| Abdomen 2 views (74019) |
$205 |
$205 |
1.6× |
| Acute gi blood loss imaging (78278) |
$703 |
$703 |
1.5× |
| Angiography extremity bilateral rs&i (75716) |
$1,528 |
$1,528 |
0.4× |
| Angiography extremity unilateral rs&i (75710) |
$4,707 |
$4,707 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$14,994 |
$14,994 |
2.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$14,994 |
$14,994 |
2.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$3,000 |
$3,000 |
0.8× |
| Ankle 2 views (73600) |
$176 |
$176 |
1.7× |
| Aortogram thoracic (75605) |
$14,994 |
$14,994 |
2.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,520 |
$5,520 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$5,018 |
$5,018 |
1.3× |
| Arthrogram elbow (73085) |
$1,049 |
$1,049 |
2.5× |
| Arthrogram hip (73525) |
$627 |
$627 |
1.5× |
| Arthrogram knee (73580) |
$474 |
$474 |
1.1× |
| Arthrogram shoulder (73040) |
$704 |
$704 |
1.7× |
| Arthrogram wrist (73115) |
$627 |
$627 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$607 |
$607 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$986 |
$986 |
2.1× |
| Bone age studies (77072) |
$250 |
$250 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$829 |
$829 |
1.7× |
| Bone survey complete (77075) |
$388 |
$388 |
3.1× |
| Bone survey infant (77076) |
$414 |
$414 |
3.3× |
| Bowel imaging (78290) |
$774 |
$774 |
1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$598 |
$598 |
0.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,131 |
$1,131 |
2.4× |
| Cardiac shunt detection (78428) |
$370 |
$370 |
0.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$260 |
$260 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$239 |
$239 |
2.3× |
| Chest 1 view (71045) |
$192 |
$192 |
1.8× |
| Chest xray 3 views (71047) |
$397 |
$397 |
3.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$302 |
$302 |
1.4× |
| Clavicle complete (73000) |
$143 |
$143 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$920 |
$920 |
7.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,900 |
$1,900 |
4.5× |
| CT abdomen and pelvis without contrast (74176) |
$569 |
$569 |
2.0× |
| CT abdomen w contrast (74160) |
$658 |
$658 |
3.1× |
| CT abdomen w wo contrast (74170) |
$815 |
$815 |
3.9× |
| CT abdomen w/o contrast (74150) |
$880 |
$880 |
7.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,233 |
$1,233 |
5.9× |
| CT angiography upper extremity lt (73206) |
$1,116 |
$1,116 |
5.3× |
| CT c-spine w/contrast (72126) |
$700 |
$700 |
1.7× |
| CT c-spine w/o contrast (72125) |
$450 |
$450 |
3.6× |
| CT cervical spine w&w/o contrast (72127) |
$900 |
$900 |
4.3× |
| CT chest w contrast (71260) |
$1,151 |
$1,151 |
5.5× |
| CT chest w/wo contrast (71270) |
$1,352 |
$1,352 |
6.4× |
| CT colonography screening (74263) |
$842 |
$842 |
2.9× |
| CT colonography w/dye (74262) |
$968 |
$968 |
4.6× |
| CT colonography w/o cntrst (74261) |
$842 |
$842 |
6.7× |
| CT head/brain with contrast (70460) |
$1,106 |
$1,106 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,156 |
$1,156 |
5.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$248 |
$248 |
2.4× |
| CT iac w contrast (70481) |
$883 |
$883 |
4.2× |
| CT limited/localized follow up study (76380) |
$435 |
$435 |
4.2× |
| CT lower ext w/o (73700) |
$1,003 |
$1,003 |
8.0× |
| CT lower extremity w wo contrast (73702) |
$1,350 |
$1,350 |
6.4× |
| CT lower extremity w/contrast material (73701) |
$1,234 |
$1,234 |
5.9× |
| CT lumbar spine w & w/o contrast (72133) |
$900 |
$900 |
4.3× |
| CT lumbar spine w/contrast (72132) |
$700 |
$700 |
1.7× |
| CT lumbar spine w/o contrast (72131) |
$500 |
$500 |
4.0× |
| CT maxillofacial w contrast (70487) |
$1,007 |
$1,007 |
4.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,144 |
$1,144 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$917 |
$917 |
7.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,087 |
$1,087 |
5.2× |
| CT orbits w/o contrast (70480) |
$781 |
$781 |
6.2× |
| CT pelvis w/o contrast (72192) |
$1,170 |
$1,170 |
9.3× |
| CT pelvis w/wo contrast (72194) |
$1,437 |
$1,437 |
6.8× |
| CT scan of arm combo (73202) |
$1,174 |
$1,174 |
5.6× |
| CT soft tissue neck w contrast (70491) |
$965 |
$965 |
4.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$992 |
$992 |
4.7× |
| CT soft tissue neck w/o contrast (70490) |
$765 |
$765 |
6.1× |
| CT thoracic spine w/contrast (72129) |
$700 |
$700 |
3.3× |
| CT thoracic spine w/o contrast (72128) |
$500 |
$500 |
4.0× |
| CT thoracic spine w/wo contrast (72130) |
$438 |
$438 |
2.1× |
| CT thorax w/o contrast (71250) |
$968 |
$968 |
7.7× |
| CT unlisted procedure (76497) |
$178.35 |
$178.35 |
1.7× |
| CT upper ext wo (73200) |
$1,003 |
$1,003 |
8.0× |
| CT upper extremity with contrast (73201) |
$1,097 |
$1,097 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,116 |
$1,116 |
5.3× |
| Cta Abdomen (74175) |
$1,116 |
$1,116 |
5.3× |
| CTA abdomen pelvis (74174) |
$1,590 |
$1,590 |
3.8× |
| CTA chest (71275) |
$1,496 |
$1,496 |
7.1× |
| Cta Head (70496) |
$1,121 |
$1,121 |
