| Abdomen 1 View (74018) |
$66.78 |
$126 |
0.7× |
| 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× |
| Arthrogram ankle (73615) |
$334.65 |
$485 |
0.9× |
| Arthrogram hip (73525) |
$403.65 |
$585 |
1.1× |
| Arthrogram Wrist (73115) |
$210.45 |
$305 |
0.6× |
| Bone age studies (77072) |
$104.41 |
$197 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$706.99 |
$1,339 |
1.7× |
| Bone Imaging Limited Area (78300) |
$467.81 |
$886 |
1.1× |
| Bone Imaging Whole Body (78306) |
$615.12 |
$1,165 |
1.4× |
| Bone marrow imaging limited area (78102) |
$784.61 |
$1,486 |
1.8× |
| Bone marrow imaging; whole body (78104) |
$1,136.78 |
$2,153 |
2.7× |
| Bone survey infant (77076) |
$209.88 |
$396 |
1.9× |
| Brain Flow Imaging Only (78610) |
$221.23 |
$419 |
0.4× |
| Brain Image W/Flow < 4 Views (78601) |
$227.57 |
$431 |
0.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,151.79 |
$4,924 |
1.4× |
| Cat Scan Follow-Up Study (76380) |
$177.75 |
$375 |
1.9× |
| Cerebrospinal Fluid Scan (78630) |
$374.88 |
$710 |
0.6× |
| Chest 1 view (71045) |
$92.52 |
$180 |
1.0× |
| Chest 2 views (71046) |
$117.71 |
$229 |
1.3× |
| Chest 3 views (71047) |
$129.01 |
$251 |
1.4× |
| Chest 4 or more views (71048) |
$159.85 |
$311 |
1.4× |
| Cholecystography Oral Contrast (74290) |
$149.99 |
$283 |
0.8× |
| Cineradiograpy/vidradiograpy xcpt where spec (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 Exam Abdominl Aorta (75625) |
$2,923.54 |
$5,168 |
0.9× |
| Contrast X-Ray Bladder (74430) |
$181.26 |
$342 |
0.5× |
| Contrast X-Ray Of Elbow (73085) |
$339.48 |
$492 |
0.9× |
| Contrast X-Ray Of Knee Joint (73580) |
$289.11 |
$419 |
0.8× |
| Contrast Xray Throat/Cerv Esopha (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 Angio Abdomen and Pelvis (74174) |
$1,336.85 |
$2,642 |
3.6× |
| CT Angio Chest (71275) |
$787.34 |
$1,556 |
4.2× |
| CT Angio Head (70496) |
$770.13 |
$1,519 |
4.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$625.92 |
$1,237 |
3.3× |
| CT Angio Neck (70498) |
$757.46 |
$1,494 |
4.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$701.32 |
$1,386 |
3.7× |
| CT bone density (77078) |
$42 |
$83 |
0.5× |
| CT cervical spine w/ contrast (72126) |
$816.68 |
$1,614 |
2.2× |
| CT cervical spine w/o contrast (72125) |
$653.25 |
$1,291 |
5.9× |
| CT cervical spine w/wo cont (72127) |
$980.12 |
$1,937 |
5.2× |
| CT chest w contrast (71260) |
$624.40 |
$1,234 |
3.3× |
| CT chest w/wo contrast (71270) |
$749.39 |
$1,481 |
4.0× |
| 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 l-spine w&w/o contrast (72133) |
$656.79 |
$1,298 |
3.5× |
| CT lower ext w/o (73700) |
$397.21 |
$785 |
3.6× |
| CT lower extremity w/contrast material (73701) |
$496.89 |
$982 |
2.7× |
| CT lumbar spine w contrast (72132) |
$547.49 |
$1,082 |
1.5× |
| CT lumbar spine w/o contrast (72131) |
$437.69 |
$865 |
3.9× |
| CT maxillofacial w contrast (70487) |
$548.57 |
$1,082 |
2.9× |
| CT maxillofacial wo contrast (70486) |
$438.56 |
$865 |
3.9× |
| CT neck tissue combo (70492) |
$720.95 |
$1,422 |
3.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (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 of leg combo (73702) |
$596.07 |
$1,178 |
3.2× |
| CT scans face/jaw combo (70488) |
$658.09 |
$1,298 |
3.5× |
| CT soft tissue neck w contrast (70491) |
$600.80 |
$1,185 |
3.2× |
| 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 cont (72130) |
$719.03 |
$1,421 |
3.8× |
| CT thorax w/o contrast (71250) |
$499.42 |
$987 |
4.5× |
| CT upper ext wo (73200) |
$445.28 |
$880 |
4.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$667.92 |
$1,320 |
3.6× |
| 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 pelvis (72191) |
$1,029.20 |
$2,034 |
5.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$159.53 |
$301 |
0.6× |
| Discography Cerv/Thor Spine (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 Axial (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 exam uterus (76831) |
$313.54 |
$509 |
1.2× |
| Echo Guide For Artery Repair (76936) |
$753.98 |
$1,224 |
3.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$168.17 |
$273 |
0.7× |
| Echograp Trans R Pros Study (76873) |
$335.72 |
$545 |
3.0× |
| Esophagram (74220) |
$147.87 |
$279 |
0.8× |
| Fetal Biophys Profile W/Nst (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 (78264) |
$548.59 |
$1,039 |
1.3× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$686.93 |
$1,301 |
1.6× |
