| Abdomen 2 views (74019) |
$121.37 |
$229 |
1.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$615.12 |
$1,165 |
1.4× |
| Angiography extremity bilateral rs&i (75716) |
$505.17 |
$893 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$471.23 |
$833 |
0.1× |
| Ankle 2 views (73600) |
$94.34 |
$178 |
1.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$246.98 |
$466 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$471.23 |
$833 |
0.1× |
| Aortography abdominal serialography rs&i (75625) |
$2,923.54 |
$5,168 |
0.9× |
| Arthrogram elbow (73085) |
$339.48 |
$492 |
0.9× |
| Arthrogram hip (73525) |
$403.65 |
$585 |
1.1× |
| Arthrogram shoulder (73040) |
$316.02 |
$458 |
0.8× |
| Arthrogram wrist (73115) |
$210.45 |
$305 |
0.6× |
| Arthrography knee lt (73580) |
$289.11 |
$419 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$467.81 |
$886 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$615.12 |
$1,165 |
1.4× |
| Bone age studies (77072) |
$104.41 |
$197 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$706.99 |
$1,339 |
1.7× |
| Bone Marrow Imaging Limited Area (78102) |
$784.61 |
$1,486 |
1.8× |
| Bone survey complete (77075) |
$131.44 |
$248 |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$227.57 |
$431 |
0.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,151.79 |
$4,924 |
1.4× |
| Brain Imaging Vascular Flow Only (78610) |
$221.23 |
$419 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$120.84 |
$228 |
1.3× |
| Chest 1 view (71045) |
$92.52 |
$180 |
1.0× |
| Chest 3 views (71047) |
$129.01 |
$251 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$154.23 |
$291 |
0.8× |
| Cineradiography/videoradiography (76120) |
$355.63 |
$671 |
3.2× |
| Clavicle complete (73000) |
$113.42 |
$214 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$177.61 |
$351 |
1.6× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$270.83 |
$511 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,273.10 |
$2,516 |
3.4× |
| CT abdomen and pelvis without contrast (74176) |
$848.56 |
$1,677 |
3.3× |
| CT abdomen w contrast (74160) |
$778.23 |
$1,538 |
4.2× |
| CT abdomen w wo contrast (74170) |
$933.57 |
$1,845 |
5.0× |
| CT abdomen w/o contrast (74150) |
$622.38 |
$1,230 |
5.6× |
| CT angiography upper extremity lt (73206) |
$701.32 |
$1,386 |
3.7× |
| CT c-spine w/o contrast (72125) |
$653.25 |
$1,291 |
5.9× |
| CT cervical spine w&w/o contrast (72127) |
$980.12 |
$1,937 |
5.2× |
| CT cervical spine with contrast (72126) |
$816.68 |
$1,614 |
2.2× |
| CT chest w/wo contrast (71270) |
$749.39 |
$1,481 |
4.0× |
| CT chest with contrast (71260) |
$624.40 |
$1,234 |
3.3× |
| CT head/brain with contrast (70460) |
$610.94 |
$1,205 |
3.3× |
| CT head/brain without and with contrast (70470) |
$733.12 |
$1,446 |
3.9× |
| CT iac w contrast (70481) |
$655.04 |
$1,292 |
3.5× |
| CT limited/localized follow up study (76380) |
$177.75 |
$375 |
1.9× |
| CT lower ext w/o (73700) |
$397.21 |
$785 |
3.6× |
| CT lower extremity w wo contrast (73702) |
$596.07 |
$1,178 |
3.2× |
| CT lower extremity with contrast (73701) |
$496.89 |
$982 |
2.7× |
| CT lumbar spine w & w/o contrast (72133) |
$656.79 |
$1,298 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$437.69 |
$865 |
3.9× |
| CT lumbar spine with contrast (72132) |
$547.49 |
$1,082 |
1.5× |
| CT maxillofacial w contrast (70487) |
$548.57 |
$1,082 |
2.9× |
| CT maxillofacial w/o contrast (70486) |
$438.56 |
$865 |
3.9× |
| CT maxillofacial w/wo contrast (70488) |
$658.09 |
$1,298 |
3.5× |
| CT neck soft tissue w contrast (70491) |
$600.80 |
$1,185 |
3.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$785.85 |
$1,550 |
4.2× |
| CT orbits w/o contrast (70480) |
$523.73 |
$1,033 |
4.7× |
| CT pelvis w & w/o contrast (72194) |
$980.12 |
$1,937 |
5.2× |
| CT pelvis w/o contrast (72192) |
$653.25 |
$1,291 |
5.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$42 |
$83 |
0.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$720.95 |
$1,422 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$480.64 |
$948 |
4.3× |
| CT thoracic spine w/contrast (72129) |
$599.10 |
$1,184 |
3.2× |
| CT thoracic spine w/o contrast (72128) |
$479.18 |
$947 |
4.3× |
| CT thoracic spine w/wo contrast (72130) |
$719.03 |
$1,421 |
3.8× |
| CT thorax w/o contrast (71250) |
$499.42 |
$987 |
4.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$667.92 |
