| Acute gastrointestinal blood loss imaging (78278) |
$399 |
$2,008.24 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,156 |
$7,924.56 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,156 |
$11,279.74 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,156 |
$8,215.27 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$3,156 |
$7,924.56 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,562 |
$13,129.60 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,156 |
$10,989.03 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,156 |
$7,924.56 |
1.0× |
| Angiography Spinal Selective Rs&I (75705) |
$5,562 |
$13,129.60 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,562 |
$23,055.65 |
1.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,156 |
$3,280.89 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,156 |
$3,280.89 |
1.0× |
| Ankle 2 views (73600) |
$86 |
$496.66 |
1.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$348 |
$1,157.64 |
1.0× |
| Aortogram thoracic (75605) |
$5,562 |
$13,148.40 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,156 |
$18,999.10 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,156 |
$8,215.27 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,156 |
$3,280.89 |
1.0× |
| Arthrogram hip (73525) |
$348 |
$1,543.52 |
1.0× |
| Arthrogram shoulder (73040) |
$348 |
$1,570.05 |
1.0× |
| Arthrogram wrist (73115) |
$348 |
$1,157.64 |
1.0× |
| Arthrography knee lt (73580) |
$348 |
$1,283.30 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$399 |
$1,711 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$399 |
$1,711 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$399 |
$2,486.89 |
1.0× |
| Bone age studies (77072) |
$104 |
$573.38 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$399 |
$2,416.78 |
1.0× |
| Bone survey complete (77075) |
$104 |
$906.30 |
1.0× |
| Brain image w/flow 4 + views (78606) |
$542 |
$1,435.25 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$542 |
$1,366.56 |
1.0× |
| Brain Imaging Vascular Flow Only (78610) |
$542 |
$1,435.25 |
1.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$399 |
$1,159.25 |
1.0× |
| Cardiac shunt detection (78428) |
$399 |
$1,133.98 |
1.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$542 |
$1,366.56 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$86 |
$641.60 |
1.0× |
| Chest 1 view (71045) |
$86 |
$463.40 |
1.0× |
| Chest 3 views (71047) |
$86 |
$787 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$175 |
$843.22 |
1.0× |
| Clavicle complete (73000) |
$86 |
$536.96 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$348 |
$7,372.93 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$238 |
$4,666.14 |
1.0× |
| CT abdomen w contrast (74160) |
$175 |
$3,420.32 |
1.0× |
| CT abdomen w wo contrast (74170) |
$175 |
$4,612.37 |
1.0× |
| CT abdomen w/o contrast (74150) |
$104 |
$2,985.50 |
1.0× |
| CT angio hrt w/3d image (75574) |
$348 |
$1,839.75 |
1.0× |
| CT angiography upper extremity lt (73206) |
$175 |
$3,782.54 |
1.0× |
| CT c-spine w/o contrast (72125) |
$104 |
$2,887.53 |
1.0× |
| CT cervical spine w&w/o contrast (72127) |
$175 |
$3,382.28 |
1.0× |
| CT cervical spine with contrast (72126) |
$348 |
$3,019.96 |
1.0× |
| CT chest w/wo contrast (71270) |
$175 |
$4,018.55 |
1.0× |
| CT chest with contrast (71260) |
$175 |
$3,463.19 |
1.0× |
| CT head/brain with contrast (70460) |
$175 |
$3,019.96 |
1.0× |
| CT head/brain without and with contrast (70470) |
$175 |
$3,635.30 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$348 |
$1,500.75 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$86 |
$186.90 |
1.0× |
| CT hrt w/3d image congen (75573) |
$348 |
$1,523.75 |
1.0× |
| CT iac w contrast (70481) |
$175 |
$3,019.96 |
1.0× |
| CT limited/localized follow up study (76380) |
$86 |
$876 |
1.0× |
| CT lower ext w/o (73700) |
$104 |
$2,948.24 |
1.0× |
| CT lower extremity w wo contrast (73702) |
$175 |
$3,286.58 |
1.0× |
| CT lower extremity with contrast (73701) |
$175 |
$3,493.05 |
1.0× |
| CT lumbar spine w & w/o contrast (72133) |
$175 |
$3,523.82 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$104 |
$2,870.84 |
1.0× |
| CT lumbar spine with contrast (72132) |
$348 |
$3,382.64 |
1.0× |
| CT maxillofacial w contrast (70487) |
$175 |
$3,080.38 |
1.0× |
| CT maxillofacial w/o contrast (70486) |
$104 |
$2,703.42 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
$175 |
$3,282.84 |
1.0× |
| CT neck soft tissue w contrast (70491) |
$175 |
$3,138.49 |
1.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$175 |