| Gated Heart Planar Single (78472) |
$654.72 |
$1,240 |
1.5× |
| Gated Heart, Multiple (78473) |
$796.22 |
$1,508 |
1.9× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$885.46 |
$1,677 |
1.5× |
| Hand 2 views (73120) |
$99.64 |
$188 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$661.58 |
$1,253 |
1.1× |
| Hepatobiliary System Imaging (78226) |
$475.20 |
$900 |
1.1× |
| Ht Muscle Image Spect Sing (78451) |
$1,410.29 |
$2,671 |
1.0× |
| Hysterosalpingogram (74740) |
$228.96 |
$432 |
0.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$147.84 |
$240 |
1.6× |
| Infant hip ultrasound, limited static exam (76886) |
$107.80 |
$175 |
1.2× |
| Infusion Ivp (74410) |
$553.32 |
$1,044 |
3.0× |
| Joint Survey Single View (77077) |
$80.03 |
$151 |
0.7× |
| K Flow/Funct Image Multiple (78709) |
$422.93 |
$801 |
0.7× |
| K Flow/Funct Image W/Drug (78708) |
$346.90 |
$657 |
0.6× |
| K Flow/Funct Image W/O Drug (78707) |
$267.17 |
$506 |
0.5× |
| 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× |
| Lung Ventilat&Perfus Imaging (78582) |
$465.17 |
$881 |
0.8× |
| Lymph System Imaging (78195) |
$481.01 |
$911 |
0.8× |
Magnetic Image Jaw Joint (70336)
range across 3 matching MRF lines |
$463.30–$694.95 |
$820–$1,230 |
varies |
| Mammary ductogram or galactogram multiple (77054) |
$234.26 |
$442 |
0.9× |
| Mammary ductogram or galactogram single (77053) |
$178.61 |
$337 |
0.7× |
| Meckels Divert Exam (78290) |
$551.76 |
$1,045 |
1.3× |
| Mr safety determination physician/other qhp (76016) |
$57.24 |
$108 |
0.6× |
| 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 implt pos&/immoblj (76019) |
$153.70 |
$290 |
2.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$239.03 |
$451 |
0.9× |
| Mra Head W/O & W/Contrast Material (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 contrast (74181) |
$655.40 |
$1,160 |
2.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$756.54 |
$1,339 |
0.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$907.95 |
$1,607 |
2.4× |
| 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 Without Contrast Material Unilateral (77046) |
$554.26 |
$981 |
2.2× |
| MRI cervical spine w contrast (72142) |
$1,015.31 |
$2,047 |
2.7× |
| MRI cervical spine w/o cont (72141) |
$811.95 |
$1,637 |
3.2× |
| MRI chest w/o contrast (71550) |
$444.09 |
$786 |
1.7× |
| MRI chest with contrast (71551) |
$555.40 |
$983 |
0.7× |
| MRI chest wo w contrast (71552) |
$666.14 |
$1,179 |
1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$496.63 |
$879 |
1.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$596.07 |
$1,055 |
1.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$397.19 |
$703 |
1.6× |
| MRI lumbar spine w contrast (72149) |
$1,015.31 |
$2,047 |
2.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,218.18 |
$2,456 |
3.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$483.99 |
$949 |
1.9× |
| MRI orbit face neck w contrast (70542) |
$605.37 |
$1,187 |
1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$726.24 |
$1,424 |
2.0× |
| MRI pelvis w contrast (72196) |
$972.93 |
$1,722 |
2.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,167.29 |
$2,066 |
3.1× |
| MRI pelvis w/o contrast (72195) |
$778 |
$1,377 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$811.95 |
$1,637 |
3.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$628.28 |
$1,112 |
1.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$502.28 |
$889 |
2.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$753.71 |
$1,334 |
2.0× |
| MRI, abdomen, combo (74183) |
$983.10 |
$1,740 |
2.6× |
| MRI, dorsal spine combo (72157) |
$1,218.18 |
$2,456 |
3.3× |
| MRI, dorsal spine contrast (72147) |
$1,015.31 |
$2,047 |
2.7× |
| MRI, joint upper extrem (73221) |
$597.77 |
$1,058 |
2.3× |
| MRI, joint upper extrem combo (73223) |
$896.65 |
$1,587 |
2.4× |
| MRI, lumbar spine combo (72158) |
$1,218.18 |
$2,456 |
3.3× |
| Myelogram cervical (72240) |
$511.45 |
$965 |
0.6× |
| Myelogram Lumbar (72265) |
$518.87 |
$979 |
0.6× |
| Myelography thoracic (72255) |
$509.86 |
$962 |
0.6× |
| Myelograpy 2/more regions rs&i (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× |
| Nonvascular Shunt X-Ray (75809) |
$180.73 |
$341 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$272.10 |
$481 |
1.1× |
| Ob us nuchal meas 1 gest (76813) |
$211.29 |
$343 |
1.9× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$164.47 |
$267 |
1.5× |
| Optic foramina (70190) |
