| Abdomen 2 views (74019) |
$205.80 |
$343 |
1.7× |
| Acute gi blood loss imaging (78278) |
$754.80 |
$1,258 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,577.20 |
$5,962 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$1,848 |
$3,080 |
0.5× |
| Ankle 2 views (73600) |
$172.50 |
$287.50 |
1.7× |
| Arthrogram ankle (73615) |
$535.80 |
$893 |
1.3× |
| Arthrogram elbow (73085) |
$535.80 |
$893 |
1.3× |
| Arthrogram hip (73525) |
$535.80 |
$893 |
1.3× |
| Arthrogram knee (73580) |
$535.80 |
$893 |
1.3× |
| Arthrogram shoulder (73040) |
$684 |
$1,140 |
1.7× |
| Arthrogram wrist (73115) |
$535.80 |
$893 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$743.40 |
$1,239 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$841.20 |
$1,402 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$934.20 |
$1,557 |
2.0× |
| Bone age studies (77072) |
$180.60 |
$301 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$942.60 |
$1,571 |
2.0× |
| Bone survey complete (77075) |
$424.80 |
$708 |
3.4× |
| Bone survey infant (77076) |
$298.80 |
$498 |
2.4× |
| Bowel imaging (78290) |
$743.40 |
$1,239 |
1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$964.80 |
$1,608 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$785.40 |
$1,309 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$261 |
$435 |
2.5× |
| Chest 1 view (71045) |
$192.60 |
$321 |
1.9× |
| Chest xray 3 views (71047) |
$280.80 |
$468 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$365.40 |
$609 |
1.8× |
| Clavicle complete (73000) |
$231.90 |
$386.50 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$488.40 |
$814 |
4.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,128.20 |
$3,547 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,667.70 |
$2,779.50 |
5.9× |
| CT abdomen w contrast (74160) |
$914.10 |
$1,523.50 |
4.4× |
| CT abdomen w wo contrast (74170) |
$1,034.70 |
$1,724.50 |
5.0× |
| CT abdomen w/o contrast (74150) |
$809.10 |
$1,348.50 |
6.6× |
| CT angio hrt w/3d image (75574) |
$1,034.40 |
$1,724 |
2.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,424.10 |
$2,373.50 |
6.9× |
| CT angiography upper extremity lt (73206) |
$1,407 |
$2,345 |
6.8× |
| CT c-spine w/contrast (72126) |
$1,119 |
$1,865 |
2.7× |
| CT c-spine w/o contrast (72125) |
$878.40 |
$1,464 |
7.1× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,331.40 |
$2,219 |
6.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,113 |
$1,855 |
5.4× |
| CT chest w contrast (71260) |
$1,269 |
$2,115 |
6.1× |
| CT chest w/wo contrast (71270) |
$1,527 |
$2,545 |
7.4× |
| CT head/brain with contrast (70460) |
$1,095 |
$1,825 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,254 |
$2,090 |
6.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$816.60 |
$1,361 |
2.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$125.40 |
$209 |
1.2× |
| CT iac w contrast (70481) |
$1,290.60 |
$2,151 |
6.2× |
| CT lower ext w/o (73700) |
$1,155 |
$1,925 |
9.4× |
| CT lower extremity w wo contrast (73702) |
$1,715.10 |
$2,858.50 |
8.3× |
| CT lower extremity w/contrast material (73701) |
$1,288.20 |
$2,147 |
6.2× |
| CT lumbar spine w & w/o contrast (72133) |
$904.20 |
$1,507 |
4.4× |
| CT lumbar spine w/contrast (72132) |
$957 |
$1,595 |
2.3× |
| CT lumbar spine w/o contrast (72131) |
$619.20 |
$1,032 |
5.0× |
| CT maxillofacial w contrast (70487) |
$1,138.80 |
$1,898 |
5.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,380 |
$2,300 |
6.7× |
| CT maxillofacial wo contrast (70486) |
$829.80 |
$1,383 |
6.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,417.80 |
$2,363 |
6.8× |
| CT orbits w/o contrast (70480) |
$1,052.40 |
$1,754 |
8.5× |
| CT pelvis w/o contrast (72192) |
$664.80 |
$1,108 |
5.4× |
| CT pelvis w/wo contrast (72194) |
$854.40 |
$1,424 |
4.1× |
| CT scan of arm combo (73202) |
$1,611 |
$2,685 |
7.8× |
| CT soft tissue neck w contrast (70491) |
$1,213.80 |
$2,023 |
5.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,417.80 |
$2,363 |
6.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,103.40 |
$1,839 |
8.9× |
| CT thoracic spine w/contrast (72129) |
$1,119 |
$1,865 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$1,167 |
$1,945 |
9.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,113 |
$1,855 |
5.4× |
| CT thorax w/o contrast (71250) |
$1,005.60 |
$1,676 |
8.1× |
| CT unlisted procedure (76497) |
$1,083.60 |
$1,806 |
10.5× |
| CT upper ext wo (73200) |
$1,174.80 |
$1,958 |
9.5× |
| CT upper extremity with contrast (73201) |
$1,424.40 |
$2,374 |
3.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,531.80 |
$2,553 |
7.4× |
| Cta Abdomen (74175) |
$1,654.80 |
$2,758 |
8.0× |
| CTA abdomen pelvis (74174) |
$1,446 |
$2,410 |
3.5× |
| CTA chest (71275) |
$1,468.50 |
$2,447.50 |
7.1× |
| Cta Head (70496) |
$1,273.20 |