$1,320 |
3.6× |
| CT upper extremity w/o contrast rt (73200) |
$445.28 |
$880 |
4.0× |
| CT upper extremity with contrast (73201) |
$556.60 |
$1,100 |
1.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$626.63 |
$1,322 |
3.3× |
| Cta Abdomen (74175) |
$980.63 |
$1,938 |
5.2× |
| CTA abdomen pelvis (74174) |
$1,336.85 |
$2,642 |
3.6× |
| CTA chest (71275) |
$787.34 |
$1,556 |
4.2× |
| Cta Head (70496) |
$770.13 |
$1,519 |
4.1× |
| CTA lwr ext w&w/o contrast (73706) |
$625.92 |
$1,237 |
3.3× |
| Cta Neck (70498) |
$757.46 |
$1,494 |
4.0× |
| Cta Pelvis (72191) |
$1,029.20 |
$2,034 |
5.5× |
| Cystography minimum 3 views rs&i (74430) |
$181.26 |
$342 |
0.5× |
| Dacryocystography (70170) |
$159.53 |
$301 |
0.6× |
| Diskogram cervical (72285) |
$758.43 |
$1,431 |
0.4× |
| Diskography lumbar (72295) |
$928.03 |
$1,751 |
0.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$182.95 |
$297 |
1.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$202.66 |
$329 |
1.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$308.62 |
$501 |
2.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$219.42 |
$414 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$121.37 |
$229 |
1.3× |
| Echo exam of fetal heart (76825) |
$317.86 |
$516 |
0.5× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$168.17 |
$273 |
0.7× |
| Echoencephalography real time imaging (76506) |
$244.55 |
$397 |
2.2× |
| Esophagus (74220) |
$147.87 |
$279 |
0.8× |
| Fetal biophysical profile non-stress testing (76818) |
$297.53 |
$483 |
2.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$232.85 |
$378 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$192.39 |
$363 |
0.8× |
| Foot 2 views (73620) |
$82.15 |
$155 |
0.9× |
| Forearm 2 views (73090) |
$103.35 |
$195 |
1.1× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$885.46 |
$1,677 |
1.5× |
| Gated Heart Planar Single (78472) |
$654.72 |
$1,240 |
1.5× |
| Hand 2 views (73120) |
$99.64 |
$188 |
0.9× |
| Hand 3 views (73130) |
$121.90 |
$230 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$661.58 |
$1,253 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$475.20 |
$900 |
1.1× |
| Ht muscle image spect sing (78451) |
$1,410.29 |
$2,671 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$125.61 |
$237 |
1.4× |
| Hysterosalpingogram (74740) |
$228.96 |
$432 |
0.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$80.03 |
$151 |
0.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$267.17 |
$506 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$346.90 |
$657 |
0.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$422.93 |
$801 |
0.7× |
| Knee 3 views (73562) |
$135.15 |
$255 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$393.36 |
$745 |
0.7× |
| Lung perfusion differential (78597) |
$347.95 |
$659 |
0.8× |
| Lymphoscintigraphy (78195) |
$481.01 |
$911 |
0.8× |
| Mammary ductogram or galactogram multiple (77054) |
$234.26 |
$442 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$178.61 |
$337 |
0.7× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$171.72 |
$324 |
1.8× |
| Meckels Diverticulum (78290) |
$551.76 |
$1,045 |
1.3× |
| Mr safety determination physician/other qhp (76016) |
$57.24 |
$108 |
0.6× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$153.70 |
$290 |
2.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$20.14 |
$38 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$100.70 |
$190 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$239.03 |
$451 |
0.9× |
| MRA head w & w/o contrast (70546) |
$716.60 |
$1,419 |
1.9× |
| MRA head w/o contrast (70544) |
$477.73 |
$946 |
1.9× |
| MRA head with contrast (70545) |
$597.42 |
$1,183 |
1.6× |
| MRA neck w contrast (70548) |
$645.39 |
$1,278 |
1.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$774.16 |
$1,533 |
2.1× |
| MRA neck w/o contrast (70547) |
$516.11 |
$1,022 |
2.0× |
| MRI abdomen w contrast (74182) |
$819.25 |
$1,450 |
2.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$983.10 |
$1,740 |
2.6× |
| MRI abdomen w/o contrast (74181) |
$655.40 |
$1,160 |
2.6× |
| MRI any jnt lwr ext with con lt (73722) |
$756.54 |
$1,339 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$747.49 |
$1,323 |
0.9× |
| MRI bone marrow blood supply (77084) |
$870.66 |
$1,541 |
3.4× |
| MRI breast w/o contrast bilateral (77047) |
