| Abdomen 2 views (74019) |
$191.60 |
$479 |
1.8× |
| Acute gi blood loss imaging (78278) |
$2,104 |
$5,260 |
5.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,094.80 |
$7,737 |
0.9× |
| Ankle 2 views (73600) |
$122 |
$305 |
1.3× |
| Arthrogram ankle (73615) |
$550.80 |
$1,377 |
1.5× |
| Arthrogram elbow (73085) |
$550.80 |
$1,377 |
1.5× |
| Arthrogram hip (73525) |
$416.80 |
$1,042 |
1.1× |
| Arthrogram knee (73580) |
$650.80 |
$1,627 |
1.8× |
| Arthrogram shoulder (73040) |
$834 |
$2,085 |
2.3× |
| Arthrogram wrist (73115) |
$447.20 |
$1,118 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,426 |
$3,565 |
3.4× |
| Bone &/joint imaging whole body (78306) |
$2,358 |
$5,895 |
5.6× |
| Bone age studies (77072) |
$426 |
$1,065 |
3.9× |
| Bone Imaging 3 Phase (78315) |
$2,536.40 |
$6,341 |
6.1× |
| Bone Marrow Imaging Limited Area (78102) |
$1,158.80 |
$2,897 |
2.8× |
| Bone survey complete (77075) |
$180 |
$450 |
1.6× |
| Bone survey infant (77076) |
$328.40 |
$821 |
3.0× |
| Bowel imaging (78290) |
$1,138.80 |
$2,847 |
2.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$990 |
$2,475 |
1.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$876.40 |
$2,191 |
2.1× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,012 |
$2,530 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,652.40 |
$4,131 |
4.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$775.20 |
$1,938 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$91.20 |
$228 |
1.0× |
| Chest 1 view (71045) |
$145 |
$362.50 |
1.6× |
| Chest xray 3 views (71047) |
$286.20 |
$715.50 |
3.1× |
| Cholecystography, oral contrast Non-Facility (74290) |
$466.80 |
$1,167 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$564.40 |
$1,411 |
3.1× |
| Clavicle complete (73000) |
$266.80 |
$667 |
2.9× |
| 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) |
$1,460.80 |
$3,652 |
4.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,460.80 |
$3,652 |
5.9× |
| CT abdomen w contrast (74160) |
$1,310.40 |
$3,276 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,313.20 |
$3,283 |
7.2× |
| CT abdomen w/o contrast (74150) |
$924 |
$2,310 |
8.5× |
| CT angio hrt w/3d image (75574) |
$507.20 |
$1,268 |
1.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,460.80 |
$3,652 |
8.0× |
| CT angiography upper extremity lt (73206) |
$2,563.60 |
$6,409 |
14.0× |
| CT c-spine w/contrast (72126) |
$1,418 |
$3,545 |
3.9× |
| CT c-spine w/o contrast (72125) |
$1,382.40 |
$3,456 |
12.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,687.20 |
$4,218 |
9.2× |
| CT chest w contrast (71260) |
$1,213.60 |
$3,034 |
6.6× |
| CT chest w/wo contrast (71270) |
$1,460.80 |
$3,652 |
8.0× |
| CT head/brain with contrast (70460) |
$1,460.80 |
$3,652 |
8.0× |
| CT head/brain without and with contrast (70470) |
$1,460.80 |
$3,652 |
8.0× |
| CT heart contrast eval cardiac structure&morph (75572) |
$507.20 |
$1,268 |
1.4× |
| CT iac w contrast (70481) |
$1,384 |
$3,460 |
7.6× |
| CT limited/localized follow up study (76380) |
$528.40 |
$1,321 |
5.8× |
| CT lower ext w/o (73700) |
$1,152.40 |
$2,881 |
10.6× |
| CT lower extremity w wo contrast (73702) |
$1,152.40 |
$2,881 |
6.3× |
| CT lower extremity w/contrast material (73701) |
$1,152.40 |
$2,881 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,635.20 |
$4,088 |
8.9× |
| CT lumbar spine w/contrast (72132) |
$1,373.60 |
$3,434 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,246 |
$3,115 |
11.4× |
| CT maxillofacial w contrast (70487) |
$1,337.60 |
$3,344 |
7.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,592.80 |
$3,982 |
8.7× |
| CT maxillofacial wo contrast (70486) |
$1,196.80 |
$2,992 |
11.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,647.20 |
$4,118 |
9.0× |
| CT orbits w/o contrast (70480) |
$1,384.40 |
$3,461 |
12.7× |
| CT pelvis w/o contrast (72192) |
$1,009.20 |
$2,523 |
9.2× |
| CT pelvis w/wo contrast (72194) |
$1,293.20 |
$3,233 |
7.1× |
| CT scan of arm combo (73202) |
$1,692.40 |
$4,231 |
9.2× |
| CT soft tissue neck w contrast (70491) |
$1,042.80 |
$2,607 |
5.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,110 |
$2,775 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,110 |
$2,775 |
10.2× |
