| Abdomen 1 View (74018) |
$86 |
$496.38 |
1.0× |
| Abdomen 2 views (74019) |
$104 |
$587.86 |
1.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$399 |
$1,970.45 |
1.0× |
| Angio internal mammary (75756) |
$3,156 |
$14,053.50 |
1.0× |
| Angio pulmonary bilat (75743) |
$3,156 |
$13,207.60 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,156 |
$13,207.60 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,156 |
$14,952.20 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$3,156 |
$13,207.60 |
1.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,156 |
$13,207.60 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,156 |
$6,420.36 |
1.0× |
| Ankle 2 views (73600) |
$86 |
$422.70 |
1.0× |
| Aortography thoracic serialography rs&i (75605) |
$5,562 |
$21,882.60 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$3,156 |
$13,207.60 |
1.0× |
| Artery X-Rays Abdomen (75726) |
$5,562 |
$24,228.70 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,156 |
$6,420.36 |
1.0× |
| Artery X-Rays Pelvis (75736) |
$5,562 |
$24,228.70 |
1.0× |
| Artery X-Rays Spine (75705) |
$5,562 |
$21,882.60 |
1.0× |
| Arthrogram ankle (73615) |
$348 |
$1,929.40 |
1.0× |
| Arthrogram hip (73525) |
$348 |
$2,016.22 |
1.0× |
| Arthrogram Wrist (73115) |
$348 |
$1,929.40 |
1.0× |
| Bone age studies (77072) |
$104 |
$823.01 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$399 |
$2,145.39 |
1.0× |
| Bone Imaging Limited Area (78300) |
$399 |
$1,767.45 |
1.0× |
| Bone Imaging Multiple Areas (78305) |
$399 |
$1,767.45 |
1.0× |
| Bone Imaging Whole Body (78306) |
$399 |
$2,369.02 |
1.0× |
| Bone marrow imaging; whole body (78104) |
$399 |
$2,474.43 |
1.0× |
| Bone survey infant (77076) |
$104 |
$587.86 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$399 |
$1,767.45 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$542 |
$2,383.05 |
1.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$542 |
$2,277.60 |
1.0× |
| Cat Scan Follow-Up Study (76380) |
$86 |
$689 |
1.0× |
| Cerebrospinal Fluid Scan (78630) |
$542 |
$2,277.60 |
1.0× |
| Chest 1 view (71045) |
$86 |
$422.70 |
1.0× |
| Chest 2 views (71046) |
$86 |
$557.53 |
1.0× |
| Chest 4 or more views (71048) |
$104 |
$683 |
1.0× |
| Cholecystography Oral Contrast (74290) |
$175 |
$1,008.70 |
1.0× |
| Clavicle complete (73000) |
$86 |
$775.39 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$104 |
$484.70 |
1.0× |
| Contrast Exam Abdominl Aorta (75625) |
$3,156 |
$14,952.20 |
1.0× |
| Contrast X-Ray Bladder (74430) |
$348 |
$2,016.22 |
1.0× |
| Contrast X-Ray Of Elbow (73085) |
$348 |
$1,929.40 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$348 |
$1,929.40 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$348 |
$4,003.40 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$238 |
$4,949.57 |
1.0× |
| CT abdomen w contrast (74160) |
$175 |
$2,314.68 |
1.0× |
| CT abdomen w wo contrast (74170) |
$175 |
$4,003.40 |
1.0× |
| CT abdomen w/o contrast (74150) |
$104 |
$3,178.89 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$348 |
$2,403.50 |
1.0× |
| CT Angio Chest (71275) |
$175 |
$3,166.35 |
1.0× |
| CT Angio Head (70496) |
$175 |
$2,875.84 |
1.0× |
| CT angio hrt w/3d image (75574) |
$348 |
$1,008.70 |
1.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$175 |
$2,379 |
1.0× |
| CT Angio Neck (70498) |
$175 |
$2,657.44 |
1.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$175 |
$2,336.62 |
1.0× |
| CT bone density (77078) |
$86 |
$551 |
1.0× |
| CT cervical spine w/ contrast (72126) |
$348 |
$3,214.42 |
1.0× |
| CT cervical spine w/o contrast (72125) |
$104 |
$3,535.24 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$175 |
$3,057.67 |
1.0× |
| CT chest w contrast (71260) |
$175 |
$3,522.17 |
1.0× |
| CT chest w/wo contrast (71270) |
$175 |
$4,300.18 |
1.0× |
| CT colonography screening (74263) |
$238 |
$2,199.56 |
1.0× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$104 |
$1,386 |
1.0× |
| CT head/brain with contrast (70460) |
$175 |
$2,026.26 |
1.0× |
| CT head/brain without and with contrast (70470) |
$175 |
$3,545.69 |
1.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$348 |
$1,008.70 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$86 |
