| Abdomen 2 views (74019) |
$374.40 |
$468 |
3.1× |
| Acute gi blood loss imaging (78278) |
$1,707.20 |
$2,134 |
3.7× |
| Angiography extremity unilateral rs&i (75710) |
$4,352 |
$5,440 |
1.2× |
| Ankle 2 views (73600) |
$296.80 |
$371 |
3.0× |
| Arthrogram ankle (73615) |
$520.80 |
$651 |
1.3× |
| Arthrogram elbow (73085) |
$520.80 |
$651 |
1.3× |
| Arthrogram hip (73525) |
$1,029.60 |
$1,287 |
2.6× |
| Arthrogram knee (73580) |
$1,082.40 |
$1,353 |
2.7× |
| Arthrogram shoulder (73040) |
$937.60 |
$1,172 |
2.4× |
| Arthrogram wrist (73115) |
$888.80 |
$1,111 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,007.20 |
$1,259 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,346.40 |
$1,683 |
3.0× |
| Bone &/joint imaging whole body (78306) |
$1,832 |
$2,290 |
4.0× |
| Bone age studies (77072) |
$308 |
$385 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$2,027.20 |
$2,534 |
4.5× |
| Bone Marrow Imaging Limited Area (78102) |
$2,652 |
$3,315 |
5.8× |
| Bone survey complete (77075) |
$786.40 |
$983 |
6.6× |
| Bone survey infant (77076) |
$156.80 |
$196 |
1.3× |
| Bowel imaging (78290) |
$1,707.20 |
$2,134 |
3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$823.20 |
$1,029 |
1.3× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$839.20 |
$1,049 |
1.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,920 |
$2,400 |
4.2× |
| Cervical spine 2 or 3 views (72040) |
$348 |
$435 |
3.5× |
| Chest 1 view (71045) |
$256 |
$320 |
2.6× |
| Chest xray 3 views (71047) |
$120 |
$150 |
1.2× |
| Cholecystography, oral contrast Non-Facility (74290) |
$498.40 |
$623 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$603.20 |
$754 |
3.0× |
| Clavicle complete (73000) |
$296 |
$370 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$355.20 |
$444 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,484 |
$5,605 |
11.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,897.60 |
$3,622 |
10.7× |
| CT abdomen w contrast (74160) |
$2,048.80 |
$2,561 |
10.3× |
| CT abdomen w wo contrast (74170) |
$2,304 |
$2,880 |
11.5× |
| CT abdomen w/o contrast (74150) |
$1,732.80 |
$2,166 |
14.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,297.60 |
$2,872 |
11.5× |
| CT angiography upper extremity lt (73206) |
$2,343.20 |
$2,929 |
11.7× |
| CT c-spine w/contrast (72126) |
$2,098.40 |
$2,623 |
5.3× |
| CT c-spine w/o contrast (72125) |
$1,731.20 |
$2,164 |
14.5× |
| CT chest w contrast (71260) |
$2,032.80 |
$2,541 |
10.2× |
| CT chest w/wo contrast (71270) |
$2,256 |
$2,820 |
11.3× |
| CT head/brain with contrast (70460) |
$1,594.40 |
$1,993 |
8.0× |
| CT head/brain without and with contrast (70470) |
$2,223.20 |
$2,779 |
11.1× |
| CT iac w contrast (70481) |
$1,787.20 |
$2,234 |
8.9× |
| CT lower ext w/o (73700) |
$2,008 |
$2,510 |
16.9× |
| CT lower extremity w wo contrast (73702) |
$2,204.80 |
$2,756 |
11.0× |
| CT lower extremity w/contrast material (73701) |
$2,108 |
$2,635 |
10.6× |
| CT lumbar spine w & w/o contrast (72133) |
$2,857.60 |
$3,572 |
14.3× |
| CT lumbar spine w/contrast (72132) |
$2,309.60 |
$2,887 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$1,874.40 |
$2,343 |
15.7× |
| CT maxillofacial w contrast (70487) |
$1,795.20 |
$2,244 |
9.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,064.80 |
$2,581 |
10.3× |
| CT maxillofacial wo contrast (70486) |
$1,336.80 |
$1,671 |
11.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,010.40 |
$2,513 |
10.1× |
| CT orbits w/o contrast (70480) |
$1,651.20 |
$2,064 |
13.9× |
| CT pelvis w/o contrast (72192) |
$1,563.20 |
$1,954 |
13.1× |
| CT pelvis w/wo contrast (72194) |
$2,270.40 |
$2,838 |
11.4× |
| CT scan of arm combo (73202) |
$2,360.80 |
$2,951 |
11.8× |
| CT soft tissue neck w contrast (70491) |
$2,008 |
$2,510 |
10.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,108 |
$2,635 |