$3,667.48 |
1.0× |
| CT orbits w/o contrast (70480) |
$104 |
$2,717.05 |
1.0× |
| CT pelvis w & w/o contrast (72194) |
$175 |
$3,299.42 |
1.0× |
| CT pelvis w/o contrast (72192) |
$104 |
$2,891.86 |
1.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$175 |
$3,286.58 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$104 |
$2,664.14 |
1.0× |
| CT thoracic spine w/contrast (72129) |
$175 |
$3,202.86 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$104 |
$2,664.14 |
1.0× |
| CT thoracic spine w/wo contrast (72130) |
$175 |
$3,286.58 |
1.0× |
| CT thorax w/o contrast (71250) |
$104 |
$2,769.06 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$175 |
$3,286.58 |
1.0× |
| CT upper extremity w/o contrast rt (73200) |
$104 |
$2,700.27 |
1.0× |
| CT upper extremity with contrast (73201) |
$348 |
$2,973.60 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$175 |
$5,159.65 |
1.0× |
| Cta Abdomen (74175) |
$175 |
$3,704.98 |
1.0× |
| CTA abdomen pelvis (74174) |
$348 |
$3,697.97 |
1.0× |
| CTA chest (71275) |
$175 |
$4,591.75 |
1.0× |
| Cta Head (70496) |
$175 |
$3,599.74 |
1.0× |
| CTA lwr ext w&w/o contrast (73706) |
$175 |
$4,946.66 |
1.0× |
| Cta Neck (70498) |
$175 |
$3,672.85 |
1.0× |
| Cta Pelvis (72191) |
$175 |
$4,946.66 |
1.0× |
| Cystography minimum 3 views rs&i (74430) |
$348 |
$1,570.05 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$104 |
$337.53 |
1.0× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$104 |
$586.71 |
1.0× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$104 |
$337.53 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$104 |
$549.10 |
1.0× |
| Echo exam of eye (76529) |
$86 |
$323 |
1.0× |
| Echo exam of fetal heart (76825) |
$546 |
$1,492.47 |
1.0× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$238 |
$691.68 |
1.0× |
| Echoencephalography real time imaging (76506) |
$104 |
$1,004.38 |
1.0× |
| Esophagus (74220) |
$175 |
$1,299.50 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$104 |
$925 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$104 |
$799.22 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$238 |
$712.94 |
1.0× |
| Foot 2 views (73620) |
$86 |
$533.78 |
1.0× |
| Forearm 2 views (73090) |
$86 |
$724.83 |
1.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$542 |
$2,123 |
1.0× |
| Gated Heart Planar Single (78472) |
$399 |
$1,808.35 |
1.0× |
| Hand 2 views (73120) |
$104 |
$765.94 |
1.0× |
| Hand 3 views (73130) |
$86 |
$400.60 |
1.0× |
| Heart Infarct Image (78466) |
$399 |
$1,300.35 |
1.0× |
| Heart infarct image w ef (78468) |
$542 |
$1,435.25 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,156 |
$10,566.08 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$542 |
$2,161.77 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$399 |
$1,818.40 |
1.0× |
| Ht muscle image spect sing (78451) |
$1,294 |
$3,688.14 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$86 |
$746.55 |
1.0× |
| Hysterosalpingogram (74740) |
$238 |
$920.89 |
1.0× |
| Kidney imaging morphology (78700) |
$399 |
$1,540.45 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$542 |
$1,911 |
1.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$542 |
$2,209.30 |
1.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$542 |
$2,180 |
1.0× |
| Knee 3 views (73562) |
$86 |
$836.52 |
1.0× |
| Liver & spleen imaging static only (78215) |
$399 |
$1,767 |
1.0× |
| Lung Ventilation Imaging (78579) |
$399 |
$1,338 |
1.0× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$627 |
$1,860.03 |
1.0× |
| Lymphoscintigraphy (78195) |
$542 |
$2,059 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$238 |
$691.68 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$238 |
$695.45 |
1.0× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$86 |
$414.50 |
1.0× |
| Meckels Diverticulum (78290) |
$399 |
$1,664.70 |
1.0× |
| MRA head w & w/o contrast (70546) |
$348 |
$3,830.75 |
1.0× |
| MRA head w/o contrast (70544) |
$238 |
$4,509 |
1.0× |
| MRA head with contrast (70545) |
$348 |
$3,830.75 |
1.0× |
| MRA neck w contrast (70548) |
$348 |
$3,830.75 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$348 |
$4,451.22 |
1.0× |
| MRA neck w/o contrast (70547) |
$238 |
$3,910 |
1.0× |
| MRI abdomen w contrast (74182) |
$348 |
$2,934.25 |
1.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$348 |
$4,871.55 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$238 |
$4,084.31 |
1.0× |
| MRI any jnt lwr ext with con lt (73722) |
$783 |
$2,719.92 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$783 |
$2,552.38 |
