| Abdomen 1 View (74018) |
$134 |
$268 |
1.6× |
| Abdomen 2 views (74019) |
$159 |
$318 |
1.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$618 |
$1,236 |
1.6× |
| Angio internal mammary (75756) |
$852 |
$1,704 |
0.3× |
| Angio pulmonary bilat (75743) |
$2,662 |
$5,324 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$2,517 |
$5,034 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,450 |
$4,900 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,517 |
$5,034 |
0.8× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$933 |
$1,866 |
0.3× |
| Ankle 2 views (73600) |
$89.50 |
$179 |
1.1× |
Aortography thoracic serialography rs&i (75605)
unusually low: confirm this is the full procedure |
$2,517 |
$5,034 |
0.5× |
Artery X-Rays Abdomen (75726)
unusually low: confirm this is the full procedure |
$2,517 |
$5,034 |
0.5× |
Artery X-Rays Pelvis (75736)
unusually low: confirm this is the full procedure |
$2,517 |
$5,034 |
0.5× |
Artery X-Rays Spine (75705)
unusually low: confirm this is the full procedure |
$2,549 |
$5,098 |
0.5× |
| Arthrogram hip (73525) |
$337 |
$674 |
1.0× |
| Arthrogram Wrist (73115) |
$337 |
$674 |
1.0× |
| Bone age studies (77072) |
$84 |
$168 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$618 |
$1,236 |
1.6× |
| Bone Imaging Limited Area (78300) |
$688 |
$1,376 |
1.8× |
| Bone Imaging Whole Body (78306) |
$764.50 |
$1,529 |
2.0× |
| Bone survey infant (77076) |
$140 |
$280 |
1.4× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$632.50 |
$1,265 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$458.50 |
$917 |
1.4× |
| Cat Scan Follow-Up Study (76380) |
$212 |
$424 |
2.5× |
| Cerebrospinal Fluid Scan (78630) |
$1,316.50 |
$2,633 |
2.5× |
| Chest 1 view (71045) |
$207 |
$414 |
2.5× |
| Chest 2 views (71046) |
$248 |
$496 |
2.9× |
| Chest 3 views (71047) |
$289.50 |
$579 |
3.4× |
| Chest 4 or more views (71048) |
$344.50 |
$689 |
3.4× |
| Cineradiograpy/vidradiograpy xcpt where spec (76120) |
$95.50 |
$191 |
0.9× |
| Clavicle complete (73000) |
$105.50 |
$211 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$54.50 |
$109 |
0.5× |
| Contrast Exam Abdominl Aorta (75625) |
$2,517 |
$5,034 |
0.8× |
| Contrast X-Ray Bladder (74430) |
$510 |
$1,020 |
1.5× |
| Contrast X-Ray Of Elbow (73085) |
$337 |
$674 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$337 |
$674 |
1.0× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$229.50 |
$459 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,327 |
$2,654 |
3.9× |
| CT abdomen and pelvis without contrast (74176) |
$903 |
$1,806 |
3.9× |
| CT abdomen w contrast (74160) |
$663.50 |
$1,327 |
3.9× |
| CT abdomen w wo contrast (74170) |
$797.50 |
$1,595 |
4.7× |
| CT abdomen w/o contrast (74150) |
$394.50 |
$789 |
3.9× |
| CT Angio Abdomen and Pelvis (74174) |
$863 |
$1,726 |
2.6× |
| CT Angio Chest (71275) |
$1,034 |
$2,068 |
6.1× |
| CT Angio Head (70496) |
$617.50 |
$1,235 |
3.6× |
| CT angio hrt w/3d image (75574) |
$604 |
$1,208 |
1.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$732 |
$1,464 |
4.3× |
| CT Angio Neck (70498) |
$791 |
$1,582 |
4.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$803.50 |
$1,607 |
4.7× |
| CT cervical spine w/ contrast (72126) |
$609 |
$1,218 |
1.8× |
| CT cervical spine w/o contrast (72125) |
$402.50 |
$805 |
4.0× |
| CT cervical spine w/wo cont (72127) |
$730.50 |
$1,461 |
4.3× |
| CT chest w contrast (71260) |
$567 |
$1,134 |
3.3× |
| CT chest w/wo contrast (71270) |
$665.50 |
$1,331 |
3.9× |
| CT Colonogrphy Dx Image Postprocess W/Contrast (74262) |
$529 |
$1,058 |
3.1× |
| CT colonogrphy dx image postprocess w/o contrast (74261) |
$347.50 |
$695 |
3.4× |
| CT head/brain with contrast (70460) |
$487.50 |
$975 |
2.9× |
| CT head/brain without and with contrast (70470) |
$548 |
$1,096 |
3.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$513 |
$1,026 |
1.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$130 |
0.8× |
