| Abdomen 1 View (74018) |
$139.20 |
$232 |
1.7× |
| Abdomen 2 views (74019) |
$363 |
$605 |
3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$868.80 |
$1,448 |
2.3× |
| Ankle 2 views (73600) |
$151.20 |
$252 |
1.8× |
| Arthrogram ankle (73615) |
$780.60 |
$1,301 |
2.3× |
| Arthrogram hip (73525) |
$645 |
$1,075 |
1.9× |
| Arthrogram Wrist (73115) |
$784.80 |
$1,308 |
2.4× |
| Bone age studies (77072) |
$142.80 |
$238 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$2,019.60 |
$3,366 |
5.3× |
| Bone Imaging Limited Area (78300) |
$939 |
$1,565 |
2.5× |
| Bone Imaging Multiple Areas (78305) |
$1,162.80 |
$1,938 |
3.0× |
| Bone Imaging Whole Body (78306) |
$1,862.40 |
$3,104 |
4.9× |
| Bone marrow imaging limited area (78102) |
$594 |
$990 |
1.6× |
| Bone survey infant (77076) |
$213 |
$355 |
2.1× |
| Brain Flow Imaging Only (78610) |
$926.40 |
$1,544 |
1.8× |
| Brain Image W/Flow < 4 Views (78601) |
$714.60 |
$1,191 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,522.20 |
$2,537 |
4.6× |
| Cat Scan Follow-Up Study (76380) |
$624.60 |
$1,041 |
7.5× |
| Cerebrospinal Fluid Scan (78630) |
$1,245.60 |
$2,076 |
2.4× |
| Chest 1 view (71045) |
$150.60 |
$251 |
1.8× |
| Chest 2 views (71046) |
$295.20 |
$492 |
3.6× |
| Chest 4 or more views (71048) |
$487.80 |
$813 |
4.9× |
| Cholecystography Oral Contrast (74290) |
$361.20 |
$602 |
2.2× |
| Cisternography Positive Contrast Rs&I (70015) |
$755.40 |
$1,259 |
1.0× |
| Clavicle complete (73000) |
$196.20 |
$327 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$267.60 |
$446 |
2.7× |
| Contrast X-Ray Bladder (74430) |
$468.60 |
$781 |
1.4× |
| Contrast X-Ray Of Elbow (73085) |
$441.60 |
$736 |
1.3× |
| Contrast X-Ray Of Knee Joint (73580) |
$684.60 |
$1,141 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,274 |
$3,790 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,940.40 |
$3,234 |
8.5× |
| CT abdomen w contrast (74160) |
$1,363.80 |
$2,273 |
8.1× |
| CT abdomen w wo contrast (74170) |
$1,478.40 |
$2,464 |
8.8× |
| CT abdomen w/o contrast (74150) |
$1,212.60 |
$2,021 |
12.1× |
| CT Angio Abdomen and Pelvis (74174) |
$1,474.20 |
$2,457 |
4.4× |
| CT Angio Chest (71275) |
$1,023.60 |
$1,706 |
6.1× |
| CT Angio Head (70496) |
$921 |
$1,535 |
5.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,100 |
$3,500 |
12.5× |
| CT Angio Neck (70498) |
$921 |
$1,535 |
5.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,100 |
$3,500 |
12.5× |
| CT cervical spine w/ contrast (72126) |
$1,363.80 |
$2,273 |
4.1× |
| CT cervical spine w/o contrast (72125) |
$970.20 |
$1,617 |
9.7× |
| CT cervical spine w/wo cont (72127) |
$1,478.40 |
$2,464 |
8.8× |
| CT chest w contrast (71260) |
$1,090.80 |
$1,818 |
6.5× |
| CT chest w/wo contrast (71270) |
$1,478.40 |
$2,464 |
8.8× |
| CT head/brain with contrast (70460) |
$1,062.60 |
$1,771 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,151.40 |
$1,919 |
6.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$227 |
$227 |
2.7× |
| CT iac w contrast (70481) |
$1,062.60 |
$1,771 |
6.3× |
| CT l-spine w&w/o contrast (72133) |
$1,478.40 |
$2,464 |
8.8× |
| CT lower ext w/o (73700) |
$1,091.40 |
$1,819 |
10.9× |
| CT lower extremity w/contrast material (73701) |
$1,363.80 |
$2,273 |
8.1× |
| CT lumbar spine w contrast (72132) |
$1,363.80 |
$2,273 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$970.20 |
$1,617 |
9.7× |
| CT maxillofacial w contrast (70487) |
$1,062.60 |
$1,771 |
6.3× |
| CT maxillofacial wo contrast (70486) |
$756 |
$1,260 |
7.6× |
| CT neck tissue combo (70492) |
$1,151.40 |
$1,919 |
6.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,151.40 |
$1,919 |
6.9× |
| CT orbits w/o contrast (70480) |
$945 |
$1,575 |
9.5× |
| CT pelvis w&w/o contrast (72194) |
$1,478.40 |
$2,464 |
8.8× |
| CT pelvis w/o contrast (72192) |
$1,212.60 |
$2,021 |
12.1× |
| CT scan of leg combo (73702) |
$1,478.40 |
$2,464 |
8.8× |
| CT scans face/jaw combo (70488) |
$1,151.40 |
$1,919 |
6.9× |
| CT soft tissue neck w contrast (70491) |
$1,062.60 |
$1,771 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$945 |
$1,575 |
