| Abdomen 2 views (74019) |
$612.40 |
$1,531 |
5.6× |
| Acute gi blood loss imaging (78278) |
$866.40 |
$2,166 |
2.1× |
| Angio Adrenal Bilat Select (75733) |
$3,588.40 |
$8,971 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$5,111.60 |
$12,779 |
1.6× |
| Angiography extremity unilateral rs&i (75710) |
$3,285.20 |
$8,213 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$3,393.60 |
$8,484 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$11,338.40 |
$28,346 |
2.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,296.40 |
$5,741 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,580 |
$6,450 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$3,393.60 |
$8,484 |
0.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$11,338.40 |
$28,346 |
2.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,279.20 |
$5,698 |
0.7× |
| Ankle 2 views (73600) |
$162.40 |
$406 |
1.8× |
| Aortogram thoracic (75605) |
$3,704 |
$9,260 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,804 |
$12,010 |
1.5× |
| Aortography abdominal serialography rs&i (75625) |
$1,895.20 |
$4,738 |
0.6× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$3,393.60 |
$8,484 |
1.0× |
| Artery X-Rays Adrenal Gland (75731) |
$3,588.40 |
$8,971 |
1.1× |
| Arthrogram ankle (73615) |
$539.20 |
$1,348 |
1.5× |
| Arthrogram elbow (73085) |
$539.20 |
$1,348 |
1.5× |
| Arthrogram hip (73525) |
$622.40 |
$1,556 |
1.7× |
| Arthrogram knee (73580) |
$648 |
$1,620 |
1.8× |
| Arthrogram shoulder (73040) |
$1,132.40 |
$2,831 |
3.1× |
| Arthrogram wrist (73115) |
$477.60 |
$1,194 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$676.40 |
$1,691 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,265.60 |
$3,164 |
3.0× |
| Bone age studies (77072) |
$632.80 |
$1,582 |
5.8× |
| Bone Imaging 3 Phase (78315) |
$1,200.80 |
$3,002 |
2.9× |
| Bone survey complete (77075) |
$1,336 |
$3,340 |
12.2× |
| Bone survey infant (77076) |
$494.40 |
$1,236 |
4.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$839.60 |
$2,099 |
1.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,400 |
$3,500 |
0.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,274.40 |
$3,186 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$281.60 |
$704 |
3.1× |
| Chest 1 view (71045) |
$314.40 |
$786 |
3.5× |
| Chest xray 3 views (71047) |
$670.40 |
$1,676 |
7.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$628 |
$1,570 |
3.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$981.60 |
$2,454 |
5.4× |
| Clavicle complete (73000) |
$729.20 |
$1,823 |
8.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,313.20 |
$3,283 |
12.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,395.60 |
$10,989 |
12.1× |
| CT abdomen and pelvis without contrast (74176) |
$3,033.20 |
$7,583 |
12.2× |
| CT abdomen w contrast (74160) |
$2,518.40 |
$6,296 |
13.7× |
| CT abdomen w wo contrast (74170) |
$2,627.20 |
$6,568 |
14.3× |
| CT abdomen w/o contrast (74150) |
$1,774.80 |
$4,437 |
16.3× |
| CT angio hrt w/3d image (75574) |
$1,013.20 |
$2,533 |
2.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,115.20 |
$7,788 |
17.0× |
| CT angiography upper extremity lt (73206) |
$2,643.60 |
$6,609 |
14.4× |
| CT c-spine w/contrast (72126) |
$2,024.40 |
$5,061 |
5.6× |
| CT c-spine w/o contrast (72125) |
$1,856 |
$4,640 |
17.0× |
| CT cervical spine w&w/o contrast (72127) |
$2,470.40 |
$6,176 |
13.5× |
| CT chest w contrast (71260) |
$2,424.80 |
$6,062 |
13.2× |
| CT chest w/wo contrast (71270) |
$2,643.60 |
$6,609 |
14.4× |
| CT head/brain with contrast (70460) |
$2,643.60 |
$6,609 |
14.4× |
| CT head/brain without and with contrast (70470) |
$2,643.60 |
$6,609 |
14.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,013.20 |
$2,533 |
2.8× |
| CT iac w contrast (70481) |
$2,643.60 |
$6,609 |
14.4× |
| CT limited/localized follow up study (76380) |
$726.80 |
$1,817 |
8.0× |
| CT lower ext w/o (73700) |
$2,643.60 |
$6,609 |
24.2× |
| CT lower extremity w wo contrast (73702) |
$1,924.80 |
$4,812 |
10.5× |
| CT lower extremity w/contrast material (73701) |
$1,934 |
$4,835 |