| CT hrt w/3d image congen (75573) |
$483.50 |
$967 |
1.4× |
| CT iac w contrast (70481) |
$487.50 |
$975 |
2.9× |
| CT l-spine w&w/o contrast (72133) |
$795 |
$1,590 |
4.7× |
| CT lower ext w/o (73700) |
$438 |
$876 |
4.3× |
| CT lower extremity w/contrast material (73701) |
$531 |
$1,062 |
3.1× |
| CT lumbar spine w contrast (72132) |
$662 |
$1,324 |
2.0× |
| CT lumbar spine w/o contrast (72131) |
$438 |
$876 |
4.3× |
| CT maxillofacial w contrast (70487) |
$487.50 |
$975 |
2.9× |
| CT maxillofacial wo contrast (70486) |
$402.50 |
$805 |
4.0× |
| CT neck tissue combo (70492) |
$722 |
$1,444 |
4.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$616 |
$1,232 |
3.6× |
| CT orbits w/o contrast (70480) |
$321.50 |
$643 |
3.2× |
| CT pelvis w&w/o contrast (72194) |
$752 |
$1,504 |
4.4× |
| CT pelvis w/o contrast (72192) |
$441 |
$882 |
4.4× |
| CT scan of leg combo (73702) |
$1,010.50 |
$2,021 |
6.0× |
| CT scans face/jaw combo (70488) |
$548 |
$1,096 |
3.2× |
| CT soft tissue neck w contrast (70491) |
$610 |
$1,220 |
3.6× |
| CT soft tissue neck w/o contrast (70490) |
$321.50 |
$643 |
3.2× |
| CT thoracic spine w contrast (72129) |
$662 |
$1,324 |
3.9× |
| CT thoracic spine w/o contrast (72128) |
$438 |
$876 |
4.3× |
| CT thoracic spine w/wo cont (72130) |
$795 |
$1,590 |
4.7× |
| CT thorax w/o contrast (71250) |
$394.50 |
$789 |
3.9× |
| CT unlisted procedure (76497) |
$586 |
$1,172 |
7.0× |
| CT upper ext wo (73200) |
$438 |
$876 |
4.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$678 |
$1,356 |
4.0× |
| CT upper extremity with contrast (73201) |
$531 |
$1,062 |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$610 |
$1,220 |
3.6× |
| Cta Abdomen (74175) |
$863 |
$1,726 |
5.1× |
| CTA pelvis (72191) |
$848 |
$1,696 |
5.0× |
| Dilation ureters/urethra rs&i (74485) |
$3,407 |
$6,814 |
1.7× |
| Discography Cerv/Thor Spine (72285) |
$2,869 |
$5,738 |
1.5× |
| Diskography lumbar (72295) |
$2,869 |
$5,738 |
1.5× |
| Dxa Bone Density Axial (77080) |
$129 |
$258 |
1.3× |
| Echo exam uterus (76831) |
$280 |
$560 |
1.2× |
| Esophagram (74220) |
$325.50 |
$651 |
1.9× |
| Fetal Biophys Profile W/Nst (76818) |
$176.50 |
$353 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$134.50 |
$269 |
0.6× |
| Follow-Up Angiography (75898) |
$416 |
$832 |
0.1× |
| Foot 2 views (73620) |
$105.50 |
$211 |
1.3× |
| Forearm 2 views (73090) |
$105.50 |
$211 |
1.3× |
| Gastric emptying imaging study (78264) |
$686 |
$1,372 |
1.8× |
| Gated Heart Planar Single (78472) |
$857.50 |
$1,715 |
2.2× |
| Hand 2 views (73120) |
$105.50 |
$211 |
1.0× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,517 |
$5,034 |
0.8× |
| Hepatobil Syst Image W/Drug (78227) |
$762.50 |
$1,525 |
1.5× |
| Hepatobiliary System Imaging (78226) |
$762.50 |
$1,525 |
2.0× |
| Ht Muscle Image Spect Sing (78451) |
$1,704.50 |
$3,409 |
1.4× |
| Hysterosalpingogram (74740) |
$591 |
$1,182 |
2.6× |
| K Flow/Funct Image Multiple (78709) |
$725.50 |
$1,451 |
1.4× |
| K Flow/Funct Image W/Drug (78708) |
$725.50 |
$1,451 |
1.4× |
| K Flow/Funct Image W/O Drug (78707) |
$725.50 |
$1,451 |
1.4× |
| Knee 3 Views (73562) |
$113.50 |
$227 |
1.3× |
| Leveen/Shunt Patency Exam (78291) |
$618 |
$1,236 |
1.6× |
| Liver & Spleen Imaging Static Only (78215) |
$647.50 |
$1,295 |
1.7× |
| Lung Perf&Ventilat Diferentl (78598) |
$719 |
$1,438 |
1.4× |
| Lung Ventilat&Perfus Imaging (78582) |
$719 |
$1,438 |
1.4× |
| Lung Ventilation Imaging (78579) |
$564.50 |
$1,129 |
1.5× |
| Lymph System Imaging (78195) |
$618 |
$1,236 |
1.2× |
| Magnetic Image Jaw Joint (70336) |
$1,003 |
$2,006 |
4.3× |
| Mammary ductogram or galactogram multiple (77054) |
$289.50 |
$579 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$248 |
$496 |
1.1× |
| Meckels Divert Exam (78290) |
$618 |
$1,236 |
1.6× |
| Mr safety determination physician/other qhp (76016) |
$25 |
$50 |
0.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$25 |
$50 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$25 |
