| Abdomen 2 views (74019) |
$155.23 |
$539 |
1.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$610.10 |
$1,943 |
1.4× |
| Acute venous thrombus image (78456) |
$662.85 |
$2,111 |
0.5× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$895.02 |
$4,262 |
0.3× |
| Angiography extremity bilateral rs&i (75716) |
$1,766.73 |
$8,413 |
0.5× |
| Angiography extremity unilateral rs&i (75710) |
$1,704.99 |
$8,119 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$624.75 |
$2,975 |
0.2× |
Angiography pelvic slctv/supraslctv rs&i (75736)
likely a partial charge, not the full procedure |
$1,262.52 |
$6,012 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,178.10 |
$5,610 |
0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,048.53 |
$4,993 |
0.3× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,227.45 |
$5,845 |
0.2× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,623.72 |
$7,732 |
0.3× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$455.28 |
$2,168 |
0.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,033.83 |
$4,923 |
0.3× |
| Ankle 2 views (73600) |
$97.63 |
$339 |
1.1× |
| Antegrade urography radiological supvj & interpj (74425) |
$389.66 |
$1,353 |
1.0× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,068.69 |
$5,089 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,216.32 |
$5,792 |
0.4× |
| Aortography abdominal serialography rs&i (75625) |
$1,033.83 |
$4,923 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$828.45 |
$3,945 |
0.2× |
| Arthrogram elbow (73085) |
$115.60 |
$1,101 |
0.3× |
| Arthrogram hip (73525) |
$130.20 |
$1,240 |
0.3× |
| Arthrogram shoulder (73040) |
$115.60 |
$1,101 |
0.3× |
| Arthrogram wrist (73115) |
$114.45 |
$1,090 |
0.3× |
| Arthrography knee lt (73580) |
$115.60 |
$1,101 |
0.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$570.22 |
$1,816 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$837.75 |
$2,668 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$1,138.25 |
$3,625 |
2.7× |
| Bone age studies (77072) |
$95.90 |
$333 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$1,309.07 |
$4,169 |
3.1× |
| Bone Marrow Imaging Limited Area (78102) |
$499.26 |
$1,590 |
1.2× |
| Bone survey complete (77075) |
$158.11 |
$549 |
1.4× |
| Brain image w/flow 4 + views (78606) |
$726.60 |
$2,314 |
1.3× |
| Brain imaging < 4 static views (78600) |
$325.62 |
$1,037 |
0.8× |
| Brain imaging < 4 static views w vascular flow (78601) |
$383.71 |
$1,222 |
0.9× |
| Brain Imaging Minimum 4 Static Views (78605) |
$348.85 |
$1,111 |
0.6× |
| Brain Imaging Vascular Flow Only (78610) |
$415.11 |
$1,322 |
0.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$393.76 |
$1,254 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$459.32 |
$2,595 |
1.2× |
| Cardiac shunt detection (78428) |
$366.44 |
$1,167 |
0.9× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$474.14 |
$1,510 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$106.56 |
$370 |
1.1× |
| Chest 1 view (71045) |
$62.56 |
$272 |
0.7× |
| Chest 3 views (71047) |
$84.18 |
$366 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$178.27 |
$619 |
1.0× |
| Clavicle complete (73000) |
$92.16 |
$320 |
1.0× |
| Corpora cavernosography (74445) |
$235.58 |
$818 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$596.60 |
$3,800 |
1.6× |
| CT abdomen and pelvis without contrast (74176) |
$397.68 |
$2,533 |
1.6× |
| CT abdomen w contrast (74160) |
$349.32 |
$2,225 |
1.9× |
| CT abdomen w wo contrast (74170) |
$419.19 |
$2,670 |
2.2× |
| CT abdomen w/o contrast (74150) |
$279.46 |
$1,780 |
2.5× |
| CT angio hrt w/3d image (75574) |
$408.97 |
$2,509 |
1.1× |
| CT angiography upper extremity lt (73206) |
$425.94 |
$2,713 |
2.3× |
| CT c-spine w/o contrast (72125) |
$414.79 |
$2,642 |
3.7× |
| CT cervical spine w&w/o contrast (72127) |
$622.19 |
$3,963 |
3.3× |
| CT cervical spine with contrast (72126) |
$518.57 |
$3,303 |
1.4× |
| CT chest w/wo contrast (71270) |
$552.80 |
$3,521 |
3.0× |
| CT chest with contrast (71260) |
$460.64 |
$2,934 |
2.5× |
| CT head/brain with contrast (70460) |
$339.51 |
$2,033 |
1.8× |
| CT head/brain without and with contrast (70470) |
$407.31 |
$2,439 |
2.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$372.13 |
$2,283 |
