| Abdomen 1 View (74018) |
$178.18 |
$302 |
1.7× |
| Abdomen 2 views (74019) |
$251.93 |
$427 |
2.0× |
| Angio internal mammary (75756) |
$7,941.99 |
$13,461 |
2.1× |
| Angio pulmonary bilat (75743) |
$6,594.43 |
$11,177 |
1.8× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$8,824.63 |
$14,957 |
2.4× |
| Angiography extremity bilateral rs&i (75716) |
$6,594.43 |
$11,177 |
1.8× |
| Angiography extremity unilateral rs&i (75710) |
$4,396.68 |
$7,452 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,396.68 |
$7,452 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,557.65 |
$4,335 |
0.7× |
| Ankle 2 views (73600) |
$181.13 |
$307 |
1.8× |
| Aortography thoracic serialography rs&i (75605) |
$6,594.43 |
$11,177 |
1.0× |
| Aortography thoracic w/o serialography rs&i (75600) |
$7,941.99 |
$13,461 |
2.1× |
| Artery X-Rays Abdomen (75726) |
$4,885.20 |
$8,280 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$2,301.59 |
$3,901 |
0.6× |
| Artery X-Rays Pelvis (75736) |
$6,594.43 |
$11,177 |
1.0× |
| Artery X-Rays Spine (75705) |
$8,801.62 |
$14,918 |
1.3× |
| Arthrogram ankle (73615) |
$1,512.76 |
$2,564 |
3.7× |
| Arthrogram hip (73525) |
$1,512.76 |
$2,564 |
3.7× |
| Arthrogram Wrist (73115) |
$1,512.76 |
$2,564 |
3.7× |
| Bone age studies (77072) |
$463.74 |
$786 |
3.8× |
| Bone survey infant (77076) |
$463.74 |
$786 |
3.8× |
| Chest 1 view (71045) |
$147.50 |
$250 |
1.4× |
| Chest 2 views (71046) |
$177 |
$300 |
1.7× |
| Chest 3 views (71047) |
$206.50 |
$350 |
2.0× |
| Chest 4 or more views (71048) |
$236 |
$400 |
1.9× |
| Chg us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$198.83 |
$337 |
1.6× |
| Cholecystography Oral Contrast (74290) |
$463.74 |
$786 |
2.2× |
| Clavicle complete (73000) |
$214.17 |
$363 |
2.1× |
| Contrast Exam Abdominl Aorta (75625) |
$4,396.68 |
$7,452 |
1.2× |
| Contrast X-Ray Bladder (74430) |
$928.66 |
$1,574 |
2.3× |
| Contrast X-Ray Of Elbow (73085) |
$1,848.47 |
$3,133 |
4.5× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,512.76 |
$2,564 |
3.7× |
| Dilation ureters/urethra rs&i (74485) |
$6,762.58 |
$11,462 |
2.7× |
| Discography Cerv/Thor Spine (72285) |
$5,261.03 |
$8,917 |
2.3× |
| Diskography lumbar (72295) |
$6,428.05 |
$10,895 |
2.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$463.74 |
$786 |
3.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$928.66 |
$1,574 |
7.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$379.96 |
$644 |
3.1× |
| Dxa Bone Density Axial (77080) |
$314.47 |
$533 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$246.62 |
$418 |
2.4× |
| Echo exam of fetal heart (76825) |
$1,848.47 |
$3,133 |
2.9× |
| Echo exam uterus (76831) |
$928.66 |
$1,574 |
3.3× |
| Echo Guide For Artery Repair (76936) |
$911.55 |
$1,545 |
3.6× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$928.66 |
$1,574 |
3.3× |
| Esophagram (74220) |
$447.81 |
$759 |
2.2× |
| Fetal Biophys Profile W/Nst (76818) |
$463.74 |
$786 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$463.74 |
$786 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$604.16 |
$1,024 |
2.1× |
| Follow-Up Angiography (75898) |
$2,301.59 |
$3,901 |
0.6× |
| Foot 2 views (73620) |
$204.73 |
$347 |
2.0× |
| Forearm 2 views (73090) |
$214.17 |
$363 |
2.1× |
| Hand 2 views (73120) |
$277.30 |
$470 |
2.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$7,941.99 |
$13,461 |
2.1× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$7,941.99 |
$13,461 |
2.1× |
| Hysterosalpingogram (74740) |
$928.66 |
$1,574 |
3.3× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$323.32 |
$548 |
3.1× |
| Infant hip ultrasound, limited static exam (76886) |
$300.90 |
$510 |
2.9× |
| Joint Survey Single View (77077) |
$463.74 |
$786 |
3.8× |
| Knee 3 Views (73562) |
$237.77 |
$403 |
2.3× |
| Mammary ductogram or galactogram multiple (77054) |
$928.66 |
$1,574 |
3.3× |
| Mammary ductogram or galactogram single (77053) |
$928.66 |
$1,574 |
3.3× |
| Myelogram cervical (72240) |
$1,512.76 |
$2,564 |
1.6× |
| Myelogram Lumbar (72265) |
$1,512.76 |
$2,564 |
1.6× |
| Myelography thoracic (72255) |
$1,512.76 |
$2,564 |
1.6× |
| Myelograpy 2/more regions rs&i (72270) |
$1,512.76 |
$2,564 |
1.6× |
| Neck soft tissue (70360) |
$295.59 |
$501 |
2.9× |
| Nonvascular Shunt X-Ray (75809) |
$463.74 |
$786 |
3.8× |
| Ob us nuchal meas 1 gest (76813) |
$463.74 |
$786 |
3.8× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$199.42 |
$338 |
1.6× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$216.53 |
$367 |
1.8× |
| Ophthalmic US Dx Corneal Pachymetry Uni/Bi (76514) |
$54.28 |
$92 |
1.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$463.74 |
$786 |
3.8× |
| Panoramic X-ray of jaws (70355) |
$246.62 |