10.6× |
| CT lumbar spine w & w/o contrast (72133) |
$2,021.20 |
$5,053 |
11.0× |
| CT lumbar spine w/contrast (72132) |
$1,656.40 |
$4,141 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$1,828 |
$4,570 |
16.7× |
| CT maxillofacial w contrast (70487) |
$2,256.40 |
$5,641 |
12.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,643.60 |
$6,609 |
14.4× |
| CT maxillofacial wo contrast (70486) |
$1,864.40 |
$4,661 |
17.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,643.60 |
$6,609 |
14.4× |
| CT orbits w/o contrast (70480) |
$2,643.60 |
$6,609 |
24.2× |
| CT pelvis w/o contrast (72192) |
$2,419.20 |
$6,048 |
22.2× |
| CT pelvis w/wo contrast (72194) |
$2,643.60 |
$6,609 |
14.4× |
| CT scan of arm combo (73202) |
$2,144.40 |
$5,361 |
11.7× |
| CT soft tissue neck w contrast (70491) |
$1,441.60 |
$3,604 |
7.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,995.20 |
$4,988 |
10.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,534.40 |
$3,836 |
14.1× |
| CT thoracic spine w/contrast (72129) |
$2,147.20 |
$5,368 |
11.7× |
| CT thoracic spine w/o contrast (72128) |
$2,031.60 |
$5,079 |
18.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,618.80 |
$6,547 |
14.3× |
| CT thorax w/o contrast (71250) |
$1,739.60 |
$4,349 |
15.9× |
| CT upper ext wo (73200) |
$1,956.80 |
$4,892 |
17.9× |
| CT upper extremity with contrast (73201) |
$1,956.80 |
$4,892 |
5.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,717.60 |
$6,794 |
14.8× |
| Cta Abdomen (74175) |
$2,643.60 |
$6,609 |
14.4× |
| CTA abdomen pelvis (74174) |
$7,209.20 |
$18,023 |
19.8× |
| CTA chest (71275) |
$3,218 |
$8,045 |
17.6× |
| Cta Head (70496) |
$2,901.20 |
$7,253 |
15.8× |
| Cta Neck (70498) |
$2,901.20 |
$7,253 |
15.8× |
| Cta Pelvis (72191) |
$4,160 |
$10,400 |
22.7× |
| Cystography minimum 3 views rs&i (74430) |
$382.40 |
$956 |
1.0× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,000.40 |
$2,501 |
0.5× |
| Diskogram cervical (72285) |
$3,662.80 |
$9,157 |
1.8× |
| Diskography lumbar (72295) |
$4,384 |
$10,960 |
2.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$575.60 |
$1,439 |
5.3× |
| Dxa bone density study axial skeleton (77085) |
$401.20 |
$1,003 |
3.7× |
| Esophagus (74220) |
$799.60 |
$1,999 |
4.4× |
| Facial bones min 3 views (70150) |
$573.60 |
$1,434 |
5.3× |
| Fetal biophysical profile non-stress testing (76818) |
$279.60 |
$699 |
2.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$609.20 |
$1,523 |
5.6× |
| Fluoroscopy up to 1 hr (76000) |
$1,905.60 |
$4,764 |
7.6× |
| Foot 2 views (73620) |
$287.60 |
$719 |
3.2× |
| Forearm 2 views (73090) |
$581.20 |
$1,453 |
6.4× |
| Hand 2 views (73120) |
$286 |
$715 |
2.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,393.60 |
$8,484 |
1.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,393.60 |
$8,484 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,321.60 |
$5,804 |
4.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,321.60 |
$5,804 |
5.6× |
| Hysterosalpingogram (74740) |
$585.20 |
$1,463 |
2.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$754 |
$1,885 |
6.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,198 |
$2,995 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,227.20 |
$5,568 |
3.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,130.40 |
$2,826 |
2.0× |
| Knee 3 views (73562) |
$516 |
$1,290 |
5.7× |
| Liver & spleen imaging static only (78215) |
$1,632.40 |
$4,081 |
3.9× |
| Lung perfusion differential (78597) |
$648 |
$1,620 |
1.6× |
| Lymphoscintigraphy (78195) |
$2,333.20 |
$5,833 |
4.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$730.40 |
$1,826 |
0.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$730.40 |
$1,826 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$688.80 |
$1,722 |
1.9× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$172 |
$430 |
1.9× |
| MRA head w & w/o contrast (70546) |
$972 |
$2,430 |
2.7× |
| MRA head w/o contrast (70544) |
$607.20 |
$1,518 |
2.4× |
| MRA head with contrast (70545) |
$664.40 |
$1,661 |
1.8× |
| MRA neck w contrast (70548) |
$664.40 |