$422.70 |
1.0× |
| CT hrt w/3d image congen (75573) |
$348 |
$1,008.70 |
1.0× |
| CT iac w contrast (70481) |
$175 |
$2,231.08 |
1.0× |
| CT l-spine w&w/o contrast (72133) |
$175 |
$3,878 |
1.0× |
| CT lower ext w/o (73700) |
$104 |
$2,612.50 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$175 |
$4,075.34 |
1.0× |
| CT lumbar spine w contrast (72132) |
$348 |
$3,964.73 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$104 |
$3,967.87 |
1.0× |
| CT maxillofacial w contrast (70487) |
$175 |
$1,641.07 |
1.0× |
| CT maxillofacial wo contrast (70486) |
$104 |
$2,897.79 |
1.0× |
| CT neck tissue combo (70492) |
$175 |
$4,293.91 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$175 |
$3,983.41 |
1.0× |
| CT orbits w/o contrast (70480) |
$104 |
$2,853.90 |
1.0× |
| CT pelvis w&w/o contrast (72194) |
$175 |
$3,888.45 |
1.0× |
| CT pelvis w/o contrast (72192) |
$104 |
$3,364.90 |
1.0× |
| CT scan of leg combo (73702) |
$175 |
$2,700.28 |
1.0× |
| CT scans face/jaw combo (70488) |
$175 |
$3,035.73 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$175 |
$3,354.15 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$104 |
$3,714.98 |
1.0× |
| CT thoracic spine w contrast (72129) |
$175 |
$4,963.75 |
1.0× |
| CT thoracic spine w/o contrast (72128) |
$104 |
$3,188.30 |
1.0× |
| CT thoracic spine w/wo cont (72130) |
$175 |
$3,635.56 |
1.0× |
| CT thorax w/o contrast (71250) |
$104 |
$3,722.29 |
1.0× |
| CT upper ext wo (73200) |
$104 |
$2,314.68 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$175 |
$2,691.92 |
1.0× |
| CT upper extremity with contrast (73201) |
$348 |
$3,935.47 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$175 |
$1,710.67 |
1.0× |
| Cta Abdomen (74175) |
$175 |
$2,903.01 |
1.0× |
| CTA pelvis (72191) |
$175 |
$3,304 |
1.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,089 |
$8,698.75 |
1.0× |
| Discography Cerv/Thor Spine (72285) |
$1,952 |
$11,420.40 |
1.0× |
| Diskography lumbar (72295) |
$1,952 |
$11,420.40 |
1.0× |
| Dxa Bone Density Axial (77080) |
$104 |
$823.01 |
1.0× |
| Dxa bone density study (77085) |
$104 |
$787.57 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86 |
$458.20 |
1.0× |
| Echo Guide For Artery Repair (76936) |
$215 |
$1,766.17 |
1.0× |
| Esophagram (74220) |
$175 |
$1,054.09 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$104 |
$980.21 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$238 |
$1,204.68 |
1.0× |
| Follow-Up Angiography (75898) |
$3,156 |
$5,468.15 |
1.0× |
| Foot 2 views (73620) |
$86 |
$517.28 |
1.0× |
| Forearm 2 views (73090) |
$86 |
$737.17 |
1.0× |
| Gastric emptying imaging study (78264) |
$399 |
$2,746.78 |
1.0× |
| Gastroesophageal Reflux Exam (78262) |
$399 |
$1,767.45 |
1.0× |
| Gated Heart Planar Single (78472) |
$399 |
$2,192 |
1.0× |
| Hand 2 views (73120) |
$104 |
$587.86 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,156 |
$13,207.60 |
1.0× |
| Hepatobil Syst Image W/Drug (78227) |
$542 |
$3,332.13 |
1.0× |
| Hepatobiliary System Imaging (78226) |
$399 |
$1,970.45 |
1.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,294 |
$6,146.90 |
1.0× |
| Hysterosalpingogram (74740) |
$238 |
$1,204.68 |
1.0× |
| Infant hip ultrasound, limited static exam (76886) |
$86 |
$669 |
1.0× |
| K Flow/Funct Image Multiple (78709) |
$542 |
$2,457 |
1.0× |
| K Flow/Funct Image W/Drug (78708) |
$542 |
$2,383.05 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$542 |
$2,557 |
1.0× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$399 |
$2,457 |
1.0× |
| Kidney Imaging Morphol (78700) |
$399 |
$1,885.60 |
1.0× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$399 |
$1,767.45 |
1.0× |
| Knee 3 Views (73562) |
$86 |
$850.77 |
1.0× |
| Leveen/Shunt Patency Exam (78291) |
$399 |
$2,474.43 |
1.0× |
| Liver & Spleen Imaging Static Only (78215) |
$399 |
$1,818.40 |
1.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$399 |
$3,342 |
1.0× |
| Liver imaging static only (78201) |
$542 |
$6,146.90 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$542 |
$6,146.90 |
1.0× |
| Lung Perf&Ventilat Diferentl (78598) |
$542 |
$3,188.64 |
1.0× |
| Lung perfusion differential (78597) |
$399 |
$1,767.45 |