5.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$535 |
$535 |
1.3× |
| Cta Neck (70498) |
$1,121 |
$1,121 |
5.3× |
| Cta Pelvis (72191) |
$1,350 |
$1,350 |
6.4× |
| Cystography minimum 3 views rs&i (74430) |
$486 |
$486 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,764 |
$2,764 |
1.1× |
| Diskography lumbar (72295) |
$296 |
$296 |
0.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$276 |
$276 |
2.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$458 |
$458 |
3.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$182 |
$182 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$345 |
$345 |
2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$171 |
$171 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$345 |
$345 |
2.8× |
| Echo exam of eye (76529) |
$255 |
$255 |
2.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$391 |
$391 |
1.4× |
| Esophagus (74220) |
$398 |
$398 |
1.9× |
| Facial bones min 3 views (70150) |
$433 |
$433 |
3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$350 |
$350 |
2.8× |
| Fetal Echo (76825) |
$510 |
$510 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$359 |
$359 |
1.3× |
| Foot 2 views (73620) |
$211 |
$211 |
2.0× |
| Forearm 2 views (73090) |
$216 |
$216 |
2.1× |
| Hand 2 views (73120) |
$275 |
$275 |
2.2× |
| Heart Infarct Image (78466) |
$489 |
$489 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$8,697 |
$8,697 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,129 |
$1,129 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$830 |
$830 |
1.7× |
| Hysterosalpingogram (74740) |
$592 |
$592 |
2.1× |
| Kidney imaging morphology (78700) |
$649 |
$649 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$851 |
$851 |
1.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$936 |
$936 |
1.4× |
| Knee 3 views (73562) |
$272 |
$272 |
2.6× |
| Liver & spleen imaging static only (78215) |
$773 |
$773 |
1.6× |
| Liver imaging w/vascular flow (78202) |
$904 |
$904 |
1.4× |
| Lung perf&ventilat diferentl (78598) |
$1,290 |
$1,290 |
2.0× |
| Lung perfusion differential (78597) |
$675 |
$675 |
1.4× |
| Lung ventilation imaging (78579) |
$675 |
$675 |
1.4× |
| Lymphoscintigraphy (78195) |
$836 |
$836 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,076 |
$2,076 |
2.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,634 |
$1,634 |
3.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,876 |
$1,876 |
4.5× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$150 |
$150 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,200 |
$1,200 |
2.9× |
| MRA head w/o contrast (70544) |
$854 |
$854 |
3.0× |
| MRA head with contrast (70545) |
$1,000 |
$1,000 |
2.4× |
| MRA neck w contrast (70548) |
$1,000 |
$1,000 |
2.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,200 |
$1,200 |
2.9× |
| MRA neck w/o contrast (70547) |
$800 |
$800 |
2.8× |
| MRI abdomen w contrast (74182) |
$2,076 |
$2,076 |
5.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,800 |
$2,800 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$1,535 |
$1,535 |
5.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,973 |
$1,973 |
2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,400 |
$3,400 |
8.1× |
| MRI breast w/o contrast bilateral (77047) |
$3,000 |
$3,000 |
10.5× |
| MRI breast wo contrast unilateral (77046) |
$2,000 |
$2,000 |
7.0× |
| MRI c-spine with contrast (72142) |
$2,101 |
$2,101 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$1,862 |
$1,862 |
6.5× |
| MRI chest w/o & w/contrast material (71552) |
$3,248 |
$3,248 |
7.8× |
| MRI chest w/o contrast (71550) |
$1,535 |
$1,535 |
5.4× |
| MRI chest with contrast (71551) |
$2,075 |
$2,075 |
2.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,900 |
$1,900 |
4.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,500 |
$2,500 |
6.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,751 |
$1,751 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,686 |
$1,686 |
5.9× |
| MRI orbit face neck w contrast (70542) |
$1,708 |
$1,708 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,040 |
$3,040 |
7.3× |
| MRI pelvis w/contrast (72196) |
$1,751 |
$1,751 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,250 |
$3,250 |
7.8× |
| MRI pelvis w/o contrast (72195) |
$1,533 |
$1,533 |
5.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,825 |
$2,825 |
6.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,427 |
$2,427 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,074 |
$3,074 |
7.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,460 |
$2,460 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,074 |
$3,074 |
7.4× |
| MRI temporomandibular joint (70336) |
$1,919 |
$1,919 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,740 |
$1,740 |
6.1× |
| MRI up ext w/o contrast (73218) |
$1,516 |
$1,516 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,770 |
$1,770 |
6.2× |
| MRI, joint upper extrem combo (73223) |
$3,400 |
$3,400 |
8.1× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$3,982 |
$3,982 |
2.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,994 |
