| Abdomen 2 views (74019) |
$171.20 |
$171.20 |
1.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$236.45 |
$236.45 |
0.6× |
| Acute venous thrombus image (78456) |
$4,898.30 |
$4,898.30 |
3.8× |
| Ankle 2 views (73600) |
$137.41 |
$137.41 |
1.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$1,469.60 |
$1,469.60 |
4.2× |
| Arthrography knee lt (73580) |
$637.95 |
$637.95 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$849.02 |
$849.02 |
2.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,416.80 |
$1,416.80 |
3.5× |
| Bone &/joint imaging whole body (78306) |
$1,220.42 |
$1,220.42 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$1,420.05 |
$1,420.05 |
3.5× |
| Bone Marrow Imaging Limited Area (78102) |
$1,416.80 |
$1,416.80 |
3.5× |
| Bone survey complete (77075) |
$431.20 |
$431.20 |
4.1× |
| Brain image w/flow 4 + views (78606) |
$1,817.20 |
$1,817.20 |
3.3× |
| Brain imaging < 4 static views (78600) |
$1,416.80 |
$1,416.80 |
3.5× |
| Brain imaging < 4 static views w vascular flow (78601) |
$1,416.80 |
$1,416.80 |
3.5× |
| Brain Imaging Minimum 4 Static Views (78605) |
$1,817.20 |
$1,817.20 |
3.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,922.06 |
$4,922.06 |
3.4× |
| Brain Imaging Vascular Flow Only (78610) |
$1,817.20 |
$1,817.20 |
3.3× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$36.49 |
$36.49 |
3.3× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$1,416.80 |
$1,416.80 |
3.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,469.60 |
$1,469.60 |
4.2× |
| Cardiac shunt detection (78428) |
$1,416.80 |
$1,416.80 |
3.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,817.20 |
$1,817.20 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$189.77 |
$189.77 |
2.2× |
| Chest 1 view (71045) |
$114.57 |
$114.57 |
1.3× |
| Chest 3 views (71047) |
$184.97 |
$184.97 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$443.56 |
$443.56 |
2.5× |
| Clavicle complete (73000) |
$122.15 |
$122.15 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,499.19 |
$1,499.19 |
4.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,237.50 |
$1,237.50 |
5.2× |
| CT abdomen w contrast (74160) |
$1,614.84 |
$1,614.84 |
9.2× |
| CT abdomen w wo contrast (74170) |
$1,946.86 |
$1,946.86 |
11.0× |
| CT abdomen w/o contrast (74150) |
$1,194.55 |
$1,194.55 |
11.4× |
| CT angio hrt w/3d image (75574) |
$2,643.85 |
$2,643.85 |
7.5× |
| CT angiography upper extremity lt (73206) |
$1,882.59 |
$1,882.59 |
10.7× |
| CT c-spine w/o contrast (72125) |
$1,179.72 |
$1,179.72 |
11.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,318.50 |
$1,318.50 |
7.5× |
| CT cervical spine with contrast (72126) |
$1,117.55 |
$1,117.55 |
3.2× |
| CT chest w/wo contrast (71270) |
$893.09 |
$893.09 |
5.1× |
| CT chest with contrast (71260) |
$431.20 |
$431.20 |
2.4× |
| CT colonography screening (74263) |
$369.60 |
$369.60 |
1.5× |
| CT colonography w/dye (74262) |
$2,031.39 |
$2,031.39 |
11.5× |
| CT colonography w/o cntrst (74261) |
$1,493.58 |
$1,493.58 |
14.2× |
| CT head/brain with contrast (70460) |
$1,238.77 |
$1,238.77 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,498.77 |
$1,498.77 |
8.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$701.80 |
$701.80 |
2.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$357.10 |
$357.10 |
4.1× |
| CT hrt w/3d image congen (75573) |
$701.80 |
$701.80 |
2.0× |
| CT iac w contrast (70481) |
$1,766.99 |
$1,766.99 |
10.0× |
| CT limited/localized follow up study (76380) |
$780.86 |
$780.86 |
8.9× |
| CT lower ext w/o (73700) |
$1,179.64 |
$1,179.64 |
11.2× |
| CT lower extremity w wo contrast (73702) |
$1,861.68 |
$1,861.68 |
10.6× |
| CT lower extremity with contrast (73701) |
$1,461.02 |
$1,461.02 |
8.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,049.86 |
$1,049.86 |
6.0× |
| CT lumbar spine w/o contrast (72131) |
$1,179.72 |
$1,179.72 |
11.2× |
| CT lumbar spine with contrast (72132) |
$1,500.35 |
$1,500.35 |
4.3× |
| CT maxillofacial w contrast (70487) |
$821.52 |
$821.52 |
4.7× |
| CT maxillofacial w/o contrast (70486) |
$1,207.71 |
$1,207.71 |
