| Abdomen 1 View (74018) |
$106.40 |
$266 |
1.0× |
| Abdomen 2 views (74019) |
$106.40 |
$266 |
0.8× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$893.60 |
$2,234 |
1.7× |
| Adrenal Cortex & Medulla Img (78075) |
$1,360.40 |
$3,401 |
0.8× |
| Angio pulmonary bilat (75743) |
$3,000.40 |
$7,501 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$3,000.40 |
$7,501 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$3,000.40 |
$7,501 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,461.20 |
$3,653 |
0.4× |
| Ankle 2 views (73600) |
$106.40 |
$266 |
1.0× |
Aortography thoracic serialography rs&i (75605) unusually low: confirm this is the full procedure |
$2,232 |
$5,580 |
0.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$1,846.80 |
$4,617 |
0.5× |
Artery X-Rays Abdomen (75726) unusually low: confirm this is the full procedure |
$2,523.60 |
$6,309 |
0.4× |
Artery X-Rays Pelvis (75736) unusually low: confirm this is the full procedure |
$3,000.40 |
$7,501 |
0.4× |
| Arthrogram hip (73525) |
$629.60 |
$1,574 |
1.4× |
| Arthrogram Wrist (73115) |
$629.60 |
$1,574 |
1.4× |
| Bone age studies (77072) |
$106.40 |
$266 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,473.20 |
$3,683 |
2.9× |
| Bone Imaging Limited Area (78300) |
$1,059.20 |
$2,648 |
2.1× |
| Bone Imaging Multiple Areas (78305) |
$1,466.80 |
$3,667 |
2.9× |
| Bone Imaging Whole Body (78306) |
$1,550 |
$3,875 |
3.0× |
| Bone survey infant (77076) |
$168.80 |
$422 |
1.3× |
| Brain Image W/Flow < 4 Views (78601) |
$991.20 |
$2,478 |
1.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$591.60 |
$1,479 |
1.2× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$591.60 |
$1,479 |
0.8× |
| Cardiac Shunt Detection (78428) |
$794.40 |
$1,986 |
1.5× |
| Cat Scan Follow-Up Study (76380) |
$147.60 |
$369 |
1.3× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$591.20 |
$1,478 |
0.8× |
| Cerebrospinal Fluid Scan (78630) |
$1,528 |
$3,820 |
2.2× |
| Chest 1 view (71045) |
$106.40 |
$266 |
1.0× |
| Chest 2 views (71046) |
$106.40 |
$266 |
1.0× |
| Chest 3 views (71047) |
$106.40 |
$266 |
1.0× |
| Chest 4 or more views (71048) |
$168.80 |
$422 |
1.3× |
| Clavicle complete (73000) |
$106.40 |
$266 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$234.40 |
$586 |
1.7× |
Contrast Exam Abdominl Aorta (75625) range across 2 matching MRF lines |
$3,000.40–$5,474.80 |
$7,501–$13,687 |
varies |
| Contrast X-Ray Bladder (74430) |
$477.60 |
$1,194 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$724 |
$1,810 |
1.6× |
| CT abdomen and pelvis without contrast (74176) |
$448.40 |
$1,121 |
1.5× |
| CT abdomen w contrast (74160) |
$462 |
$1,155 |
2.0× |
| CT abdomen w wo contrast (74170) |
$520.40 |
$1,301 |
2.3× |
| CT abdomen w/o contrast (74150) |
$234.40 |
$586 |
1.7× |
| CT Angio Abdomen and Pelvis (74174) |
$724 |
$1,810 |
1.6× |
| CT Angio Chest (71275) |
$541.60 |
$1,354 |
2.4× |
| CT Angio Head (70496) |
$541.60 |
$1,354 |
2.4× |
| CT angio hrt w/3d image (75574) |
$412.40 |
$1,031 |
0.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$541.60 |
$1,354 |
2.4× |
| CT Angio Neck (70498) |
$541.60 |
$1,354 |
2.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$541.60 |
$1,354 |
2.4× |
| CT Cere Prfuj Alys C+ W/O CT/Cta Same Anatomy (70473) |
$312 |
$780 |
1.4× |
| CT cervical spine w/ contrast (72126) |
$462 |
$1,155 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$234.40 |
$586 |
1.7× |
| CT cervical spine w/wo cont (72127) |
$520.40 |
$1,301 |
2.3× |
| CT chest w contrast (71260) |
$462 |
$1,155 |
2.0× |
| CT chest w/wo contrast (71270) |
$520.40 |
$1,301 |
2.3× |
| CT head/brain with contrast (70460) |
$462 |
$1,155 |
2.0× |
| CT head/brain without and with contrast (70470) |
$520.40 |
$1,301 |
2.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$412.40 |
$1,031 |
0.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$189.20 |
$473 |
1.7× |
| CT iac w contrast (70481) |
$462 |
$1,155 |
2.0× |
| CT l-spine w&w/o contrast (72133) |
$480 |
$1,200 |
2.1× |
| CT lower ext w/o (73700) |
$234.40 |
$586 |
1.7× |
| CT lower extremity w/contrast material (73701) |
$462 |
$1,155 |
2.0× |
| CT lumbar spine w contrast (72132) |
$462 |