| CT thoracic spine w/contrast (72129) |
$1,578.40 |
$3,946 |
8.6× |
| CT thoracic spine w/o contrast (72128) |
$1,413.60 |
$3,534 |
12.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,878.80 |
$4,697 |
10.3× |
| CT thorax w/o contrast (71250) |
$1,287.20 |
$3,218 |
11.8× |
| CT upper ext wo (73200) |
$1,421.20 |
$3,553 |
13.0× |
| CT upper extremity with contrast (73201) |
$1,421.20 |
$3,553 |
3.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,561.60 |
$6,404 |
14.0× |
| Cta Abdomen (74175) |
$2,561.60 |
$6,404 |
14.0× |
| CTA abdomen pelvis (74174) |
$3,413.60 |
$8,534 |
9.4× |
| CTA chest (71275) |
$1,460.80 |
$3,652 |
8.0× |
| Cta Head (70496) |
$2,039.20 |
$5,098 |
11.1× |
| Cta Neck (70498) |
$2,140.40 |
$5,351 |
11.7× |
| Cta Pelvis (72191) |
$2,567.60 |
$6,419 |
14.0× |
| Cystography minimum 3 views rs&i (74430) |
$392.80 |
$982 |
1.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$115.40 |
$288.50 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$127.80 |
$319.50 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$71.20 |
$178 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$329.60 |
$824 |
3.0× |
| Esophagus (74220) |
$348.40 |
$871 |
1.9× |
| Facial bones min 3 views (70150) |
$409.20 |
$1,023 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$268 |
$670 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$445.20 |
$1,113 |
1.8× |
| Foot 2 views (73620) |
$242 |
$605 |
2.7× |
| Forearm 2 views (73090) |
$273.60 |
$684 |
3.0× |
| Hand 2 views (73120) |
$260.40 |
$651 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,187.60 |
$5,469 |
3.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,187.60 |
$5,469 |
5.2× |
| Hysterosalpingogram (74740) |
$552 |
$1,380 |
2.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$495.20 |
$1,238 |
4.5× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$654 |
$1,635 |
1.6× |
| Kidney imaging morphology (78700) |
$1,235.60 |
$3,089 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,327.60 |
$5,819 |
4.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,626.40 |
$6,566 |
4.6× |
| Knee 3 views (73562) |
$273.60 |
$684 |
3.0× |
| Liver & spleen imaging static only (78215) |
$1,740.80 |
$4,352 |
4.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,301.60 |
$3,254 |
3.1× |
| Lung perfusion differential (78597) |
$573.60 |
$1,434 |
1.4× |
| Lung ventilation imaging (78579) |
$514 |
$1,285 |
1.2× |
| Lymphoscintigraphy (78195) |
$2,392 |
$5,980 |
4.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,342.80 |
$3,357 |
1.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,342.80 |
$3,357 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,266.40 |
$3,166 |
3.5× |
| Mammary ductogram or galactogram multiple (77054) |
$242 |
$605 |
1.0× |
| Mammary ductogram or galactogram single (77053) |
$242 |
$605 |
1.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$138.80 |
$347 |
1.5× |
| MRA head w & w/o contrast (70546) |
$2,009.20 |
$5,023 |
5.5× |
| MRA head w/o contrast (70544) |
$895.20 |
$2,238 |
3.6× |
| MRA head with contrast (70545) |
$1,155.20 |
$2,888 |
3.2× |
| MRA neck w contrast (70548) |
$1,155.20 |
$2,888 |
3.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,009.20 |
$5,023 |
5.5× |
| MRA neck w/o contrast (70547) |
$895.20 |
$2,238 |
3.6× |
| MRI abdomen w contrast (74182) |
$1,333.60 |
$3,334 |
3.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,066.80 |
$2,667 |
2.9× |
| MRI abdomen w/o contrast (74181) |
$1,009.60 |
$2,524 |
4.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,009.60 |
$2,524 |
1.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,414.80 |
$3,537 |
3.9× |
| MRI breast w/o contrast bilateral (77047) |
$2,239.60 |
$5,599 |
9.0× |
| MRI breast wo contrast unilateral (77046) |
$1,606.80 |
$4,017 |
6.4× |
| MRI c-spine with contrast (72142) |
$1,252 |
$3,130 |
3.4× |
| MRI cardiac w/o cont stress (75559) |
$660.80 |
$1,652 |
1.2× |
| MRI cardiac w/o contrast (75557) |
$1,172.40 |
$2,931 |
4.7× |
| MRI cervical spine w/o contrast (72141) |
$1,009.60 |
$2,524 |
4.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,333.60 |
$3,334 |
3.7× |
| MRI chest w/o contrast (71550) |
$1,333.60 |
$3,334 |
5.4× |
| MRI chest with contrast (71551) |