11.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,207.71 |
$1,207.71 |
6.9× |
| CT neck soft tissue w contrast (70491) |
$1,369.72 |
$1,369.72 |
7.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,967.76 |
$1,967.76 |
11.2× |
| CT orbits w/o contrast (70480) |
$1,242.12 |
$1,242.12 |
11.8× |
| CT pelvis w & w/o contrast (72194) |
$1,822.39 |
$1,822.39 |
10.3× |
| CT pelvis w/o contrast (72192) |
$1,174.96 |
$1,174.96 |
11.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$306.90 |
$306.90 |
3.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$701.80 |
$701.80 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,242.12 |
$1,242.12 |
11.8× |
| CT thoracic spine w/contrast (72129) |
$1,503.61 |
$1,503.61 |
8.5× |
| CT thoracic spine w/o contrast (72128) |
$1,179.72 |
$1,179.72 |
11.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,320.22 |
$1,320.22 |
7.5× |
| CT thorax w/o contrast (71250) |
$606.03 |
$606.03 |
5.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,851.87 |
$1,851.87 |
10.5× |
| CT upper extremity w/o contrast rt (73200) |
$1,179.64 |
$1,179.64 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,447.95 |
$1,447.95 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,211.13 |
$2,211.13 |
12.5× |
| Cta Abdomen (74175) |
$2,091.18 |
$2,091.18 |
11.9× |
| CTA abdomen pelvis (74174) |
$1,674.59 |
$1,674.59 |
4.8× |
| CTA chest (71275) |
$1,476.42 |
$1,476.42 |
8.4× |
| Cta Head (70496) |
$2,053.48 |
$2,053.48 |
11.7× |
| CTA lwr ext w&w/o contrast (73706) |
$2,089.64 |
$2,089.64 |
11.9× |
| Cta Neck (70498) |
$2,053.48 |
$2,053.48 |
11.7× |
| Cta Pelvis (72191) |
$701.80 |
$701.80 |
4.0× |
| Cystography minimum 3 views rs&i (74430) |
$294.58 |
$294.58 |
0.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$431.20 |
$431.20 |
4.1× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$431.20 |
$431.20 |
4.1× |
| Echo exam of eye (76529) |
$306.90 |
$306.90 |
3.5× |
| Echoencephalography real time imaging (76506) |
$431.20 |
$431.20 |
4.1× |
| Esophageal motility (78258) |
$1,416.80 |
$1,416.80 |
3.5× |
| Esophagus (74220) |
$436.92 |
$436.92 |
2.5× |
| Foot 2 views (73620) |
$306.90 |
$306.90 |
3.5× |
| Forearm 2 views (73090) |
$135.82 |
$135.82 |
1.6× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,817.20 |
$1,817.20 |
3.3× |
| Gastric mucosa imaging (78261) |
$1,416.80 |
$1,416.80 |
3.5× |
| Gastrointestinal Protein Loss (78282) |
$1,416.80 |
$1,416.80 |
3.5× |
| Gated Heart Planar Single (78472) |
$1,416.80 |
$1,416.80 |
3.5× |
| Hand 2 views (73120) |
$134.15 |
$134.15 |
1.3× |
| Hand 3 views (73130) |
$155.40 |
$155.40 |
1.8× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$2,851.20 |
$2,851.20 |
4.1× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$2,851.20 |
$2,851.20 |
4.1× |
| Hdr rdncl ntrstl/intrcav brachytx >12 channels (77772) |
$2,851.20 |
$2,851.20 |
4.1× |
| Hdr rdncl sk srf brchytx les >2cm&2chan/mlt les (77768) |
$909.70 |
$909.70 |
2.3× |
| Hdr rdncl skn surf brachytx les </2cm/1 chan (77767) |
$909.70 |
$909.70 |
2.3× |
| Heart Infarct Image (78466) |
$1,416.80 |
$1,416.80 |
3.5× |
| Heart infarct image w ef (78468) |
$1,817.20 |
$1,817.20 |
3.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,920.27 |
$1,920.27 |
3.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,402.36 |
$1,402.36 |
3.5× |
| Ht muscle image spect sing (78451) |
$1,642.78 |
$1,642.78 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$142.34 |
$142.34 |
1.6× |
| Interstitial radiation source applic complex (77778) |
$2,851.20 |
$2,851.20 |
4.1× |
| Intracavitary Radiation Source Applic Complex (77763) |
$2,851.20 |
$2,851.20 |
4.1× |
| Intracavitary Radiation Source Applic Intermed (77762) |
$2,074.60 |
$2,074.60 |
3.7× |
| Intracavitary radiation source applic simple (77761) |
$2,074.60 |
$2,074.60 |
3.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$165 |
$165 |
1.6× |
| Kidney funcj study non-img radioisotopic study (78725) |
$1,416.80 |
$1,416.80 |
3.5× |
| Kidney imaging morphology (78700) |
$1,416.80 |
$1,416.80 |
3.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,817.20 |