1.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$421.84 |
$2,588 |
4.5× |
| CT hrt w/3d image congen (75573) |
$389.41 |
$2,389 |
1.0× |
| CT iac w contrast (70481) |
$397.79 |
$2,382 |
2.1× |
| CT limited/localized follow up study (76380) |
$95.52 |
$586 |
1.0× |
| CT lower ext w/o (73700) |
$256.22 |
$1,632 |
2.3× |
| CT lower extremity w wo contrast (73702) |
$384.34 |
$2,448 |
2.1× |
| CT lower extremity with contrast (73701) |
$320.28 |
$2,040 |
1.7× |
| CT lumbar spine w & w/o contrast (72133) |
$610.73 |
$3,890 |
3.3× |
| CT lumbar spine w/o contrast (72131) |
$407.10 |
$2,593 |
3.6× |
| CT lumbar spine with contrast (72132) |
$508.99 |
$3,242 |
1.4× |
| CT maxillofacial w contrast (70487) |
$317.97 |
$1,904 |
1.7× |
| CT maxillofacial w/o contrast (70486) |
$254.34 |
$1,523 |
2.3× |
| CT maxillofacial w/wo contrast (70488) |
$381.60 |
$2,285 |
2.0× |
| CT neck soft tissue w contrast (70491) |
$310.12 |
$1,857 |
1.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$477.29 |
$2,858 |
2.6× |
| CT orbits w/o contrast (70480) |
$318.14 |
$1,905 |
2.9× |
| CT pelvis w & w/o contrast (72194) |
$460.95 |
$2,936 |
2.5× |
| CT pelvis w/o contrast (72192) |
$307.25 |
$1,957 |
2.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$372.08 |
$2,228 |
2.0× |
| CT soft tissue neck w/o contrast (70490) |
$248 |
$1,485 |
2.2× |
| CT thoracic spine w/contrast (72129) |
$516.37 |
$3,289 |
2.8× |
| CT thoracic spine w/o contrast (72128) |
$413.07 |
$2,631 |
3.7× |
| CT thoracic spine w/wo contrast (72130) |
$619.68 |
$3,947 |
3.3× |
| CT thorax w/o contrast (71250) |
$368.48 |
$2,347 |
3.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$405.53 |
$2,583 |
2.2× |
| CT upper extremity w/o contrast rt (73200) |
$270.35 |
$1,722 |
2.4× |
| CT upper extremity with contrast (73201) |
$338.02 |
$2,153 |
0.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$398.70 |
$2,446 |
2.1× |
| Cta Abdomen (74175) |
$440.23 |
$2,804 |
2.4× |
| CTA abdomen pelvis (74174) |
$626.43 |
$3,990 |
1.7× |
| CTA chest (71275) |
$580.59 |
$3,698 |
3.1× |
| Cta Head (70496) |
$427.69 |
$2,561 |
2.3× |
| CTA lwr ext w&w/o contrast (73706) |
$403.65 |
$2,571 |
2.2× |
| Cta Neck (70498) |
$390.78 |
$2,340 |
2.1× |
| Cta Pelvis (72191) |
$484.03 |
$3,083 |
2.6× |
| Cystography minimum 3 views rs&i (74430) |
$293.18 |
$1,018 |
0.8× |
| Diskogram cervical (72285) |
$1,023.55 |
$3,554 |
0.5× |
| Diskography lumbar (72295) |
$1,034.50 |
$3,592 |
0.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$192.96 |
$603 |
1.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$245.76 |
$768 |
2.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$127.68 |
$399 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$127.30 |
$442 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$77.76 |
$270 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$102.82 |
$357 |
0.9× |
| Echo exam of fetal heart (76825) |
$462.40 |
$1,445 |
0.8× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$220.16 |
$688 |
0.9× |
| Echoencephalography real time imaging (76506) |
$237.44 |
$742 |
2.1× |
| Esophageal motility (78258) |
$468.17 |
$1,491 |
1.1× |
| Esophagus (74220) |
$153.79 |
$534 |
0.8× |
| Fetal biophysical profile non-stress testing (76818) |
$311.36 |
$973 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$203.52 |
$636 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$198.14 |
$688 |
0.8× |
| Foot 2 views (73620) |
$89.86 |
$312 |
1.0× |
| Forearm 2 views (73090) |
$93.60 |
$325 |
1.0× |
| Functional MRI brain by tech (70554) |
$457.19 |
$2,583 |
1.8× |
| Gated Heart Planar Single (78472) |
$824.56 |
$2,626 |
1.9× |
| Hand 2 views (73120) |
$93.89 |
$326 |
0.8× |
| Hand 3 views (73130) |
$103.68 |
$360 |
1.1× |
| Heart Infarct Image (78466) |
$532.86 |
$1,697 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$1,430.78 |
$4,968 |
0.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$566.14 |
$1,803 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$460.95 |
$1,468 |
1.1× |
| Ht muscle image spect sing (78451) |
$1,118.15 |
$3,561 |
0.8× |
| Humerus Min 2 Views Left (73060) |
$101.38 |
$352 |
1.1× |
| Hysterosalpingogram (74740) |
$198.14 |
$688 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$723.14 |