$1,155 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$234.40 |
$586 |
1.7× |
| CT maxillofacial w contrast (70487) |
$462 |
$1,155 |
2.0× |
| CT maxillofacial wo contrast (70486) |
$234.40 |
$586 |
1.7× |
| CT neck tissue combo (70492) |
$520.40 |
$1,301 |
2.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$520.40 |
$1,301 |
2.3× |
| CT orbits w/o contrast (70480) |
$234.40 |
$586 |
1.7× |
| CT pelvis w&w/o contrast (72194) |
$520.40 |
$1,301 |
2.3× |
| CT pelvis w/o contrast (72192) |
$234.40 |
$586 |
1.7× |
| CT scan of leg combo (73702) |
$520.40 |
$1,301 |
2.3× |
| CT scans face/jaw combo (70488) |
$520.40 |
$1,301 |
2.3× |
| CT soft tissue neck w contrast (70491) |
$462 |
$1,155 |
2.0× |
| CT soft tissue neck w/o contrast (70490) |
$234.40 |
$586 |
1.7× |
| CT thoracic spine w contrast (72129) |
$462 |
$1,155 |
2.0× |
| CT thoracic spine w/o contrast (72128) |
$234.40 |
$586 |
1.7× |
| CT thoracic spine w/wo cont (72130) |
$520.40 |
$1,301 |
2.3× |
| CT thorax w/o contrast (71250) |
$234.40 |
$586 |
1.7× |
| CT upper ext wo (73200) |
$234.40 |
$586 |
1.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$520.40 |
$1,301 |
2.3× |
| CT upper extremity with contrast (73201) |
$462 |
$1,155 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$541.60 |
$1,354 |
2.4× |
| Cta Abdomen (74175) |
$541.60 |
$1,354 |
2.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,031.20 |
$2,578 |
2.3× |
| CTA pelvis (72191) |
$541.60 |
$1,354 |
2.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$199.60 |
$499 |
1.5× |
| Dxa Bone Density Axial (77080) |
$398.80 |
$997 |
3.0× |
| Echo Guide For Artery Repair (76936) |
$243.20 |
$608 |
0.9× |
| Esophageal Motility Study (78258) |
$485.60 |
$1,214 |
0.9× |
| Esophagram (74220) |
$189.20 |
$473 |
0.8× |
| Fetal Biophys Profile W/Nst (76818) |
$239.60 |
$599 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$239.60 |
$599 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$461.20 |
$1,153 |
1.5× |
| Follow-Up Angiography (75898) |
$140 |
$350 |
0.0× |
Foot 2 views (73620) range across 2 matching MRF lines |
$106.40–$470.40 |
$266–$1,176 |
varies |
| Forearm 2 views (73090) |
$106.40 |
$266 |
1.0× |
| Gastric emptying imaging study (78264) |
$581.60 |
$1,454 |
1.1× |
| Gastroesophageal Reflux Exam (78262) |
$1,304.40 |
$3,261 |
2.5× |
| Gated Heart Planar Single (78472) |
$846.40 |
$2,116 |
1.6× |
| Gated Heart, Multiple (78473) |
$1,561.60 |
$3,904 |
3.0× |
Hand 2 views (73120) range across 2 matching MRF lines |
$106.40–$642.80 |
$266–$1,607 |
varies |
| Heart first pass single,planar (78481) |
$731.60 |
$1,829 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,656.80 |
$9,142 |
0.9× |
| Hepatobil Syst Image W/Drug (78227) |
$925.20 |
$2,313 |
1.3× |
| Hepatobiliary System Imaging (78226) |
$1,146.40 |
$2,866 |
2.2× |
| Ht Musc Image Planar Mult (78454) |
$838.80 |
$2,097 |
0.5× |
| Ht Muscle Image Spect Sing (78451) |
$1,011.60 |
$2,529 |
0.6× |
| Hysterosalpingogram (74740) |
$590 |
$1,475 |
1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$166.80 |
$417 |
1.5× |
| Interstitial radiation source applic complex (77778) |
$1,557.60 |
$3,894 |
1.7× |
| K Flow/Funct Image Multiple (78709) |
$1,717.20 |
$4,293 |
2.5× |
| K Flow/Funct Image W/Drug (78708) |
$1,630.40 |
$4,076 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$1,464.80 |
$3,662 |
2.1× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$352.80 |
$882 |
0.7× |
| Kidney Imaging Morphol (78700) |
$652.40 |
$1,631 |
1.3× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$739.20 |
$1,848 |
1.4× |
| Knee 3 Views (73562) |
$106.40 |
$266 |
1.0× |
| Leveen/Shunt Patency Exam (78291) |
$1,044.80 |
$2,612 |
2.0× |
| Liver & Spleen Imaging Static Only (78215) |
$1,059.20 |
$2,648 |
2.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,356 |
$3,390 |
2.6× |
| Liver imaging w/vascular flow (78202) |
$537.60 |
$1,344 |
0.8× |
| Lung Perf&Ventilat Diferentl (78598) |
$783.60 |
$1,959 |
1.1× |
| Lung perfusion differential (78597) |
$1,780.80 |
$4,452 |
3.5× |
| Lung Ventilat&Perfus Imaging (78582) |
$783.60 |
$1,959 |
1.1× |
| Lung Ventilation Imaging (78579) |
$1,325.60 |
$3,314 |
2.6× |
