| Abdomen 1 View (74018) |
$140 |
$140 |
1.9× |
| Abdomen 2 views (74019) |
$154 |
$154 |
1.7× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,032 |
$1,032 |
3.0× |
| Angio pulmonary bilat (75743) |
$2,880 |
$2,880 |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,880 |
$2,880 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$3,183 |
$3,183 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$2,880 |
$2,880 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,880 |
$2,880 |
1.1× |
| Ankle 2 views (73600) |
$121 |
$121 |
1.6× |
| Aortography thoracic serialography rs&i (75605) |
$2,880 |
$2,880 |
0.6× |
| Artery X-Rays Abdomen (75726) |
$3,744 |
$3,744 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$2,880 |
$2,880 |
1.1× |
| Artery X-Rays Pelvis (75736) |
$2,880 |
$2,880 |
0.6× |
| Arthrogram ankle (73615) |
$389 |
$389 |
1.3× |
| Arthrogram hip (73525) |
$545 |
$545 |
1.8× |
| Arthrogram Wrist (73115) |
$534 |
$534 |
1.8× |
| Basic radiation dosimetry calculation (77300) |
$591 |
$591 |
5.1× |
| Bone age studies (77072) |
$207 |
$207 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,050 |
$1,050 |
3.0× |
| Bone Imaging Limited Area (78300) |
$715 |
$715 |
2.1× |
| Bone Imaging Multiple Areas (78305) |
$773 |
$773 |
2.2× |
| Bone Imaging Whole Body (78306) |
$1,012 |
$1,012 |
2.9× |
Bone survey infant (77076) range across 2 matching MRF lines |
$140–$196 |
$140–$196 |
varies |
| Brain Flow Imaging Only (78610) |
$405 |
$405 |
0.9× |
| Brain imaging < 4 static views (78600) |
$715 |
$715 |
2.1× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,233 |
$1,233 |
2.6× |
| Cat Scan Follow-Up Study (76380) |
$587 |
$587 |
7.8× |
| Chest 1 view (71045) |
$362 |
$362 |
4.8× |
Chest 2 views (71046) range across 4 matching MRF lines |
$214–$1,071 |
$214–$1,071 |
varies |
| Chest 3 views (71047) |
$327 |
$327 |
4.4× |
| Chest 4 or more views (71048) |
$190 |
$190 |
2.1× |
| Clavicle complete (73000) |
$234 |
$234 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$429 |
$429 |
4.8× |
| Contrast Exam Abdominl Aorta (75625) |
$2,880 |
$2,880 |
1.1× |
| Contrast X-Ray Bladder (74430) |
$353 |
$353 |
1.2× |
| Contrast X-Ray Of Elbow (73085) |
$469 |
$469 |
1.6× |
| Contrast X-Ray Of Knee Joint (73580) |
$582 |
$582 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,310 |
$2,310 |
7.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,339 |
$1,339 |
6.5× |
| CT abdomen w contrast (74160) |
$1,617 |
$1,617 |
10.7× |
| CT abdomen w wo contrast (74170) |
$1,712 |
$1,712 |
11.3× |
| CT abdomen w/o contrast (74150) |
$1,157 |
$1,157 |
12.8× |
| CT Angio Abdomen and Pelvis (74174) |
$1,940 |
$1,940 |
6.4× |
| CT Angio Chest (71275) |
$1,944 |
$1,944 |
12.9× |
| CT Angio Head (70496) |
$1,944 |
$1,944 |
12.9× |
| CT angio hrt w/3d image (75574) |
$1,677 |
$1,677 |
5.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$774 |
$774 |
5.1× |
| CT Angio Neck (70498) |
$2,067 |
$2,067 |
13.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$774 |
$774 |
5.1× |
| CT cervical spine w/ contrast (72126) |
$1,658 |
$1,658 |
5.5× |
| CT cervical spine w/o contrast (72125) |
$1,244 |
$1,244 |
13.8× |
| CT cervical spine w/wo cont (72127) |
$1,712 |
$1,712 |
11.3× |
| CT chest w contrast (71260) |
$1,156 |
$1,156 |
7.6× |
| CT chest w/wo contrast (71270) |
$1,712 |
$1,712 |
11.3× |
| CT head/brain with contrast (70460) |
$1,050 |
$1,050 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,712 |
$1,712 |
11.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$165 |
$165 |
2.2× |
| CT hrt w/3d image congen (75573) |
$2,157 |
$2,157 |
7.2× |
| CT iac w contrast (70481) |
$1,177 |
$1,177 |
7.8× |
| CT l-spine w&w/o contrast (72133) |
$1,712 |
$1,712 |
11.3× |
| CT lower ext w/o (73700) |
$1,004 |
$1,004 |
11.1× |
| CT lower extremity w/contrast material (73701) |
$1,169 |
$1,169 |
7.7× |
| CT lumbar spine w contrast (72132) |
$1,658 |
$1,658 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,244 |
$1,244 |
13.8× |
CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$809–$1,133 |
$809–$1,133 |
varies |
| CT maxillofacial wo contrast (70486) |
$399 |
$399 |
4.4× |
| CT neck tissue combo (70492) |
$1,284 |
$1,284 |
8.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,606 |
$1,606 |
10.6× |
| CT orbits w/o contrast (70480) |
$1,050 |
$1,050 |
11.6× |
| CT pelvis w&w/o contrast (72194) |
$1,712 |
$1,712 |
11.3× |
| CT pelvis w/o contrast (72192) |
$1,157 |
$1,157 |
12.8× |
| CT scan of leg combo (73702) |
$1,411 |
$1,411 |
9.3× |
| CT scans face/jaw combo (70488) |
$1,200 |
$1,200 |
7.9× |
| CT soft tissue neck w contrast (70491) |
$1,101 |
$1,101 |
7.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,050 |
$1,050 |
11.6× |
| CT thoracic spine w contrast (72129) |
$1,658 |
$1,658 |
11.0× |
| CT thoracic spine w/o contrast (72128) |
$1,286 |
$1,286 |
14.3× |
| CT thoracic spine w/wo cont (72130) |
$1,712 |
$1,712 |
11.3× |
| CT thorax w/o contrast (71250) |
$999 |
$999 |
11.1× |
| CT unlisted procedure (76497) |
$400 |
$400 |
5.3× |
| CT upper ext wo (73200) |
$994 |
$994 |
11.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,541 |
$1,541 |
10.2× |
| CT upper extremity with contrast (73201) |
$1,169 |
$1,169 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,059 |
$2,059 |
13.6× |
| Cta Abdomen (74175) |
$1,999 |
$1,999 |
13.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,067 |
$2,067 |
6.9× |
| CTA pelvis (72191) |
$1,970 |
$1,970 |
13.0× |
| Dilation ureters/urethra rs&i (74485) |
$2,359 |
$2,359 |
1.3× |
Dxa Bone Density Axial (77080) range across 2 matching MRF lines |
$235–$329 |
$235–$329 |
varies |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$140 |
$140 |
1.9× |
| Echo exam uterus (76831) |
$1,142 |
$1,142 |
5.6× |
| Echo Guide For Artery Repair (76936) |
$1,062 |
$1,062 |
5.7× |
| Esophagram (74220) |
$300 |
$300 |
2.0× |
| Fetal Biophys Profile W/Nst (76818) |
$361 |
$361 |
4.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$361 |
$361 |
4.0× |
Fluoroscopy up to 1 hr (76000) range across 7 matching MRF lines |
$220–$309 |
$220–$309 |
varies |
| Follow-Up Angiography (75898) |
$515 |
$515 |
0.2× |
| Foot 2 views (73620) |
$121 |
$121 |
1.6× |
| Forearm 2 views (73090) |
$152 |
$152 |
2.0× |
| Gastric emptying imaging study (78264) |
$851 |
$851 |
2.5× |
| Gastroesophageal Reflux Exam (78262) |
$773 |
$773 |
2.2× |
| Gated Heart Planar Single (78472) |
$1,072 |
$1,072 |
3.1× |
| Gated Heart, Multiple (78473) |
$1,544 |
$1,544 |
4.5× |
| Hand 2 views (73120) |
$121 |
$121 |
1.3× |
| Hepatobil Syst Image W/Drug (78227) |
$1,200 |
$1,200 |
2.6× |
| Hepatobiliary System Imaging (78226) |
$1,200 |
$1,200 |
3.5× |
| Ht Muscle Image Spect Sing (78451) |
$1,659 |
$1,659 |
1.5× |
| Hysterosalpingogram (74740) |
$571 |
$571 |
2.8× |
| Infant hip ultrasound, limited static exam (76886) |
$308 |
$308 |
4.1× |
| Infusion Ivp (74410) |
$316 |
$316 |
2.1× |
| Joint Survey Single View (77077) |
$263 |
$263 |
2.9× |
| K Flow/Funct Image W/Drug (78708) |
$1,064 |
$1,064 |
2.3× |
| K Flow/Funct Image W/O Drug (78707) |
$1,064 |
$1,064 |
2.3× |
| Kidney Imaging Morphol (78700) |
$529 |
$529 |
1.5× |
| Knee 3 Views (73562) |
$162 |
$162 |
2.2× |
| Labeled RBC Sequestration Differntl Organ/Tissue (78140) |
$820 |
$820 |
2.4× |
| Liver & Spleen Imaging Static Only (78215) |
$937 |
$937 |
2.7× |
| Liver imaging static only (78201) |
$684 |
$684 |
1.5× |
| Lung perfusion differential (78597) |
$1,389 |
$1,389 |
4.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,273 |
$1,273 |
2.7× |
| Lung Ventilation Imaging (78579) |
$1,115 |
$1,115 |
3.2× |
| Lymph System Imaging (78195) |
$881 |
$881 |
1.9× |
| Magnetic Image Jaw Joint (70336) |
$2,221 |
$2,221 |
10.8× |
| Meckels Divert Exam (78290) |
$749 |
$749 |
2.2× |
| Mr safety determination physician/other qhp (76016) |
$112 |
$112 |
1.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$42 |
$42 |
1.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$308 |
$308 |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,515 |
