| Abdomen 2 views (74019) |
$218.12 |
$589.50 |
2.0× |
| Acute gi blood loss imaging (78278) |
$1,550.95 |
$4,191.75 |
3.7× |
| Angiography extremity bilateral rs&i (75716) |
$1,990.79 |
$5,380.50 |
0.6× |
| Angiography extremity unilateral rs&i (75710) |
$1,729.01 |
$4,673 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$1,745.20 |
$4,716.75 |
0.5× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,832.61 |
$4,953 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,192.25 |
$5,925 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$907.06 |
$2,451.50 |
0.3× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,320.35 |
$3,568.50 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,712.50 |
$4,628.38 |
0.5× |
| Ankle 2 views (73600) |
$191.48 |
$517.50 |
2.1× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,767.68 |
$4,777.50 |
0.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,235.43 |
$3,339 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,281.31 |
$3,463 |
0.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,436.06 |
$3,881.25 |
3.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$668.87 |
$1,807.75 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,665.83 |
$4,502.25 |
4.0× |
| Bone age studies (77072) |
$206.28 |
$557.50 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,550.95 |
$4,191.75 |
3.7× |
| Bone Marrow Imaging Limited Area (78102) |
$1,550.95 |
$4,191.75 |
3.7× |
| Bone survey complete (77075) |
$689.50 |
$1,863.50 |
6.3× |
| Bone survey infant (77076) |
$763.59 |
$2,063.75 |
7.0× |
| Bowel imaging (78290) |
$1,550.95 |
$4,191.75 |
3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,550.95 |
$4,191.75 |
2.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,274.98 |
$3,445.88 |
3.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,550.95 |
$4,191.75 |
3.7× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,100.75 |
$2,975 |
1.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$856.64 |
$2,315.25 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$293.50 |
$793.25 |
3.2× |
| Chest 1 view (71045) |
$163.73 |
$442.50 |
1.8× |
| Chest xray 3 views (71047) |
$195.73 |
$529 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$216.82 |
$586 |
1.2× |
| Clavicle complete (73000) |
$202.12 |
$546.25 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$647.32 |
$1,749.50 |
5.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$738.98 |
$1,997.25 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$647.32 |
$1,749.50 |
2.6× |
| CT abdomen w contrast (74160) |
$647.32 |
$1,749.50 |
3.5× |
| CT abdomen w wo contrast (74170) |
$693.10 |
$1,873.25 |
3.8× |
| CT abdomen w/o contrast (74150) |
$601.44 |
$1,625.50 |
5.5× |
| CT angio hrt w/3d image (75574) |
$647.32 |
$1,749.50 |
1.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$647.32 |
$1,749.50 |
3.5× |
| CT angiography upper extremity lt (73206) |
$647.32 |
$1,749.50 |
3.5× |
| CT c-spine w/contrast (72126) |
$693.10 |
$1,873.25 |
1.9× |
| CT c-spine w/o contrast (72125) |
$647.32 |
$1,749.50 |
5.9× |
| CT cervical spine w&w/o contrast (72127) |
$785.70 |
$2,123.50 |
4.3× |
| CT chest w contrast (71260) |
$693.10 |
$1,873.25 |
3.8× |
| CT chest w/wo contrast (71270) |
$738.98 |
$1,997.25 |
4.0× |
| CT head/brain with contrast (70460) |
$722.43 |
$1,952.50 |
3.9× |
| CT head/brain without and with contrast (70470) |
$768.31 |
$2,076.50 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$647.32 |
$1,749.50 |
1.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$38.85 |
$105 |
0.4× |
| CT iac w contrast (70481) |
$624.28 |
$1,687.25 |
3.4× |
| CT lower ext w/o (73700) |
$555.56 |
$1,501.50 |
5.1× |
| CT lower extremity w wo contrast (73702) |
$647.32 |
$1,749.50 |
3.5× |
| CT lower extremity w/contrast material (73701) |
$601.44 |
$1,625.50 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$693.10 |
$1,873.25 |
3.8× |
| CT lumbar spine w/contrast (72132) |
$647.32 |
$1,749.50 |
1.8× |
| CT lumbar spine w/o contrast (72131) |
$601.44 |
$1,625.50 |
5.5× |