9.5× |
| CT thoracic spine w contrast (72129) |
$1,363.80 |
$2,273 |
8.1× |
| CT thoracic spine w/o contrast (72128) |
$970.20 |
$1,617 |
9.7× |
| CT thoracic spine w/wo cont (72130) |
$1,478.40 |
$2,464 |
8.8× |
| CT thorax w/o contrast (71250) |
$970.20 |
$1,617 |
9.7× |
| CT upper ext wo (73200) |
$1,212.60 |
$2,021 |
12.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,478.40 |
$2,464 |
8.8× |
| CT upper extremity with contrast (73201) |
$1,363.80 |
$2,273 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,363.80 |
$2,273 |
8.1× |
| Cta Abdomen (74175) |
$1,363.80 |
$2,273 |
8.1× |
| CTA pelvis (72191) |
$2,100 |
$3,500 |
12.5× |
| Discography Cerv/Thor Spine (72285) |
$1,456.80 |
$2,428 |
0.8× |
| Diskography lumbar (72295) |
$1,700.40 |
$2,834 |
0.9× |
| Dxa Bone Density Axial (77080) |
$272.40 |
$454 |
2.7× |
| Dxa bone density study (77085) |
$931.20 |
$1,552 |
9.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$69.60 |
$116 |
0.8× |
| Echo Guide For Artery Repair (76936) |
$320.40 |
$534 |
1.6× |
| Echograp Trans R Pros Study (76873) |
$670.80 |
$1,118 |
6.7× |
| Esophagram (74220) |
$300.60 |
$501 |
1.8× |
| Fetal Biophys Profile W/Nst (76818) |
$421.20 |
$702 |
4.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,255.80 |
$2,093 |
12.6× |
| Fluoroscopy up to 1 hr (76000) |
$400.20 |
$667 |
1.8× |
| Foot 2 views (73620) |
$188.40 |
$314 |
2.3× |
| Forearm 2 views (73090) |
$213.60 |
$356 |
2.6× |
| Gastric emptying imaging study (78264) |
$1,042.20 |
$1,737 |
2.7× |
| Gated Heart Planar Single (78472) |
$2,367.60 |
$3,946 |
6.2× |
| Gated Heart, Multiple (78473) |
$714.60 |
$1,191 |
1.9× |
| Hand 2 views (73120) |
$216 |
$360 |
2.2× |
| Hepatobil Syst Image W/Drug (78227) |
$1,354.80 |
$2,258 |
2.6× |
| Hepatobiliary System Imaging (78226) |
$1,354.80 |
$2,258 |
3.5× |
| Ht Musc Image Planar Mult (78454) |
$2,379.60 |
$3,966 |
1.9× |
| Ht Muscle Image Spect Sing (78451) |
$1,325.40 |
$2,209 |
1.1× |
| Hysterosalpingogram (74740) |
$586.20 |
$977 |
2.6× |
| Infant hip ultrasound, limited static exam (76886) |
$516.60 |
$861 |
6.2× |
| Joint Survey Single View (77077) |
$87.60 |
$146 |
0.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,519.20 |
$2,532 |
2.9× |
| K Flow/Funct Image W/O Drug (78707) |
$1,578 |
$2,630 |
3.0× |
| Knee 3 Views (73562) |
$226.80 |
$378 |
2.7× |
| Leveen/Shunt Patency Exam (78291) |
$1,090.80 |
$1,818 |
2.9× |
| Liver & Spleen Imaging Static Only (78215) |
$1,372.80 |
$2,288 |
3.6× |
| Liver imaging static only (78201) |
$814.80 |
$1,358 |
1.6× |
| Liver imaging w/vascular flow (78202) |
$957.60 |
$1,596 |
1.8× |
| Lung Perf&Ventilat Diferentl (78598) |
$1,972.80 |
$3,288 |
3.8× |
| Lung perfusion differential (78597) |
$1,238.40 |
$2,064 |
3.2× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,972.80 |
$3,288 |
3.8× |
| Lung Ventilation Imaging (78579) |
$1,238.40 |
$2,064 |
3.2× |
| Lymph System Imaging (78195) |
$1,550.40 |
$2,584 |
3.0× |
| Magnetic Image Jaw Joint (70336) |
$1,388.40 |
$2,314 |
6.1× |
| Mammary ductogram or galactogram multiple (77054) |
$352.20 |
$587 |
1.5× |
| Meckels Divert Exam (78290) |
$847.20 |
$1,412 |
2.2× |
| Mr safety determination physician/other qhp (76016) |
$132 |
$220 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$36.60 |
$61 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$137.40 |
$229 |
1.5× |
| Mr safety implt pos&/immoblj (76019) |
$89.40 |
$149 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$362.40 |
$604 |
1.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,236.80 |
$3,728 |
6.7× |
| MRA head w/o contrast (70544) |
$1,899 |
$3,165 |
8.3× |
| MRA head with contrast (70545) |
$1,931.40 |
$3,219 |
5.8× |
| MRA neck w contrast (70548) |
$1,931.40 |
$3,219 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,236.80 |
$3,728 |
6.7× |
| MRA neck w/o contrast (70547) |
$1,899 |
$3,165 |
8.3× |
| MRI abdomen w contrast (74182) |
$1,522.20 |
$2,537 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,388.40 |
$2,314 |
6.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,522.20 |