10.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,536 |
$1,920 |
12.9× |
| CT thoracic spine w/contrast (72129) |
$1,832.80 |
$2,291 |
9.2× |
| CT thoracic spine w/o contrast (72128) |
$1,745.60 |
$2,182 |
14.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,924 |
$2,405 |
9.6× |
| CT thorax w/o contrast (71250) |
$1,730.40 |
$2,163 |
14.5× |
| CT upper ext wo (73200) |
$2,008 |
$2,510 |
16.9× |
| CT upper extremity with contrast (73201) |
$2,200.80 |
$2,751 |
5.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,368 |
$2,960 |
11.9× |
| Cta Abdomen (74175) |
$2,603.20 |
$3,254 |
13.0× |
| CTA abdomen pelvis (74174) |
$4,484 |
$5,605 |
11.3× |
| CTA chest (71275) |
$2,328.80 |
$2,911 |
11.7× |
| Cta Head (70496) |
$2,540 |
$3,175 |
12.7× |
| Cta Neck (70498) |
$2,489.60 |
$3,112 |
12.5× |
| Cta Pelvis (72191) |
$2,261.60 |
$2,827 |
11.3× |
| Cystography minimum 3 views rs&i (74430) |
$756.80 |
$946 |
1.9× |
| Diskogram cervical (72285) |
$1,660.80 |
$2,076 |
0.7× |
| Diskography lumbar (72295) |
$1,660.80 |
$2,076 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$595.20 |
$744 |
5.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$182.40 |
$228 |
1.8× |
| Esophagus (74220) |
$656.80 |
$821 |
3.3× |
| Facial bones min 3 views (70150) |
$531.20 |
$664 |
4.5× |
| Fetal biophysical profile non-stress testing (76818) |
$1,058.40 |
$1,323 |
8.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$556 |
$695 |
4.7× |
| Fluoroscopy up to 1 hr (76000) |
$712 |
$890 |
2.6× |
| Foot 2 views (73620) |
$319.20 |
$399 |
3.2× |
| Forearm 2 views (73090) |
$286.40 |
$358 |
2.9× |
| Hand 2 views (73120) |
$310.40 |
$388 |
2.6× |
| Heart first pass single,planar (78481) |
$1,629.60 |
$2,037 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,032.80 |
$2,541 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,757.60 |
$2,197 |
3.9× |
| Hysterosalpingogram (74740) |
$664.80 |
$831 |
2.4× |
| Kidney imaging morphology (78700) |
$1,249.60 |
$1,562 |
2.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,049.60 |
$2,562 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,668.80 |
$2,086 |
2.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,940 |
$2,425 |
3.1× |
| Knee 3 views (73562) |
$348 |
$435 |
3.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$952.80 |
$1,191 |
2.1× |
| Liver imaging w/vascular flow (78202) |
$520.80 |
$651 |
0.8× |
| Lung perfusion differential (78597) |
$1,400.80 |
$1,751 |
3.1× |
| Lung ventilation imaging (78579) |
$1,032 |
$1,290 |
2.3× |
| Lymphoscintigraphy (78195) |
$1,660 |
$2,075 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,680 |
$3,350 |
3.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,553.60 |
$3,192 |
6.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,190.40 |
$3,988 |
8.0× |
| Mammary ductogram or galactogram multiple (77054) |
$916.80 |
$1,146 |
3.4× |
| Mammary ductogram or galactogram single (77053) |
$700.80 |
$876 |
2.6× |
| MRA head w & w/o contrast (70546) |
$2,626.40 |
$3,283 |
6.6× |
| MRA head w/o contrast (70544) |
$2,244.80 |
$2,806 |
8.3× |
| MRA head with contrast (70545) |
$2,399.20 |
$2,999 |
6.0× |
| MRA neck w contrast (70548) |
$2,071.20 |
$2,589 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,349.60 |
$4,187 |
8.4× |
| MRA neck w/o contrast (70547) |
$1,977.60 |
$2,472 |
7.3× |
| MRI abdomen w contrast (74182) |
$3,059.20 |
$3,824 |
7.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,687.20 |
$4,609 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$2,172.80 |
$2,716 |
8.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,470.40 |
$3,088 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,168.80 |
$3,961 |
8.0× |
| MRI bone marrow blood supply (77084) |
$1,440 |
$1,800 |
5.3× |
| MRI c-spine with contrast (72142) |
$3,144 |
$3,930 |
7.9× |
| MRI cervical spine w/o contrast (72141) |