$2,515 |
8.4× |
| MRA head w/o contrast (70544) |
$2,168 |
$2,168 |
10.5× |
| MRA head with contrast (70545) |
$2,565 |
$2,565 |
8.5× |
| MRA neck w contrast (70548) |
$1,999 |
$1,999 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,411 |
$2,411 |
8.0× |
| MRA neck w/o contrast (70547) |
$1,738 |
$1,738 |
8.4× |
| MRI abdomen w contrast (74182) |
$2,799 |
$2,799 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$2,171 |
$2,171 |
10.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,799 |
$2,799 |
4.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,799 |
$2,799 |
9.3× |
MRI any jt upper extremity w/contrast matrl (73222) range across 4 matching MRF lines |
$1,999–$2,799 |
$1,999–$2,799 |
varies |
| MRI cervical spine w contrast (72142) |
$2,799 |
$2,799 |
9.3× |
| MRI cervical spine w/o cont (72141) |
$1,738 |
$1,738 |
8.4× |
| MRI chest w/o contrast (71550) |
$2,433 |
$2,433 |
11.8× |
| MRI chest with contrast (71551) |
$2,247 |
$2,247 |
3.3× |
| MRI chest wo w contrast (71552) |
$1,519 |
$1,519 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,799 |
$2,799 |
9.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,778 |
$2,778 |
9.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,738 |
$1,738 |
8.4× |
| MRI lumbar spine w contrast (72149) |
$2,799 |
$2,799 |
9.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,755 |
$2,755 |
9.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,200 |
$2,200 |
10.7× |
| MRI orbit face neck w contrast (70542) |
$2,593 |
$2,593 |
8.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,030 |
$3,030 |
10.1× |
| MRI pelvis w contrast (72196) |
$2,593 |
$2,593 |
8.6× |
| MRI pelvis w/o & w contrast (72197) |
$3,030 |
$3,030 |
10.1× |
| MRI pelvis w/o contrast (72195) |
$1,827 |
$1,827 |
8.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,924 |
$1,924 |
9.4× |
MRI upper extremity oth than jt w/contr matrl (73219) range across 4 matching MRF lines |
$1,999–$2,799 |
$1,999–$2,799 |
varies |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,738 |
$1,738 |
8.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,380 |
$2,380 |
7.9× |
| MRI, abdomen, combo (74183) |
$3,030 |
$3,030 |
10.1× |
| MRI, dorsal spine combo (72157) |
$3,168 |
$3,168 |
10.5× |
| MRI, dorsal spine contrast (72147) |
$2,799 |
$2,799 |
9.3× |
| MRI, joint upper extrem (73221) |
$1,738 |
$1,738 |
8.4× |
| MRI, joint upper extrem combo (73223) |
$2,799 |
$2,799 |
9.3× |
| MRI, lumbar spine combo (72158) |
$2,755 |
$2,755 |
9.2× |
Myocardial Spect Multiple Studies (78452) range across 2 matching MRF lines |
$1,658.89–$2,126 |
$1,658.89–$2,126 |
varies |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,200 |
$3,200 |
2.6× |
| Myocrd Img Pet Prfuj Mlt Std Rst&Strs Cncrnt CT (78431) |
$5,200 |
$5,200 |
2.7× |
| Neck soft tissue (70360) |
$158 |
$158 |
2.1× |
| Nonvascular Shunt X-Ray (75809) |
$462 |
$462 |
5.1× |
| Nuclear Rx Oral Admin (79005) |
$806 |
$806 |
4.0× |
| Parathyroid Planar Imaging (78070) |
$693 |
$693 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$201 |
$201 |
2.2× |
| Peritoneogram Rs&I (74190) |
$309 |
$309 |
0.7× |
| Pet Image W/Ct Lmtd (78814) |
$4,706 |
$4,706 |
3.8× |
| PET image w/CT, full body (78816) |
$6,588 |
$6,588 |
5.3× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$6,588 |
$6,588 |
5.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$843 |
$843 |
2.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$244 |
$244 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$309 |
$309 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$129 |
$129 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$168 |
$168 |
2.2× |
Radex elbow complete minimum 3 views (73080) range across 2 matching MRF lines |
$140–$196 |
$140–$196 |
varies |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$221 |
$221 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$121 |
$121 |
1.6× |
| Radex foot complete minimum 3 views (73630) |
$121 |
$121 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$135 |