$831.11 |
$1,471 |
3.3× |
| MRI breast w/o contrast unilat (77046) |
$554.26 |
$981 |
2.2× |
| MRI c-spine with contrast (72142) |
$1,015.31 |
$2,047 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$811.95 |
$1,637 |
3.2× |
| MRI chest w/o & w/contrast material (71552) |
$666.14 |
$1,179 |
1.8× |
| MRI chest w/o contrast (71550) |
$444.09 |
$786 |
1.7× |
| MRI chest with contrast (71551) |
$555.40 |
$983 |
0.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$628.28 |
$1,112 |
1.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$496.63 |
$879 |
1.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$397.19 |
$703 |
1.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$483.99 |
$949 |
1.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$726.24 |
$1,424 |
2.0× |
| MRI orbit/face/neck w/contrast (70542) |
$605.37 |
$1,187 |
1.6× |
| MRI pelvis w contrast (72196) |
$972.93 |
$1,722 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,167.29 |
$2,066 |
3.1× |
| MRI pelvis w/o contrast (72195) |
$778 |
$1,377 |
3.1× |
| MRI scan of arm joint before and after contrast (73223) |
$896.65 |
$1,587 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$907.95 |
$1,607 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,218.18 |
$2,456 |
3.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,015.31 |
$2,047 |
2.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,218.18 |
$2,456 |
3.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,015.31 |
$2,047 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,218.18 |
$2,456 |
3.3× |
| MRI thoracic spine w/o contrast (72146) |
$811.95 |
$1,637 |
3.2× |
| MRI tmj (70336) |
$463.30 |
$820 |
1.8× |
| MRI upper ext joint w/o contrast (73221) |
$597.77 |
$1,058 |
2.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$753.71 |
$1,334 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$502.28 |
$889 |
2.0× |
| Myelogram Cervical (72240) |
$511.45 |
$965 |
0.6× |
| Myelogram Lumbar (72265) |
$518.87 |
$979 |
0.6× |
| Myelogram thoracic (72255) |
$509.86 |
$962 |
0.6× |
| Myelography 2 or more regions (72270) |
$474.35 |
$895 |
0.6× |
| Myocardial Spect Multiple Studies (78452) |
$1,698.58 |
$3,217 |
1.2× |
| Neck soft tissue (70360) |
$100.17 |
$189 |
1.1× |
| Nm bone marrow wb (78104) |
$1,136.78 |
$2,153 |
2.7× |
| Nm cisternogram (78630) |
$374.88 |
$710 |
0.6× |
| Nm gastric emptying study (78264) |
$548.59 |
$1,039 |
1.3× |
| Nuclear medicine of heart pumping function (78473) |
$796.22 |
$1,508 |
1.9× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$686.93 |
$1,301 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$272.10 |
$481 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$242.70 |
$394 |
2.2× |
| Orthopantogram (70355) |
$191.86 |
$362 |
2.1× |
| Osseous survey infant (77076) |
$209.88 |
$396 |
1.9× |
| Osseous survey limited (77074) |
$122.96 |
$232 |
1.1× |
| Parathyrd planar w/spect&CT (78072) |
$365.90 |
$693 |
0.6× |
| Parathyrd planar w/wo subtrj (78071) |
$335.28 |
$635 |
0.8× |
| Parathyroid imaging (78070) |
$255.02 |
$483 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$107.06 |
$202 |
1.0× |
| Perineogram (74775) |
$425.59 |
$803 |
1.7× |
| Peritoneogram rs&i (74190) |
$327.54 |
$618 |
0.6× |
| PET image w/CT, skull-thigh (78815) |
$2,151.79 |
$4,924 |
1.4× |
| PET imaging CT for attenuation limited area (78814) |
$1,461.77 |
$3,345 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$2,195.05 |
$5,023 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$596.07 |
$1,055 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$330 |
$625 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$465.17 |
$881 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$182.85 |
$345 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$87.98 |
$166 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$195.57 |
$369 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$119.25 |
$225 |
1.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$142.04 |
$268 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$286.20 |
$540 |
2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$108.65 |
$205 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$66.78 |
$126 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$141.51 |
$267 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$117.71 |