$1,817.20 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,817.20 |
$1,817.20 |
3.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,765.36 |
$1,765.36 |
3.2× |
| Knee 3 views (73562) |
$129.14 |
$129.14 |
1.5× |
| Liver & spleen imaging static only (78215) |
$1,416.80 |
$1,416.80 |
3.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,416.80 |
$1,416.80 |
3.5× |
| Liver imaging static only (78201) |
$4,898.30 |
$4,898.30 |
9.0× |
| Liver imaging w/vascular flow (78202) |
$4,898.30 |
$4,898.30 |
9.0× |
| Lung perf&ventilat diferentl (78598) |
$1,817.20 |
$1,817.20 |
3.3× |
| Lung perfusion differential (78597) |
$1,416.80 |
$1,416.80 |
3.5× |
| Lung Ventilation Imaging (78579) |
$1,416.80 |
$1,416.80 |
3.5× |
| Lymphoscintigraphy (78195) |
$1,817.20 |
$1,817.20 |
3.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$237.21 |
$237.21 |
2.7× |
| Meckels Diverticulum (78290) |
$1,416.80 |
$1,416.80 |
3.5× |
| Mr elastography (76391) |
$897.60 |
$897.60 |
3.7× |
| MRA head w & w/o contrast (70546) |
$2,970.35 |
$2,970.35 |
8.5× |
| MRA head w/o contrast (70544) |
$1,940.09 |
$1,940.09 |
8.1× |
| MRA head with contrast (70545) |
$2,391.35 |
$2,391.35 |
6.8× |
| MRA neck w contrast (70548) |
$2,391.35 |
$2,391.35 |
6.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,001.81 |
$3,001.81 |
8.6× |
| MRA neck w/o contrast (70547) |
$1,923.15 |
$1,923.15 |
8.0× |
| MRI abdomen w contrast (74182) |
$2,519.39 |
$2,519.39 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,110.18 |
$3,110.18 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$5,300.94 |
$5,300.94 |
22.1× |
| MRI any jnt lwr ext with con lt (73722) |
$1,862.87 |
$1,862.87 |
2.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,847.60 |
$1,847.60 |
2.3× |
| MRI bone marrow blood supply (77084) |
$897.60 |
$897.60 |
3.7× |
| MRI breast w/o contrast bilateral (77047) |
$897.60 |
$897.60 |
3.7× |
| MRI breast w/o contrast unilat (77046) |
$897.60 |
$897.60 |
3.7× |
| MRI c-spine with contrast (72142) |
$2,565.37 |
$2,565.37 |
7.3× |
| MRI cardiac w/o cont stress (75559) |
$1,854.60 |
$1,854.60 |
3.4× |
| MRI cardiac w/o contrast (75557) |
$897.60 |
$897.60 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$2,036.89 |
$2,036.89 |
8.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,469.60 |
$1,469.60 |
4.2× |
| MRI chest w/o contrast (71550) |
$897.60 |
$897.60 |
3.7× |
| MRI chest with contrast (71551) |
$2,219.58 |
$2,219.58 |
2.8× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,970.10 |
$1,970.10 |
5.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,974.41 |
$1,974.41 |
5.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,976.17 |
$1,976.17 |
8.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,330.89 |
$1,330.89 |
5.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,469.60 |
$1,469.60 |
4.2× |
| MRI orbit/face/neck w/contrast (70542) |
$1,965.70 |
$1,965.70 |
5.6× |
| MRI pelvis w contrast (72196) |
$2,521.02 |
$2,521.02 |
7.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,111.81 |
$3,111.81 |
8.9× |
| MRI pelvis w/o contrast (72195) |
$2,337.80 |
$2,337.80 |
9.8× |
| MRI scan of arm joint before and after contrast (73223) |
$2,289.49 |
$2,289.49 |
6.5× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$2,621.30 |
$2,621.30 |
3.3× |
| MRI scan of leg joint before and after contrast (73723) |
$3,085.54 |
$3,085.54 |
8.8× |
| MRI spectroscopy (76390) |
$224.40 |
$224.40 |
2.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,190.48 |
$3,190.48 |
9.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,534.09 |
$2,534.09 |
7.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,141.20 |
$3,141.20 |
9.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,545.75 |
$2,545.75 |
7.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,190.48 |
$3,190.48 |
9.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,036.89 |
$2,036.89 |
8.5× |
| MRI tmj (70336) |
$1,562.39 |
$1,562.39 |
6.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,982.64 |
$1,982.64 |
8.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,437.64 |