$2,537 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,761.60 |
$2,936 |
5.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,522.20 |
$2,537 |
2.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,388.40 |
$2,314 |
6.1× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$1,388.40 |
$2,314 |
6.1× |
| MRI cardiac w/o contrast (75557) |
$1,388.40 |
$2,314 |
6.1× |
| MRI cervical spine w contrast (72142) |
$1,498.80 |
$2,498 |
4.5× |
| MRI cervical spine w/o cont (72141) |
$1,367.40 |
$2,279 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,388.40 |
$2,314 |
6.1× |
| MRI chest with contrast (71551) |
$1,522.20 |
$2,537 |
2.0× |
| MRI chest wo w contrast (71552) |
$1,761.60 |
$2,936 |
5.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,522.20 |
$2,537 |
4.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,761.60 |
$2,936 |
5.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,388.40 |
$2,314 |
6.1× |
| MRI lumbar spine w contrast (72149) |
$1,498.80 |
$2,498 |
4.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,735.20 |
$2,892 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,693.80 |
$2,823 |
7.4× |
| MRI orbit face neck w contrast (70542) |
$1,856.40 |
$3,094 |
5.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,150.40 |
$3,584 |
6.5× |
| MRI pelvis w contrast (72196) |
$1,522.20 |
$2,537 |
4.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,761.60 |
$2,936 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,388.40 |
$2,314 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,367.40 |
$2,279 |
6.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,522.20 |
$2,537 |
4.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,388.40 |
$2,314 |
6.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,761.60 |
$2,936 |
5.3× |
| MRI, abdomen, combo (74183) |
$1,761.60 |
$2,936 |
5.3× |
| MRI, dorsal spine combo (72157) |
$1,735.20 |
$2,892 |
5.2× |
| MRI, dorsal spine contrast (72147) |
$1,498.80 |
$2,498 |
4.5× |
| MRI, joint upper extrem (73221) |
$1,388.40 |
$2,314 |
6.1× |
| MRI, joint upper extrem combo (73223) |
$1,761.60 |
$2,936 |
5.3× |
| MRI, lumbar spine combo (72158) |
$1,735.20 |
$2,892 |
5.2× |
| Myelogram cervical (72240) |
$1,337.40 |
$2,229 |
1.8× |
| Myelogram Lumbar (72265) |
$1,924.20 |
$3,207 |
2.6× |
| Myelography thoracic (72255) |
$1,672.80 |
$2,788 |
2.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,433.40 |
$2,389 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$5,052 |
$8,420 |
4.1× |
| Neck soft tissue (70360) |
$223.20 |
$372 |
2.7× |
| Nm csf leak detection (78650) |
$1,102.80 |
$1,838 |
0.9× |
| Nm myocard infarct spect (78469) |
$1,380.60 |
$2,301 |
2.7× |
| Nonvascular Shunt X-Ray (75809) |
$869.40 |
$1,449 |
8.7× |
| Nuclear Rx Oral Admin (79005) |
$748.80 |
$1,248 |
3.4× |
| Ob us nuchal meas 1 gest (76813) |
$198 |
$330 |
2.0× |
| Optic foramina (70190) |
$154.20 |
$257 |
1.9× |
| Panoramic X-ray of jaws (70355) |
$109.80 |
$183 |
1.3× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$947.40 |
$1,579 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$817.20 |
$1,362 |
2.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$888.60 |
$1,481 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$196.20 |
$327 |
2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,363.20 |
$2,272 |
3.6× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$288 |
$480 |
2.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$388.20 |
$647 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$386.40 |
$644 |
4.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$187.80 |
$313 |
2.3× |
| Radex elbow complete minimum 3 views (73080) |
$262.80 |
$438 |
3.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$315 |
$525 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$196.20 |
$327 |
2.4× |
| Radex foot complete minimum 3 views (73630) |
$226.80 |
$378 |
2.7× |
| Radex Hand Minimum 3 Views (73130) |
$427.20 |
$712 |
5.1× |
| Radex lower extremity infant minimum 2 views (73592) |
$162 |
$270 |
1.9× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$216 |
