| Abdomen 1 View (74018) |
— |
$376.95 |
— |
| Abdomen 2 views (74019) |
— |
$524.90 |
— |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
— |
$5,005.15 |
— |
| Adrenal Cortex & Medulla Img (78075) |
— |
$13,881.15 |
— |
| Angio internal mammary (75756) |
— |
$7,599.45 |
— |
| Angio pulmonary bilat (75743) |
— |
$9,817.20 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$4,317.90 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$4,054.35 |
— |
| Angiography extremity unilateral rs&i (75710) |
— |
$3,895.05 |
— |
| Angiography pulmonary unilateral slctv rs&i (75741) |
— |
$6,544.80 |
— |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
— |
$3,286.40 |
— |
| Ankle 2 views (73600) |
— |
$376.95 |
— |
| Aortography thoracic serialography rs&i (75605) |
— |
$12,633.40 |
— |
| Artery X-Rays Abdomen (75726) |
— |
$7,603.35 |
— |
| Artery X-Rays Adrenal Gland (75731) |
— |
$3,286.40 |
— |
| Artery X-Rays Pelvis (75736) |
— |
$12,001.70 |
— |
| Artery X-Rays Spine (75705) |
— |
$12,633.40 |
— |
| Arthrogram hip (73525) |
— |
$1,396.30 |
— |
| Arthrogram Wrist (73115) |
— |
$1,516.45 |
— |
| Bone age studies (77072) |
— |
$693 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$5,483.25 |
— |
| Bone Imaging Limited Area (78300) |
— |
$2,428.95 |
— |
| Bone Imaging Whole Body (78306) |
— |
$6,799.50 |
— |
| Bone survey infant (77076) |
— |
$3,232.95 |
— |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
— |
$4,774.30 |
— |
| Brain Imaging Pet Metabolic Evaluation (78608) |
— |
$9,378.95 |
— |
| Cat Scan Follow-Up Study (76380) |
— |
$966.40 |
— |
| Cerebrospinal Fluid Scan (78630) |
— |
$4,914.45 |
— |
| Chest 1 view (71045) |
— |
$417.85 |
— |
| Chest 2 views (71046) |
— |
$557.70 |
— |
| Chest 3 views (71047) |
— |
$566.80 |
— |
| Chest 4 or more views (71048) |
— |
$582.40 |
— |
| Clavicle complete (73000) |
— |
$445.75 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$887.75 |
— |
| Continuing medical physics consltj pr wk (77336) |
— |
$1,581.20 |
— |
| Contrast Exam Abdominl Aorta (75625) |
— |
$7,599.45 |
— |
| Contrast X-Ray Bladder (74430) |
— |
$737.85 |
— |
| Contrast X-Ray Of Knee Joint (73580) |
— |
$1,816.30 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
— |
$8,983.15 |
— |
| CT abdomen and pelvis without contrast (74176) |
— |
$4,308.05 |
— |
| CT abdomen w contrast (74160) |
— |
$3,889.25 |
— |
| CT abdomen w wo contrast (74170) |
— |
$4,663.65 |
— |
| CT abdomen w/o contrast (74150) |
— |
$3,379.45 |
— |
| CT Angio Abdomen and Pelvis (74174) |
— |
$6,822.80 |
— |
| CT Angio Chest (71275) |
— |
$3,754.60 |
— |
| CT Angio Head (70496) |
— |
$3,191.20 |
— |
| CT angio hrt w/3d image (75574) |
— |
$2,809.85 |
— |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
— |
$2,371.15 |
— |
| CT Angio Neck (70498) |
— |
$3,191.20 |
— |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
— |
$2,141.25 |
— |
| CT cervical spine w/ contrast (72126) |
— |
$2,905.20 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$2,489.40 |
— |
| CT cervical spine w/wo cont (72127) |
— |
$3,062.25 |
— |
| CT chest w contrast (71260) |
— |
$3,190.65 |
— |
| CT chest w/wo contrast (71270) |
— |
$3,253.65 |
— |
| CT head/brain with contrast (70460) |
— |
$2,380.25 |
— |
| CT head/brain without and with contrast (70470) |
— |
$3,313.65 |