$1,333.60 |
$3,334 |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,209.60 |
$3,024 |
3.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,140.80 |
$2,852 |
3.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,009.60 |
$2,524 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$895.20 |
$2,238 |
3.6× |
| MRI orbit face neck w contrast (70542) |
$895.20 |
$2,238 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,184 |
$2,960 |
3.2× |
| MRI pelvis w/contrast (72196) |
$1,066.80 |
$2,667 |
2.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,066.80 |
$2,667 |
2.9× |
| MRI pelvis w/o contrast (72195) |
$1,009.60 |
$2,524 |
4.1× |
| MRI spectroscopy (76390) |
$1,106 |
$2,765 |
12.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,539.20 |
$3,848 |
4.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,278 |
$3,195 |
3.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,009.60 |
$2,524 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,262.80 |
$3,157 |
3.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,009.60 |
$2,524 |
2.8× |
| MRI temporomandibular joint (70336) |
$1,172.40 |
$2,931 |
4.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,009.60 |
$2,524 |
4.1× |
| MRI up ext w/o contrast (73218) |
$1,009.60 |
$2,524 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,009.60 |
$2,524 |
4.1× |
| MRI, joint upper extrem combo (73223) |
$1,566.40 |
$3,916 |
4.3× |
| Myelogram Cervical (72240) |
$1,066 |
$2,665 |
1.3× |
| Myelogram Lumbar (72265) |
$934.40 |
$2,336 |
1.1× |
| Myelogram thoracic (72255) |
$868.40 |
$2,171 |
1.1× |
| Myelography 2 or more regions (72270) |
$1,330.40 |
$3,326 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$4,977.60 |
$12,444 |
3.7× |
| Myocardial spect single study at rest or stress (78451) |
$2,430.80 |
$6,077 |
1.8× |
| Neck soft tissue (70360) |
$277.60 |
$694 |
3.1× |
| Nm bone marrow wb (78104) |
$1,369.60 |
$3,424 |
3.3× |
| Nm cisternogram (78630) |
$1,192.80 |
$2,982 |
2.1× |
| Nm csf leak detection (78650) |
$678 |
$1,695 |
0.5× |
| Nm gastric emptying study (78264) |
$2,093.60 |
$5,234 |
5.0× |
| Nm gastroesophageal reflux study (78262) |
$2,104 |
$5,260 |
5.0× |
| Nm kidney scan w/flow (78701) |
$1,218.40 |
$3,046 |
2.9× |
| Nuclear Rx Oral Admin (79005) |
$1,384.40 |
$3,461 |
5.7× |
| Ob us nuchal meas 1 gest (76813) |
$288 |
$720 |
2.6× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$8.74 |
$21.86 |
0.3× |
| Orthopantogram (70355) |
$160.40 |
$401 |
1.8× |
| Osseous survey limited (77074) |
$199.20 |
$498 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$2,517.20 |
$6,293 |
6.0× |
| Pelvis 1 or 2 views (72170) |
$154.20 |
$385.50 |
1.4× |
| Perineogram (74775) |
$391.20 |
$978 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$693.60 |
$1,734 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,426.80 |
$3,567 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$550.80 |
$1,377 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$303.20 |
$758 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$295.20 |
$738 |
3.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$321.20 |
$803 |
3.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$160.80 |
$402 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$266.80 |
$667 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$508 |
$1,270 |
4.7× |
| Radex fingr minimum 2 views (73140) |
$264.80 |
$662 |
2.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$275.20 |
$688 |
3.0× |
| Radex Hand Minimum 3 Views (73130) |
$300.40 |
$751 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$160.80 |
$402 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$266.80 |
$667 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$266.80 |
$667 |
2.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$508 |
$1,270 |
4.7× |
| Radex Humerus Minimum 2 Views (73060) |
$283.20 |
$708 |
3.1× |
| Radex Kne 1/2 Views (73560) |
$261.20 |
$653 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$360.40 |
$901 |
3.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$311.60 |
$779 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$256.40 |
$641 |
2.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$358.80 |