$2,122 |
6.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,331.40 |
$2,219 |
3.2× |
| Cta Neck (70498) |
$1,157.70 |
$1,929.50 |
5.6× |
| Cta Pelvis (72191) |
$1,501.80 |
$2,503 |
7.2× |
| Cystography minimum 3 views rs&i (74430) |
$494.40 |
$824 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,962.60 |
$3,271 |
0.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$409.20 |
$682 |
3.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$417.60 |
$696 |
3.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$368.40 |
$614 |
3.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$249.60 |
$416 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$146.40 |
$244 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$390 |
$650 |
1.4× |
| Esophagus (74220) |
$258 |
$430 |
1.2× |
| Facial bones min 3 views (70150) |
$377.40 |
$629 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$333.90 |
$556.50 |
2.7× |
| Fetal Echo (76825) |
$510.90 |
$851.50 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$471 |
$785 |
1.7× |
| Foot 2 views (73620) |
$178.20 |
$297 |
1.7× |
| Forearm 2 views (73090) |
$231.30 |
$385.50 |
2.2× |
| Hand 2 views (73120) |
$229.20 |
$382 |
1.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$979.80 |
$1,633 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$754.80 |
$1,258 |
1.6× |
| Hysterosalpingogram (74740) |
$533.40 |
$889 |
1.9× |
| Kidney imaging morphology (78700) |
$743.40 |
$1,239 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$979.80 |
$1,633 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,148.40 |
$1,914 |
1.8× |
| Knee 3 views (73562) |
$297 |
$495 |
2.9× |
| Liver & spleen imaging static only (78215) |
$743.40 |
$1,239 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$857.40 |
$1,429 |
1.8× |
| Lung perfusion differential (78597) |
$754.80 |
$1,258 |
1.6× |
| Lymphoscintigraphy (78195) |
$972.30 |
$1,620.50 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,691.40 |
$2,819 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,546.80 |
$2,578 |
3.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,647.60 |
$2,746 |
4.0× |
| Mammary ductogram or galactogram multiple (77054) |
$423 |
$705 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$343.80 |
$573 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$202.20 |
$337 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$56.40 |
$94 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$222.60 |
$371 |
2.0× |
| Mr safety implt pos&/immoblj (76019) |
$151.20 |
$252 |
2.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$555 |
$925 |
2.0× |
| MRA head w & w/o contrast (70546) |
$1,661.40 |
$2,769 |
4.0× |
| MRA head w/o contrast (70544) |
$1,172.40 |
$1,954 |
4.2× |
| MRA head with contrast (70545) |
$1,763.40 |
$2,939 |
4.3× |
| MRA neck w contrast (70548) |
$1,641 |
$2,735 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,688.40 |
$2,814 |
4.1× |
| MRA neck w/o contrast (70547) |
$1,459.20 |
$2,432 |
5.2× |
| MRI abdomen w contrast (74182) |
$1,361.40 |
$2,269 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,604.40 |
$2,674 |
3.9× |
| MRI abdomen w/o contrast (74181) |
$1,300.20 |
$2,167 |
4.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,689 |
$2,815 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,742.40 |
$2,904 |
4.2× |
| MRI bone marrow blood supply (77084) |
$1,371.60 |
$2,286 |
4.9× |
| MRI c-spine with contrast (72142) |
$1,323.60 |
$2,206 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$1,060.20 |
$1,767 |
3.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,726.20 |
$2,877 |
4.2× |
| MRI chest w/o contrast (71550) |
$1,438.20 |
$2,397 |
5.1× |
| MRI chest with contrast (71551) |
$1,686 |
$2,810 |
1.8× |
| MRI fetal sngl/1st gestation (74712) |
$1,285.80 |
$2,143 |
4.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,578 |
$2,630 |
3.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,647.60 |
$2,746 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,517.10 |
$2,528.50 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,300.20 |
$2,167 |
4.6× |
| MRI orbit face neck w contrast (70542) |
$1,323.60 |
$2,206 |
3.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,543.20 |
$2,572 |
3.7× |
| MRI pelvis w/contrast (72196) |
$1,246.20 |
$2,077 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,372.20 |
$2,287 |
3.3× |
| MRI pelvis w/o contrast (72195) |
$1,239 |
$2,065 |
4.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,546.80 |
$2,578 |
3.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,369.80 |
$2,283 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,447.80 |
$2,413 |
3.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$805.80 |
$1,343 |
2.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$999.60 |
$1,666 |
2.4× |