1.0× |
| MRI bone marrow blood supply (77084) |
$238 |
$2,939.75 |
1.0× |
| MRI breast w/o contrast bilateral (77047) |
$238 |
$3,826.83 |
1.0× |
| MRI breast w/o contrast unilat (77046) |
$238 |
$2,095.75 |
1.0× |
| MRI c-spine with contrast (72142) |
$348 |
$3,563.03 |
1.0× |
| MRI cervical spine w/o contrast (72141) |
$238 |
$3,445.08 |
1.0× |
| MRI chest w/o & w/contrast material (71552) |
$348 |
$2,611.25 |
1.0× |
| MRI chest w/o contrast (71550) |
$238 |
$2,607.75 |
1.0× |
| MRI chest with contrast (71551) |
$783 |
$2,607.75 |
1.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$348 |
$2,093.57 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$348 |
$2,345.82 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$238 |
$1,897.36 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$238 |
$3,890 |
1.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$348 |
$4,339.25 |
1.0× |
| MRI orbit/face/neck w/contrast (70542) |
$348 |
$3,830.75 |
1.0× |
| MRI pelvis w contrast (72196) |
$348 |
$3,767.75 |
1.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$348 |
$4,172.66 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$238 |
$3,767.75 |
1.0× |
| MRI scan of arm joint before and after contrast (73223) |
$348 |
$2,616.26 |
1.0× |
| MRI scan of leg joint before and after contrast (73723) |
$348 |
$2,656.54 |
1.0× |
| MRI spectroscopy (76390) |
$86 |
$3,077.50 |
1.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$348 |
$4,722.05 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$348 |
$3,843 |
1.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$348 |
$5,219.34 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$348 |
$3,950.25 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$348 |
$5,344.93 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$238 |
$4,004.56 |
1.0× |
| MRI tmj (70336) |
$238 |
$3,950.25 |
1.0× |
| MRI upper ext joint w/o contrast (73221) |
$238 |
$2,157.72 |
1.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$348 |
$2,543 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$238 |
$1,860.59 |
1.0× |
| Myelogram Cervical (72240) |
$783 |
$2,079 |
1.0× |
| Myelogram Lumbar (72265) |
$783 |
$2,075.25 |
1.0× |
| Myelogram thoracic (72255) |
$783 |
$2,075.25 |
1.0× |
| Myelography 2 or more regions (72270) |
$783 |
$2,254.48 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,294 |
$7,551.41 |
1.0× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$858 |
$1,200 |
1.0× |
| Neck soft tissue (70360) |
$86 |
$494.16 |
1.0× |
| Nm adrenal scan (78075) |
$1,294 |
$3,688.14 |
1.0× |
| Nm cisternogram (78630) |
$542 |
$1,829.50 |
1.0× |
| Nm gastric emptying study (78264) |
$399 |
$2,262.12 |
1.0× |
| Nm gastroesophageal reflux study (78262) |
$399 |
$1,823.45 |
1.0× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,294 |
$4,000.72 |
1.0× |
| Nuclear medicine of heart pumping function (78473) |
$399 |
$2,217.35 |
1.0× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$542 |
$2,104.66 |
1.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,294 |
$3,688.14 |
1.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$399 |
$1,606.78 |
1.0× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$399 |
$1,923.45 |
1.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$399 |
$1,060.47 |
1.0× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$542 |
$3,688.14 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$233 |
$1,674.28 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$104 |
$748 |
1.0× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$104 |
$527 |
1.0× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$104 |
$527 |
1.0× |
| Osseous survey infant (77076) |
$104 |
$562.55 |
1.0× |
| Osseous survey limited (77074) |
$104 |
$660.76 |
1.0× |
| Parathyroid imaging (78070) |
$399 |
$1,674.25 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$104 |
$693.62 |
1.0× |
| PET whole body (78813) |
$1,429 |
$4,126.62 |
1.0× |
| Pr heart first pass single,planar (78481) |
$542 |
$2,383.05 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$348 |
$2,638.96 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$399 |
$1,999.24 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$542 |
$1,603.25 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$546 |
$2,432.30 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$86 |
$576.31 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$104 |
$692.77 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$104 |
$809.23 |
1.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$104 |