1.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$542 |
$2,557.12 |
1.0× |
| Lymph System Imaging (78195) |
$542 |
$2,557.12 |
1.0× |
| Magnetic Image Jaw Joint (70336) |
$238 |
$2,731.63 |
1.0× |
| Mammary ductogram or galactogram multiple (77054) |
$238 |
$1,152.80 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$238 |
$1,152.80 |
1.0× |
| Meckels Divert Exam (78290) |
$399 |
$1,767.45 |
1.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$348 |
$2,393 |
1.0× |
| MRA head w/o contrast (70544) |
$238 |
$2,383.65 |
1.0× |
| MRA head with contrast (70545) |
$348 |
$2,291 |
1.0× |
| MRA neck w contrast (70548) |
$348 |
$2,704 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$348 |
$2,537 |
1.0× |
| MRA neck w/o contrast (70547) |
$238 |
$2,188.23 |
1.0× |
| MRI abdomen w contrast (74182) |
$348 |
$3,934 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$238 |
$2,234.21 |
1.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$783 |
$4,282.41 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$348 |
$3,884.27 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$783 |
$3,520 |
1.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$238 |
$2,721.10 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$238 |
$2,721.10 |
1.0× |
| MRI cervical spine w contrast (72142) |
$348 |
$3,810 |
1.0× |
| MRI cervical spine w/o cont (72141) |
$238 |
$4,224.94 |
1.0× |
| MRI chest w/o contrast (71550) |
$238 |
$3,802 |
1.0× |
| MRI chest with contrast (71551) |
$783 |
$3,458.75 |
1.0× |
| MRI chest wo w contrast (71552) |
$348 |
$3,802 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$348 |
$3,321 |
1.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$348 |
$7,013.95 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$238 |
$4,654.43 |
1.0× |
| MRI lumbar spine w contrast (72149) |
$348 |
$3,914 |
1.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$348 |
$4,224.94 |
1.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$238 |
$4,956.44 |
1.0× |
| MRI orbit face neck w contrast (70542) |
$348 |
$2,553 |
1.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$348 |
$4,956.44 |
1.0× |
| MRI pelvis w contrast (72196) |
$348 |
$4,175 |
1.0× |
| MRI pelvis w/o & w contrast (72197) |
$348 |
$4,185.23 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$238 |
$4,185.23 |
1.0× |
| MRI thoracic spine w/o contrast (72146) |
$238 |
$2,882.11 |
1.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$348 |
$3,421 |
1.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$238 |
$4,222.85 |
1.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$348 |
$4,222.85 |
1.0× |
| MRI, abdomen, combo (74183) |
$348 |
$7,134.22 |
1.0× |
| MRI, dorsal spine combo (72157) |
$348 |
$2,882.11 |
1.0× |
| MRI, dorsal spine contrast (72147) |
$348 |
$1,929.40 |
1.0× |
| MRI, joint upper extrem (73221) |
$238 |
$4,222.85 |
1.0× |
| MRI, joint upper extrem combo (73223) |
$348 |
$4,222.85 |
1.0× |
| MRI, lumbar spine combo (72158) |
$348 |
$4,339.89 |
1.0× |
| Myelogram cervical (72240) |
$783 |
$3,575.90 |
1.0× |
| Myelogram Lumbar (72265) |
$783 |
$3,458.75 |
1.0× |
| Myelography thoracic (72255) |
$783 |
$3,458.75 |
1.0× |
| Myelograpy 2/more regions rs&i (72270) |
$783 |
$3,458.75 |
1.0× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$399 |
$1,767.45 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,294 |
$6,823.54 |
1.0× |
| Neck soft tissue (70360) |
$86 |
$520.41 |
1.0× |
| Nm myocard infarct spect (78469) |
$542 |
$6,146.90 |
1.0× |
| Nuclear Rx Oral Admin (79005) |
$233 |
$1,884 |
1.0× |
| Optic foramina (70190) |
$86 |
$311.50 |
1.0× |
| Parathyroid Planar Imaging (78070) |
$399 |
$2,029.39 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$104 |
$823.01 |
1.0× |
| Peritoneogram Rs&I (74190) |
$546 |
$2,487.45 |
1.0× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,156 |
$18,490.60 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$399 |
$1,970.45 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$546 |
$2,487.45 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$86 |
$800.40 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$86 |
$657.83 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$86 |
$422.70 |