— |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$3,062.90 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$887.90 |
— |
| CT iac w contrast (70481) |
— |
$1,849.45 |
— |
| CT l-spine w&w/o contrast (72133) |
— |
$2,326.55 |
— |
| CT lower ext w/o (73700) |
— |
$1,147.45 |
— |
| CT lower extremity w/contrast material (73701) |
— |
$2,457.15 |
— |
| CT lumbar spine w contrast (72132) |
— |
$1,916.90 |
— |
| CT lumbar spine w/o contrast (72131) |
— |
$1,338.20 |
— |
| CT maxillofacial w contrast (70487) |
— |
$2,361.95 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,796.20 |
— |
| CT neck tissue combo (70492) |
— |
$2,917.40 |
— |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
— |
$2,069.05 |
— |
| CT orbits w/o contrast (70480) |
— |
$1,832.90 |
— |
| CT pelvis w&w/o contrast (72194) |
— |
$2,841.10 |
— |
| CT pelvis w/o contrast (72192) |
— |
$2,468.45 |
— |
| CT scan of leg combo (73702) |
— |
$2,600 |
— |
| CT scans face/jaw combo (70488) |
— |
$2,467.95 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$2,139.20 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,288 |
— |
| CT thoracic spine w contrast (72129) |
— |
$2,176.85 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$2,077.45 |
— |
| CT thoracic spine w/wo cont (72130) |
— |
$2,284.60 |
— |
| CT thorax w/o contrast (71250) |
— |
$2,777.10 |
— |
CT unlisted procedure (76497)
range across 2 matching MRF lines |
— |
$1,642.35–$7,198.45 |
— |
| CT upper ext wo (73200) |
— |
$1,734.35 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
— |
$2,101.85 |
— |
| CT upper extremity with contrast (73201) |
— |
$2,001.95 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$2,116.80 |
— |
| Cta Abdomen (74175) |
— |
$3,768.05 |
— |
| CTA pelvis (72191) |
— |
$2,420.50 |
— |
| Dilation ureters/urethra rs&i (74485) |
— |
$6,618.25 |
— |
| Discography Cerv/Thor Spine (72285) |
— |
$4,781.45 |
— |
| Diskography lumbar (72295) |
— |
$5,033.10 |
— |
| Echo exam uterus (76831) |
— |
$2,243.55 |
— |
| Esophagram (74220) |
— |
$904.55 |
— |
| Fetal Biophys Profile W/Nst (76818) |
— |
$2,295.75 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
— |
$1,678.20 |
— |
| Fluoroscopy up to 1 hr (76000) |
— |
$1,788.25 |
— |
| Follow-Up Angiography (75898) |
— |
$3,332.10 |
— |
| Foot 2 views (73620) |
— |
$372.75 |
— |
| Forearm 2 views (73090) |
— |
$376.95 |
— |
| Gastric emptying imaging study (78264) |
— |
$4,979.50 |
— |
| Gated Heart Planar Single (78472) |
— |
$3,490.05 |
— |
| Hand 2 views (73120) |
— |
$359.60 |
— |
| Heart Image (Pet) Multiple (78492) |
— |
$9,822.60 |
— |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
— |
$5,310.95 |
— |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
— |
$5,256.40 |
— |
| Hepatobil Syst Image W/Drug (78227) |
— |
$6,645.10 |
— |
| Hepatobiliary System Imaging (78226) |
— |
$4,619.40 |
— |
| Ht Muscle Image Spect Sing (78451) |
— |
$5,076.05 |
— |
| Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators Non-Facility (77610) |
— |
$1,804.80 |
— |
| Hysterosalpingogram (74740) |
— |
$798.75 |
— |
| K Flow/Funct Image Multiple (78709) |
— |
$3,020.35 |
— |
| K Flow/Funct Image W/Drug (78708) |
— |
$2,461.35 |
— |
| K Flow/Funct Image W/O Drug (78707) |
— |
$2,314.25 |
— |
| Knee 3 Views (73562) |
— |
$479.70 |
— |
| Liver & Spleen Imaging Static Only (78215) |
— |
$2,225.60 |