$379.89 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$104 |
$761.63 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$86 |
$519.92 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$104 |
$654.01 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$86 |
$674.04 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$175 |
$1,471.96 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$175 |
$1,643 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$175 |
$1,619 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$86 |
$656 |
1.0× |
| Radiological examination surgical specimen (76098) |
$546 |
$2,024.16 |
1.0× |
| Ribs bilateral 3 views (71110) |
$104 |
$685.89 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$399 |
$1,291.75 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$542 |
$3,688.14 |
1.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$542 |
$2,795.28 |
1.0× |
| Sacroiliac Joints < 3 Views (72200) |
$104 |
$693.62 |
1.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$238 |
$879.78 |
1.0× |
| Scanogram (77073) |
$104 |
$457.78 |
1.0× |
| Scapula complete (73010) |
$104 |
$609.28 |
1.0× |
| Screening digital breast tomosynthesis (77063) |
$22 |
$154.13 |
0.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$104 |
$536.76 |
1.0× |
| Small bowel series (74250) |
$175 |
$724.65 |
1.0× |
| Speech evaluation complex (70371) |
$238 |
$1,019 |
1.0× |
| Spine thoracic 3 views (72072) |
$104 |
$798.40 |
1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$238 |
$799.75 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$399 |
$1,798.25 |
1.0× |
| Therapeutic Enema (74283) |
$175 |
$1,707 |
1.0× |
| Thoracolumbar 2 views (72080) |
$86 |
$438.69 |
1.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$542 |
$2,043.58 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$399 |
$1,060.47 |
1.0× |
| Thyroid uptake measurement (78012) |
$399 |
$1,060.47 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$399 |
$1,476.36 |
1.0× |
| Tmj unilateral (70328) |
$86 |
$296.19 |
1.0× |
| Tomogram (76100) |
$104 |
$2,384.34 |
1.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$399 |
$1,112 |
1.0× |
| Ultrasound scan to determine eye length and lens power (76519) |
$104 |
$527 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$104 |
$891.99 |
1.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$86 |
$1,077 |
1.0× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$399 |
$1,060.47 |
1.0× |
| Unlisted Ultrasound Procedure (76999) |
$86 |
$545 |
1.0× |
| Upper Extremity Infant (73092) |
$104 |
$562.55 |
1.0× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$399 |
$1,197.75 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$238 |
$886.14 |
1.0× |
| Urethrocystography voiding (74455) |
$238 |
$872.60 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$175 |
$1,457.47 |
1.0× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$175 |
$1,950 |
1.0× |
| Us abdl aorta screen aaa (76706) |
$104 |
$950.44 |
1.0× |
| Us breast unilateral complete (76641) |
$104 |
$1,028.35 |
1.0× |
| Us breast unilateral limited (76642) |
$86 |
$837.03 |
1.0× |
| Us chest (76604) |
$104 |
$545.53 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$104 |
$518.60 |
1.0× |
| Us elastography parenchyma (76981) |
$104 |
$450 |
1.0× |
| Us guided compression repair (76936) |
$215 |
$976.96 |
1.0× |
| Us infant hips dynamic (76885) |
$86 |
$749.18 |
1.0× |
| Us infant hips limited static (76886) |
$86 |
$739.23 |
1.0× |
| Us ob transvaginal (76817) |
$104 |
$784.13 |
1.0× |
| Us pelvic non ob complete (76856) |
$104 |
$1,318.89 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$104 |
$1,163.14 |
1.0× |
| Us pregnancy ltd (76815) |
$104 |
$551.75 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$104 |
$887.98 |
1.0× |
| Us retroperitoneal complete (76770) |
$104 |
$809.30 |
1.0× |
| Us retroperitoneal limited (76775) |
$104 |
$950.44 |
1.0× |
| Us scrotum and contents (76870) |
$104 |
$964.38 |
1.0× |
| Us soft tissue head/neck (76536) |
$104 |
$675.06 |
1.0× |
| Us spinal canal and contents (76800) |
$104 |
$786.98 |
1.0× |
| Us transrectal (76872) |
$104 |
$598.01 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$104 |
$479.44 |
1.0× |
| Us, eye b-scan (76512) |
$104 |
$527 |
1.0× |
| Vascular flow imaging (78445) |
$399 |
$1,552 |
1.0× |
| Venogram extremity bilateral (75822) |
$1,573 |
$5,468.15 |
1.0× |
| Venogram orbital (75880) |
$627 |
$1,860.03 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,156 |
