |
$1,114 |
2.6× |
| Urethrocystography retrograde rs&i (74450) |
$591.02 |
$1,019 |
2.4× |
| Us breast unilateral limited (76642) |
$171.68 |
$296 |
1.9× |
| Us chest (76604) |
$280.14 |
$483 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$401.94 |
$693 |
3.7× |
| Us encephalogram (76506) |
$251.14 |
$433 |
2.3× |
| Us hips infant static (76886) |
$244.76 |
$422 |
2.7× |
| Us infant hips w manipulation (76885) |
$244.76 |
$422 |
2.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$326.54 |
$563 |
3.0× |
| Us ob limited (76815) |
$205.90 |
$355 |
1.9× |
| Us ob transvaginal (76817) |
$173.13 |
$298.50 |
1.6× |
| Us pelvic non ob complete (76856) |
$400.20 |
$690 |
3.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$365.98 |
$631 |
3.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$267.38 |
$461 |
2.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$179.22 |
$309 |
1.7× |
| Us retroperitoneal complete (76770) |
$381.64 |
$658 |
3.5× |
| Us retroperitoneal limited (76775) |
$336.98 |
$581 |
3.1× |
| Us scrotum and contents (76870) |
$346.84 |
$598 |
3.2× |
| Us soft tissue head/neck (76536) |
$284.78 |
$491 |
2.6× |
| Us spinal canal and contents (76800) |
$311.46 |
$537 |
2.9× |
| Us transrectal (76872) |
$454.14 |
$783 |
4.2× |
| Us transrectal prostate volume (76873) |
$307.98 |
$531 |
2.9× |
| Us, eye b-scan (76512) |
$174.29 |
$300.50 |
1.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$400.20 |
$690 |
3.7× |
| Wrist 2 views (73100) |
$150.22 |
$259 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$373.52 |
$644 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$161.24 |
$278 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$718.04 |
$1,238 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$143.26 |
$247 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$215.18 |
$371 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$196.04 |
$338 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$179.22 |
$309 |
2.0× |
| X-ray eye for foreign body (70030) |
$180.38 |
$311 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$218.66 |
$377 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$597.98 |
$1,031 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$218.66 |
$377 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$204.16 |
$352 |
2.3× |
| X-ray leg, infant (73592) |
$143.26 |
$247 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$161.24 |
$278 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$254.62 |
$439 |
2.4× |
| X-ray nose-rectum child f.b. (76010) |
$143.26 |
$247 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$302.76 |
$522 |
2.8× |
| X-ray retrograde pyelogram (74420) |
$725.58 |
$1,251 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$124.12 |
$214 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$308.56 |
$532 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$313.78 |
$541 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$252.30 |
$435 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$201.84 |
$348 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$294.06 |
$507 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$241.28 |
$416 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$196.62 |
$339 |
1.8× |
| X-Ray Small Bowel Enteroclysis (74251) |
$783 |
$1,350 |
4.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$187.92 |
$324 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$161.24 |
$278 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$196.62 |
$339 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$210.54 |
$363 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$233.74 |
$403 |
2.2× |
| Xr bone length studies (77073) |
$179.22 |
$309 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$249.40 |
$430 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$253.46 |
$437 |
2.3× |
| Xr chest 4+ views (71048) |
$285.94 |
$493 |
2.7× |
| Xr urogram antegrade (74425) |
$636.26 |
$1,097 |
1.8× |