| Abdomen 2 views (74019) |
$251.93 |
$427 |
2.0× |
| Angio Adrenal Bilat Select (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 internal mammary rs&i (75756) |
$7,941.99 |
$13,461 |
2.1× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$6,594.43 |
$11,177 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,594.43 |
$11,177 |
1.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,396.68 |
$7,452 |
1.2× |
| Angiography Spinal Selective Rs&I (75705) |
$8,801.62 |
$14,918 |
1.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,885.20 |
$8,280 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,301.59 |
$3,901 |
0.6× |
| 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× |
| Aortogram thoracic (75605) |
$6,594.43 |
$11,177 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,396.68 |
$7,452 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$4,396.68 |
$7,452 |
1.2× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$7,941.99 |
$13,461 |
2.1× |
| Artery X-Rays Adrenal Gland (75731) |
$2,301.59 |
$3,901 |
0.6× |
| Arthrogram ankle (73615) |
$1,512.76 |
$2,564 |
3.7× |
| Arthrogram elbow (73085) |
$1,848.47 |
$3,133 |
4.5× |
| Arthrogram hip (73525) |
$1,512.76 |
$2,564 |
3.7× |
| Arthrogram knee (73580) |
$1,512.76 |
$2,564 |
3.7× |
| Arthrogram shoulder (73040) |
$759.33 |
$1,287 |
1.8× |
| Arthrogram wrist (73115) |
$1,512.76 |
$2,564 |
3.7× |
| Bone age studies (77072) |
$463.74 |
$786 |
3.8× |
| Bone survey complete (77075) |
$691.48 |
$1,172 |
5.6× |
| Bone survey infant (77076) |
$463.74 |
$786 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$250.16 |
$424 |
2.4× |
| Chest 1 view (71045) |
$147.50 |
$250 |
1.4× |
| Chest xray 3 views (71047) |
$206.50 |
$350 |
2.0× |
| Cholecystography, oral contrast Non-Facility (74290) |
$463.74 |
$786 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$402.38 |
$682 |
1.9× |
| Clavicle complete (73000) |
$214.17 |
$363 |
2.1× |
| Cystography minimum 3 views rs&i (74430) |
$928.66 |
$1,574 |
2.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$6,762.58 |
$11,462 |
2.7× |
| Diskogram cervical (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 study 1/> sites axial skel (77080) |
$314.47 |
$533 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$246.62 |
$418 |
2.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$928.66 |
$1,574 |
3.3× |
| Esophagus (74220) |
$447.81 |
$759 |
2.2× |
| Facial bones min 3 views (70150) |
$463.74 |
$786 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$463.74 |
$786 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$463.74 |
$786 |
3.8× |
| Fetal Echo (76825) |
$1,848.47 |
$3,133 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$604.16 |
$1,024 |
2.1× |
| 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× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (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× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$246.62 |
$418 |
2.4× |
| Myelogram Cervical (72240) |
$1,512.76 |
$2,564 |
1.6× |
| Myelogram Lumbar (72265) |
$1,512.76 |
$2,564 |
1.6× |
| Myelogram thoracic (72255) |
$1,512.76 |
$2,564 |
1.6× |
| Myelography 2 or more regions (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× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$199.42 |
$338 |
1.6× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$54.28 |
$92 |
1.6× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$463.74 |
$786 |
3.8× |
| Orthopantogram (70355) |
$246.62 |
$418 |
2.4× |
| Osseous survey limited (77074) |
$463.74 |
$786 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$216.53 |
$367 |
1.8× |
| Peritoneogram after injection (74190) |
$1,848.47 |
$3,133 |
2.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$7,941.99 |
$13,461 |
2.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,301.59 |
$3,901 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,848.47 |
$3,133 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$239.54 |
$406 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$169.92 |
$288 |
1.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$241.90 |
$410 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$246.62 |
$418 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$402.38 |
$682 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$928.66 |
$1,574 |
7.5× |
| Radex fingr minimum 2 views (73140) |
$165.79 |
$281 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$295 |
$500 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$267.86 |
$454 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$269.63 |
$457 |
2.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$463.74 |
$786 |
3.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$355.77 |
$603 |
2.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$605.93 |
$1,027 |
4.9× |
| Radex Humerus Minimum 2 Views (73060) |
$204.73 |
$347 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$204.73 |
$347 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$413 |
$700 |
3.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$463.74 |
$786 |
3.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$246.62 |
$418 |
2.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$275.53 |
$467 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$225.97 |
$383 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$246.62 |
$418 |
2.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$320.96 |
$544 |
2.6× |
| 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 Wrst Compl 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× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$178.18 |
$302 |
1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$378.19 |
$641 |
3.1× |
| Radiologic exam chest 2 views (71046) |
$177 |
$300 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$574.07 |
$973 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$532.77 |