1.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$104 |
$823.01 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$86 |
$422.70 |
1.0× |
| Radex foot complete minimum 3 views (73630) |
$86 |
$783.73 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$86 |
$784.78 |
1.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$86 |
$404.50 |
1.0× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$104 |
$562.55 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$86 |
$506.83 |
1.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$86 |
$592.52 |
1.0× |
| Radex shoulder complete minimum 2 views (73030) |
$86 |
$824.86 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$86 |
$422.70 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$86 |
$422.70 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$86 |
$520 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$86 |
$455.72 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$104 |
$587.86 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$86 |
$832.34 |
1.0× |
| Radiologic exam colon double contrast study (74280) |
$175 |
$1,338 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$175 |
$1,195.48 |
1.0× |
| Radiologic exam knee complete 4/more views (73564) |
$104 |
$587.86 |
1.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$175 |
$932.92 |
1.0× |
| Radiologic exam swallow function contrast study (74230) |
$175 |
$932.92 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$175 |
$1,008.70 |
1.0× |
| Radiologic examination femur 1 view (73551) |
$86 |
$504.74 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$86 |
$589.76 |
1.0× |
| Radiologic examination knee 1/2 views (73560) |
$86 |
$422.70 |
1.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$104 |
$562.55 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$86 |
$757.70 |
1.0× |
| Renal Cyst Study (74470) |
$546 |
$2,487.45 |
1.0× |
| Ribs bilateral 3 views (71110) |
$104 |
$661.49 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$399 |
$1,767.45 |
1.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$399 |
$1,767.45 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$542 |
$6,146.90 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$542 |
$6,260.50 |
1.0× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$542 |
$6,823.54 |
1.0× |
| Scapula (73010) |
$104 |
$823.01 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$22 |
$170.69 |
0.9× |
| Sella turcica (70240) |
$86 |
$311.50 |
1.0× |
| Shoulder 1 view (73020) |
$86 |
$765.24 |
1.0× |
| Shoulder Arthrography (73040) |
$348 |
$2,016.22 |
1.0× |
| Sialogram (70390) |
$238 |
$1,152.80 |
1.0× |
| Skull less than 4 views (70250) |
$104 |
$823.01 |
1.0× |
| Speech evaluation, complex (70371) |
$238 |
$1,152.80 |
1.0× |
| Sternoclavicular joints (71130) |
$86 |
$311.50 |
1.0× |
| Superior sagittal sinus venogram (75870) |
$3,156 |
$5,468.15 |
1.0× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$238 |
$1,152.80 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$399 |
$1,767.45 |
1.0× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$175 |
$1,095 |
1.0× |
| Thoracic spine 2 views (72070) |
$104 |
$823.01 |
1.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$399 |
$2,049 |
1.0× |
| Thyroid Met Imaging Body (78018) |
$542 |
$2,262 |
1.0× |
| Thyroid Uptake Measurement (78012) |
$399 |
$1,885.60 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$399 |
$2,474.43 |
1.0× |
| Ultrasound Breast Limited (76642) |
$86 |
$724.19 |
1.0× |
| Ultrasound Exam Aaa Screen (76706) |
$104 |
$791 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$104 |
$1,155.27 |
1.0× |
| Unlisted Dx Radiographic Procedure (76499) |
$86 |
$404.50 |
1.0× |
| Unlisted fluoroscopic procedure (76496) |
$86 |
$311.50 |
1.0× |
| Unlisted Miscellaneous Px Dx Nuclear Medicine (78999) |
$399 |
$1,767.45 |
1.0× |
| Unlisted us procedure (76999) |
$86 |
$653.13 |
1.0× |
| Upper gi w/o kub (74240) |
$175 |
$952.10 |
1.0× |
| Urethrocystogram voiding (74455) |
$238 |
$1,204.68 |
1.0× |
| Urethrocystography retrograde (74450) |
$238 |
$1,152.80 |
1.0× |
| Us breast unilateral complete (76641) |
$104 |
$587.86 |
1.0× |
| Us chest (76604) |
$104 |
$587.86 |