$10,989.03 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,573 |
$3,157.93 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,573 |
$2,480.04 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$3,156 |
$7,924.56 |
1.0× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,156 |
$7,924.56 |
1.0× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$5,562 |
$13,129.60 |
1.0× |
| Wrist 2 views (73100) |
$86 |
$531.65 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$104 |
$631.76 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$492.95 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$86 |
$651.14 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$175 |
$1,691 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$513.24 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$86 |
$857.22 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$86 |
$473.68 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$86 |
$722 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$104 |
$722 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$104 |
$710.77 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$104 |
$732.44 |
1.0× |
| X-ray exam of femur 1 (73551) |
$86 |
$330.29 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$175 |
$1,010.73 |
1.0× |
| X-ray eye for foreign body (70030) |
$86 |
$320.82 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$104 |
$917.30 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$86 |
$614.02 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$86 |
$585.60 |
1.0× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,089 |
$5,219.25 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$86 |
$354.75 |
1.0× |
| X-ray IV pyelogram+drip infusn (74410) |
$175 |
$776.50 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86 |
$330.45 |
1.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$104 |
$580.80 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$86 |
$423.59 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$86 |
$397.70 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$104 |
$809.23 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$104 |
$1,082.21 |
1.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$104 |
$843 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$86 |
$460.27 |
1.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$86 |
$406.05 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$104 |
$457.78 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$104 |
$622.92 |
1.0× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$546 |
$1,492.47 |
1.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$348 |
$1,966.54 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$86 |
$491.60 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$104 |
$693.62 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$104 |
$656.20 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$104 |
$652.20 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$688.92 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$86 |
$811.05 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86 |
$536.80 |
1.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$86 |
$321.42 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$104 |
$906.51 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$104 |
$685.89 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$86 |
$387.32 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$86 |
$450.45 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$86 |
$483.75 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$104 |
$809.23 |
1.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$104 |
$1,233.74 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$86 |
$424.34 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$86 |
$818.40 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$104 |
$841.89 |
1.0× |
| Xr chest 4+ views (71048) |
$104 |
$337.53 |
1.0× |
| Xr Cholecystography Oral Contrast (74290) |
$175 |
$605.22 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$86 |
$475.04 |
1.0× |
| Xr internal auditory meati complete (70134) |
$546 |
$1,492.47 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$104 |
$411.12 |
1.0× |
| Xr optic foramina (70190) |
$86 |
$332.20 |
1.0× |
| Xr shoulder 1 view (73020) |
$86 |
$469.66 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$104 |
$871.83 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$86 |
$745.01 |
1.0× |
| Xr tmj bilateral (70330) |
$86 |
$616.96 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$86 |
$733.73 |
1.0× |