$229 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$233.73 |
$441 |
1.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$164.30 |
$310 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$468.52 |
$884 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$410.22 |
$774 |
2.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$132.50 |
$250 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$314.29 |
$593 |
3.4× |
| Radiological examination surgical specimen (76098) |
$66.78 |
$126 |
0.1× |
| Ribs bilateral 3 views (71110) |
$149.99 |
$283 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$351.12 |
$665 |
0.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$553.87 |
$1,049 |
1.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$553.87 |
$1,049 |
0.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$616.18 |
$1,167 |
0.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$504.24 |
$955 |
0.4× |
| Rp Therapy Intravenous Administration (79101) |
$381.28 |
$674 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$120.31 |
$227 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$313.54 |
$509 |
1.2× |
| Scanogram (77073) |
$146.28 |
$276 |
1.3× |
| Scapula complete (73010) |
$116.07 |
$219 |
1.0× |
| Screening digital breast tomosynthesis (77063) |
$53.11 |
$68 |
2.3× |
| Sella turcica (70240) |
$78.44 |
$148 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$180.73 |
$341 |
1.6× |
| Sialogram (70390) |
$262.88 |
$496 |
1.0× |
| Small bowel series (74250) |
$144.69 |
$273 |
0.8× |
| Speech evaluation complex (70371) |
$328.60 |
$620 |
1.3× |
| Spine thoracic 3 views (72072) |
$158.47 |
$299 |
1.4× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$429.18 |
$622 |
1.7× |
| Therapeutic Enema (74283) |
$461.63 |
$871 |
2.5× |
| Thoracolumbar 2 views (72080) |
$102.29 |
$193 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$288.82 |
$547 |
0.7× |
| Tmj unilateral (70328) |
$97.52 |
$184 |
1.1× |
| Tomogram (76100) |
$213.59 |
$403 |
1.9× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$578.69 |
$1,096 |
1.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$299.38 |
$567 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$266.11 |
$432 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$150.92 |
$245 |
1.4× |
| Upper Extremity Infant (73092) |
$112.89 |
$213 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$246.45 |
$465 |
1.0× |
| Urethrocystography voiding (74455) |
$246.45 |
$465 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$341.85 |
$645 |
1.8× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$602.61 |
$1,137 |
3.2× |
| Us abdl aorta screen aaa (76706) |
$115.19 |
$187 |
1.0× |
| Us breast unilateral complete (76641) |
$211.29 |
$343 |
1.9× |
| Us breast unilateral limited (76642) |
$173.10 |
$281 |
1.9× |
| Us chest (76604) |
$178.02 |
$289 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$184.18 |
$299 |
1.7× |
| Us fetal nuchal translucency 1st gestation (76813) |
$211.29 |
$343 |
1.9× |
| Us guided compression repair (76936) |
$753.98 |
$1,224 |
3.3× |
| Us infant hips dynamic (76885) |
$147.84 |
$240 |
1.6× |
| Us infant hips limited static (76886) |
$107.80 |
$175 |
1.2× |
| Us kidney transplant (76776) |
$176.79 |
$287 |
1.6× |
| Us ob detailed single fetus (76811) |
$313.54 |
$509 |
1.2× |
| Us ob transvaginal (76817) |
$205.74 |
$334 |
1.8× |
| Us pelvic non ob complete (76856) |
$314.78 |
$511 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$286.44 |
$465 |
2.6× |
| Us pregnancy ltd (76815) |
$179.26 |
$291 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$272.89 |
$443 |
2.4× |
| Us retroperitoneal complete (76770) |
$325.86 |
$529 |
2.9× |
| Us retroperitoneal limited (76775) |
$170.02 |
$276 |
1.5× |
| Us scrotum and contents (76870) |
$292.60 |
$475 |
2.6× |
| Us soft tissue head/neck (76536) |
$277.82 |
$451 |
2.5× |
| Us spinal canal and contents (76800) |
$150.92 |
$245 |
1.4× |
| Us transrectal (76872) |
$205.74 |
$334 |
1.8× |
| Us transrectal prostate volume (76873) |
$335.72 |
$545 |
3.0× |
| Us xtr non-vasc lmtd (76882) |
$174.33 |
$283 |
1.6× |
| Us, eye b-scan (76512) |
$164.47 |
$267 |
1.5× |
| Venogram extremity bilateral (75822) |
$202.46 |
$382 |
0.1× |
| Venography caval superior serialography rs&i (75827) |
$1,278.36 |
$2,412 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$173.31 |