$2,994 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,644 |
$1,644 |
1.1× |
| Neck soft tissue (70360) |
$195 |
$195 |
1.9× |
| Nm bone marrow wb (78104) |
$924 |
$924 |
1.9× |
| Nm cisternogram (78630) |
$1,067 |
$1,067 |
1.6× |
| Nm csf leak detection (78650) |
$3,982 |
$3,982 |
2.6× |
| Nm gastric emptying study (78264) |
$850 |
$850 |
1.8× |
| Nm gastroesophageal reflux study (78262) |
$598 |
$598 |
1.2× |
| Nm kidney scan w/flow (78701) |
$714 |
$714 |
1.5× |
| Nm peritoneal-venous shunt patency (78291) |
$777 |
$777 |
1.6× |
| Nonvascular shunt X-ray (75809) |
$180 |
$180 |
1.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$649 |
$649 |
1.4× |
| Nuclear Rx Oral Admin (79005) |
$517 |
$517 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$350 |
$350 |
2.8× |
| Parathyrd planar w/spect&CT (78072) |
$995 |
$995 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$649 |
$649 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$790 |
$790 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$205 |
$205 |
1.6× |
| Peritoneogram after injection (74190) |
$1,505 |
$1,505 |
2.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$558 |
$558 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$968 |
$968 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$316 |
$316 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$227 |
$227 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$170 |
$170 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$224 |
$224 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$335 |
$335 |
3.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$350 |
$350 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$183 |
$183 |
1.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$224 |
$224 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$300 |
$300 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$128 |
$128 |
1.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$180 |
$180 |
1.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$350 |
$350 |
2.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$183 |
$183 |
1.5× |
| Radex Humerus Minimum 2 Views (73060) |
$212 |
$212 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$216 |
$216 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$286 |
$286 |
2.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$335 |
$335 |
2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$217 |
$217 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$226 |
$226 |
1.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$222 |
$222 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$214 |
$214 |
2.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$246 |
$246 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$191 |
$191 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$170 |
$170 |
1.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$150 |
$150 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$222 |
$222 |
2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$220 |
$220 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$167 |
$167 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$226 |
$226 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$253 |
$253 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$470 |
$470 |
2.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$541 |
$541 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$510 |
$510 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$397 |
$397 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$180 |
$180 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$222 |
$222 |
2.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$282 |
$282 |
2.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$175 |
$175 |
1.4× |
| Red cell volume determination (separate procedure); multiple samplings Non-Facility (78121) |
$1,383 |
$1,383 |
2.1× |
| Ribs bilateral 3 views (71110) |
$448 |
$448 |
3.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$675 |
$675 |
1.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,146 |
$2,146 |
3.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$998 |
$998 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,601 |
$1,601 |
2.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,985 |
$1,985 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$173 |
$173 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$604 |
$604 |
2.1× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$611 |
$611 |
1.3× |
| Scapula (73010) |
$193 |
$193 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$210 |
$210 |
9.0× |
| Sella turcica (70240) |
$67 |
$67 |
0.6× |
| Shoulder 1 view (73020) |
$166 |
$166 |
1.6× |
| Sialogram (70390) |
$440 |
$440 |
1.5× |
| Small bowel series (74250) |
$399 |
$399 |
1.9× |
| Spine thoracic 3 views (72072) |
$280 |
$280 |
2.2× |
| Testicular Imaging With Vascular Flow (78761) |
$589 |
$589 |
1.2× |
| Thoracolumbar 2 views (72080) |
$278 |
$278 |