$50 |
0.3× |
| Mr safety implt pos&/immoblj (76019) |
$25 |
$50 |
0.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$25 |
$50 |
0.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,211 |
$2,422 |
3.6× |
| MRA head w/o contrast (70544) |
$1,511 |
$3,022 |
6.6× |
| MRA neck w contrast (70548) |
$1,772 |
$3,544 |
5.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,260 |
$8,520 |
12.6× |
| MRA neck w/o contrast (70547) |
$1,288.50 |
$2,577 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,253.50 |
$2,507 |
5.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,914.50 |
$7,829 |
5.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,880 |
$9,760 |
14.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,370.50 |
$2,741 |
1.8× |
| MRI cardiac w/o contrast (75557) |
$298 |
$596 |
1.3× |
| MRI cervical spine w contrast (72142) |
$646.50 |
$1,293 |
1.9× |
| MRI cervical spine w/o cont (72141) |
$540 |
$1,080 |
2.3× |
| MRI chest w/o contrast (71550) |
$1,003 |
$2,006 |
4.3× |
| MRI chest with contrast (71551) |
$1,203.50 |
$2,407 |
1.6× |
| MRI chest wo w contrast (71552) |
$1,525 |
$3,050 |
4.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,251.50 |
$6,503 |
9.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,525 |
$3,050 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,253.50 |
$2,507 |
5.4× |
| MRI lumbar spine w contrast (72149) |
$1,202.50 |
$2,405 |
3.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$820.50 |
$1,641 |
2.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,208.50 |
$2,417 |
5.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,298.50 |
$4,597 |
6.8× |
| MRI pelvis w contrast (72196) |
$1,203.50 |
$2,407 |
3.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,525 |
$3,050 |
4.5× |
| MRI pelvis w/o contrast (72195) |
$1,003 |
$2,006 |
4.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,003 |
$2,006 |
4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,003 |
$2,006 |
4.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,525 |
$3,050 |
4.5× |
| MRI, abdomen, combo (74183) |
$1,525 |
$3,050 |
4.5× |
| MRI, dorsal spine combo (72157) |
$1,525 |
$3,050 |
4.5× |
| MRI, dorsal spine contrast (72147) |
$1,202.50 |
$2,405 |
3.6× |
| MRI, joint upper extrem (73221) |
$1,253.50 |
$2,507 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$1,525 |
$3,050 |
4.5× |
| MRI, lumbar spine combo (72158) |
$1,525 |
$3,050 |
4.5× |
| Myelogram cervical (72240) |
$606 |
$1,212 |
0.8× |
| Myelogram Lumbar (72265) |
$606 |
$1,212 |
0.8× |
| Myelography thoracic (72255) |
$606 |
$1,212 |
0.8× |
| Myelograpy 2/more regions rs&i (72270) |
$606 |
$1,212 |
0.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,704.50 |
$3,409 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,130.50 |
$4,261 |
1.7× |
| Neck soft tissue (70360) |
$167.50 |
$335 |
2.0× |
| Nonvascular Shunt X-Ray (75809) |
$204.50 |
$409 |
2.0× |
| Nuclear Rx Oral Admin (79005) |
$478.50 |
$957 |
2.1× |
| Oph bmtry us echograpy a-scan io lens pwr cal (76519) |
$306.50 |
$613 |
3.0× |
| Ophthalmic Biometry US Echograpy a-Scan (76516) |
$304 |
$608 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$490 |
$980 |
1.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,749.50 |
$3,499 |
4.5× |
| Pelvis 1 or 2 views (72170) |
$117 |
$234 |
1.2× |
| Peritoneogram Rs&I (74190) |
$345 |
$690 |
0.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,517 |
$5,034 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$494 |
$988 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$199.50 |
$399 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$591 |
$1,182 |
1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$105.50 |
$211 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$105.50 |
$211 |
1.3× |
| Radex elbow complete minimum 3 views (73080) |
$105.50 |
$211 |
1.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$101 |
