| Abdomen 2 views (74019) |
$100 |
$125 |
1.0× |
| Acute gi blood loss imaging (78278) |
$330.40 |
$413 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$282.40 |
$353 |
0.1× |
| Ankle 2 views (73600) |
$100.40 |
$125.50 |
1.2× |
| Arthrogram ankle (73615) |
$270 |
$337.50 |
0.8× |
| Arthrogram elbow (73085) |
$304.60 |
$380.75 |
0.9× |
| Arthrogram hip (73525) |
$312.20 |
$390.25 |
0.9× |
| Arthrogram knee (73580) |
$400.20 |
$500.25 |
1.2× |
| Arthrogram shoulder (73040) |
$613 |
$766.25 |
1.8× |
| Arthrogram wrist (73115) |
$339 |
$423.75 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$580 |
$725 |
1.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$387.20 |
$484 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$781.60 |
$977 |
2.0× |
| Bone age studies (77072) |
$136 |
$170 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$625.20 |
$781.50 |
1.6× |
| Bone survey complete (77075) |
$176 |
$220 |
1.7× |
| Bone survey infant (77076) |
$182.40 |
$228 |
1.8× |
| Bowel imaging (78290) |
$310 |
$387.50 |
0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$557.60 |
$697 |
1.0× |
| Brain Imaging Vascular Flow Only (78610) |
$42.40 |
$53 |
0.1× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$495.20 |
$619 |
1.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$363.60 |
$454.50 |
0.9× |
| Cardiac shunt detection (78428) |
$469.20 |
$586.50 |
1.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$385.60 |
$482 |
0.7× |
| Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Non-Facility (78635) |
$389.60 |
$487 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$99.20 |
$124 |
1.2× |
| Chest 1 view (71045) |
$96.80 |
$121 |
1.1× |
| Chest xray 3 views (71047) |
$101.60 |
$127 |
1.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$154.80 |
$193.50 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$194.40 |
$243 |
1.1× |
| Clavicle complete (73000) |
$33.60 |
$42 |
0.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,198.40 |
$1,498 |
3.5× |
| CT abdomen and pelvis without contrast (74176) |
$882.80 |
$1,103.50 |
3.7× |
| CT abdomen w contrast (74160) |
$579.60 |
$724.50 |
3.3× |
| CT abdomen w wo contrast (74170) |
$641.20 |
$801.50 |
3.7× |
| CT abdomen w/o contrast (74150) |
$392.40 |
$490.50 |
3.8× |
| CT angio hrt w/3d image (75574) |
$441.60 |
$552 |
1.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$567.20 |
$709 |
3.3× |
| CT angiography upper extremity lt (73206) |
$695.20 |
$869 |
4.0× |
| CT c-spine w/contrast (72126) |
$569.60 |
$712 |
1.7× |
| CT c-spine w/o contrast (72125) |
$429.20 |
$536.50 |
4.2× |
| CT cervical spine w&w/o contrast (72127) |
$410.80 |
$513.50 |
2.4× |
| CT chest w contrast (71260) |
$641.20 |
$801.50 |
3.7× |
| CT chest w/wo contrast (71270) |
$432 |
$540 |
2.5× |
| CT colonography screening (74263) |
$489.20 |
$611.50 |
2.1× |
| CT colonography w/dye (74262) |
$706.80 |
$883.50 |
4.1× |
| CT head/brain with contrast (70460) |
$548 |
$685 |
3.2× |
| CT head/brain without and with contrast (70470) |
$706.80 |
$883.50 |
4.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$88 |
$110 |
1.0× |
| CT iac w contrast (70481) |
$567.60 |
$709.50 |
3.3× |
| CT limited/localized follow up study (76380) |
$250.40 |
$313 |
2.9× |
| CT lower ext w/o (73700) |
$691.20 |
$864 |
6.7× |
| CT lower extremity w wo contrast (73702) |
$666.40 |
$833 |
3.8× |
| CT lower extremity w/contrast material (73701) |
$588.40 |
$735.50 |
3.4× |
| CT lumbar spine w & w/o contrast (72133) |
$421.20 |
$526.50 |
2.4× |
| CT lumbar spine w/contrast (72132) |
$569.60 |
$712 |
1.7× |
| CT lumbar spine w/o contrast (72131) |
$424.40 |
$530.50 |
4.1× |
| CT maxillofacial w contrast (70487) |
$551.20 |
$689 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$420.80 |
$526 |
2.4× |
| CT maxillofacial wo contrast (70486) |
$259.20 |
$324 |
2.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$461.20 |
$576.50 |
2.7× |
| CT orbits w/o contrast (70480) |
$444 |
$555 |
4.3× |
| CT pelvis w/o contrast (72192) |
$386 |
$482.50 |
3.7× |
| CT pelvis w/wo contrast (72194) |
$618 |
$772.50 |
3.6× |
| CT scan of arm combo (73202) |
$453.80 |
$567.25 |
2.6× |
| CT soft tissue neck w contrast (70491) |
$652 |
$815 |
3.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$718.80 |
$898.50 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$292.80 |
$366 |
2.8× |
| CT thoracic spine w/contrast (72129) |
$553.60 |
$692 |
3.2× |
| CT thoracic spine w/o contrast (72128) |
$424.40 |
$530.50 |
4.1× |
| CT thoracic spine w/wo contrast (72130) |
$410.80 |
$513.50 |
2.4× |
| CT thorax w/o contrast (71250) |
$425.60 |
$532 |
4.1× |
| CT unlisted procedure (76497) |
$40 |
$50 |
0.5× |
| CT upper ext wo (73200) |
$198 |
$247.50 |
1.9× |
| CT upper extremity with contrast (73201) |
$606.60 |
$758.25 |
1.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$791.60 |