2.7× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Non-Facility (78016) |
$523 |
$523 |
1.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$489 |
$489 |
0.8× |
| Thyroid imaging w/blood flow (78013) |
$378 |
$378 |
0.8× |
| Thyroid uptake measurement (78012) |
$384 |
$384 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$522 |
$522 |
1.1× |
| Tmj unilateral (70328) |
$169 |
$169 |
1.6× |
| Tomogram (76100) |
$437 |
$437 |
3.5× |
| Ultrasound breast complete (76641) |
$347 |
$347 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$534 |
$534 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$205 |
$205 |
1.6× |
| Umbilical-artery Doppler (OB) (76820) |
$344 |
$344 |
2.7× |
| Ureteral reflux study (78740) |
$727 |
$727 |
1.5× |
| Urethrocystogram voiding (74455) |
$486 |
$486 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$364 |
$364 |
1.3× |
| Us breast unilateral limited (76642) |
$330 |
$330 |
3.2× |
| Us chest (76604) |
$681 |
$681 |
5.4× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$642 |
$642 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$320 |
$320 |
2.6× |
| Us elastography parenchyma (76981) |
$198 |
$198 |
1.6× |
| Us encephalogram (76506) |
$320 |
$320 |
2.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$294 |
$294 |
2.3× |
| Us ob detailed single fetus (76811) |
$658 |
$658 |
2.3× |
| Us ob limited (76815) |
$350 |
$350 |
2.8× |
| Us ob transvaginal (76817) |
$350 |
$350 |
2.8× |
| Us pelvic non ob complete (76856) |
$226 |
$226 |
1.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$205 |
$205 |
1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$556 |
$556 |
4.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$232.50 |
$232.50 |
1.9× |
| Us retroperitoneal complete (76770) |
$453 |
$453 |
3.6× |
| Us retroperitoneal limited (76775) |
$408 |
$408 |
3.3× |
| Us scrotum and contents (76870) |
$372 |
$372 |
3.0× |
| Us soft tissue head/neck (76536) |
$347 |
$347 |
2.8× |
| Us spinal canal and contents (76800) |
$518 |
$518 |
4.1× |
| Us transrectal (76872) |
$367 |
$367 |
2.9× |
| Us, eye b-scan (76512) |
$185 |
$185 |
1.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$321 |
$321 |
2.6× |
| Venogram extremity bilateral (75822) |
$4,370 |
$4,370 |
2.3× |
| Venogram Extremity Unilateral (75820) |
$2,194 |
$2,194 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$5,736 |
$5,736 |
1.5× |
| Venography caval superior serialography rs&i (75827) |
$1,546 |
$1,546 |
0.8× |
| Venography Renal Bilateral (75833) |
$8,697 |
$8,697 |
2.3× |
| Venography renal unilateral selective rs&i (75831) |
$8,697 |
$8,697 |
2.3× |
| Venous sampling by catheter (75893) |
$9,851 |
$9,851 |
1.5× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$325 |
$325 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$397 |
$397 |
3.8× |
| Wrist 2 views (73100) |
$188 |
$188 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$288 |
$288 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$268 |
$268 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$583 |
$583 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$195 |
$195 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$172 |
$172 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$443 |
$443 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$118 |
$118 |
1.1× |
| X-ray eye for foreign body (70030) |
$228 |
$228 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$219 |
$219 |
2.1× |
| X-ray IV pyelogram (ivp) (74400) |
$434 |
$434 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161 |
$161 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$216 |
$216 |
2.1× |
| X-ray leg, infant (73592) |
$143 |
$143 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$285 |
$285 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$400 |
$400 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$227 |
$227 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$382 |
$382 |
3.0× |
| X-ray retrograde pyelogram (74420) |
$595 |
$595 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$274 |
$274 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$420 |
$420 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$482 |
$482 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$218 |
$218 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$247 |
$247 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$331 |
$331 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$573 |
$573 |
4.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$272 |
$272 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$168 |
$168 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$197 |
$197 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$268 |
$268 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$230 |
$230 |
1.8× |
| Xr bone length studies (77073) |
$390 |
$390 |
3.1× |
| Xr c-spine 4 or 5 views (72050) |
$381 |
$381 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$420 |
$420 |
3.4× |
| Xr chest 4+ views (71048) |
$430 |
$430 |
3.4× |
| Xr urogram antegrade (74425) |
$595 |
$595 |
1.4× |