| MRI temporomandibular joint (70336) |
$1,242 |
$2,070 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$885 |
$1,475 |
3.1× |
| MRI up ext w/o contrast (73218) |
$1,250.40 |
$2,084 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,260 |
$2,100 |
4.5× |
| MRI, joint upper extrem combo (73223) |
$1,623.60 |
$2,706 |
3.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,785.80 |
$4,643 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,575.80 |
$4,293 |
1.7× |
| N-invas est c ffr sw aly CTA (75580) |
$1,431 |
$2,385 |
1.4× |
| Neck soft tissue (70360) |
$205.80 |
$343 |
2.0× |
| Nm gastric emptying study (78264) |
$754.80 |
$1,258 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$506.40 |
$844 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$153.60 |
$256 |
1.2× |
| Osseous survey limited (77074) |
$276 |
$460 |
2.2× |
| Parathyroid Planar Imaging (78070) |
$754.80 |
$1,258 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$754.80 |
$1,258 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$198 |
$330 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$754.80 |
$1,258 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$979.80 |
$1,633 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$474.60 |
$791 |
0.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$234.60 |
$391 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$173.40 |
$289 |
1.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$235.20 |
$392 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$201.60 |
$336 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$310.80 |
$518 |
2.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$305.40 |
$509 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$166.20 |
$277 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$235.20 |
$392 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$275.40 |
$459 |
2.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$201.60 |
$336 |
2.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$310.80 |
$518 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$348.60 |
$581 |
2.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$532.20 |
$887 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$157.80 |
$263 |
1.5× |
| Radex Kne 1/2 Views (73560) |
$271.20 |
$452 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$310.80 |
$518 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$327.60 |
$546 |
2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$205.80 |
$343 |
2.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$280.80 |
$468 |
2.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$256.20 |
$427 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$188.40 |
$314 |
1.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$204.60 |
$341 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$453.60 |
$756 |
4.4× |
| Radex Toe Minimum 2 Views (73660) |
$155.40 |
$259 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$254.10 |
$423.50 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$263.70 |
$439.50 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$497.40 |
$829 |
4.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$192 |
$320 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$221.40 |
$369 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$230.40 |
$384 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$509.40 |
$849 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$254.40 |
$424 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$254.40 |
$424 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$222 |
$370 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$192 |
$320 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$244.20 |
$407 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$291.60 |
$486 |
2.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$169.20 |
$282 |
1.4× |
| Radiological examination surgical specimen (76098) |
$600.60 |
$1,001 |
0.9× |
| Ribs bilateral 3 views (71110) |
$275.40 |
$459 |
2.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$743.40 |
$1,239 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$857.40 |
$1,429 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,330.40 |
$3,884 |
3.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,981.80 |
$3,303 |
3.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,610.40 |
$2,684 |
2.5× |
| Rp Therapy Intravenous Administration (79101) |
$478.20 |
$797 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$177 |
$295 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$516 |
$860 |
1.8× |
| Scapula (73010) |
$266.70 |
$444.50 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$58.50 |
$97.50 |
2.5× |
| Shoulder 1 view (73020) |
$208.50 |
$347.50 |
2.0× |
| Small bowel series (74250) |
$470.40 |