$897 |
3.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$315.20 |
$788 |
3.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$194.40 |
$486 |
2.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$173.20 |
$433 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$278.40 |
$696 |
3.1× |
| Radex Toe Minimum 2 Views (73660) |
$190.80 |
$477 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$126.80 |
$317 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$318.80 |
$797 |
3.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$508 |
$1,270 |
4.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$189.20 |
$473 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$217.80 |
$544.50 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$166.80 |
$417 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$428.80 |
$1,072 |
2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$653.20 |
$1,633 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$222 |
$555 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$222 |
$555 |
1.2× |
| Radiologic examination femur 1 view (73551) |
$160.80 |
$402 |
1.8× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$445.20 |
$1,113 |
4.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$294.40 |
$736 |
3.2× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$424 |
$1,060 |
0.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$430.40 |
$1,076 |
3.9× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$3,235.20 |
$8,088 |
13.3× |
| Ribs bilateral 3 views (71110) |
$131.20 |
$328 |
1.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$2,876 |
$7,190 |
6.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,551.20 |
$11,378 |
8.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,876 |
$7,190 |
5.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$717.20 |
$1,793 |
1.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,551.20 |
$11,378 |
3.4× |
| Rp Therapy Intravenous Administration (79101) |
$1,595.60 |
$3,989 |
6.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$332.40 |
$831 |
1.3× |
| Salivary gland function study (78232) |
$753.60 |
$1,884 |
1.8× |
| Salivary gland imaging (78230) |
$757.60 |
$1,894 |
1.8× |
| Scapula (73010) |
$271.20 |
$678 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46 |
$115 |
2.0× |
| Sella turcica (70240) |
$324.40 |
$811 |
3.6× |
| Shoulder 1 view (73020) |
$106 |
$265 |
1.2× |
| Sialogram (70390) |
$488.40 |
$1,221 |
2.0× |
| Small bowel series (74250) |
$486.80 |
$1,217 |
2.7× |
| Speech evaluation complex (70371) |
$234.80 |
$587 |
0.9× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$147.60 |
$369 |
1.6× |
| Tbs technical calculation only (77091) |
$147.60 |
$369 |
1.6× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$550.80 |
$1,377 |
2.2× |
| Thoracolumbar 2 views (72080) |
$292.40 |
$731 |
3.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,670.80 |
$6,677 |
4.7× |
| Thyroid imaging w/blood flow (78013) |
$1,165.20 |
$2,913 |
2.8× |
| Thyroid uptake measurement (78012) |
$956.40 |
$2,391 |
2.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,342 |
$3,355 |
3.2× |
| Tmj unilateral (70328) |
$114 |
$285 |
1.3× |
| Tomogram (76100) |
$224 |
$560 |
2.1× |
| Ultrasound breast complete (76641) |
$247.60 |
$619 |
2.3× |
| Ultrasound elastography first target lesion (76982) |
$410 |
$1,025 |
3.8× |
| Ultrasound Exam Aaa Screen (76706) |
$292 |
$730 |
2.7× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$345.60 |
$864 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$377.20 |
$943 |
3.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$355.60 |
$889 |
3.9× |
| Unlisted fluoroscopic procedure (76496) |
$95.80 |
$239.49 |
1.1× |
| Unlisted ultrasound procedure (76999) |
$195.60 |
$489 |
2.2× |
| Ureteral reflux study (78740) |
$845.20 |
$2,113 |
2.0× |
| Urethrocystogram voiding (74455) |
$285.20 |
$713 |
1.1× |
| Urethrocystography retrograde rs&i (74450) |
$429.20 |
$1,073 |
1.7× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$968.40 |
$2,421 |
5.3× |
| Us breast unilateral limited (76642) |
$247.60 |
$619 |
2.7× |
| Us chest (76604) |
$178.40 |
$446 |
1.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$506.80 |