$2,437.64 |
7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,776.58 |
$1,776.58 |
7.4× |
| Myelogram Cervical (72240) |
$700.61 |
$700.61 |
0.9× |
| Myelography 2 or more regions (72270) |
$1,039.45 |
$1,039.45 |
1.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,159.49 |
$5,159.49 |
4.0× |
| Myocardial infarct spect (78469) |
$4,898.30 |
$4,898.30 |
9.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,300.27 |
$2,300.27 |
1.8× |
| Neck soft tissue (70360) |
$134.15 |
$134.15 |
1.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$909.70 |
$909.70 |
2.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nm adrenal scan (78075) |
$4,898.30 |
$4,898.30 |
3.8× |
| Nm bone marrow multiple (78103) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nm bone marrow wb (78104) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nm cisternogram (78630) |
$1,817.20 |
$1,817.20 |
3.3× |
| Nm csf leak detection (78650) |
$4,898.30 |
$4,898.30 |
3.8× |
| Nm gastric emptying study (78264) |
$1,336.36 |
$1,336.36 |
3.3× |
| Nm gastroesophageal reflux study (78262) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nm peritoneal-venous shunt patency (78291) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nm red cell sequestration (78140) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nm whole blood volume (78122) |
$1,817.20 |
$1,817.20 |
3.3× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$5,840.23 |
$5,840.23 |
4.1× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$4,898.30 |
$4,898.30 |
3.8× |
| Nuclear medicine of heart pumping function (78473) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$1,817.20 |
$1,817.20 |
3.3× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$5,024.58 |
$5,024.58 |
3.5× |
| Nuclear medicine study of digestive tracts (78299) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine study of endocrine organs (78099) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$4,898.30 |
$4,898.30 |
3.8× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,416.80 |
$1,416.80 |
3.5× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$4,898.30 |
$4,898.30 |
9.0× |
| Nuclear Rx Oral Admin (79005) |
$914.10 |
$914.10 |
3.9× |
| Nuclr Rx Interstit Colloid (79300) |
$914.10 |
$914.10 |
3.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$460.51 |
$460.51 |
4.4× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$420.20 |
$420.20 |
3.1× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$431.20 |
$431.20 |
4.1× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$431.20 |
$431.20 |
4.1× |
| Parathyrd planar w/spect&CT (78072) |
$1,817.20 |
$1,817.20 |
3.3× |
| Parathyrd planar w/wo subtrj (78071) |
$1,416.80 |
$1,416.80 |
3.5× |
| Parathyroid imaging (78070) |
$1,416.80 |
$1,416.80 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$132.44 |
$132.44 |
1.3× |
| PET image w/CT, skull-thigh (78815) |
$589.33 |
$589.33 |
0.4× |
| PET imaging limited area chest head/neck (78811) |
$5,405.18 |
$5,405.18 |
4.2× |
| PET whole body (78813) |
$5,405.18 |
$5,405.18 |
3.8× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$4,898.30 |
$4,898.30 |
3.8× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$4,898.30 |
$4,898.30 |
3.8× |
| Platelet survival study (78191) |
$1,416.80 |
$1,416.80 |
3.5× |
| Pr csf ventriculography (78635) |
$1,817.20 |
$1,817.20 |
3.3× |
| Pr gi endoscopic ultrasound (76975) |
$535.34 |
$535.34 |
2.2× |
| Pr heart first pass single,planar (78481) |
$1,817.20 |
$1,817.20 |
3.3× |
| Pr MRI brain w/ dye (70558) |
$701.80 |
$701.80 |
4.0× |
| Pr MRI brain w/o & w/ dye (70559) |
$701.80 |
$701.80 |
4.0× |
| Pr MRI brain w/o dye (70557) |
$1,854.60 |
$1,854.60 |
3.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,453.30 |
$2,453.30 |
7.0× |
| Pr non-imaging heart function (78414) |
$1,817.20 |
$1,817.20 |
3.3× |
| Pr red cell survival study (78130) |
$1,416.80 |
$1,416.80 |
3.5× |
| Pr sono bone density measure,peripheral (76977) |
$431.20 |
$431.20 |
4.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,024.10 |
$1,024.10 |