| CT maxillofacial w contrast (70487) |
$647.32 |
$1,749.50 |
3.5× |
| CT maxillofacial w/wo contrast (70488) |
$693.10 |
$1,873.25 |
3.8× |
| CT maxillofacial wo contrast (70486) |
$601.44 |
$1,625.50 |
5.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$670.16 |
$1,811.25 |
3.7× |
| CT orbits w/o contrast (70480) |
$578.40 |
$1,563.25 |
5.3× |
| CT pelvis w/o contrast (72192) |
$624.28 |
$1,687.25 |
5.7× |
| CT pelvis w/wo contrast (72194) |
$716.04 |
$1,935.25 |
3.9× |
| CT scan of arm combo (73202) |
$693.10 |
$1,873.25 |
3.8× |
| CT soft tissue neck w contrast (70491) |
$647.32 |
$1,749.50 |
3.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$693.10 |
$1,873.25 |
3.8× |
| CT soft tissue neck w/o contrast (70490) |
$601.44 |
$1,625.50 |
5.5× |
| CT thoracic spine w/contrast (72129) |
$624.28 |
$1,687.25 |
3.4× |
| CT thoracic spine w/o contrast (72128) |
$578.40 |
$1,563.25 |
5.3× |
| CT thoracic spine w/wo contrast (72130) |
$670.16 |
$1,811.25 |
3.7× |
| CT thorax w/o contrast (71250) |
$647.32 |
$1,749.50 |
5.9× |
| CT upper ext wo (73200) |
$601.44 |
$1,625.50 |
5.5× |
| CT upper extremity with contrast (73201) |
$647.32 |
$1,749.50 |
1.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Abdomen (74175) |
$647.32 |
$1,749.50 |
3.5× |
| CTA abdomen pelvis (74174) |
$647.32 |
$1,749.50 |
1.8× |
| CTA chest (71275) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Head (70496) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Neck (70498) |
$647.32 |
$1,749.50 |
3.5× |
| Cta Pelvis (72191) |
$647.32 |
$1,749.50 |
3.5× |
| Cystography minimum 3 views rs&i (74430) |
$366.02 |
$989.25 |
1.0× |
| Diskography lumbar (72295) |
$3,630.07 |
$9,811 |
1.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$273.80 |
$740 |
2.5× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$283.42 |
$766 |
2.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$196.01 |
$529.75 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$250.40 |
$676.75 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$145.88 |
$394.25 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$245.68 |
$664 |
2.3× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$274.91 |
$743 |
1.1× |
| Esophagus (74220) |
$419.77 |
$1,134.50 |
2.3× |
| Facial bones min 3 views (70150) |
$204.06 |
$551.50 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$616.05 |
$1,665 |
5.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$883.65 |
$2,388.25 |
8.1× |
| Fetal Echo (76825) |
$439.65 |
$1,188.25 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$248.27 |
$671 |
1.0× |
| Foot 2 views (73620) |
$194.90 |
$526.75 |
2.1× |
| Forearm 2 views (73090) |
$208.54 |
$563.62 |
2.3× |
| Hand 2 views (73120) |
$189.53 |
$512.25 |
1.7× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,359.25 |
$11,781.75 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,550.95 |
$4,191.75 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,550.95 |
$4,191.75 |
3.7× |
| Hysterosalpingogram (74740) |
$665.50 |
$1,798.62 |
2.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,550.95 |
$4,191.75 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,550.95 |
$4,191.75 |
2.7× |
| Knee 3 views (73562) |
$235.51 |
$636.50 |
2.6× |
| Liver & spleen imaging static only (78215) |
$1,550.95 |
$4,191.75 |
3.7× |
| Lung perfusion differential (78597) |
$1,550.95 |
$4,191.75 |
3.7× |
| Lymphoscintigraphy (78195) |
$1,550.95 |
$4,191.75 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$622.25 |
$1,681.75 |
0.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,101.40 |
$2,976.75 |
3.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$622.25 |
$1,681.75 |
1.7× |
| Mr safety determination physician/other qhp (76016) |
$156.42 |
$422.75 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$135.88 |
$367.25 |
1.4× |
| MRA head w & w/o contrast (70546) |
$638.34 |
$1,725.25 |
1.8× |
| MRA head w/o contrast (70544) |
$574.06 |
$1,551.50 |
2.3× |
| MRA head with contrast (70545) |
$606.15 |
$1,638.25 |
1.7× |
| MRA neck w contrast (70548) |