| Lymph System Imaging (78195) |
$926 |
$2,315 |
1.3× |
| Magnetic Image Jaw Joint (70336) |
$547.20 |
$1,368 |
1.8× |
| Meckels Divert Exam (78290) |
$574.40 |
$1,436 |
1.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$914.40 |
$2,286 |
2.0× |
| MRA head w/o contrast (70544) |
$547.20 |
$1,368 |
1.8× |
| MRA head with contrast (70545) |
$791.60 |
$1,979 |
1.8× |
| MRA neck w contrast (70548) |
$791.60 |
$1,979 |
1.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$914.40 |
$2,286 |
2.0× |
| MRA neck w/o contrast (70547) |
$547.20 |
$1,368 |
1.8× |
| MRI abdomen w/o contrast (74181) |
$547.20 |
$1,368 |
1.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$791.60 |
$1,979 |
0.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$914.40 |
$2,286 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$791.60 |
$1,979 |
0.8× |
| MRI cervical spine w contrast (72142) |
$791.60 |
$1,979 |
1.8× |
| MRI cervical spine w/o cont (72141) |
$547.20 |
$1,368 |
1.8× |
| MRI chest w/o contrast (71550) |
$547.20 |
$1,368 |
1.8× |
| MRI chest wo w contrast (71552) |
$914.40 |
$2,286 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$791.60 |
$1,979 |
1.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$914.40 |
$2,286 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$547.20 |
$1,368 |
1.8× |
| MRI lumbar spine w contrast (72149) |
$791.60 |
$1,979 |
1.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$914.40 |
$2,286 |
2.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$547.20 |
$1,368 |
1.8× |
| MRI orbit face neck w contrast (70542) |
$791.60 |
$1,979 |
1.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$914.40 |
$2,286 |
2.0× |
| MRI pelvis w contrast (72196) |
$791.60 |
$1,979 |
1.8× |
| MRI pelvis w/o & w contrast (72197) |
$914.40 |
$2,286 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$547.20 |
$1,368 |
1.8× |
| MRI thoracic spine w/o contrast (72146) |
$547.20 |
$1,368 |
1.8× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$791.60 |
$1,979 |
1.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$547.20 |
$1,368 |
1.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$914.40 |
$2,286 |
2.0× |
| MRI, abdomen, combo (74183) |
$914.40 |
$2,286 |
2.0× |
| MRI, dorsal spine combo (72157) |
$914.40 |
$2,286 |
2.0× |
| MRI, dorsal spine contrast (72147) |
$791.60 |
$1,979 |
1.8× |
| MRI, joint upper extrem (73221) |
$547.20 |
$1,368 |
1.8× |
| MRI, joint upper extrem combo (73223) |
$914.40 |
$2,286 |
2.0× |
| MRI, lumbar spine combo (72158) |
$914.40 |
$2,286 |
2.0× |
| Myelogram cervical (72240) |
$1,108.40 |
$2,771 |
1.1× |
| Myelogram Lumbar (72265) |
$1,108.40 |
$2,771 |
1.1× |
| Myelograpy 2/more regions rs&i (72270) |
$1,108.40 |
$2,771 |
1.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$591.60 |
$1,479 |
1.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,542 |
$3,855 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,783.20 |
$4,458 |
1.1× |
| Neck soft tissue (70360) |
$106.40 |
$266 |
1.0× |
| Nm csf leak detection (78650) |
$1,066.40 |
$2,666 |
0.6× |
| Nm myocard infarct spect (78469) |
$1,096.80 |
$2,742 |
1.6× |
| Nuclear Rx Intra-Arterial (79445) |
$410 |
$1,025 |
1.4× |
| Nuclear Rx Oral Admin (79005) |
$1,305.60 |
$3,264 |
4.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$191.20 |
$478 |
1.4× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$914.80 |
$2,287 |
1.3× |
| Parathyroid Planar Imaging (78070) |
$1,337.20 |
$3,343 |
2.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$3,130 |
$7,825 |
6.1× |
| Pelvis 1 or 2 views (72170) |
$106.40 |
$266 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,044.80 |
$2,612 |
2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$114.80 |
$287 |
0.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$942.40 |
$2,356 |
1.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$106.40 |
$266 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$106.40 |
$266 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$106.40 |
$266 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$168.80 |
$422 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$106.40 |
$266 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$106.40 |