$989.50 |
4.6× |
| Cta Abdomen (74175) |
$752.40 |
$940.50 |
4.3× |
| CTA abdomen pelvis (74174) |
$664.80 |
$831 |
1.9× |
| CTA chest (71275) |
$753.60 |
$942 |
4.3× |
| Cta Head (70496) |
$748 |
$935 |
4.3× |
| Cta Neck (70498) |
$747.60 |
$934.50 |
4.3× |
| Cta Pelvis (72191) |
$499.20 |
$624 |
2.9× |
| Cystography minimum 3 views rs&i (74430) |
$113.20 |
$141.50 |
0.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$138.40 |
$173 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$28.80 |
$36 |
0.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$46 |
$57.50 |
0.5× |
| Dxa bone density study axial skeleton (77085) |
$369.60 |
$462 |
3.6× |
| Esophageal motility (78258) |
$281.60 |
$352 |
0.7× |
| Esophagus (74220) |
$189.60 |
$237 |
1.1× |
| Facial bones min 3 views (70150) |
$101.20 |
$126.50 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$346.40 |
$433 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$226.80 |
$283.50 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$178 |
$222.50 |
0.8× |
| Foot 2 views (73620) |
$99.20 |
$124 |
1.2× |
| Forearm 2 views (73090) |
$100.40 |
$125.50 |
1.2× |
| Hand 2 views (73120) |
$100.40 |
$125.50 |
1.0× |
| Heart first pass single,planar (78481) |
$362 |
$452.50 |
0.7× |
| Heart Infarct Image (78466) |
$464.80 |
$581 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$426.40 |
$533 |
0.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$594 |
$742.50 |
1.5× |
| Hysterosalpingogram (74740) |
$450.80 |
$563.50 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$42.40 |
$53 |
0.4× |
| Kidney imaging morphology (78700) |
$394 |
$492.50 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$378 |
$472.50 |
0.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$683.60 |
$854.50 |
1.3× |
| Knee 3 views (73562) |
$102.20 |
$127.75 |
1.2× |
| Liver & spleen imaging static only (78215) |
$296 |
$370 |
0.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$467.60 |
$584.50 |
1.2× |
| Liver imaging static only (78201) |
$459.20 |
$574 |
0.9× |
| Liver imaging w/vascular flow (78202) |
$463.20 |
$579 |
0.9× |
| Lung ventilation imaging (78579) |
$196 |
$245 |
0.5× |
| Lymphoscintigraphy (78195) |
$475.20 |
$594 |
0.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$634.40 |
$793 |
0.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$795.20 |
$994 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$813.20 |
$1,016.50 |
2.4× |
| Mammary ductogram or galactogram multiple (77054) |
$60 |
$75 |
0.3× |
| Mammary ductogram or galactogram single (77053) |
$151.60 |
$189.50 |
0.6× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$80 |
$100 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,001.60 |
$1,252 |
2.9× |
| MRA head w/o contrast (70544) |
$713.20 |
$891.50 |
3.0× |
| MRA head with contrast (70545) |
$766.80 |
$958.50 |
2.2× |
| MRA neck w contrast (70548) |
$767.20 |
$959 |
2.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,032.80 |
$1,291 |
3.0× |
| MRA neck w/o contrast (70547) |
$448 |
$560 |
1.9× |
| MRI abdomen w contrast (74182) |
$802 |
$1,002.50 |
2.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,146.80 |
$1,433.50 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$730.40 |
$913 |
3.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$824.40 |
$1,030.50 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,119.60 |
$1,399.50 |
3.2× |
| MRI bone marrow blood supply (77084) |
$472.40 |
$590.50 |
2.0× |
| MRI c-spine with contrast (72142) |
$236.80 |
$296 |
0.7× |
| MRI cervical spine w/o contrast (72141) |
$700.40 |
$875.50 |
3.0× |
| MRI chest w/o & w/contrast material (71552) |
$732 |
$915 |
2.1× |
| MRI chest w/o contrast (71550) |
$465.20 |
$581.50 |
2.0× |
| MRI chest with contrast (71551) |
$802 |
$1,002.50 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$848.40 |
$1,060.50 |
2.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,204 |
$1,505 |
3.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$844.60 |
$1,055.75 |
3.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$718.80 |
$898.50 |
3.0× |
| MRI orbit face neck w contrast (70542) |
$891.60 |
$1,114.50 |
2.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,138 |
$1,422.50 |
3.3× |
| MRI pelvis w/contrast (72196) |
$802.40 |
$1,003 |
2.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$756 |
$945 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$731.20 |
$914 |
3.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,148 |
$1,435 |
3.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$826.80 |
$1,033.50 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,148.80 |
$1,436 |
3.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$806 |
$1,007.50 |
2.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,148.80 |
$1,436 |
3.3× |
| MRI temporomandibular joint (70336) |