$590.15 |
$1,595 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$622.25 |
$1,681.75 |
1.7× |
| MRA neck w/o contrast (70547) |
$558.05 |
$1,508.25 |
2.2× |
| MRI abdomen w contrast (74182) |
$590.15 |
$1,595 |
1.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$622.25 |
$1,681.75 |
1.7× |
| MRI abdomen w/o contrast (74181) |
$558.05 |
$1,508.25 |
2.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$622.25 |
$1,681.75 |
0.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$654.35 |
$1,768.50 |
1.8× |
| MRI breast w/o contrast bilateral (77047) |
$566.01 |
$1,529.75 |
2.3× |
| MRI c-spine with contrast (72142) |
$574.06 |
$1,551.50 |
1.6× |
| MRI cardiac w/o cont stress (75559) |
$675.53 |
$1,825.75 |
1.2× |
| MRI cardiac w/o contrast (75557) |
$437.16 |
$1,181.50 |
1.8× |
| MRI cervical spine w/o contrast (72141) |
$558.05 |
$1,508.25 |
2.2× |
| MRI chest w/o & w/contrast material (71552) |
$654.35 |
$1,768.50 |
1.8× |
| MRI chest w/o contrast (71550) |
$590.15 |
$1,595 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$622.25 |
$1,681.75 |
1.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$654.35 |
$1,768.50 |
1.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$590.15 |
$1,595 |
2.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$525.86 |
$1,421.25 |
2.1× |
| MRI orbit face neck w contrast (70542) |
$558.05 |
$1,508.25 |
1.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$590.15 |
$1,595 |
1.6× |
| MRI pelvis w/contrast (72196) |
$720.02 |
$1,946 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$590.15 |
$1,595 |
1.6× |
| MRI pelvis w/o contrast (72195) |
$525.86 |
$1,421.25 |
2.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$606.15 |
$1,638.25 |
1.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$622.25 |
$1,681.75 |
1.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$654.35 |
$1,768.50 |
1.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$590.15 |
$1,595 |
1.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$622.25 |
$1,681.75 |
1.7× |
| MRI temporomandibular joint (70336) |
$590.15 |
$1,595 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$558.05 |
$1,508.25 |
2.2× |
| MRI up ext w/o contrast (73218) |
$558.05 |
$1,508.25 |
2.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,136.27 |
$3,071 |
4.6× |
| MRI, joint upper extrem combo (73223) |
$654.35 |
$1,768.50 |
1.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,608.39 |
$4,347 |
1.2× |
| Myocardial spect single study at rest or stress (78451) |
$1,493.51 |
$4,036.50 |
1.1× |
| N-invas est c ffr sw aly CTA (75580) |
$1,210.55 |
$3,271.76 |
1.3× |
| Neck soft tissue (70360) |
$199.25 |
$538.50 |
2.2× |
| Nm gastric emptying study (78264) |
$1,550.95 |
$4,191.75 |
3.7× |
| Nm peritoneal-venous shunt patency (78291) |
$752.49 |
$2,033.75 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$249.10 |
$673.25 |
2.3× |
| Ob us nuchal meas 1 gest (76813) |
$196.01 |
$529.75 |
1.8× |
| Parathyroid Planar Imaging (78070) |
$1,550.95 |
$4,191.75 |
3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,723.28 |
$4,657.50 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$188.15 |
$508.50 |
1.7× |
| Peritoneogram after injection (74190) |
$466.11 |
$1,259.75 |
0.8× |
| PET image w/CT, skull-thigh (78815) |
$1,998 |
$5,400 |
1.3× |
| PET imaging CT for attenuation limited area (78814) |
$1,979.50 |
$5,350 |
1.3× |
| PET imaging for CT attenuation whole body (78816) |
$2,016.50 |
$5,450 |
1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,370.04 |
$6,405.50 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,550.95 |
$4,191.75 |
3.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,550.95 |
$4,191.75 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$507.55 |
$1,371.75 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$232.68 |
$628.88 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$203.78 |
$550.75 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$163.68 |
$442.38 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$130.98 |