$121.37 |
$229 |
1.3× |
| Panoramic X-ray of jaws (70355) |
$191.86 |
$362 |
2.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$365.90 |
$693 |
0.6× |
| Parathyroid Planar Imaging (78070) |
$255.02 |
$483 |
0.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$335.28 |
$635 |
0.8× |
| 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 Lmtd (78814) |
$1,461.77 |
$3,345 |
1.0× |
| PET image w/CT, full body (78816) |
$2,195.05 |
$5,023 |
1.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,151.79 |
$4,924 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$330 |
$625 |
0.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$175.96 |
$332 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$182.85 |
$345 |
0.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$102.82 |
$194 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$75.26 |
$142 |
0.8× |
| Radex elbow complete minimum 3 views (73080) |
$120.31 |
$227 |
1.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$122.96 |
$232 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$84.27 |
$159 |
0.9× |
| Radex foot complete minimum 3 views (73630) |
$115.54 |
$218 |
1.2× |
| Radex Hand Minimum 3 Views (73130) |
$121.90 |
$230 |
1.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$80.56 |
$152 |
0.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$142.04 |
$268 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$82.15 |
$155 |
0.9× |
| Radex Pharynx/Larx W/Fluor&/Magnification Tq (70370) |
$178.08 |
$336 |
1.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$126.67 |
$239 |
1.4× |
| Radex shoulder complete minimum 2 views (73030) |
$131.44 |
$248 |
1.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$98.58 |
$186 |
1.1× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$1,559.79 |
$2,943 |
8.3× |
| Radex Spine 1 View Specify Level (72020) |
$85.33 |
$161 |
0.9× |
| Radex Sternum Minimum 2 Views (71120) |
$134.09 |
$253 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$175.43 |
$331 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$82.68 |
$156 |
0.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$112.89 |
$213 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$114.48 |
$216 |
1.2× |
| 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 3+ Views - Xr Abdomen 3+ Views (74021) |
$141.51 |
$267 |
1.3× |
| Radiologic exam colon double contrast study (74280) |
$269.24 |
$508 |
1.4× |
| 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 knee complete 4/more views (73564) |
$149.46 |
$282 |
1.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$117.13 |
$221 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$144.69 |
$273 |
0.8× |
| Radiologic exam swallow function contrast study (74230) |
$154.23 |
$291 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$468.52 |
$884 |
2.5× |
| Radiologic examination femur 1 view (73551) |
$112.89 |
$213 |
1.2× |
| Radiologic examination femur minimum 2 views (73552) |
$132.50 |
$250 |
1.4× |
| Radiologic examination knee 1/2 views (73560) |
$118.72 |
$224 |
1.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$122.96 |
$232 |
1.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$314.29 |
$593 |
3.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$115.54 |
$218 |
1.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$125.61 |
$237 |
0.2× |
| Ribs bilateral 3 views (71110) |
$149.99 |
$283 |
1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$299.38 |
$567 |
0.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$578.69 |
$1,096 |
1.0× |
| 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/acquisj 1day img (78830) |
$504.24 |
$955 |
0.4× |
| Rp Therapy Intravenous Administration (79101) |
$381.28 |
$674 |
1.5× |
| Scapula (73010) |
$116.07 |
$219 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$53.11 |
$68 |
2.3× |
| Sella turcica (70240) |
$78.44 |
$148 |
0.8× |
| Shoulder 1 view (73020) |
$94.87 |
$179 |
1.0× |
| Shoulder Arthrography (73040) |
$316.02 |
$458 |
0.8× |
| Sialogram (70390) |
$262.88 |
$496 |
1.0× |
| Skull less than 4 views (70250) |
$105.47 |
$199 |
0.9× |
| Speech evaluation, complex (70371) |
$328.60 |
$620 |
1.3× |
| Sternoclavicular joints (71130) |
$106 |
$200 |
1.1× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$429.18 |
$622 |
1.7× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$461.63 |
$871 |
2.5× |
| Thoracic spine 2 views (72070) |
$148.93 |
$281 |
1.3× |