$135 |
1.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$200 |
$200 |
2.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$244 |
$244 |
2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$168 |
$168 |
2.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$121 |
$121 |
1.6× |
| Radex shoulder complete minimum 2 views (73030) |
$154 |
$154 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$146 |
$146 |
1.9× |
| Radex Spine 1 View Specify Level (72020) |
$121 |
$121 |
1.6× |
| Radex Sternum Minimum 2 Views (71120) |
$178 |
$178 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$174 |
$174 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$149 |
$149 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$168 |
$168 |
1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$121 |
$121 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$189 |
$189 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$244 |
$244 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$189 |
$189 |
2.1× |
| Radiologic exam colon double contrast study (74280) |
$496 |
$496 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$365 |
$365 |
2.4× |
| Radiologic exam knee complete 4/more views (73564) |
$189 |
$189 |
2.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$271 |
$271 |
3.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$300 |
$300 |
2.0× |
| Radiologic exam swallow function contrast study (74230) |
$316 |
$316 |
2.1× |
| Radiologic exam teeth complete full mouth (70320) |
$137 |
$137 |
0.7× |
| Radiologic Exam Teeth Prtl Exam < Full Mouth (70310) |
$307 |
$307 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$316 |
$316 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$294 |
$294 |
3.9× |
| Radiologic examination femur minimum 2 views (73552) |
$248 |
$248 |
3.3× |
| Radiologic examination knee 1/2 views (73560) |
$121 |
$121 |
1.6× |
| Radiologic Examination Osseous Survey Limited (77074) |
$281 |
$281 |
3.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$140 |
$140 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$112 |
$112 |
1.5× |
| Renal Cyst Study (74470) |
$309 |
$309 |
0.7× |
| Ribs bilateral 3 views (71110) |
$196 |
$196 |
2.2× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$894 |
$894 |
2.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,764 |
$1,764 |
3.8× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,115 |
$2,115 |
4.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,309 |
$1,309 |
2.8× |
| Scapula (73010) |
$168 |
$168 |
1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$100 |
$100 |
4.3× |
| Shoulder 1 view (73020) |
$149 |
$149 |
2.0× |
| Shoulder Arthrography (73040) |
$545 |
$545 |
1.8× |
| Skull less than 4 views (70250) |
$127 |
$127 |
1.4× |
| Speech evaluation, complex (70371) |
$307 |
$307 |
1.5× |
| Spleen Imaging (78185) |
$461 |
$461 |
1.3× |
| Sternoclavicular joints (71130) |
$157 |
$157 |
2.1× |
| Tbs technical calculation only (77091) |
$200 |
$200 |
2.7× |
| Thoracic spine 2 views (72070) |
$154 |
$154 |
1.7× |
| Thoracic spine 3 views (72072) |
$216 |
$216 |
2.4× |
| Thoracolumbar 2 views (72080) |
$216 |
$216 |
2.9× |
| Thyroid Carcinoma Metastases Img Lmtd Area (78015) |
$811 |
$811 |
2.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$402 |
$402 |
1.2× |
| Thyroid Met Imaging Body (78018) |
$1,144 |
$1,144 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$693 |
$693 |
2.0× |
| Ultrasound Breast Limited (76642) |
$308 |
$308 |
4.1× |
| Ultrasound Elastography Parenchyma (76981) |
$417 |
$417 |
4.6× |
| Ultrasound Exam Aaa Screen (76706) |
$308 |
$308 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$455 |
$455 |
5.0× |
| Umbilical-artery Doppler (OB) (76820) |
$330 |
$330 |
3.7× |
| Unlisted Dx Radiographic Procedure (76499) |
$105 |
$105 |
1.4× |
| Unlisted magnetic resonance procedure (76498) |
$1,738 |
$1,738 |
23.2× |
| Unlisted us procedure (76999) |
$349 |
$349 |
4.7× |
| Upper gi w/o kub (74240) |
$496 |
$496 |
3.3× |
| Urethrocystogram voiding (74455) |