$354 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$233.19 |
$630.25 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$263.35 |
$711.75 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$195.73 |
$529 |
2.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$221.68 |
$599.12 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$224.04 |
$605.50 |
2.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$179.40 |
$484.88 |
2.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$191.48 |
$517.50 |
1.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$254.28 |
$687.25 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$278.52 |
$752.75 |
2.6× |
| Radex Humerus Minimum 2 Views (73060) |
$177.23 |
$479 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$236.94 |
$640.38 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$275.74 |
$745.25 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$258.08 |
$697.50 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$269.55 |
$728.50 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$148.37 |
$401 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$237.26 |
$641.25 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$169.09 |
$457 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$448.16 |
$1,211.25 |
4.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$148.46 |
$401.25 |
1.6× |
| Radex Toe Minimum 2 Views (73660) |
$163.73 |
$442.50 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$123.54 |
$333.88 |
1.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$247.76 |
$669.62 |
2.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$299.79 |
$810.25 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$203.78 |
$550.75 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$232.45 |
$628.25 |
2.1× |
| Radiologic exam chest 2 views (71046) |
$177.42 |
$479.50 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$538.17 |
$1,454.50 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$581.27 |
$1,571 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$129.27 |
$349.38 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$242.49 |
$655.38 |
2.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$217.19 |
$587 |
2.0× |
| Ribs bilateral 3 views (71110) |
$301.09 |
$813.75 |
2.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,493.51 |
$4,036.50 |
3.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,608.39 |
$4,347 |
2.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,608.39 |
$4,347 |
2.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,493.51 |
$4,036.50 |
2.6× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,064.53 |
$8,282.50 |
2.1× |
| Rp therapy intra-arterial particulate admn (79445) |
$403.39 |
$1,090.25 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$177.05 |
$478.50 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$460.93 |
$1,245.75 |
1.8× |
| Scapula (73010) |
$221.72 |
$599.25 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$76.04 |
$205.50 |
3.3× |
| Shoulder 1 view (73020) |
$110.08 |
$297.50 |
1.2× |
| Small bowel series (74250) |
$480.17 |
$1,297.75 |
2.6× |
| Spine thoracic 3 views (72072) |
$179.45 |
$485 |
1.6× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$150.82 |
$407.62 |
1.7× |
| Tbs technical calculation only (77091) |
$150.82 |
$407.62 |
1.7× |
| Thoracolumbar 2 views (72080) |
$197.86 |
$534.75 |
2.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,665.83 |
$4,502.25 |
2.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,550.95 |
$4,191.75 |
3.7× |
| Ultrasound breast complete (76641) |
$377.40 |
$1,020 |
3.5× |
| Ultrasound Exam Aaa Screen (76706) |
$218.62 |
$590.88 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$875.70 |
$2,366.75 |
8.0× |
| Umbilical-artery Doppler (OB) (76820) |
$624.28 |
$1,687.25 |
5.7× |
| Urethrocystogram voiding (74455) |
$432.81 |
$1,169.75 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$370 |
$1,000 |
1.5× |
| Us breast unilateral limited (76642) |
$333 |
$900 |
3.7× |
| Us chest (76604) |