| Thoracic spine 3 views (72072) |
$158.47 |
$299 |
1.4× |
| Thoracolumbar 2 views (72080) |
$102.29 |
$193 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$288.82 |
$547 |
0.7× |
Ultrasound Breast Limited (76642)
range across 3 matching MRF lines |
$173.10–$259.95 |
$281–$422 |
varies |
| Ultrasound Exam Aaa Screen (76706) |
$115.19 |
$187 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$266.11 |
$432 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$150.92 |
$245 |
1.4× |
| Upper gi w/o kub (74240) |
$410.22 |
$774 |
2.2× |
| Urethrocystogram voiding (74455) |
$246.45 |
$465 |
1.0× |
| Urethrocystography retrograde (74450) |
$246.45 |
$465 |
1.0× |
Us breast unilateral complete (76641)
range across 3 matching MRF lines |
$211.29–$317.24 |
$343–$515 |
varies |
| Us chest (76604) |
$178.02 |
$289 |
1.6× |
| Us complete joint (76881) |
$184.18 |
$299 |
1.7× |
| Us exam, pelvic, limited (76857) |
$286.44 |
$465 |
2.6× |
| Us head (76506) |
$244.55 |
$397 |
2.2× |
| Us kidney transplant (76776) |
$176.79 |
$287 |
1.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$174.33 |
$283 |
1.6× |
| Us ob detailed single fetus (76811) |
$313.54 |
$509 |
1.2× |
| Us ob limited 1 or more fetuses (76815) |
$179.26 |
$291 |
1.6× |
| Us ob transvaginal (76817) |
$205.74 |
$334 |
1.8× |
| Us pelvic non ob complete (76856) |
$314.78 |
$511 |
2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$272.89 |
$443 |
2.4× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$242.70 |
$394 |
2.2× |
| 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 spinal canal and contents (76800) |
$150.92 |
$245 |
1.4× |
| Us thyroid (76536) |
$277.82 |
$451 |
2.5× |
| Us transrectal (76872) |
$205.74 |
$334 |
1.8× |
| Vein X-Ray Chest (75827) |
$1,278.36 |
$2,412 |
0.8× |
| Venography extremity bilateral rs&i (75822) |
$202.46 |
$382 |
0.1× |
| 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 Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$103.35 |
$195 |
1.1× |
| X-ray antegrade pyelogram tube (74425) |
$246.98 |
$466 |
0.7× |
| X-Ray Aorta Leg Arteries (75630) |
$471.23 |
$833 |
0.1× |
| X-Ray Bend Only L-S Spine (72120) |
$201.93 |
$381 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$97.52 |
$184 |
1.1× |
| X-Ray Exam Breast Specimen (76098) |
$66.78 |
$126 |
0.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$87.98 |
$166 |
0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$195.57 |
$369 |
1.8× |
| 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 2 Views (73521) |
$119.25 |
$225 |
1.1× |
| 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 L-S Spine Bending (72114) |
$271.89 |
$513 |
2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$120.84 |
$228 |
1.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$197.16 |
$372 |
1.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$143.63 |
$271 |
1.3× |
| X-ray eye for foreign body (70030) |
$58.83 |
$111 |
0.6× |
| X-ray humerus (73060) |
$125.61 |
$237 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$341.85 |
$645 |
1.8× |
| X-ray IV pyelogram+tomography (74415) |
$602.61 |
$1,137 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$93.28 |
$176 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$135.15 |
$255 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$171.72 |
$324 |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$59.89 |
$113 |
0.6× |
| 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 Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$120.31 |
$227 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$104.94 |
$198 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$121.37 |
$229 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$120.84 |
$228 |
1.1× |
| X-Ray Stress View (77071) |
$171.72 |
$324 |
1.8× |
| X-ray thoracic spine 4 vw (72074) |
$173.84 |
$328 |
1.6× |
| X-Ray Tmj Unilat (70328) |
$97.52 |
$184 |
1.1× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$246.98 |
$466 |
0.7× |
| X-Rays Bone Length Studies (77073) |
$146.28 |
$276 |
1.3× |
| X-Rays Bone Survey Complete (77075) |
$131.44 |
$248 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$165.89 |
$313 |
1.5× |
| Xr facial bones less than 3 views (70140) |
$85.33 |
$161 |
0.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$127.73 |
$241 |
1.1× |
| Xr orbits complete 4 views (70200) |
$146.28 |
$276 |
1.3× |
| Xr Tomogram Single Plane (76100) |
$213.59 |
$403 |
1.9× |