$1,661 |
1.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$972 |
$2,430 |
2.7× |
| MRA neck w/o contrast (70547) |
$514.40 |
$1,286 |
2.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$972 |
$2,430 |
2.7× |
| MRI abdomen w/o contrast (74181) |
$972 |
$2,430 |
3.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$847.60 |
$2,119 |
1.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$972 |
$2,430 |
2.7× |
| MRI breast w/o contrast bilateral (77047) |
$1,148 |
$2,870 |
4.6× |
| MRI breast wo contrast unilateral (77046) |
$823.20 |
$2,058 |
3.3× |
| MRI cervical spine w/o contrast (72141) |
$884 |
$2,210 |
3.5× |
| MRI chest w/o & w/contrast material (71552) |
$799.60 |
$1,999 |
2.2× |
| MRI chest w/o contrast (71550) |
$799.60 |
$1,999 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$847.60 |
$2,119 |
2.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$799.60 |
$1,999 |
2.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$799.60 |
$1,999 |
3.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$514.40 |
$1,286 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$972 |
$2,430 |
2.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$972 |
$2,430 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$972 |
$2,430 |
3.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$934.80 |
$2,337 |
2.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$804.40 |
$2,011 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$972 |
$2,430 |
2.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$644 |
$1,610 |
1.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$791.20 |
$1,978 |
2.2× |
| MRI temporomandibular joint (70336) |
$972 |
$2,430 |
3.9× |
| MRI thoracic spine w/o contrast (72146) |
$755.20 |
$1,888 |
3.0× |
| MRI up ext w/o contrast (73218) |
$688.80 |
$1,722 |
2.8× |
| MRI upper ext joint w/o contrast (73221) |
$951.20 |
$2,378 |
3.8× |
| MRI, joint upper extrem combo (73223) |
$852.40 |
$2,131 |
2.3× |
| Myelogram Cervical (72240) |
$2,073.60 |
$5,184 |
2.5× |
| Myelogram Lumbar (72265) |
$1,817.60 |
$4,544 |
2.2× |
| Myelogram thoracic (72255) |
$1,896 |
$4,740 |
2.3× |
| Myelography 2 or more regions (72270) |
$2,735.60 |
$6,839 |
3.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,400 |
$3,500 |
1.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,142.40 |
$5,356 |
1.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,253.60 |
$5,634 |
1.7× |
| Neck soft tissue (70360) |
$870.80 |
$2,177 |
9.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$625.25 |
$1,563.12 |
1.5× |
| Nm gastric emptying study (78264) |
$815.60 |
$2,039 |
2.0× |
| Nm kidney scan w/flow (78701) |
$1,322.40 |
$3,306 |
3.2× |
| Nuclear Rx Oral Admin (79005) |
$1,174 |
$2,935 |
4.8× |
| Orthopantogram (70355) |
$164 |
$410 |
1.8× |
| Osseous survey limited (77074) |
$355.20 |
$888 |
3.3× |
| Parathyroid Planar Imaging (78070) |
$1,266.40 |
$3,166 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$673.60 |
$1,684 |
6.2× |
| PET image w/CT, skull-thigh (78815) |
$1,687.60 |
$4,219 |
1.1× |
| PET imaging CT for attenuation limited area (78814) |
$1,400 |
$3,500 |
0.9× |
| PET imaging for CT attenuation whole body (78816) |
$1,687.60 |
$4,219 |
1.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,393.60 |
$8,484 |
1.0× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$3,393.60 |
$8,484 |
1.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$588 |
$1,470 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$784.40 |
$1,961 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$286 |
$715 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$483.20 |
$1,208 |
5.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$709.60 |
$1,774 |
7.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$720 |
$1,800 |
7.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$247.60 |
$619 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$410.80 |
$1,027 |
3.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$768 |
$1,920 |
7.0× |
| Radex fingr minimum 2 views (73140) |
$581.20 |
$1,453 |