$266 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$106.40 |
$266 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$106.40 |
$266 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$106.40 |
$266 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$106.40 |
$266 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$106.40 |
$266 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$106.40 |
$266 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$106.40 |
$266 |
1.0× |
Radex Sternum Minimum 2 Views (71120) range across 2 matching MRF lines |
$106.40–$156 |
$266–$390 |
varies |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$106.40 |
$266 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$106.40 |
$266 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$168.80 |
$422 |
1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$106.40 |
$266 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$168.80 |
$422 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$106.40 |
$266 |
0.8× |
| Radiologic exam colon double contrast study (74280) |
$280.40 |
$701 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$280.40 |
$701 |
1.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$321.60 |
$804 |
1.4× |
| Radiologic exam knee complete 4/more views (73564) |
$106.40 |
$266 |
0.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$106.40 |
$266 |
0.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$189.20 |
$473 |
0.8× |
| Radiologic exam swallow function contrast study (74230) |
$189.20 |
$473 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$280.40 |
$701 |
1.2× |
| Radiologic examination femur 1 view (73551) |
$106.40 |
$266 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$106.40 |
$266 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$106.40 |
$266 |
1.0× |
Radiologic examination tibia & fibula 2 views (73590) range across 2 matching MRF lines |
$106.40–$152 |
$266–$380 |
varies |
| Ribs bilateral 3 views (71110) |
$168.80 |
$422 |
1.3× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,165.60 |
$2,914 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,165.60 |
$2,914 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$414.40 |
$1,036 |
0.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$537.60 |
$1,344 |
0.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,566.40 |
$6,416 |
1.4× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,566.40 |
$6,416 |
1.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$663.20 |
$1,658 |
2.2× |
| Rp Therapy Intravenous Administration (79101) |
$528 |
$1,320 |
1.8× |
| Scapula (73010) |
$106.40 |
$266 |
0.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$114.80 |
$287 |
4.9× |
| Shoulder 1 view (73020) |
$106.40 |
$266 |
1.0× |
| Shoulder Arthrography (73040) |
$629.60 |
$1,574 |
1.4× |
| Skull less than 4 views (70250) |
$106.40 |
$266 |
0.8× |
| Sternoclavicular joints (71130) |
$224.40 |
$561 |
2.0× |
| Testicular Imaging W/Flow (78761) |
$652.40 |
$1,631 |
1.3× |
| Thoracic spine 2 views (72070) |
$118.80 |
$297 |
0.9× |
| Thoracic spine 3 views (72072) |
$168.80 |
$422 |
1.3× |
| Thoracolumbar 2 views (72080) |
$106.40 |
$266 |
1.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$520.80 |
$1,302 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$646.40 |
$1,616 |
1.3× |
| Thyroid Met Imaging Body (78018) |
$1,360.40 |
$3,401 |
1.9× |
| Thyroid Uptake Measurement (78012) |
$291.60 |
$729 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$937.60 |
$2,344 |
1.8× |
| Ultrasound Breast Limited (76642) |
$159.20 |
$398 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$278.40 |
$696 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$249.60 |
$624 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$166.80 |
$417 |
1.2× |
| Unlisted us procedure (76999) |
$159.20 |
$398 |
1.4× |
| Upper gi w/o kub (74240) |
$280.40 |
$701 |
1.2× |
| Ureteral Reflux Study (78740) |
$652.40 |
$1,631 |
1.3× |
| Urethrocystogram voiding (74455) |
$477.60 |
$1,194 |
1.6× |
| Urethrocystography retrograde (74450) |
$477.60 |
$1,194 |
1.6× |
| Us breast unilateral complete (76641) |
$662 |
$1,655 |
4.9× |
| Us chest (76604) |
$249.60 |
$624 |