$202 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$105.50 |
$211 |
1.3× |
| Radex foot complete minimum 3 views (73630) |
$114.50 |
$229 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$105.50 |
$211 |
1.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$84 |
$168 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$105.50 |
$211 |
1.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$140 |
$280 |
1.7× |
| Radex shoulder complete minimum 2 views (73030) |
$105.50 |
$211 |
1.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$84 |
$168 |
1.0× |
| Radex Spine 1 View Specify Level (72020) |
$84 |
$168 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$84 |
$168 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$84 |
$168 |
1.0× |
| Radex Toe Minimum 2 Views (73660) |
$105.50 |
$211 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$84 |
$168 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$105.50 |
$211 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$152.50 |
$305 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$191 |
$382 |
1.9× |
| Radiologic exam colon double contrast study (74280) |
$529 |
$1,058 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$260.50 |
$521 |
1.5× |
| Radiologic exam knee complete 4/more views (73564) |
$120.50 |
$241 |
1.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$117.50 |
$235 |
1.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$260.50 |
$521 |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$325.50 |
$651 |
1.9× |
| Radiologic exam teeth complete full mouth (70320) |
$57 |
$114 |
0.2× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$173 |
$346 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$325.50 |
$651 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$219 |
$438 |
2.6× |
| Radiologic examination knee 1/2 views (73560) |
$105.50 |
$211 |
1.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$140 |
$280 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$71.50 |
$143 |
0.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$105.50 |
$211 |
1.3× |
| Renal Cyst Study (74470) |
$654.50 |
$1,309 |
1.2× |
| Ribs bilateral 3 views (71110) |
$140 |
$280 |
1.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,196 |
$2,392 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,196 |
$2,392 |
3.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,196 |
$2,392 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,017 |
$2,034 |
1.9× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$3,407 |
$6,814 |
6.5× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,465 |
$2,930 |
1.2× |
| Salivary Gland Imaging Serial Images (78231) |
$445.50 |
$891 |
1.2× |
| Scapula (73010) |
$89.50 |
$179 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$358 |
$716 |
15.3× |
| Shoulder 1 view (73020) |
$84 |
$168 |
1.0× |
| Shoulder Arthrography (73040) |
$337 |
$674 |
1.0× |
| Sialogram (70390) |
$591 |
$1,182 |
2.6× |
| Skull less than 4 views (70250) |
$84 |
$168 |
0.8× |
| Special treatment procedure (77470) |
$2,058 |
$4,116 |
3.9× |
| Sternoclavicular joints (71130) |
$84 |
$168 |
1.0× |
| Testicular Imaging W/Flow (78761) |
$725.50 |
$1,451 |
1.9× |
| Thoracic spine 2 views (72070) |
$105.50 |
$211 |
1.0× |
| Thoracic spine 3 views (72072) |
$105.50 |
$211 |
1.0× |
| Thoracolumbar 2 views (72080) |
$585.50 |
$1,171 |
7.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$353 |
$706 |
0.9× |
| Thyroid Met Imaging Body (78018) |
$649.50 |
$1,299 |
1.2× |
| Thyroid Uptake Measurement (78012) |
$288 |
$576 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$507 |
$1,014 |
1.3× |
| Ultrasound Breast Limited (76642) |
$240.50 |
$481 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$267.50 |
$535 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$220 |
$440 |
2.2× |
| Unlisted Dx Radiographic Procedure (76499) |
$52.50 |
$105 |
0.6× |
| Unlisted fluoroscopic procedure (76496) |
$160 |
$320 |
1.9× |