$2,303 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$547.93 |
$1,745 |
0.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$854.71 |
$2,722 |
1.5× |
| Knee 3 views (73562) |
$115.20 |
$400 |
1.2× |
| Liver & spleen imaging static only (78215) |
$459.70 |
$1,464 |
1.1× |
| Liver imaging static only (78201) |
$501.77 |
$1,598 |
0.9× |
| Liver imaging w/vascular flow (78202) |
$541.96 |
$1,726 |
0.9× |
| Lung perf&ventilat diferentl (78598) |
$578.39 |
$1,842 |
1.0× |
| Lung perfusion differential (78597) |
$499.26 |
$1,590 |
1.2× |
| Lung Ventilation Imaging (78579) |
$386.85 |
$1,232 |
0.9× |
| Lymphoscintigraphy (78195) |
$676.36 |
$2,154 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$299.23 |
$1,039 |
1.2× |
| Mammary ductogram or galactogram single (77053) |
$230.11 |
$799 |
0.9× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$90.72 |
$315 |
1.0× |
| Meckels Diverticulum (78290) |
$557.35 |
$1,775 |
1.3× |
| Mr safety determination physician/other qhp (76016) |
$38.88 |
$135 |
0.4× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$83.52 |
$290 |
1.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$11.52 |
$40 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$59.62 |
$207 |
0.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$156.67 |
$544 |
0.6× |
| MRA head w & w/o contrast (70546) |
$566.89 |
$3,258 |
1.5× |
| MRA head w/o contrast (70544) |
$377.93 |
$2,172 |
1.5× |
| MRA head with contrast (70545) |
$472.41 |
$2,715 |
1.3× |
| MRA neck w contrast (70548) |
$389.59 |
$2,239 |
1.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$467.54 |
$2,687 |
1.3× |
| MRA neck w/o contrast (70547) |
$311.63 |
$1,791 |
1.2× |
| MRI abdomen w contrast (74182) |
$466.93 |
$2,638 |
1.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$560.20 |
$3,165 |
1.5× |
| MRI abdomen w/o contrast (74181) |
$373.47 |
$2,110 |
1.5× |
| MRI any jnt lwr ext with con lt (73722) |
$526.40 |
$2,974 |
0.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$538.96 |
$3,045 |
0.6× |
| MRI bone marrow blood supply (77084) |
$321.79 |
$1,818 |
1.3× |
| MRI breast w/o contrast bilateral (77047) |
$516.13 |
$2,916 |
2.0× |
| MRI breast w/o contrast unilat (77046) |
$344.09 |
$1,944 |
1.4× |
| MRI c-spine with contrast (72142) |
$379.64 |
$3,013 |
1.0× |
| MRI cardiac w/o cont stress (75559) |
$429.05 |
$2,424 |
0.7× |
| MRI cardiac w/o contrast (75557) |
$306.21 |
$1,730 |
1.2× |
| MRI cervical spine w/o contrast (72141) |
$303.66 |
$2,410 |
1.2× |
| MRI chest w/o & w/contrast material (71552) |
$453.47 |
$2,562 |
1.2× |
| MRI chest w/o contrast (71550) |
$302.32 |
$1,708 |
1.2× |
| MRI chest with contrast (71551) |
$377.90 |
$2,135 |
0.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$366.04 |
$2,068 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$461.79 |
$2,609 |
1.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$369.40 |
$2,087 |
1.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$337.64 |
$2,034 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$506.47 |
$3,051 |
1.4× |
| MRI orbit/face/neck w/contrast (70542) |
$422.14 |
$2,543 |
1.1× |
| MRI pelvis w contrast (72196) |
$439.49 |
$2,483 |
1.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$527.28 |
$2,979 |
1.4× |
| MRI pelvis w/o contrast (72195) |
$351.52 |
$1,986 |
1.4× |
| MRI scan of arm joint before and after contrast (73223) |
$646.76 |
$3,654 |
1.7× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$643.57 |
$3,636 |
0.8× |
| MRI scan of leg joint before and after contrast (73723) |
$631.71 |
$3,569 |
1.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$455.49 |
$3,615 |
1.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$380.77 |
$3,022 |
1.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$456.88 |
$3,626 |
1.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$378.63 |
$3,005 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$454.36 |
$3,606 |
1.2× |
| MRI thoracic spine w/o contrast (72146) |
$302.90 |
$2,404 |
1.2× |
| MRI tmj (70336) |
$292.94 |
$1,655 |
1.2× |
| MRI upper ext joint w/o contrast (73221) |
$431.17 |
$2,436 |
1.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$439.14 |
$2,481 |
1.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$292.76 |
$1,654 |
1.1× |