$784 |
2.3× |
| Spine thoracic 3 views (72072) |
$284.40 |
$474 |
2.3× |
| Thoracolumbar 2 views (72080) |
$268.80 |
$448 |
2.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$979.80 |
$1,633 |
1.5× |
| Thyroid imaging w/blood flow (78013) |
$828 |
$1,380 |
1.8× |
| Thyroid uptake measurement (78012) |
$754.80 |
$1,258 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$885 |
$1,475 |
1.9× |
| Tmj unilateral (70328) |
$240 |
$400 |
2.3× |
| Ultrasound breast complete (76641) |
$326.40 |
$544 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$159.60 |
$266 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$254.10 |
$423.50 |
2.1× |
| Umbilical-artery Doppler (OB) (76820) |
$378 |
$630 |
3.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$138.60 |
$231 |
1.3× |
| Unlisted ultrasound procedure (76999) |
$207 |
$345 |
2.0× |
| Urethrocystogram voiding (74455) |
$615.60 |
$1,026 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$504 |
$840 |
1.8× |
| Us breast unilateral limited (76642) |
$273.60 |
$456 |
2.7× |
| Us chest (76604) |
$256.20 |
$427 |
2.1× |
| Us encephalogram (76506) |
$531.60 |
$886 |
4.3× |
| Us hips infant static (76886) |
$408.60 |
$681 |
4.0× |
| Us infant hips w manipulation (76885) |
$440.40 |
$734 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$213.30 |
$355.50 |
1.7× |
| Us ob detailed single fetus (76811) |
$562.80 |
$938 |
2.0× |
| Us ob limited (76815) |
$267.30 |
$445.50 |
2.2× |
| Us ob transvaginal (76817) |
$403.80 |
$673 |
3.3× |
| Us pelvic non ob complete (76856) |
$447 |
$745 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$333.60 |
$556 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$445.20 |
$742 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$333.90 |
$556.50 |
2.7× |
| Us retroperitoneal complete (76770) |
$428.40 |
$714 |
3.5× |
| Us retroperitoneal limited (76775) |
$367.20 |
$612 |
3.0× |
| Us scrotum and contents (76870) |
$349.20 |
$582 |
2.8× |
| Us soft tissue head/neck (76536) |
$319.80 |
$533 |
2.6× |
| Us spinal canal and contents (76800) |
$358.20 |
$597 |
2.9× |
| Us, eye b-scan (76512) |
$160.20 |
$267 |
1.3× |
| Us,transplanted kidney, real time/ doppler (76776) |
$292.20 |
$487 |
2.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,735.20 |
$2,892 |
0.5× |
| Venography caval superior serialography rs&i (75827) |
$815.40 |
$1,359 |
0.4× |
| Wrist 2 views (73100) |
$252.60 |
$421 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$385.20 |
$642 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$327.60 |
$546 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$514.20 |
$857 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$166.80 |
$278 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$257.40 |
$429 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$486.60 |
$811 |
3.9× |
| X-ray exam of femur 2/> (73552) |
$247.80 |
$413 |
2.4× |
| X-ray eye for foreign body (70030) |
$215.10 |
$358.50 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$229.20 |
$382 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$642 |
$1,070 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$265.20 |
$442 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$179.40 |
$299 |
1.7× |
| X-ray leg, infant (73592) |
$238.50 |
$397.50 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$290.40 |
$484 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$363.60 |
$606 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$156.60 |
$261 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$277.20 |
$462 |
2.2× |
| X-ray retrograde pyelogram (74420) |
$784.80 |
$1,308 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$221.40 |
$369 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$273.60 |
$456 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$343.80 |
$573 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$229.80 |
$383 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$211.20 |
$352 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$270.60 |
$451 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$322.20 |
$537 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$270.60 |
$451 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$171 |
$285 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$150 |
$250 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$271.80 |
$453 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$265.20 |
$442 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$408 |
$680 |
3.3× |
| Xr bone length studies (77073) |
$371.40 |
$619 |
3.0× |
| Xr c-spine 4 or 5 views (72050) |
$318.60 |
$531 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$402 |
$670 |
3.3× |
| Xr chest 4+ views (71048) |
$307.20 |
$512 |
2.5× |
| Xr urogram antegrade (74425) |
$515.40 |
$859 |
1.3× |