$360 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$261.60 |
$436 |
3.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$240 |
$400 |
2.9× |
| Radex shoulder complete minimum 2 views (73030) |
$225 |
$375 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$148.20 |
$247 |
1.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$480 |
$800 |
2.9× |
| Radex Spine 1 View Specify Level (72020) |
$199.20 |
$332 |
2.4× |
| Radex Sternum Minimum 2 Views (71120) |
$222 |
$370 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$393 |
$655 |
4.7× |
| Radex Toe Minimum 2 Views (73660) |
$140.40 |
$234 |
1.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$210.60 |
$351 |
2.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$240 |
$400 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$398.40 |
$664 |
4.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$568.20 |
$947 |
5.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$363 |
$605 |
3.6× |
| Radiologic exam colon double contrast study (74280) |
$614.40 |
$1,024 |
3.7× |
| Radiologic exam colon single contrast study (74270) |
$523.80 |
$873 |
3.1× |
| Radiologic exam knee complete 4/more views (73564) |
$310.20 |
$517 |
3.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$235.80 |
$393 |
2.4× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$388.20 |
$647 |
2.3× |
| Radiologic exam swallow function contrast study (74230) |
$402.60 |
$671 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$579.60 |
$966 |
3.5× |
| Radiologic examination femur minimum 2 views (73552) |
$268.20 |
$447 |
3.2× |
| Radiologic examination knee 1/2 views (73560) |
$226.80 |
$378 |
2.7× |
| Radiologic Examination Osseous Survey Limited (77074) |
$422.40 |
$704 |
4.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$193.20 |
$322 |
2.3× |
| Ribs bilateral 3 views (71110) |
$264.60 |
$441 |
2.7× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$2,559 |
$4,265 |
6.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,066.80 |
$1,778 |
2.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,617 |
$2,695 |
3.1× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,874.40 |
$3,124 |
3.6× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,873.20 |
$3,122 |
3.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,132.40 |
$3,554 |
1.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,763 |
$4,605 |
2.0× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$2,434.80 |
$4,058 |
2.0× |
| Rp Therapy Intravenous Administration (79101) |
$3,762.60 |
$6,271 |
16.9× |
| Scapula (73010) |
$240 |
$400 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$22.20 |
$37 |
0.9× |
| Sella turcica (70240) |
$139.20 |
$232 |
1.7× |
| Shoulder 1 view (73020) |
$156 |
$260 |
1.9× |
| Shoulder Arthrography (73040) |
$689.40 |
$1,149 |
2.1× |
| Sialogram (70390) |
$666.60 |
$1,111 |
2.9× |
| Skull less than 4 views (70250) |
$155.40 |
$259 |
1.6× |
| Sternoclavicular joints (71130) |
$289.20 |
$482 |
3.5× |
| Therapeutic Enema Rdctj Intussusception/Obstrcj (74283) |
$375.60 |
$626 |
2.2× |
| Thoracic spine 2 views (72070) |
$213.60 |
$356 |
2.1× |
| Thoracic spine 3 views (72072) |
$252 |
$420 |
2.5× |
| Thoracolumbar 2 views (72080) |
$252 |
$420 |
3.0× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$1,057.80 |
$1,763 |
2.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$676.80 |
$1,128 |
1.8× |
| Thyroid Met Imaging Body (78018) |
$1,498.80 |
$2,498 |
2.9× |
| Thyroid Uptake Measurement (78012) |
$508.20 |
$847 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,035.60 |
$1,726 |
2.7× |
| Ultrasound Breast Limited (76642) |
$591 |
$985 |
7.1× |
| Ultrasound Exam Aaa Screen (76706) |
$156.60 |
$261 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$825.60 |
$1,376 |
8.3× |
| Umbilical-artery Doppler (OB) (76820) |
$198 |
$330 |
2.0× |
| Unlisted Dx Radiographic Procedure (76499) |
$1,143 |
$1,905 |
13.8× |
| Unlisted us procedure (76999) |
$382.80 |
$638 |
4.6× |
| Upper gi w/o kub (74240) |
$579.60 |
$966 |
3.5× |
| Ureteral Reflux Study (78740) |
$1,180.80 |
$1,968 |
3.1× |