$291.60 |
$364.50 |
1.2× |
| MRI thoracic spine w/o contrast (72146) |
$812 |
$1,015 |
3.4× |
| MRI up ext w/o contrast (73218) |
$428.40 |
$535.50 |
1.8× |
| MRI upper ext joint w/o contrast (73221) |
$765.80 |
$957.25 |
3.2× |
| MRI, joint upper extrem combo (73223) |
$1,138.40 |
$1,423 |
3.3× |
| Myelogram Cervical (72240) |
$352.40 |
$440.50 |
0.5× |
| Myelogram Lumbar (72265) |
$347.20 |
$434 |
0.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,493.60 |
$3,117 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$2,053.60 |
$2,567 |
1.6× |
| Neck soft tissue (70360) |
$94.80 |
$118.50 |
1.1× |
| Nm bone marrow wb (78104) |
$441.60 |
$552 |
1.1× |
| Nm cardiac blood pool multiple (78473) |
$690.80 |
$863.50 |
1.7× |
| Nm cisternogram (78630) |
$548.80 |
$686 |
1.0× |
| Nm gastric emptying study (78264) |
$503.60 |
$629.50 |
1.3× |
| Nm gastroesophageal reflux study (78262) |
$286.80 |
$358.50 |
0.7× |
| Nonvascular shunt X-ray (75809) |
$160.40 |
$200.50 |
1.6× |
| Parathyrd planar w/spect&CT (78072) |
$802 |
$1,002.50 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$103.20 |
$129 |
0.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$440.80 |
$551 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$96 |
$120 |
0.9× |
| Perineogram (74775) |
$310.40 |
$388 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$255.20 |
$319 |
0.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$600.40 |
$750.50 |
1.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$162.80 |
$203.50 |
0.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$106.80 |
$133.50 |
1.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$99.80 |
$124.75 |
1.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$101 |
$126.25 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$106 |
$132.50 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$106.80 |
$133.50 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$93.60 |
$117 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$106 |
$132.50 |
1.2× |
| Radex Hand Minimum 3 Views (73130) |
$101 |
$126.25 |
1.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$140.80 |
$176 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$100.40 |
$125.50 |
1.2× |
| Radex Kne 1/2 Views (73560) |
$100.40 |
$125.50 |
1.2× |
| Radex Kne Compl 4/More Views (73564) |
$140.80 |
$176 |
1.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$100.40 |
$125.50 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$95.20 |
$119 |
1.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$98 |
$122.50 |
0.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$102.20 |
$127.75 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$96 |
$120 |
1.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$98.40 |
$123 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$100.40 |
$125.50 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$92.40 |
$115.50 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$99.80 |
$124.75 |
1.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$101 |
$126.25 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$161.60 |
$202 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$101.60 |
$127 |
1.0× |
| Radiologic exam chest 2 views (71046) |
$98.80 |
$123.50 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$205.20 |
$256.50 |
1.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$205.60 |
$257 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$94.40 |
$118 |
0.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$205.20 |
$256.50 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$100.40 |
$125.50 |
1.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$148 |
$185 |
1.4× |
| Radiological examination surgical specimen (76098) |
$119.20 |
$149 |
0.2× |
| Ribs bilateral 3 views (71110) |
$154.40 |
$193 |
1.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$331.20 |
$414 |
0.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$501.60 |
$627 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,154.80 |
$1,443.50 |
2.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$504.80 |
$631 |
0.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$862.40 |
$1,078 |
1.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$824 |
$1,030 |
0.6× |
| Sacroiliac Joints < 3 Views (72200) |
$95.20 |
$119 |
0.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$201.20 |
$251.50 |
0.9× |
| Scapula (73010) |
$101.60 |
$127 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$56.40 |
$70.50 |
2.4× |
| Sella turcica (70240) |
$96.40 |
$120.50 |
1.1× |
| Shoulder 1 view (73020) |
$98.60 |
$123.25 |
1.1× |
| Sialogram (70390) |
$219.60 |
$274.50 |
0.9× |
| Small bowel series (74250) |
$192 |
$240 |
1.1× |
| Spine thoracic 3 views (72072) |
$98.80 |
$123.50 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$394.80 |