1.0× |
| Us complete joint (76881) |
$104 |
$818.24 |
1.0× |
| Us exam, pelvic, limited (76857) |
$104 |
$2,187.19 |
1.0× |
| Us head (76506) |
$104 |
$587.86 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$104 |
$1,335.51 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$104 |
$562.55 |
1.0× |
| Us ob transvaginal (76817) |
$104 |
$926.53 |
1.0× |
| Us pelvic non ob complete (76856) |
$104 |
$1,348.05 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$104 |
$587.86 |
1.0× |
| Us retroperitoneal complete (76770) |
$104 |
$730.46 |
1.0× |
| Us retroperitoneal limited (76775) |
$104 |
$730.46 |
1.0× |
| Us scrotum and contents (76870) |
$104 |
$1,015.78 |
1.0× |
| Us spinal canal and contents (76800) |
$104 |
$951.84 |
1.0× |
| Us thyroid (76536) |
$104 |
$926.92 |
1.0× |
| Us transrectal (76872) |
$104 |
$689.70 |
1.0× |
| Vasogram (74440) |
$238 |
$1,152.80 |
1.0× |
| Vein X-Ray Chest (75827) |
$1,573 |
$7,061.05 |
1.0× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$3,156 |
$5,468.15 |
1.0× |
| Vein X-Ray Spleen/Liver (75810) |
$3,156 |
$7,655.41 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$3,156 |
$14,053.50 |
1.0× |
| Venography Adrenal Unilateral (75840) |
$3,156 |
$18,490.60 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$3,156 |
$14,952.20 |
1.0× |
| Venography extremity bilateral rs&i (75822) |
$1,573 |
$7,061.05 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,573 |
$7,061.05 |
1.0× |
| Venography Orbital Rs&I (75880) |
$627 |
$3,100.05 |
1.0× |
| Venography Renal Bilateral (75833) |
$3,156 |
$18,490.60 |
1.0× |
| Venography Renal Unilateral (75831) |
$3,156 |
$13,207.60 |
1.0× |
| Venous sampling by catheter (75893) |
$5,562 |
$21,882.60 |
1.0× |
| Venous thrombosis imaging (78457) |
$542 |
$6,146.90 |
1.0× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$399 |
$1,767.45 |
1.0× |
| Vertebral fracture assessment via dxa (77086) |
$86 |
$311.50 |
1.0× |
| Wrist 2 views (73100) |
$86 |
$483.67 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86 |
$404.50 |
1.0× |
| X-ray antegrade pyelogram tube (74425) |
$348 |
$1,929.40 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,156 |
$14,053.50 |
1.0× |
| X-Ray Bend Only L-S Spine (72120) |
$104 |
$562.55 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86 |
$494.29 |
1.0× |
| X-Ray Exam Breast Specimen (76098) |
$546 |
$2,599.39 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$86 |
$566.39 |
1.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$104 |
$562.55 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$86 |
$478.61 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$86 |
$1,018.88 |
1.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$104 |
$823.01 |
1.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$104 |
$597.74 |
1.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$86 |
$652.53 |
1.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$104 |
$1,091.22 |
1.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$104 |
$823.01 |
1.0× |
| X-ray humerus (73060) |
$86 |
$759.27 |
1.0× |
| X-ray IV pyelogram (ivp) (74400) |
$175 |
$1,300 |
1.0× |
| X-ray IV pyelogram+tomography (74415) |
$175 |
$2,743 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86 |
$520 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$104 |
$587.86 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$104 |
$975.35 |
1.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$104 |
$562.55 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$86 |
$646.82 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$86 |
$853.77 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$104 |
$925.04 |
1.0× |
| X-Ray Stress View (77071) |
$86 |
$311.50 |
1.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$348 |
$1,929.40 |
1.0× |
| X-Rays Bone Length Studies (77073) |
$104 |
$587.86 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$104 |
$1,365.04 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$104 |
$587.86 |
1.0× |
| Xr facial bones less than 3 views (70140) |
$86 |
$524 |
1.0× |
| Xr myelogram posterior fossa (70010) |
$348 |
$2,701.16 |
1.0× |
| Xr orbits complete 4 views (70200) |
$104 |
$587.86 |
1.0× |