| Urethrocystogram voiding (74455) |
$669.60 |
$1,116 |
2.9× |
| Urethrocystography retrograde (74450) |
$412.20 |
$687 |
1.8× |
| Us breast unilateral complete (76641) |
$591 |
$985 |
5.9× |
| Us chest (76604) |
$861.60 |
$1,436 |
8.6× |
| Us complete joint (76881) |
$841.20 |
$1,402 |
8.4× |
| Us exam, pelvic, limited (76857) |
$417.60 |
$696 |
4.2× |
| Us head (76506) |
$1,032 |
$1,720 |
10.3× |
| Us kidney transplant (76776) |
$860.40 |
$1,434 |
8.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$736.20 |
$1,227 |
7.4× |
| Us ob detailed single fetus (76811) |
$1,255.80 |
$2,093 |
5.5× |
| Us ob limited 1 or more fetuses (76815) |
$604.80 |
$1,008 |
6.1× |
| Us ob transvaginal (76817) |
$1,059 |
$1,765 |
10.6× |
| Us pelvic non ob complete (76856) |
$1,032 |
$1,720 |
10.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$863.40 |
$1,439 |
8.6× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$198 |
$330 |
2.0× |
| Us retroperitoneal complete (76770) |
$1,032 |
$1,720 |
10.3× |
| Us retroperitoneal limited (76775) |
$929.40 |
$1,549 |
9.3× |
| Us scrotum and contents (76870) |
$1,032 |
$1,720 |
10.3× |
| Us spinal canal and contents (76800) |
$969.60 |
$1,616 |
9.7× |
| Us thyroid (76536) |
$1,032 |
$1,720 |
10.3× |
| Us transrectal (76872) |
$1,032 |
$1,720 |
10.3× |
| Venography extremity unilateral rs&i (75820) |
$2,460.60 |
$4,101 |
1.6× |
| Vertebral fracture assessment via dxa (77086) |
$274.20 |
$457 |
3.3× |
| Wrist 2 views (73100) |
$213.60 |
$356 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$273.60 |
$456 |
3.3× |
| X-ray antegrade pyelogram tube (74425) |
$468.60 |
$781 |
1.4× |
| X-Ray Bend Only L-S Spine (72120) |
$130.20 |
$217 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$219 |
$365 |
2.6× |
| X-Ray Exam Breast Specimen (76098) |
$393 |
$655 |
0.8× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$196.20 |
$327 |
2.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$252 |
$420 |
2.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$398.40 |
$664 |
4.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$168 |
$280 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$261 |
$435 |
3.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$378.60 |
$631 |
3.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$378.60 |
$631 |
3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$378.60 |
$631 |
3.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$378.60 |
$631 |
3.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$337.80 |
$563 |
3.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$252 |
$420 |
3.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$342.60 |
$571 |
3.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$261 |
$435 |
2.6× |
| X-ray eye for foreign body (70030) |
$268.20 |
$447 |
3.2× |
| X-ray humerus (73060) |
$220.80 |
$368 |
2.7× |
| X-ray IV pyelogram (ivp) (74400) |
$474 |
$790 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$315 |
$525 |
3.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$142.80 |
$238 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$252 |
$420 |
2.5× |
| X-ray nose-rectum child f.b. (76010) |
$179.40 |
$299 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$247.20 |
$412 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$213.60 |
$356 |
2.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$158.40 |
$264 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$213.60 |
$356 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$307.20 |
$512 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$320.40 |
$534 |
3.2× |
| X-Ray Stress View (77071) |
$198 |
$330 |
2.4× |
| X-Ray Tmj Unilat (70328) |
$130.20 |
$217 |
1.6× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$412.80 |
$688 |
1.2× |
| X-Rays Bone Length Studies (77073) |
$261 |
$435 |
2.6× |
| X-Rays Bone Survey Complete (77075) |
$268.80 |
$448 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$347.40 |
$579 |
3.5× |
| Xr facial bones less than 3 views (70140) |
$130.20 |
$217 |
1.6× |
| Xr orbits complete 4 views (70200) |
$471.60 |
$786 |
4.7× |