$1,267 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$233.60 |
$584 |
2.1× |
| Us elastography parenchyma (76981) |
$438.40 |
$1,096 |
4.0× |
| Us encephalogram (76506) |
$451.20 |
$1,128 |
4.1× |
| Us hips infant static (76886) |
$304 |
$760 |
3.3× |
| Us infant hips w manipulation (76885) |
$432.80 |
$1,082 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$146.40 |
$366 |
1.3× |
| Us ob detailed single fetus (76811) |
$277.60 |
$694 |
1.1× |
| Us ob limited (76815) |
$158.80 |
$397 |
1.5× |
| Us ob transvaginal (76817) |
$144.40 |
$361 |
1.3× |
| Us pelvic non ob complete (76856) |
$698 |
$1,745 |
6.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$255.20 |
$638 |
2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$232 |
$580 |
2.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$102.40 |
$256 |
0.9× |
| Us retroperitoneal complete (76770) |
$265.60 |
$664 |
2.4× |
| Us retroperitoneal limited (76775) |
$428 |
$1,070 |
3.9× |
| Us scrotum and contents (76870) |
$570 |
$1,425 |
5.2× |
| Us soft tissue head/neck (76536) |
$485.20 |
$1,213 |
4.4× |
| Us spinal canal and contents (76800) |
$451.20 |
$1,128 |
4.1× |
| Us transrectal (76872) |
$346 |
$865 |
3.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$359.20 |
$898 |
3.3× |
| Venogram extremity bilateral (75822) |
$1,800 |
$4,500 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$1,439.60 |
$3,599 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$206 |
$515 |
2.3× |
| Wrist 2 views (73100) |
$276.40 |
$691 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$311.60 |
$779 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$151.60 |
$379 |
1.7× |
| X-ray b.e. reductn intuss (74283) |
$781.60 |
$1,954 |
4.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$689.60 |
$1,724 |
3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$285.60 |
$714 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$160.80 |
$402 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$266.80 |
$667 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$160.80 |
$402 |
1.8× |
| X-ray eye for foreign body (70030) |
$395.20 |
$988 |
4.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$388 |
$970 |
4.3× |
| X-ray IV pyelogram (ivp) (74400) |
$1,007.60 |
$2,519 |
5.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$138.80 |
$347 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$224 |
$560 |
2.5× |
| X-ray leg, infant (73592) |
$126.80 |
$317 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$226.80 |
$567 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$413.20 |
$1,033 |
3.8× |
| X-ray nose-rectum child f.b. (76010) |
$313.60 |
$784 |
3.5× |
| X-ray optic foramen (70190) |
$356.40 |
$891 |
3.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$311.60 |
$779 |
2.9× |
| X-ray retrograde pyelogram (74420) |
$499.60 |
$1,249 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$129.20 |
$323 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$362.80 |
$907 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$534 |
$1,335 |
4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$243.60 |
$609 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$292.40 |
$731 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$465.20 |
$1,163 |
5.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$462 |
$1,155 |
4.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$248.80 |
$622 |
2.3× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,008.40 |
$2,521 |
5.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$316 |
$790 |
3.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$166.80 |
$417 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$280.80 |
$702 |
3.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$128.40 |
$321 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$348.80 |
$872 |
3.2× |
| Xr bone length studies (77073) |
$460.60 |
$1,151.50 |
4.2× |
| Xr c-spine 4 or 5 views (72050) |
$417.20 |
$1,043 |
3.8× |
| Xr c-spine 6 or more views (72052) |
$438.80 |
$1,097 |
4.0× |
| Xr chest 4+ views (71048) |
$308.60 |
$771.50 |
2.8× |
| Xr myelogram posterior fossa (70010) |
$844.40 |
$2,111 |
2.3× |
| Xr urogram antegrade (74425) |
$371.20 |
$928 |
1.0× |