— |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$2,233.90 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$2,947.75 |
— |
| Lung perfusion differential (78597) |
— |
$2,401.80 |
— |
| Lung Ventilat&Perfus Imaging (78582) |
— |
$5,208 |
— |
| Lymph System Imaging (78195) |
— |
$4,167.60 |
— |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
— |
$3,287.75 |
— |
| Magnetic Image Jaw Joint (70336) |
— |
$1,325.55 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70558) |
— |
$3,359.55 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70557) |
— |
$3,177.25 |
— |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem andskull base), during open intracranial procedure… (70559) |
— |
$4,410.35 |
— |
| Mammary ductogram or galactogram multiple (77054) |
— |
$1,706.50 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,251.15 |
— |
| Meckels Divert Exam (78290) |
— |
$3,224.65 |
— |
| Mra Head W/O & W/Contrast Material (70546) |
— |
$5,301.80 |
— |
| MRA head w/o contrast (70544) |
— |
$3,248.75 |
— |
| MRA neck w contrast (70548) |
— |
$3,701.15 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$5,045.50 |
— |
| MRA neck w/o contrast (70547) |
— |
$3,248.75 |
— |
| MRI abdomen w contrast (74182) |
— |
$1,867.90 |
— |
| MRI abdomen w/o contrast (74181) |
— |
$1,746.20 |
— |
| MRI any jt lower extrem w/contrast material (73722) |
— |
$2,915.75 |
— |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
— |
$4,777.45 |
— |
| MRI any jt upper extremity w/contrast matrl (73222) |
— |
$2,915.75 |
— |
| MRI bone marrow blood supply (77084) |
— |
$3,534.65 |
— |
| MRI Breast W/O Contrast Bilateral (77047) |
— |
$3,435.15 |
— |
| MRI Breast Without Contrast Material Unilateral (77046) |
— |
$2,558.70 |
— |
| MRI cervical spine w contrast (72142) |
— |
$3,280.25 |
— |
| MRI cervical spine w/o cont (72141) |
— |
$3,094.95 |
— |
| MRI chest w/o contrast (71550) |
— |
$1,705.80 |
— |
| MRI chest with contrast (71551) |
— |
$1,909.15 |
— |
| MRI chest wo w contrast (71552) |
— |
$2,604.70 |
— |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$1,941.25 |
— |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
— |
$4,777.45 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
— |
$1,779 |
— |
| MRI lumbar spine w contrast (72149) |
— |
$3,359.55 |
— |
| Mri Neck Spine W/O & W/Dye (72156) |
— |
$4,410.35 |
— |
| MRI orbit face &/neck w/o contrast (70540) |
— |
$2,321.05 |
— |
| MRI orbit face neck w contrast (70542) |
— |
$2,502.30 |
— |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
— |
$4,666.90 |
— |
| MRI pelvis w contrast (72196) |
— |
$3,189.10 |
— |
| MRI pelvis w/o & w contrast (72197) |
— |
$4,776.60 |
— |
| MRI pelvis w/o contrast (72195) |
— |
$3,084.75 |
— |
| MRI thoracic spine w/o contrast (72146) |
— |
$3,284.80 |
— |
| MRI upper extremity oth than jt w/contr matrl (73219) |
— |
$2,499.20 |
— |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
— |
$2,360.35 |
— |
| Mri Uppr Extremity W/O&W/Dye (73220) |
— |
$4,208.15 |
— |
| MRI, abdomen, combo (74183) |
— |
$4,410.35 |
— |
| MRI, dorsal spine combo (72157) |
— |
$5,177.80 |
— |
| MRI, dorsal spine contrast (72147) |
— |
$3,359.55 |
— |
| MRI, joint upper extrem (73221) |
— |
$2,757.15 |
— |
| MRI, joint upper extrem combo (73223) |
— |
$4,208.15 |
— |
| MRI, lumbar spine combo (72158) |
— |
$4,410.35 |
— |