6.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$461.20 |
$1,153 |
5.1× |
| Radex Hand Minimum 3 Views (73130) |
$464.80 |
$1,162 |
5.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$247.60 |
$619 |
2.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$410.80 |
$1,027 |
3.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$410.80 |
$1,027 |
3.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$768 |
$1,920 |
7.0× |
| Radex Humerus Minimum 2 Views (73060) |
$813.20 |
$2,033 |
8.9× |
| Radex Kne 1/2 Views (73560) |
$559.60 |
$1,399 |
6.2× |
| Radex Kne Compl 4/More Views (73564) |
$935.60 |
$2,339 |
8.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$527.60 |
$1,319 |
4.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$599.20 |
$1,498 |
6.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$1,379.60 |
$3,449 |
12.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$904.80 |
$2,262 |
10.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$375.20 |
$938 |
4.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$328 |
$820 |
3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$458 |
$1,145 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$524.80 |
$1,312 |
5.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$196 |
$490 |
1.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$547.20 |
$1,368 |
6.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$768 |
$1,920 |
7.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$589.60 |
$1,474 |
6.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$662 |
$1,655 |
6.1× |
| Radiologic exam chest 2 views (71046) |
$448.80 |
$1,122 |
4.9× |
| Radiologic exam colon single contrast study (74270) |
$1,648.40 |
$4,121 |
9.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$654.80 |
$1,637 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$489.60 |
$1,224 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$489.60 |
$1,224 |
2.7× |
| Radiologic examination femur 1 view (73551) |
$247.60 |
$619 |
2.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$597.20 |
$1,493 |
6.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$409.60 |
$1,024 |
4.5× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$587.20 |
$1,468 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$607.60 |
$1,519 |
5.6× |
| Radiological examination surgical specimen (76098) |
$220.40 |
$551 |
0.4× |
| Ribs bilateral 3 views (71110) |
$196.80 |
$492 |
1.8× |
| Salivary gland imaging (78230) |
$793.60 |
$1,984 |
1.9× |
| Scapula (73010) |
$660.40 |
$1,651 |
6.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.40 |
$116 |
2.0× |
| Sella turcica (70240) |
$426.40 |
$1,066 |
4.7× |
| Shoulder 1 view (73020) |
$319.60 |
$799 |
3.5× |
| Sialogram (70390) |
$654.80 |
$1,637 |
2.6× |
| Small bowel series (74250) |
$1,622 |
$4,055 |
8.9× |
| Speech evaluation complex (70371) |
$360.80 |
$902 |
1.4× |
| Spine thoracic 3 views (72072) |
$122.80 |
$307 |
1.1× |
| Superior sagittal sinus venogram (75870) |
$3,393.60 |
$8,484 |
1.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$539.20 |
$1,348 |
2.2× |
| Thoracolumbar 2 views (72080) |
$468.80 |
$1,172 |
5.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$977.20 |
$2,443 |
1.7× |
| Thyroid imaging w/blood flow (78013) |
$586 |
$1,465 |
1.4× |
| Thyroid uptake measurement (78012) |
$480.80 |
$1,202 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$806.40 |
$2,016 |
1.9× |
| Tmj unilateral (70328) |
$176 |
$440 |
1.9× |
| Tomogram (76100) |
$338 |
$845 |
3.1× |
| Ultrasound breast complete (76641) |
$497.20 |
$1,243 |
4.6× |
| Ultrasound Exam Aaa Screen (76706) |
$449.20 |
$1,123 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$1,721.20 |
$4,303 |
15.8× |
| Urethrocystogram voiding (74455) |
$511.60 |
$1,279 |
2.1× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,082.80 |
$2,707 |
5.9× |
| Us breast unilateral limited (76642) |
$497.20 |
$1,243 |
5.5× |
| Us chest (76604) |
$489.20 |
$1,223 |
4.5× |
| Us encephalogram (76506) |
$825.60 |
$2,064 |
7.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$694 |