$2,512 |
$3,140 |
9.2× |
| MRI chest w/o & w/contrast material (71552) |
$3,116.80 |
$3,896 |
7.8× |
| MRI chest w/o contrast (71550) |
$2,763.20 |
$3,454 |
10.2× |
| MRI chest with contrast (71551) |
$2,771.20 |
$3,464 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,400 |
$3,000 |
6.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,430.40 |
$4,288 |
8.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,120 |
$2,650 |
7.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,196.80 |
$2,746 |
8.1× |
| MRI orbit face neck w contrast (70542) |
$2,671.20 |
$3,339 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,046.40 |
$3,808 |
7.7× |
| MRI pelvis w/contrast (72196) |
$2,948 |
$3,685 |
7.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,636 |
$4,545 |
9.2× |
| MRI pelvis w/o contrast (72195) |
$2,700.80 |
$3,376 |
9.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,440 |
$4,300 |
8.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,239.20 |
$4,049 |
8.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,532 |
$4,415 |
8.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,840 |
$3,550 |
7.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,532 |
$4,415 |
8.9× |
| MRI temporomandibular joint (70336) |
$2,128.80 |
$2,661 |
7.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,512 |
$3,140 |
9.2× |
| MRI up ext w/o contrast (73218) |
$2,029.60 |
$2,537 |
7.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,296 |
$2,870 |
8.4× |
| MRI, joint upper extrem combo (73223) |
$2,771.20 |
$3,464 |
7.0× |
| Myelogram Cervical (72240) |
$1,464.80 |
$1,831 |
1.6× |
| Myelogram Lumbar (72265) |
$1,282.40 |
$1,603 |
1.4× |
| Myelogram thoracic (72255) |
$1,370.40 |
$1,713 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$3,804 |
$4,755 |
2.6× |
| Myocardial spect single study at rest or stress (78451) |
$3,192 |
$3,990 |
2.2× |
| Neck soft tissue (70360) |
$282.40 |
$353 |
2.8× |
| Nm bone marrow multi (78103) |
$803.20 |
$1,004 |
1.8× |
| Nm bone marrow wb (78104) |
$3,112 |
$3,890 |
6.8× |
| Nm gastric emptying study (78264) |
$1,885.60 |
$2,357 |
4.1× |
| Nm gastroesophageal reflux study (78262) |
$1,707.20 |
$2,134 |
3.7× |
| Nm kidney scan w/flow (78701) |
$1,312 |
$1,640 |
2.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$364.80 |
$456 |
0.8× |
| Osseous survey limited (77074) |
$636.80 |
$796 |
5.3× |
| Parathyroid Planar Imaging (78070) |
$1,580.80 |
$1,976 |
3.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,192.80 |
$1,491 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$398.40 |
$498 |
3.3× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Non-Facility (78110) |
$1,614.40 |
$2,018 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,305.60 |
$1,632 |
2.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,833.60 |
$2,292 |
3.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$968 |
$1,210 |
1.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$348 |
$435 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$283.20 |
$354 |
2.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$362.40 |
$453 |
3.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$184.80 |
$231 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$394.40 |
$493 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$290.40 |
$363 |
2.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$517.20 |
$646.50 |
5.2× |
| Radex Hand Minimum 3 Views (73130) |
$364 |
$455 |
3.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$299.20 |
$374 |
3.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$243.20 |
$304 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$480 |
$600 |
4.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$574.40 |
$718 |
4.8× |
| Radex Humerus Minimum 2 Views (73060) |
$296 |
$370 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$278.40 |