$418 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$216.53 |
$367 |
1.8× |
| Peritoneogram Rs&I (74190) |
$1,848.47 |
$3,133 |
2.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$7,941.99 |
$13,461 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$421.85 |
$715 |
3.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,848.47 |
$3,133 |
2.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$239.54 |
$406 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$169.92 |
$288 |
1.7× |
| Radex elbow complete minimum 3 views (73080) |
$241.90 |
$410 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$463.74 |
$786 |
3.8× |
| Radex fingr minimum 2 views (73140) |
$165.79 |
$281 |
1.6× |
| Radex foot complete minimum 3 views (73630) |
$295 |
$500 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$267.86 |
$454 |
2.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$246.62 |
$418 |
2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$463.74 |
$786 |
3.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$246.62 |
$418 |
2.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$225.97 |
$383 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$225.97 |
$383 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$246.62 |
$418 |
2.4× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$498.55 |
$845 |
2.4× |
| Radex Spine 1 View Specify Level (72020) |
$245.44 |
$416 |
2.4× |
| Radex Sternum Minimum 2 Views (71120) |
$246.62 |
$418 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$246.62 |
$418 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$182.31 |
$309 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$463.74 |
$786 |
3.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$230.10 |
$390 |
2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$928.66 |
$1,574 |
7.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$463.74 |
$786 |
3.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$378.19 |
$641 |
3.1× |
| Radiologic exam colon double contrast study (74280) |
$543.98 |
$922 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$574.07 |
$973 |
2.8× |
| Radiologic exam knee complete 4/more views (73564) |
$413 |
$700 |
3.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$275.53 |
$467 |
2.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$463.74 |
$786 |
2.2× |
| Radiologic exam swallow function contrast study (74230) |
$402.38 |
$682 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$532.77 |
$903 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$246.62 |
$418 |
2.4× |
| Radiologic examination femur minimum 2 views (73552) |
$234.82 |
$398 |
2.3× |
| Radiologic examination knee 1/2 views (73560) |
$204.73 |
$347 |
2.0× |
| Radiologic Examination Osseous Survey Limited (77074) |
$463.74 |
$786 |
3.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$463.74 |
$786 |
4.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$214.17 |
$363 |
2.1× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$928.66 |
$1,574 |
1.4× |
| Renal Cyst Study (74470) |
$928.66 |
$1,574 |
1.4× |
| Ribs bilateral 3 views (71110) |
$463.74 |
$786 |
3.8× |
| Scapula (73010) |
$246.62 |
$418 |
2.0× |
| Sella turcica (70240) |
$246.62 |
$418 |
2.4× |
| Shoulder 1 view (73020) |
$185.26 |
$314 |
1.8× |
| Shoulder Arthrography (73040) |
$759.33 |
$1,287 |
1.8× |
| Sialogram (70390) |
$928.66 |
$1,574 |
3.3× |
| Skull less than 4 views (70250) |
$463.74 |
$786 |
3.8× |
| Speech evaluation, complex (70371) |
$928.66 |
$1,574 |
3.3× |
| Sternoclavicular joints (71130) |
$246.62 |
$418 |
2.4× |
| Superior sagittal sinus venogram (75870) |
$2,301.59 |
$3,901 |
0.6× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$690.30 |
$1,170 |
3.3× |
| Thoracic spine 2 views (72070) |
$238.95 |
$405 |
1.9× |
| Thoracic spine 3 views (72072) |
$310.34 |
$526 |
2.5× |
| Thoracolumbar 2 views (72080) |
$320.96 |
$544 |
3.1× |
| Ultrasound Breast Limited (76642) |
$345.15 |
$585 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$408.28 |
$692 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$379.96 |
$644 |
3.1× |
| Upper gi w/o kub (74240) |
$463.74 |
$786 |
2.2× |
| Urethrocystogram voiding (74455) |
$928.66 |
$1,574 |
3.3× |
| Urethrocystography retrograde (74450) |
$928.66 |
$1,574 |
3.3× |
| Us breast unilateral complete (76641) |
$432.47 |
$733 |
3.5× |
| Us chest (76604) |
$402.38 |
$682 |
3.3× |
| Us complete joint (76881) |
$466.10 |
$790 |
3.8× |
| Us exam, pelvic, limited (76857) |
$320.96 |
$544 |
2.6× |
| Us head (76506) |
$465.51 |
$789 |
3.8× |
| Us kidney transplant (76776) |
$413 |
$700 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$222.43 |
$377 |
1.8× |
| Us ob detailed single fetus (76811) |