| Myelography thoracic (72255) |
— |
$2,066.30 |
— |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
— |
$9,239.05 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$8,731.05 |
— |
| N-invas est c ffr sw aly CTA (75580) |
— |
$4,996.60 |
— |
| Neck soft tissue (70360) |
— |
$361.05 |
— |
| Nm myocard infarct spect (78469) |
— |
$6,414.60 |
— |
| Nuclear Rx Intra-Arterial (79445) |
— |
$1,569.55 |
— |
| Nuclear Rx Oral Admin (79005) |
— |
$1,939.75 |
— |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
— |
$862.85 |
— |
| Parathyroid imaging w/tomographic spect & CT (78072) |
— |
$3,849.90 |
— |
| Parathyroid planar imaging w/wo subtraction (78071) |
— |
$2,270.15 |
— |
| Pelvis 1 or 2 views (72170) |
— |
$507.70 |
— |
| Peritoneogram Rs&I (74190) |
— |
$607.40 |
— |
| Pet Image Skull-Thigh (78812) |
— |
$7,853.40 |
— |
| Pet Image W/Ct Lmtd (78814) |
— |
$8,054.75 |
— |
| PET image w/CT, full body (78816) |
— |
$10,289.90 |
— |
| PET imaging CT attenuation skull base mid-thigh (78815) |
— |
$9,989.95 |
— |
| Pet Imaging Limited Area Chest Head/Neck (78811) |
— |
$7,511 |
— |
| Pet Myocardial Sngl Study (78491) |
— |
$8,821.75 |
— |
| PET whole body (78813) |
— |
$8,054.75 |
— |
| Proton trmt simple w/comp (77522) |
— |
$3,979.60 |
— |
| Proton tx delivery complex (77525) |
— |
$4,815.30 |
— |
| Proton tx delivery intermediate (77523) |
— |
$4,377.55 |
— |
| Proton tx delivery simple w/o compensation (77520) |
— |
$1,804.80 |
— |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$3,320.20 |
— |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
— |
$739.70 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$816.75 |
— |
| Radex Ankle Complete Minimum 3 Views (73610) |
— |
$452.30 |
— |
| Radex Calcaneus Minimum 2 Views (73650) |
— |
$378 |
— |
| Radex elbow complete minimum 3 views (73080) |
— |
$461.95 |
— |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
— |
$571.80 |
— |
| Radex fingr minimum 2 views (73140) |
— |
$376.95 |
— |
| Radex foot complete minimum 3 views (73630) |
— |
$479.70 |
— |
| Radex Hand Minimum 3 Views (73130) |
— |
$461.95 |
— |
| Radex lower extremity infant minimum 2 views (73592) |
— |
$433.25 |
— |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
— |
$762.60 |
— |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
— |
$445.80 |
— |
| Radex Ribs Unilateral 2 Views (71100) |
— |
$657.50 |
— |
| Radex shoulder complete minimum 2 views (73030) |
— |
$376.95 |
— |
| Radex Sinuses Paransl < 3 Views (70210) |
— |
$419.25 |
— |
| Radex Spine 1 View Specify Level (72020) |
— |
$358.80 |
— |
| Radex Sternum Minimum 2 Views (71120) |
— |
$423.70 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
— |
$650.65 |
— |
| Radex Toe Minimum 2 Views (73660) |
— |
$325.40 |
— |
| Radex upper extremity infant minimum 2 views (73092) |
— |
$374.35 |
— |
| Radex Wrist Complete Minimum 3 Views (73110) |
— |
$461.95 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$530.50 |
— |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
— |
$537.40 |
— |
| Radiologic exam colon double contrast study (74280) |
— |
$2,890.60 |
— |
| Radiologic exam colon single contrast study (74270) |
— |
$2,088.90 |
— |
| Radiologic exam knee complete 4/more views (73564) |
— |
$672.80 |
— |
| Radiologic exam pelvis compl minimum 3 views (72190) |
— |
$661.80 |
— |