$348 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$456 |
$570 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$488.80 |
$611 |
4.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$372.80 |
$466 |
3.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$407.20 |
$509 |
3.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$364 |
$455 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$296 |
$370 |
3.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$418.40 |
$523 |
3.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$554.40 |
$693 |
5.6× |
| Radex Toe Minimum 2 Views (73660) |
$245.60 |
$307 |
2.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$324.80 |
$406 |
2.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$362.40 |
$453 |
3.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$324.80 |
$406 |
3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$388 |
$485 |
3.3× |
| Radiologic exam chest 2 views (71046) |
$362.40 |
$453 |
3.7× |
| Radiologic exam colon single contrast study (74270) |
$1,184.80 |
$1,481 |
5.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$588 |
$735 |
2.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$932.80 |
$1,166 |
4.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$737.60 |
$922 |
3.7× |
| Radiologic examination femur 1 view (73551) |
$128 |
$160 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$296 |
$370 |
3.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$588.80 |
$736 |
0.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$628.80 |
$786 |
5.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$315.20 |
$394 |
2.6× |
| Radiological examination surgical specimen (76098) |
$880.80 |
$1,101 |
1.4× |
| Red cell volume determination (separate procedure); single sampling Non-Facility (78120) |
$1,996.80 |
$2,496 |
4.4× |
| Renal Cyst Study (74470) |
$659.20 |
$824 |
1.1× |
| Ribs bilateral 3 views (71110) |
$448 |
$560 |
3.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,506.40 |
$1,883 |
3.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,739.20 |
$2,174 |
3.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,688 |
$3,360 |
4.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,259.20 |
$2,824 |
3.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,530.40 |
$3,163 |
4.1× |
| Sacroiliac Joints < 3 Views (72200) |
$308 |
$385 |
2.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$658.40 |
$823 |
2.4× |
| Scapula (73010) |
$315.20 |
$394 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$120 |
$150 |
5.1× |
| Sella turcica (70240) |
$282.40 |
$353 |
2.8× |
| Shoulder 1 view (73020) |
$232 |
$290 |
2.3× |
| Sialogram (70390) |
$488.80 |
$611 |
1.8× |
| Small bowel series (74250) |
$744.80 |
$931 |
3.7× |
| Spine thoracic 3 views (72072) |
$476.80 |
$596 |
4.0× |
| Thoracolumbar 2 views (72080) |
$364.80 |
$456 |
3.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,124.80 |
$2,656 |
3.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,881.60 |
$2,352 |
4.1× |
| Tmj unilateral (70328) |
$382.40 |
$478 |
3.9× |
| Tomogram (76100) |
$632.80 |
$791 |
5.3× |
| Ultrasound breast complete (76641) |
$480.80 |
$601 |
4.0× |
| Ultrasound Exam Aaa Screen (76706) |
$480 |
$600 |
4.0× |
| Ultrasound, abdomen limited (76705) |
$620.80 |
$776 |
5.2× |
| Umbilical-artery Doppler (OB) (76820) |
$520 |
$650 |
4.4× |
| Unlisted fluoroscopic procedure (76496) |
$262.40 |
$328 |
2.6× |
| Urethrocystogram voiding (74455) |
$928.80 |
$1,161 |
3.4× |
| Urethrocystography retrograde rs&i (74450) |
$684.80 |
$856 |
2.5× |
| Us breast unilateral limited (76642) |
$489.60 |
$612 |
4.9× |
| Us chest (76604) |
$494.40 |
$618 |
4.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$448.80 |
$561 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$578.40 |
$723 |
4.9× |