$493.50 |
1.0× |
| Thoracolumbar 2 views (72080) |
$98 |
$122.50 |
1.1× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$457.20 |
$571.50 |
1.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$468.40 |
$585.50 |
0.9× |
| Thyroid imaging w/blood flow (78013) |
$262.80 |
$328.50 |
0.7× |
| Thyroid uptake measurement (78012) |
$302.40 |
$378 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$557.60 |
$697 |
1.4× |
| Tomogram (76100) |
$76 |
$95 |
0.7× |
| Ultrasound breast complete (76641) |
$186 |
$232.50 |
1.8× |
| Ultrasound Exam Aaa Screen (76706) |
$211.60 |
$264.50 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$346.40 |
$433 |
3.4× |
| Umbilical-artery Doppler (OB) (76820) |
$89.60 |
$112 |
0.9× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$50.40 |
$63 |
0.1× |
| Ureteral reflux study (78740) |
$352.40 |
$440.50 |
0.9× |
| Urethrocystogram voiding (74455) |
$190 |
$237.50 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$303.20 |
$379 |
1.3× |
| Us breast unilateral limited (76642) |
$187.20 |
$234 |
2.2× |
| Us chest (76604) |
$226.40 |
$283 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$215.20 |
$269 |
2.1× |
| Us encephalogram (76506) |
$154.80 |
$193.50 |
1.5× |
| Us infant hips w manipulation (76885) |
$168.40 |
$210.50 |
2.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$84.80 |
$106 |
0.8× |
| Us ob detailed single fetus (76811) |
$245.60 |
$307 |
1.0× |
| Us ob limited (76815) |
$226.40 |
$283 |
2.2× |
| Us ob transvaginal (76817) |
$168.80 |
$211 |
1.6× |
| Us pelvic non ob complete (76856) |
$226 |
$282.50 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$150.80 |
$188.50 |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$246.80 |
$308.50 |
2.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$172 |
$215 |
1.7× |
| Us retroperitoneal complete (76770) |
$229.20 |
$286.50 |
2.2× |
| Us retroperitoneal limited (76775) |
$211.20 |
$264 |
2.0× |
| Us scrotum and contents (76870) |
$222.40 |
$278 |
2.2× |
| Us soft tissue head/neck (76536) |
$217.60 |
$272 |
2.1× |
| Us spinal canal and contents (76800) |
$250.80 |
$313.50 |
2.4× |
| Venogram extremity bilateral (75822) |
$1,106 |
$1,382.50 |
0.7× |
| Venogram Extremity Unilateral (75820) |
$366.40 |
$458 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$112.80 |
$141 |
1.3× |
| Wrist 2 views (73100) |
$100.40 |
$125.50 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$233.60 |
$292 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$36 |
$45 |
0.4× |
| X-ray b.e. reductn intuss (74283) |
$287.60 |
$359.50 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$329.60 |
$412 |
1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$99.20 |
$124 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$96 |
$120 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$104.40 |
$130.50 |
1.0× |
| X-ray exam of femur 2/> (73552) |
$96.80 |
$121 |
1.1× |
| X-ray eye for foreign body (70030) |
$94.80 |
$118.50 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$97.60 |
$122 |
1.1× |
| X-ray IV pyelogram (ivp) (74400) |
$363.20 |
$454 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$82.40 |
$103 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$95.20 |
$119 |
1.1× |
| X-ray leg, infant (73592) |
$99.80 |
$124.75 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$99.20 |
$124 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$163.60 |
$204.50 |
1.6× |
| X-ray nose-rectum child f.b. (76010) |
$95.60 |
$119.50 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$102.40 |
$128 |
1.0× |
| X-ray retrograde pyelogram (74420) |
$292.80 |
$366 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$99.60 |
$124.50 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$102.40 |
$128 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$162.80 |
$203.50 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$96 |
$120 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$95.20 |
$119 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$100.40 |
$125.50 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$163.60 |
$204.50 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$100.40 |
$125.50 |
1.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$306.80 |
$383.50 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$93.60 |
$117 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$98.40 |
$123 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$97.20 |
$121.50 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$85.20 |
$106.50 |
0.8× |
| Xr bone length studies (77073) |
$102.40 |
$128 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$162.40 |
$203 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$165.60 |
$207 |
1.6× |
| Xr chest 4+ views (71048) |
$104.40 |
$130.50 |
1.0× |
| Xr urogram antegrade (74425) |
$538.40 |
$673 |
1.6× |