| Myelogram Cervical (72240) |
$616.03 |
$2,139 |
0.7× |
| Myelogram Lumbar (72265) |
$616.03 |
$2,139 |
0.7× |
| Myelogram thoracic (72255) |
$616.61 |
$2,141 |
0.7× |
| Myelography 2 or more regions (72270) |
$778.46 |
$2,703 |
0.9× |
| Myocardial infarct spect (78469) |
$592.20 |
$1,886 |
1.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,347.37 |
$4,291 |
1.0× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$452.03 |
$4,566 |
0.5× |
| Neck soft tissue (70360) |
$88.99 |
$309 |
1.0× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$208.50 |
$664 |
0.5× |
| Nm bone marrow multiple (78103) |
$671.02 |
$2,137 |
1.6× |
| Nm bone marrow wb (78104) |
$776.52 |
$2,473 |
1.8× |
| Nm cisternogram (78630) |
$520.93 |
$1,659 |
0.9× |
| Nm csf leak detection (78650) |
$662.85 |
$2,111 |
0.5× |
| Nm gastric emptying study (78264) |
$586.55 |
$1,868 |
1.4× |
| Nm gastroesophageal reflux study (78262) |
$610.73 |
$1,945 |
1.4× |
| Nm peritoneal-venous shunt patency (78291) |
$387.79 |
$1,235 |
0.9× |
| Nuclear medicine of heart pumping function (78473) |
$1,038.08 |
$3,306 |
2.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$632.08 |
$2,013 |
1.5× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$540.39 |
$1,721 |
0.9× |
| Nuclear Rx Oral Admin (79005) |
$251.16 |
$1,794 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$162.56 |
$508 |
1.5× |
| Osseous survey infant (77076) |
$303.26 |
$1,053 |
2.7× |
| Osseous survey limited (77074) |
$118.94 |
$413 |
1.1× |
| Parathyrd planar w/spect&CT (78072) |
$854.39 |
$2,721 |
1.5× |
| Parathyrd planar w/wo subtrj (78071) |
$696.77 |
$2,219 |
1.6× |
| Parathyroid imaging (78070) |
$610.10 |
$1,943 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$102.53 |
$356 |
0.9× |
| Peritoneogram rs&i (74190) |
$238.18 |
$827 |
0.4× |
| Pr heart first pass single,planar (78481) |
$451.22 |
$1,437 |
0.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$554.19 |
$3,131 |
1.5× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,417.82 |
$4,923 |
0.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$842.98 |
$2,927 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$490.15 |
$1,561 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$582.47 |
$1,855 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$305.86 |
$1,062 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$103.68 |
$360 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$169.92 |
$590 |
1.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$93.89 |
$326 |
0.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$240.77 |
$836 |
2.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$234.43 |
$814 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$112.03 |
$389 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$127.30 |
$442 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$179.14 |
$622 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$75.44 |
$328 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$270.14 |
$938 |
1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$164.45 |
$571 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$177.12 |
$615 |
0.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$174.53 |
$606 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$106.56 |
$370 |
1.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$67.68 |
$235 |
0.7× |
| Radiological examination surgical specimen (76098) |
$148.03 |
$514 |
0.3× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$336.28 |
$2,402 |
1.4× |
| Review by radiologist of adrenal gland vein image (75840) |
$1,025.28 |
$3,560 |
0.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$1,417.82 |
$4,923 |
0.4× |
| Ribs bilateral 3 views (71110) |
$97.63 |
$339 |
0.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$377.11 |
$1,201 |
0.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$515.27 |
$1,641 |
0.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$646.84 |
$2,060 |
1.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,184.09 |
$3,771 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,534.83 |
$4,888 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$801.01 |
$2,551 |
0.6× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$353.22 |
$2,523 |
1.4× |