$1,735 |
6.4× |
| Us ob limited (76815) |
$437.60 |
$1,094 |
4.0× |
| Us ob transvaginal (76817) |
$375.20 |
$938 |
3.4× |
| Us pelvic non ob complete (76856) |
$1,713.20 |
$4,283 |
15.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$567.60 |
$1,419 |
5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$543.60 |
$1,359 |
5.0× |
| Us retroperitoneal complete (76770) |
$475.60 |
$1,189 |
4.4× |
| Us retroperitoneal limited (76775) |
$1,622 |
$4,055 |
14.9× |
| Us scrotum and contents (76870) |
$866 |
$2,165 |
7.9× |
| Us soft tissue head/neck (76536) |
$736 |
$1,840 |
6.7× |
| Us spinal canal and contents (76800) |
$825.60 |
$2,064 |
7.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$672 |
$1,680 |
6.2× |
| Venogram extremity bilateral (75822) |
$1,495.20 |
$3,738 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$2,266 |
$5,665 |
1.4× |
| Venography caval inferior serialography rs&i (75825) |
$3,478 |
$8,695 |
1.1× |
| Venography Renal Bilateral (75833) |
$1,724.80 |
$4,312 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,598.80 |
$3,997 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$46,797.60 |
$116,994 |
14.2× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$3,393.60 |
$8,484 |
5.2× |
| Venous sampling by catheter (75893) |
$3,393.60 |
$8,484 |
0.6× |
| Wrist 2 views (73100) |
$350.80 |
$877 |
3.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$902 |
$2,255 |
8.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$447.20 |
$1,118 |
4.9× |
| X-ray b.e. reductn intuss (74283) |
$2,528.80 |
$6,322 |
13.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,655.20 |
$6,638 |
14.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$490.40 |
$1,226 |
5.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$247.60 |
$619 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$410.80 |
$1,027 |
3.8× |
| X-ray exam of femur 2/> (73552) |
$247.60 |
$619 |
2.7× |
| X-ray eye for foreign body (70030) |
$520.40 |
$1,301 |
5.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$488.80 |
$1,222 |
5.4× |
| X-ray IV pyelogram (ivp) (74400) |
$1,365.60 |
$3,414 |
7.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$228 |
$570 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$449.20 |
$1,123 |
4.9× |
| X-ray leg, infant (73592) |
$196 |
$490 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$444 |
$1,110 |
4.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$794 |
$1,985 |
7.3× |
| X-ray nose-rectum child f.b. (76010) |
$501.20 |
$1,253 |
5.5× |
| X-ray optic foramen (70190) |
$391.20 |
$978 |
4.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$399.20 |
$998 |
3.7× |
| X-ray retrograde pyelogram (74420) |
$573.60 |
$1,434 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$178 |
$445 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$447.20 |
$1,118 |
4.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$658.40 |
$1,646 |
6.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$382.40 |
$956 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$406.40 |
$1,016 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$686.40 |
$1,716 |
7.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$784 |
$1,960 |
7.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$420.80 |
$1,052 |
3.9× |
| X-Ray Small Bowel Enteroclysis (74251) |
$2,821.60 |
$7,054 |
15.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$847.60 |
$2,119 |
9.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$236 |
$590 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$362.40 |
$906 |
4.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$365.20 |
$913 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$573.20 |
$1,433 |
5.3× |
| Xr bone length studies (77073) |
$785.20 |
$1,963 |
7.2× |
| Xr c-spine 4 or 5 views (72050) |
$1,541.20 |
$3,853 |
14.1× |
| Xr c-spine 6 or more views (72052) |
$1,196 |
$2,990 |
11.0× |
| Xr chest 4+ views (71048) |
$708 |
$1,770 |
6.5× |
| Xr myelogram posterior fossa (70010) |
$1,112.80 |
$2,782 |
3.1× |
| Xr urogram antegrade (74425) |
$307.20 |
$768 |
0.8× |