1.9× |
| Us complete joint (76881) |
$326.40 |
$816 |
2.4× |
| Us exam, pelvic, limited (76857) |
$166.80 |
$417 |
1.2× |
| Us head (76506) |
$249.60 |
$624 |
1.9× |
| Us kidney transplant (76776) |
$249.60 |
$624 |
1.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$166.80 |
$417 |
1.2× |
| Us ob detailed single fetus (76811) |
$354.40 |
$886 |
1.2× |
| Us ob limited 1 or more fetuses (76815) |
$239.60 |
$599 |
1.8× |
| Us ob transvaginal (76817) |
$239.60 |
$599 |
1.8× |
| Us pelvic non ob complete (76856) |
$249.60 |
$624 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$249.60 |
$624 |
1.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$239.60 |
$599 |
1.8× |
| Us retroperitoneal complete (76770) |
$249.60 |
$624 |
1.9× |
| Us retroperitoneal limited (76775) |
$249.60 |
$624 |
1.9× |
| Us scrotum and contents (76870) |
$249.60 |
$624 |
1.9× |
| Us spinal canal and contents (76800) |
$166.80 |
$417 |
1.2× |
| Us thyroid (76536) |
$249.60 |
$624 |
1.9× |
| Us transrectal (76872) |
$418.80 |
$1,047 |
3.1× |
| Vein X-Ray Chest (75827) |
$1,502 |
$3,755 |
0.7× |
| Venogram Sinus/Jugular (75860) |
$920.40 |
$2,301 |
0.2× |
| Venography caval inferior serialography rs&i (75825) |
$1,652.40 |
$4,131 |
0.4× |
| Venography extremity bilateral rs&i (75822) |
$1,734 |
$4,335 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$1,652.40 |
$4,131 |
0.8× |
| Venography Renal Bilateral (75833) |
$4,929.20 |
$12,323 |
1.2× |
| Venography Renal Unilateral (75831) |
$4,929.20 |
$12,323 |
1.2× |
| Venous sampling by catheter (75893) |
$3,656.80 |
$9,142 |
0.5× |
| Wrist 2 views (73100) |
$106.40 |
$266 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$106.40 |
$266 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$1,652.40 |
$4,131 |
0.4× |
| X-Ray Bend Only L-S Spine (72120) |
$476 |
$1,190 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$106.40 |
$266 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$1,116 |
$2,790 |
1.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$106.40 |
$266 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$300 |
$750 |
2.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$106.40 |
$266 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$106.40 |
$266 |
1.0× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$642.80 |
$1,607 |
4.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$178.40 |
$446 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$168.80 |
$422 |
1.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$192.40 |
$481 |
1.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$168.80 |
$422 |
1.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$106.40 |
$266 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$168.80 |
$422 |
1.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$168.80 |
$422 |
1.3× |
| X-ray eye for foreign body (70030) |
$106.40 |
$266 |
1.0× |
| X-ray humerus (73060) |
$106.40 |
$266 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$118.80 |
$297 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$208.40 |
$521 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$106.40 |
$266 |
0.8× |
| X-ray nose-rectum child f.b. (76010) |
$106.40 |
$266 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$188 |
$470 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$106.40 |
$266 |
0.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$191.60 |
$479 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$106.40 |
$266 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$106.40 |
$266 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$168.80 |
$422 |
1.3× |
| X-Ray Stress View (77071) |
$642.80 |
$1,607 |
5.7× |
| X-ray thoracic spine 4 vw (72074) |
$106.40 |
$266 |
0.8× |
| X-Ray Tmj Unilat (70328) |
$470.40 |
$1,176 |
4.2× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$477.60 |
$1,194 |
1.1× |
| X-Rays Bone Length Studies (77073) |
$118.80 |
$297 |
0.9× |
| X-Rays Bone Survey Complete (77075) |
$168.80 |
$422 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$168.80 |
$422 |
1.3× |
| Xr facial bones less than 3 views (70140) |
$106.40 |
$266 |
1.0× |
| Xr orbits complete 4 views (70200) |
$106.40 |
$266 |
0.8× |