| Rp Therapy Intravenous Administration (79101) |
$262.64 |
$1,876 |
1.1× |
| Sacroiliac Joints < 3 Views (72200) |
$93.89 |
$326 |
0.8× |
| Salivary gland function study (78232) |
$411.97 |
$1,312 |
1.0× |
| Salivary gland imaging (78230) |
$533.49 |
$1,699 |
1.3× |
| Salivary gland imaging serial images (78231) |
$321.22 |
$1,023 |
0.8× |
| Scanogram (77073) |
$110.30 |
$383 |
1.0× |
| Scapula complete (73010) |
$104.54 |
$363 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$20.18 |
$52 |
0.9× |
| Sella turcica (70240) |
$98.50 |
$342 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$93.89 |
$326 |
0.8× |
| Sialogram (70390) |
$198.14 |
$688 |
0.8× |
| Small bowel series (74250) |
$158.11 |
$549 |
0.8× |
| Spine thoracic 3 views (72072) |
$108.29 |
$376 |
1.0× |
| Spleen imaging only (78185) |
$319.97 |
$1,019 |
0.8× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$115.82 |
$1,103 |
0.5× |
| Testicular Imaging With Vascular Flow (78761) |
$463.15 |
$1,475 |
1.1× |
| Therapeutic Enema (74283) |
$386.50 |
$1,342 |
2.1× |
| Thoracolumbar 2 views (72080) |
$98.50 |
$342 |
1.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$812 |
$2,586 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$333.15 |
$1,061 |
0.8× |
| Thyroid uptake measurement (78012) |
$192.48 |
$613 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$520.61 |
$1,658 |
1.2× |
| Tmj unilateral (70328) |
$92.16 |
$320 |
1.0× |
| Tomogram (76100) |
$231.26 |
$803 |
2.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,096.17 |
$3,491 |
1.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$342.26 |
$1,090 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$210.56 |
$658 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$124.80 |
$390 |
1.1× |
| Upper Extremity Infant (73092) |
$150.62 |
$523 |
1.4× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$517.79 |
$1,649 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$305.86 |
$1,062 |
1.2× |
| Urethrocystography voiding (74455) |
$198.14 |
$688 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$436.32 |
$1,515 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$127.36 |
$398 |
1.1× |
| Us breast unilateral complete (76641) |
$134.40 |
$420 |
1.2× |
| Us breast unilateral limited (76642) |
$103.36 |
$323 |
1.1× |
| Us chest (76604) |
$141.12 |
$441 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$149.76 |
$468 |
1.3× |
| Us guided compression repair (76936) |
$200.32 |
$626 |
0.9× |
| Us infant hips dynamic (76885) |
$179.84 |
$562 |
1.9× |
| Us infant hips limited static (76886) |
$131.52 |
$411 |
1.4× |
| Us kidney transplant (76776) |
$178.56 |
$558 |
1.6× |
| Us ob transvaginal (76817) |
$183.68 |
$574 |
1.6× |
| Us pelvic non ob complete (76856) |
$247.68 |
$774 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$209.28 |
$654 |
1.9× |
| Us pregnancy ltd (76815) |
$161.60 |
$505 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$171.20 |
$535 |
1.5× |
| Us retroperitoneal complete (76770) |
$217.28 |
$679 |
1.9× |
| Us retroperitoneal limited (76775) |
$140.16 |
$438 |
1.3× |
| Us scrotum and contents (76870) |
$228.48 |
$714 |
2.0× |
| Us soft tissue head/neck (76536) |
$189.12 |
$591 |
1.7× |
| Us spinal canal and contents (76800) |
$250.88 |
$784 |
2.2× |
| Us transrectal (76872) |
$173.44 |
$542 |
1.6× |
| Us transrectal prostate volume (76873) |
$168.96 |
$528 |
1.5× |
| Us xtr non-vasc lmtd (76882) |
$107.84 |
$337 |
1.0× |
| Vascular flow imaging (78445) |
$284.17 |
$905 |
0.7× |
| Venogram extremity bilateral (75822) |
$657.22 |
$2,282 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$1,417.82 |
$4,923 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$369.22 |
$1,282 |
0.2× |
| Venography epidural rs&i (75872) |
$793.73 |
$2,756 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$561.60 |
$1,950 |
0.3× |
| Venography Renal Bilateral (75833) |
$1,265.18 |
$4,393 |
0.4× |
| Venography renal unilateral selective rs&i (75831) |
$1,054.08 |
$3,660 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,180.51 |
$4,099 |
0.4× |
Venous sampling thru cath w/wo angiography rs& (75893)
likely a partial charge, not the full procedure |
$1,341.50 |
$4,658 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$77.76 |
$270 |
0.8× |