| Radiologic Exam Small Int Single Contrast Study (74250) |
— |
$1,567.65 |
— |
| Radiologic exam swallow function contrast study (74230) |
— |
$920.15 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$1,566.95 |
— |
| Radiologic examination femur 1 view (73551) |
— |
$372.75 |
— |
| Radiologic examination femur minimum 2 views (73552) |
— |
$376.95 |
— |
| Radiologic examination knee 1/2 views (73560) |
— |
$409.25 |
— |
| Radiologic Examination Osseous Survey Limited (77074) |
— |
$2,088.90 |
— |
| Radiologic examination tibia & fibula 2 views (73590) |
— |
$376.95 |
— |
| Renal Cyst Study (74470) |
— |
$2,159.65 |
— |
| Ribs bilateral 3 views (71110) |
— |
$780 |
— |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
— |
$2,687.85 |
— |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
— |
$22,543.05 |
— |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
— |
$3,596.15 |
— |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
— |
$6,769.10 |
— |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
— |
$7,450.90 |
— |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
— |
$6,546.80 |
— |
| Scapula (73010) |
— |
$423.70 |
— |
| Screening Digital Breast Tomosynthesis Bi (77063) |
— |
$38.65 |
— |
| Shoulder 1 view (73020) |
— |
$369.30 |
— |
| Shoulder Arthrography (73040) |
— |
$1,450.10 |
— |
Sialogram (70390)
range across 2 matching MRF lines |
— |
$1,318.95–$2,637.90 |
— |
| Skull less than 4 views (70250) |
— |
$891.10 |
— |
| Sternoclavicular joints (71130) |
— |
$500.35 |
— |
| Superior sagittal sinus venogram (75870) |
— |
$3,286.40 |
— |
| Thoracic spine 2 views (72070) |
— |
$507.70 |
— |
| Thoracic spine 3 views (72072) |
— |
$547.75 |
— |
| Thoracolumbar 2 views (72080) |
— |
$516.55 |
— |
| Thyroid Met Imaging Body (78018) |
— |
$4,756.80 |
— |
| Thyroid Uptake Measurement (78012) |
— |
$914.95 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$1,897.85 |
— |
Ultrasound Breast Limited (76642)
range across 2 matching MRF lines |
— |
$685.90–$804.65 |
— |
| Ultrasound Exam Aaa Screen (76706) |
— |
$539.30 |
— |
| Ultrasound, abdomen limited (76705) |
— |
$1,468.75 |
— |
| Umbilical-artery Doppler (OB) (76820) |
— |
$790.80 |
— |
| Unlisted fluoroscopic procedure (76496) |
— |
$1,029.25 |
— |
Unlisted magnetic resonance procedure (76498)
range across 4 matching MRF lines |
— |
$4,393–$5,460 |
— |
| Upper gi w/o kub (74240) |
— |
$1,488.60 |
— |
| Urethrocystogram voiding (74455) |
— |
$967.25 |
— |
| Urethrocystography retrograde (74450) |
— |
$905.60 |
— |
Us breast unilateral complete (76641)
range across 2 matching MRF lines |
— |
$1,093.25–$1,170.60 |
— |
| Us chest (76604) |
— |
$1,153.55 |
— |
| Us complete joint (76881) |
— |
$858.75 |
— |
| Us exam, pelvic, limited (76857) |
— |
$1,444.35 |
— |
| Us head (76506) |
— |
$2,254.70 |
— |
| Us kidney transplant (76776) |
— |
$2,306.95 |
— |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
— |
$942.20 |
— |
| Us ob detailed single fetus (76811) |
— |
$2,718.95 |
— |
| Us ob limited 1 or more fetuses (76815) |
— |
$1,395.30 |
— |
| Us ob transvaginal (76817) |
— |
$1,468.75 |
— |
| Us pelvic non ob complete (76856) |
— |
$1,958.20 |
— |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
— |
$1,468.75 |
— |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
— |
$1,292.50 |
— |
| Us retroperitoneal complete (76770) |
— |