$353 |
$353 |
1.7× |
| Urethrocystography retrograde (74450) |
$252 |
$252 |
1.2× |
| Us breast unilateral complete (76641) |
$375 |
$375 |
4.2× |
| Us chest (76604) |
$354 |
$354 |
3.9× |
| Us complete joint (76881) |
$435 |
$435 |
4.8× |
| Us exam, pelvic, limited (76857) |
$365 |
$365 |
4.0× |
| Us head (76506) |
$354 |
$354 |
3.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$354 |
$354 |
3.9× |
| Us ob detailed single fetus (76811) |
$430 |
$430 |
2.1× |
| Us ob limited 1 or more fetuses (76815) |
$327 |
$327 |
3.6× |
| Us ob transvaginal (76817) |
$386 |
$386 |
4.3× |
| Us pelvic non ob complete (76856) |
$419 |
$419 |
4.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$856 |
$856 |
9.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$189 |
$189 |
2.1× |
| Us retroperitoneal complete (76770) |
$455 |
$455 |
5.0× |
| Us retroperitoneal limited (76775) |
$372 |
$372 |
4.1× |
| Us scrotum and contents (76870) |
$386 |
$386 |
4.3× |
| Us spinal canal and contents (76800) |
$586 |
$586 |
6.5× |
| Us thyroid (76536) |
$349 |
$349 |
3.9× |
| Us transrectal (76872) |
$157 |
$157 |
1.7× |
| Vein X-Ray Chest (75827) |
$1,611 |
$1,611 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$2,880 |
$2,880 |
1.1× |
| Venography extremity bilateral rs&i (75822) |
$1,019 |
$1,019 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,019 |
$1,019 |
0.8× |
| Venography Renal Bilateral (75833) |
$2,880 |
$2,880 |
1.1× |
| Venography Renal Unilateral (75831) |
$2,880 |
$2,880 |
1.1× |
| Vertebral fracture assessment via dxa (77086) |
$265 |
$265 |
3.5× |
| Wrist 2 views (73100) |
$121 |
$121 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$188 |
$188 |
2.5× |
| X-ray antegrade pyelogram tube (74425) |
$353 |
$353 |
1.2× |
| X-Ray Aorta Leg Arteries (75630) |
$2,880 |
$2,880 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$273 |
$273 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$127 |
$127 |
1.7× |
| X-Ray Exam Breast Specimen (76098) |
$594 |
$594 |
1.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$214 |
$214 |
2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$255 |
$255 |
2.8× |
| X-Ray Exam Hip Uni 1 View (73501) |
$180 |
$180 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$157 |
$157 |
2.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$189 |
$189 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$189 |
$189 |
2.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$308 |
$308 |
3.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$121 |
$121 |
1.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$300 |
$300 |
3.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$174 |
$174 |
1.9× |
| X-ray eye for foreign body (70030) |
$127 |
$127 |
1.7× |
X-ray humerus (73060) range across 3 matching MRF lines |
$120–$121 |
$120–$121 |
varies |
| X-ray IV pyelogram (ivp) (74400) |
$412 |
$412 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$157 |
$157 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$140 |
$140 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$154 |
$154 |
1.7× |
| X-ray nose-rectum child f.b. (76010) |
$207 |
$207 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$290 |
$290 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$178 |
$178 |
2.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$189 |
$189 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$121 |
$121 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$157 |
$157 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$290 |
$290 |
3.2× |
| X-Ray Stress View (77071) |
$112 |
$112 |
1.5× |
| X-ray thoracic spine 4 vw (72074) |
$300 |
$300 |
3.3× |
| X-Ray Tmj Unilat (70328) |
$178 |
$178 |
2.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$397 |
$397 |
1.3× |
| X-Rays Bone Survey Complete (77075) |
$356 |
$356 |
3.9× |
| Xr c-spine 4 or 5 views (72050) |
$207 |
$207 |
2.3× |
| Xr facial bones less than 3 views (70140) |
$178 |
$178 |
2.4× |
| Xr orbits complete 4 views (70200) |
$190 |
$190 |
2.1× |