| Wrist 2 views (73100) |
$85.54 |
$297 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$207.07 |
$719 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$86.69 |
$301 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$107.42 |
$373 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$300.67 |
$1,044 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$97.63 |
$339 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$105.98 |
$368 |
1.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$196.99 |
$684 |
1.8× |
| X-ray exam hip uni 1 view (73501) |
$75.17 |
$261 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$91.30 |
$317 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$113.18 |
$393 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$108.58 |
$377 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$127.87 |
$444 |
1.1× |
| X-ray exam of femur 1 (73551) |
$69.70 |
$242 |
0.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$569.09 |
$1,976 |
3.0× |
| X-ray eye for foreign body (70030) |
$69.70 |
$242 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$101.09 |
$351 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$91.58 |
$318 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$105.98 |
$368 |
1.1× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$737.86 |
$2,562 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$82.66 |
$287 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$98.50 |
$342 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$129.02 |
$448 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$114.05 |
$396 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$135.65 |
$471 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$127.01 |
$441 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$171.65 |
$596 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$86.69 |
$301 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$97.34 |
$338 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$124.70 |
$433 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$127.01 |
$441 |
1.1× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$403.78 |
$1,402 |
0.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$317.09 |
$1,101 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$83.23 |
$289 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$95.33 |
$331 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$133.06 |
$462 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$104.26 |
$362 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$104.54 |
$363 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$111.74 |
$388 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$97.63 |
$339 |
1.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$82.08 |
$285 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$123.84 |
$430 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$97.34 |
$338 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$69.98 |
$243 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$121.82 |
$423 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$95.62 |
$332 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$93.89 |
$326 |
0.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$116.06 |
$403 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$72.29 |
$251 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$101.95 |
$354 |
1.1× |
| Xr arthrogram ankle (73615) |
$115.60 |
$1,101 |
0.3× |
| Xr c-spine 6 or more views (72052) |
$154.37 |
$536 |
1.4× |
| Xr chest 4+ views (71048) |
$101.89 |
$443 |
0.9× |
| Xr Cholecystography Oral Contrast (74290) |
$212.26 |
$737 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$74.88 |
$260 |
0.8× |
| Xr internal auditory meati complete (70134) |
$163.30 |
$567 |
0.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$147.74 |
$513 |
1.3× |
| Xr myelogram posterior fossa (70010) |
$156.67 |
$544 |
0.4× |
| Xr optic foramina (70190) |
$120.38 |
$418 |
1.3× |
| Xr shoulder 1 view (73020) |
$80.35 |
$279 |
0.9× |
| Xr spine cervical 4 or 5 views (72050) |
$115.78 |
$402 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$91.01 |
$316 |
1.0× |
| Xr tmj bilateral (70330) |
$113.18 |
$393 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$97.92 |
$340 |
1.1× |