$444.56 |
$1,201.50 |
4.1× |
| Us compl joint r-t w/image documentation (76881) |
$693.29 |
$1,873.75 |
6.4× |
| Us encephalogram (76506) |
$659.80 |
$1,783.25 |
6.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$684.22 |
$1,849.25 |
6.3× |
| Us ob detailed single fetus (76811) |
$617.90 |
$1,670 |
2.5× |
| Us ob limited (76815) |
$340.96 |
$921.50 |
3.1× |
| Us ob transvaginal (76817) |
$549.27 |
$1,484.50 |
5.0× |
| Us pelvic non ob complete (76856) |
$762.76 |
$2,061.50 |
7.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$429.66 |
$1,161.25 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$542.33 |
$1,465.75 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$340.96 |
$921.50 |
3.1× |
| Us retroperitoneal complete (76770) |
$565.36 |
$1,528 |
5.2× |
| Us retroperitoneal limited (76775) |
$444.56 |
$1,201.50 |
4.1× |
| Us scrotum and contents (76870) |
$632.61 |
$1,709.75 |
5.8× |
| Us soft tissue head/neck (76536) |
$656.01 |
$1,773 |
6.0× |
| Us transrectal (76872) |
$750.36 |
$2,028 |
6.9× |
| Us transrectal prostate volume (76873) |
$1,963.78 |
$5,307.50 |
18.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$513.93 |
$1,389 |
4.7× |
| Venogram extremity bilateral (75822) |
$590.24 |
$1,595.25 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$581.83 |
$1,572.50 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,115.09 |
$3,013.75 |
0.3× |
| Venography caval superior serialography rs&i (75827) |
$1,312.11 |
$3,546.25 |
0.8× |
| Venography Renal Bilateral (75833) |
$4,043.45 |
$10,928.25 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$4,043.45 |
$10,928.25 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,854.36 |
$7,714.50 |
0.9× |
| Venous sampling by catheter (75893) |
$4,416.78 |
$11,937.25 |
0.8× |
| Wrist 2 views (73100) |
$210.62 |
$569.25 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$287.95 |
$778.25 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$948.87 |
$2,564.50 |
5.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$146.52 |
$396 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$197.30 |
$533.25 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$265.75 |
$718.25 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$256.32 |
$692.75 |
2.8× |
| X-ray eye for foreign body (70030) |
$130.98 |
$354 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$743.33 |
$2,009 |
4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$149.57 |
$404.25 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$236.43 |
$639 |
2.6× |
| X-ray leg, infant (73592) |
$110.08 |
$297.50 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$327.27 |
$884.50 |
3.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$474.43 |
$1,282.25 |
4.3× |
| X-ray nose-rectum child f.b. (76010) |
$199.71 |
$539.75 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$180.65 |
$488.25 |
1.7× |
| X-ray retrograde pyelogram (74420) |
$555.83 |
$1,502.25 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300.62 |
$812.50 |
3.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$272.04 |
$735.25 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$496.08 |
$1,340.75 |
4.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$207.57 |
$561 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$263.44 |
$712 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$267.14 |
$722 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$302.29 |
$817 |
3.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$307.01 |
$829.75 |
3.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$259.09 |
$700.25 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$124.51 |
$336.50 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$148.83 |
$402.25 |
1.4× |
| Xr bone length studies (77073) |
$273.62 |
$739.50 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$440.39 |
$1,190.25 |
4.0× |
| Xr c-spine 6 or more views (72052) |
$478.69 |
$1,293.75 |
4.4× |
| Xr chest 4+ views (71048) |
$214.23 |
$579 |
2.0× |
| Xr urogram antegrade (74425) |
$588.49 |
$1,590.50 |
1.6× |