| Unlisted respiratory px dx nuclear medicine (78599) |
$521 |
$1,042 |
1.3× |
| Upper gi w/o kub (74240) |
$325.50 |
$651 |
1.9× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$24 |
$48 |
2.2× |
| Urethrocystogram voiding (74455) |
$510 |
$1,020 |
2.2× |
| Urethrocystography retrograde (74450) |
$510 |
$1,020 |
2.2× |
| Us breast unilateral complete (76641) |
$240.50 |
$481 |
2.4× |
| Us chest (76604) |
$113.50 |
$227 |
1.1× |
| Us complete joint (76881) |
$126.50 |
$253 |
1.3× |
| Us exam, pelvic, limited (76857) |
$224.50 |
$449 |
2.2× |
| Us kidney transplant (76776) |
$176.50 |
$353 |
1.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$111 |
$222 |
1.1× |
| Us ob limited 1 or more fetuses (76815) |
$120.50 |
$241 |
1.2× |
| Us ob transvaginal (76817) |
$141.50 |
$283 |
1.4× |
| Us pelvic non ob complete (76856) |
$220 |
$440 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$220 |
$440 |
2.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$120.50 |
$241 |
1.2× |
| Us retroperitoneal complete (76770) |
$333.50 |
$667 |
3.3× |
| Us retroperitoneal limited (76775) |
$173 |
$346 |
1.7× |
| Us scrotum and contents (76870) |
$351 |
$702 |
3.5× |
| Us spinal canal and contents (76800) |
$176.50 |
$353 |
1.7× |
| Us thyroid (76536) |
$220 |
$440 |
2.2× |
| Vein X-Ray Chest (75827) |
$933 |
$1,866 |
0.6× |
| Venogram Sinus/Jugular (75860) |
$933 |
$1,866 |
0.3× |
| Venography Adrenal Unilateral (75840) |
$2,549 |
$5,098 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,517 |
$5,034 |
0.8× |
| Venography extremity bilateral rs&i (75822) |
$933 |
$1,866 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$933 |
$1,866 |
0.6× |
| Venography Renal Bilateral (75833) |
$2,549 |
$5,098 |
0.8× |
| Venography Renal Unilateral (75831) |
$2,549 |
$5,098 |
0.8× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,517 |
$5,034 |
0.5× |
| Wrist 2 views (73100) |
$105.50 |
$211 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$84 |
$168 |
1.0× |
| X-Ray Aorta Leg Arteries (75630) |
$2,517 |
$5,034 |
0.8× |
| X-Ray Bend Only L-S Spine (72120) |
$140 |
$280 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$105.50 |
$211 |
1.3× |
| X-Ray Exam Breast Specimen (76098) |
$496 |
$992 |
0.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$219 |
$438 |
2.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$133 |
$266 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$133 |
$266 |
1.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$176.50 |
$353 |
1.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$219 |
$438 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$219 |
$438 |
2.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$175 |
$350 |
1.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$105.50 |
$211 |
1.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$175 |
$350 |
1.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$105.50 |
$211 |
1.0× |
| X-ray humerus (73060) |
$105.50 |
$211 |
1.3× |
| X-ray IV pyelogram (ivp) (74400) |
$510 |
$1,020 |
3.0× |
| X-ray IV pyelogram+tomography (74415) |
$510 |
$1,020 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$89.50 |
$179 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$101 |
$202 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$105.50 |
$211 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$140 |
$280 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$105.50 |
$211 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$105.50 |
$211 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$89.50 |
$179 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$140 |
$280 |
1.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$510 |
$1,020 |
1.5× |
| X-Rays Bone Survey Complete (77075) |
$140 |
$280 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$175 |
$350 |
1.7× |
| Xr facial bones less than 3 views (70140) |
$84 |
$168 |
1.0× |
| Xr orbits complete 4 views (70200) |
$84 |
$168 |
0.8× |