$599.44 |
$1,016 |
2.1× |
| Us ob limited 1 or more fetuses (76815) |
$463.74 |
$786 |
3.8× |
| Us ob transvaginal (76817) |
$463.74 |
$786 |
3.8× |
| Us pelvic non ob complete (76856) |
$527.46 |
$894 |
4.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$463.74 |
$786 |
3.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$463.74 |
$786 |
3.8× |
| Us retroperitoneal complete (76770) |
$490.88 |
$832 |
4.0× |
| Us retroperitoneal limited (76775) |
$364.62 |
$618 |
3.0× |
| Us scrotum and contents (76870) |
$358.72 |
$608 |
2.9× |
| Us spinal canal and contents (76800) |
$450.76 |
$764 |
3.6× |
| Us thyroid (76536) |
$453.12 |
$768 |
3.7× |
| Us transrectal (76872) |
$324.50 |
$550 |
2.6× |
| Vein X-Ray Chest (75827) |
$2,301.59 |
$3,901 |
1.2× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$2,301.59 |
$3,901 |
0.6× |
| Vein X-Ray Skull Epidural (75872) |
$2,301.59 |
$3,901 |
3.1× |
| Vein X-Ray Spleen/Liver (75810) |
$2,301.59 |
$3,901 |
0.6× |
| Venogram Sinus/Jugular (75860) |
$7,941.99 |
$13,461 |
2.1× |
| Venography Adrenal Unilateral (75840) |
$7,941.99 |
$13,461 |
2.1× |
| Venography caval inferior serialography rs&i (75825) |
$7,941.99 |
$13,461 |
2.1× |
| Venography extremity bilateral rs&i (75822) |
$2,301.59 |
$3,901 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$2,301.59 |
$3,901 |
1.2× |
| Venography Orbital Rs&I (75880) |
$2,301.59 |
$3,901 |
3.1× |
| Venography Renal Bilateral (75833) |
$7,941.99 |
$13,461 |
2.1× |
| Venography Renal Unilateral (75831) |
$7,941.99 |
$13,461 |
2.1× |
| Venous sampling by catheter (75893) |
$13,202.43 |
$22,377 |
2.0× |
| Vertebral fracture assessment via dxa (77086) |
$200.60 |
$340 |
2.0× |
| Wrist 2 views (73100) |
$205.32 |
$348 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$246.62 |
$418 |
2.4× |
| X-ray antegrade pyelogram tube (74425) |
$1,848.47 |
$3,133 |
4.5× |
| X-Ray Aorta Leg Arteries (75630) |
$4,396.68 |
$7,452 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$320.96 |
$544 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$190.57 |
$323 |
1.9× |
| X-Ray Exam Breast Specimen (76098) |
$862.58 |
$1,462 |
1.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$246.62 |
$418 |
2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$402.38 |
$682 |
3.3× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$928.66 |
$1,574 |
7.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$269.63 |
$457 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$265.50 |
$450 |
2.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$463.74 |
$786 |
3.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$355.77 |
$603 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$481.44 |
$816 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$605.93 |
$1,027 |
4.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$501.50 |
$850 |
4.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$250.16 |
$424 |
2.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$402.38 |
$682 |
3.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$273.17 |
$463 |
2.2× |
| X-ray eye for foreign body (70030) |
$246.62 |
$418 |
2.4× |
| X-ray humerus (73060) |
$204.73 |
$347 |
2.0× |
| X-ray IV pyelogram (ivp) (74400) |
$928.66 |
$1,574 |
4.5× |
| X-ray IV pyelogram+tomography (74415) |
$928.66 |
$1,574 |
4.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$246.62 |
$418 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$320.96 |
$544 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$383.50 |
$650 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$246.62 |
$418 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$603.57 |
$1,023 |
4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$324.50 |
$550 |
2.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$463.74 |
$786 |
3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$214.17 |
$363 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$270.81 |
$459 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$463.74 |
$786 |
3.8× |
| X-Ray Stress View (77071) |
$246.62 |
$418 |
2.4× |
| X-ray thoracic spine 4 vw (72074) |
$465.51 |
$789 |
3.8× |
| X-Ray Tmj Unilat (70328) |
$246.62 |
$418 |
2.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$862.58 |
$1,462 |
2.1× |
| X-Rays Bone Length Studies (77073) |
$214.17 |
$363 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$691.48 |
$1,172 |
5.6× |
| Xr c-spine 4 or 5 views (72050) |
$402.38 |
$682 |
3.3× |
| Xr facial bones less than 3 views (70140) |
$246.62 |
$418 |
2.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$463.74 |
$786 |
3.8× |
| Xr orbits complete 4 views (70200) |
$463.74 |
$786 |
3.8× |
| Xr Tomogram Single Plane (76100) |
$421.85 |
$715 |
3.4× |