$903 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$463.74 |
$786 |
2.2× |
| Radiologic examination femur 1 view (73551) |
$246.62 |
$418 |
2.4× |
| 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× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$463.74 |
$786 |
3.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$463.74 |
$786 |
3.8× |
| Radiological examination surgical specimen (76098) |
$862.58 |
$1,462 |
1.3× |
| Renal Cyst Study (74470) |
$928.66 |
$1,574 |
1.4× |
| Ribs bilateral 3 views (71110) |
$463.74 |
$786 |
3.8× |
| Sacroiliac Joints < 3 Views (72200) |
$463.74 |
$786 |
3.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$928.66 |
$1,574 |
3.3× |
| Scapula (73010) |
$246.62 |
$418 |
2.0× |
| Sella turcica (70240) |
$246.62 |
$418 |
2.4× |
| Shoulder 1 view (73020) |
$185.26 |
$314 |
1.8× |
| Sialogram (70390) |
$928.66 |
$1,574 |
3.3× |
| Small bowel series (74250) |
$463.74 |
$786 |
2.2× |
| Speech evaluation complex (70371) |
$928.66 |
$1,574 |
3.3× |
| Spine thoracic 3 views (72072) |
$310.34 |
$526 |
2.5× |
| Splenoportograpy rs&i (75810) |
$2,301.59 |
$3,901 |
0.6× |
| Superior sagittal sinus venogram (75870) |
$2,301.59 |
$3,901 |
0.6× |
| Thoracolumbar 2 views (72080) |
$320.96 |
$544 |
3.1× |
| Tmj unilateral (70328) |
$246.62 |
$418 |
2.4× |
| Tomogram (76100) |
$421.85 |
$715 |
3.4× |
| Ultrasound breast complete (76641) |
$432.47 |
$733 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$408.28 |
$692 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$379.96 |
$644 |
3.1× |
| Urethrocystogram voiding (74455) |
$928.66 |
$1,574 |
3.3× |
| Urethrocystography retrograde rs&i (74450) |
$928.66 |
$1,574 |
3.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$928.66 |
$1,574 |
4.5× |
| Us breast unilateral limited (76642) |
$345.15 |
$585 |
3.4× |
| Us chest (76604) |
$402.38 |
$682 |
3.3× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$911.55 |
$1,545 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$466.10 |
$790 |
3.8× |
| Us encephalogram (76506) |
$465.51 |
$789 |
3.8× |
| Us hips infant static (76886) |
$300.90 |
$510 |
2.9× |
| Us infant hips w manipulation (76885) |
$323.32 |
$548 |
3.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$222.43 |
$377 |
1.8× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$198.83 |
$337 |
1.6× |
| Us ob detailed single fetus (76811) |
$599.44 |
$1,016 |
2.1× |
| Us ob limited (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 pelvic nonobstetric image dcmtn limited/f/u (76857) |
$320.96 |
$544 |
2.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$463.74 |
$786 |
3.8× |
| Us pg uter r-t img f-up tabdl appr pr 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 soft tissue head/neck (76536) |
$453.12 |
$768 |
3.7× |
| Us spinal canal and contents (76800) |
$450.76 |
$764 |
3.6× |
| Us transrectal (76872) |
$324.50 |
$550 |
2.6× |
| Us, eye b-scan (76512) |
$216.53 |
$367 |
1.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$413 |
$700 |
3.3× |
| Venogram adrenal unilat (75840) |
$7,941.99 |
$13,461 |
2.1× |
| Venogram extremity bilateral (75822) |
$2,301.59 |
$3,901 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$2,301.59 |
$3,901 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$7,941.99 |
$13,461 |
2.1× |
| Venography caval superior serialography rs&i (75827) |
$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 selective rs&i (75831) |
$7,941.99 |
$13,461 |
2.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$7,941.99 |
$13,461 |
2.1× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$2,301.59 |
$3,901 |
3.1× |
| 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 Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$421.85 |
$715 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$246.62 |
$418 |
2.4× |
| X-ray b.e. reductn intuss (74283) |
$690.30 |
$1,170 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$543.98 |
$922 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$190.57 |
$323 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$265.50 |
$450 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$481.44 |
$816 |
3.9× |
| X-ray exam of femur 2/> (73552) |
$234.82 |
$398 |
2.3× |
| X-ray eye for foreign body (70030) |
$246.62 |
$418 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$246.62 |
$418 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$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 leg, infant (73592) |
$246.62 |
$418 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$383.50 |
$650 |
3.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$501.50 |
$850 |
4.1× |
| X-ray nose-rectum child f.b. (76010) |
$246.62 |
$418 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$463.74 |
$786 |
3.8× |
| X-ray retrograde pyelogram (74420) |
$862.58 |
$1,462 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$225.97 |
$383 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$273.17 |
$463 |
2.2× |
| 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 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 Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$463.74 |
$786 |
3.8× |
| X-Ray Small Bowel Enteroclysis (74251) |
$498.55 |
$845 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$245.44 |
$416 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$246.62 |
$418 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$246.62 |
$418 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$238.95 |
$405 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$465.51 |
$789 |
3.8× |
| Xr bone length studies (77073) |
$214.17 |
$363 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$402.38 |
$682 |
3.3× |
| Xr c-spine 6 or more views (72052) |
$402.38 |
$682 |
3.3× |
| Xr chest 4+ views (71048) |
$236 |
$400 |
1.9× |
| Xr urogram antegrade (74425) |
$1,848.47 |
$3,133 |
4.5× |