$327 |
0.1× |
| Vertebral fracture assessment via dxa (77086) |
$81.09 |
$153 |
0.9× |
| Wrist 2 views (73100) |
$96.46 |
$182 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$175.96 |
$332 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$103.35 |
$195 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$102.82 |
$194 |
1.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$269.24 |
$508 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$97.52 |
$184 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$120.31 |
$227 |
1.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$201.93 |
$381 |
1.8× |
| X-ray exam hip uni 1 view (73501) |
$95.40 |
$180 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$133.03 |
$251 |
1.4× |
| X-ray exam hip uni 4/> views (73503) |
$138.86 |
$262 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$155.82 |
$294 |
1.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$182.85 |
$345 |
1.6× |
| X-ray exam of femur 1 (73551) |
$112.89 |
$213 |
1.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,559.79 |
$2,943 |
8.3× |
| X-ray eye for foreign body (70030) |
$58.83 |
$111 |
0.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$122.96 |
$232 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$85.33 |
$161 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$115.54 |
$218 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$75.26 |
$142 |
0.8× |
| X-ray IV pyelogram+drip infusn (74410) |
$553.32 |
$1,044 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$93.28 |
$176 |
1.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$149.46 |
$282 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$135.15 |
$255 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$80.56 |
$152 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$171.72 |
$324 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$271.89 |
$513 |
2.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$201.93 |
$381 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$82.15 |
$155 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$59.89 |
$113 |
0.6× |
| X-ray of voice box or throat (70370) |
$178.08 |
$336 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$146.28 |
$276 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$117.13 |
$221 |
1.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$246.98 |
$466 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$126.67 |
$239 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$143.63 |
$271 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$177.02 |
$334 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$135.15 |
$255 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$104.94 |
$198 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$131.44 |
$248 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$121.37 |
$229 |
1.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$98.58 |
$186 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$120.84 |
$228 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$105.47 |
$199 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$85.33 |
$161 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$106 |
$200 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$134.09 |
$253 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$148.93 |
$281 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$173.84 |
$328 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$82.68 |
$156 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$114.48 |
$216 |
1.2× |
| Xr arthrogram ankle (73615) |
$334.65 |
$485 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$197.16 |
$372 |
1.8× |
| Xr chest 4+ views (71048) |
$159.85 |
$311 |
1.4× |
| Xr Cholecystography Oral Contrast (74290) |
$149.99 |
$283 |
0.8× |
| Xr finger(s) 2+ views (73140) |
$84.27 |
$159 |
0.9× |
| Xr internal auditory meati complete (70134) |
$125.61 |
$237 |
0.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$127.73 |
$241 |
1.1× |
| Xr optic foramina (70190) |
$121.37 |
$229 |
1.3× |
| Xr shoulder 1 view (73020) |
$94.87 |
$179 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$165.89 |
$313 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$115.54 |
$218 |
1.2× |
| Xr tmj bilateral (70330) |
$175.43 |
$331 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$118.72 |
$224 |
1.3× |