$1,529.95 |
— |
| Us retroperitoneal limited (76775) |
— |
$1,444.35 |
— |
| Us scrotum and contents (76870) |
— |
$1,468.75 |
— |
| Us spinal canal and contents (76800) |
— |
$2,395.65 |
— |
| Us thyroid (76536) |
— |
$1,468.75 |
— |
| Vein X-Ray Chest (75827) |
— |
$2,425.75 |
— |
| Vein X-Ray Liver W/O Hemodyn (75887) |
— |
$3,286.40 |
— |
| Vein X-Ray Spleen/Liver (75810) |
— |
$5,837.90 |
— |
| Venogram Sinus/Jugular (75860) |
— |
$7,124.50 |
— |
| Venography Adrenal Unilateral (75840) |
— |
$7,599.45 |
— |
| Venography caval inferior serialography rs&i (75825) |
— |
$6,950.70 |
— |
| Venography extremity bilateral rs&i (75822) |
— |
$1,944.65 |
— |
| Venography extremity unilateral rs&i (75820) |
— |
$1,778.20 |
— |
| Venography Renal Bilateral (75833) |
— |
$9,817.20 |
— |
| Venography Renal Unilateral (75831) |
— |
$6,544.80 |
— |
| Venous sampling by catheter (75893) |
— |
$12,633.40 |
— |
| Wrist 2 views (73100) |
— |
$359.60 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$337.15 |
— |
| X-ray antegrade pyelogram tube (74425) |
— |
$1,687.50 |
— |
| X-Ray Aorta Leg Arteries (75630) |
— |
$7,979.45 |
— |
| X-Ray Bend Only L-S Spine (72120) |
— |
$564.95 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$359.60 |
— |
| X-Ray Exam Breast Specimen (76098) |
— |
$1,878.55 |
— |
| X-Ray Exam Entire Spi 1 Vw (72081) |
— |
$476 |
— |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
— |
$780.40 |
— |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
— |
$834.10 |
— |
| X-Ray Exam Hip Uni 1 View (73501) |
— |
$530.60 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
— |
$540.70 |
— |
| X-Ray Exam Hips Bi 2 Views (73521) |
— |
$663.60 |
— |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
— |
$750.75 |
— |
| X-Ray Exam L-S Spine Bending (72114) |
— |
$621.20 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
— |
$376.95 |
— |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$804.35 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
— |
$741.05 |
— |
| X-ray eye for foreign body (70030) |
— |
$383.90 |
— |
| X-ray humerus (73060) |
— |
$376.95 |
— |
| X-ray IV pyelogram (ivp) (74400) |
— |
$1,036.35 |
— |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
— |
$459.05 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$430.55 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$557.15 |
— |
| X-ray nose-rectum child f.b. (76010) |
— |
$361.05 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$806 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
— |
$464.20 |
— |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
— |
$278.98 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$387.60 |
— |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$526.15 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$814.90 |
— |
| X-ray thoracic spine 4 vw (72074) |
— |
$593.15 |
— |
| X-Ray Tmj Unilat (70328) |
— |
$415.55 |
— |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
— |
$1,656.40 |
— |
| X-Rays Bone Length Studies (77073) |
— |
$1,271.50 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$3,092.95 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$508.20 |
— |
| Xr facial bones less than 3 views (70140) |
— |
$406 |
— |
| XR Mastoids < 3 Views Bilateral (70120) |
— |
$486.30 |
— |
| Xr orbits complete 4 views (70200) |
— |
$585.05 |
— |