| Us encephalogram (76506) |
$488.80 |
$611 |
4.1× |
| Us hips infant static (76886) |
$248 |
$310 |
2.5× |
| Us infant hips w manipulation (76885) |
$328 |
$410 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$421.60 |
$527 |
3.5× |
| Us ob detailed single fetus (76811) |
$935.20 |
$1,169 |
3.4× |
| Us ob limited (76815) |
$553.60 |
$692 |
4.6× |
| Us ob transvaginal (76817) |
$561.60 |
$702 |
4.7× |
| Us pelvic non ob complete (76856) |
$672 |
$840 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$483.20 |
$604 |
4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$599.20 |
$749 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$398.40 |
$498 |
3.3× |
| Us retroperitoneal complete (76770) |
$744.80 |
$931 |
6.3× |
| Us retroperitoneal limited (76775) |
$564 |
$705 |
4.7× |
| Us scrotum and contents (76870) |
$662.40 |
$828 |
5.6× |
| Us soft tissue head/neck (76536) |
$641.60 |
$802 |
5.4× |
| Us spinal canal and contents (76800) |
$567.60 |
$709.50 |
4.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$720.80 |
$901 |
6.1× |
| Venogram extremity bilateral (75822) |
$2,545.60 |
$3,182 |
1.4× |
| Venogram Extremity Unilateral (75820) |
$1,475.20 |
$1,844 |
0.8× |
| Wrist 2 views (73100) |
$280 |
$350 |
2.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$444 |
$555 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$364.80 |
$456 |
3.7× |
| X-ray b.e. reductn intuss (74283) |
$1,299.20 |
$1,624 |
6.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,101.60 |
$1,377 |
5.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$268.80 |
$336 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$328 |
$410 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$420 |
$525 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$315.20 |
$394 |
3.2× |
| X-ray eye for foreign body (70030) |
$281.60 |
$352 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$334.40 |
$418 |
3.4× |
| X-ray IV pyelogram (ivp) (74400) |
$1,234.40 |
$1,543 |
6.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$315.20 |
$394 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$244.80 |
$306 |
2.5× |
| X-ray leg, infant (73592) |
$324 |
$405 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$424 |
$530 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$770.40 |
$963 |
6.5× |
| X-ray nose-rectum child f.b. (76010) |
$217.60 |
$272 |
2.2× |
| X-ray optic foramen (70190) |
$315.20 |
$394 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$609.60 |
$762 |
5.1× |
| X-ray retrograde pyelogram (74420) |
$1,021.60 |
$1,277 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$419.20 |
$524 |
4.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$563.20 |
$704 |
4.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$571.20 |
$714 |
4.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$422.40 |
$528 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$339.20 |
$424 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$609.60 |
$762 |
6.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$588.80 |
$736 |
4.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$394.40 |
$493 |
3.3× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,239.20 |
$1,549 |
6.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$290.40 |
$363 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$315.20 |
$394 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$315.20 |
$394 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$364.80 |
$456 |
3.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$588.80 |
$736 |
4.9× |
| Xr bone length studies (77073) |
$515.20 |
$644 |
4.3× |
| Xr c-spine 4 or 5 views (72050) |
$571.20 |
$714 |
4.8× |
| Xr c-spine 6 or more views (72052) |
$637.60 |
$797 |
5.4× |
| Xr chest 4+ views (71048) |
$252.80 |
$316 |
2.1× |
| Xr urogram antegrade (74425) |
$877.60 |
$1,097 |
2.2× |