2.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,817.20 |
$1,817.20 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$188.45 |
$188.45 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$303.16 |
$303.16 |
2.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$192.28 |
$192.28 |
1.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$393.62 |
$393.62 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$198.17 |
$198.17 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$139.39 |
$139.39 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$197.12 |
$197.12 |
1.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$149.99 |
$149.99 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$701.80 |
$701.80 |
4.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$701.80 |
$701.80 |
4.0× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$187.22 |
$187.22 |
0.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$672.18 |
$672.18 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$541.77 |
$541.77 |
3.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$187.30 |
$187.30 |
2.1× |
| Radiopharm Dacryocystography (78660) |
$1,416.80 |
$1,416.80 |
3.5× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$914.10 |
$914.10 |
3.9× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$914.10 |
$914.10 |
3.9× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$914.10 |
$914.10 |
3.9× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$1,416.80 |
$1,416.80 |
3.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$1,817.20 |
$1,817.20 |
3.3× |
| Ribs bilateral 3 views (71110) |
$396.08 |
$396.08 |
3.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,416.80 |
$1,416.80 |
3.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,898.30 |
$4,898.30 |
9.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,898.30 |
$4,898.30 |
9.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$914.10 |
$914.10 |
3.9× |
| Rp therapy intra-arterial particulate admn (79445) |
$914.10 |
$914.10 |
3.9× |
| Rp Therapy Intravenous Administration (79101) |
$914.10 |
$914.10 |
3.9× |
| Sacroiliac Joints < 3 Views (72200) |
$143.96 |
$143.96 |
1.4× |
| Salivary gland function study (78232) |
$1,416.80 |
$1,416.80 |
3.5× |
| Salivary gland imaging (78230) |
$1,416.80 |
$1,416.80 |
3.5× |
| Salivary gland imaging serial images (78231) |
$1,416.80 |
$1,416.80 |
3.5× |
| Scapula complete (73010) |
$76.55 |
$76.55 |
0.7× |
| Small bowel series (74250) |
$132.66 |
$132.66 |
0.8× |
| Speech evaluation complex (70371) |
$457.02 |
$457.02 |
1.9× |
| Spine thoracic 3 views (72072) |
$183.26 |
$183.26 |
1.7× |
| Spleen imaging only (78185) |
$1,416.80 |
$1,416.80 |
3.5× |
| Surface Applic Low Dose Rate Radionuclide Source (77789) |
$471.90 |
$471.90 |
4.6× |
| Testicular Imaging With Vascular Flow (78761) |
$1,416.80 |
$1,416.80 |
3.5× |
| Thoracolumbar 2 views (72080) |
$148.85 |
$148.85 |
1.7× |
| Thyroid carcinoma metastases img addl study (78016) |
$1,416.80 |
$1,416.80 |
3.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,817.20 |
$1,817.20 |
3.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,416.80 |
$1,416.80 |
3.5× |
| Thyroid uptake measurement (78012) |
$1,416.80 |
$1,416.80 |
3.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,416.80 |
$1,416.80 |
3.5× |
| Tmj unilateral (70328) |
$297 |
$297 |
3.4× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$4,898.30 |
$4,898.30 |
9.0× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,416.80 |
$1,416.80 |
3.5× |
| Ultrasound elastography first target lesion (76982) |
$431.20 |
$431.20 |
4.1× |
| Ultrasound scan of cornea to determine thickness (76514) |
$88 |
$88 |
3.0× |
| Ultrasound scan to determine eye length and lens power (76519) |
$431.20 |
$431.20 |
4.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$701.80 |
$701.80 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$431.20 |
$431.20 |
4.1× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted magnetic resonance procedure (76498) |
$306.90 |
$306.90 |
3.5× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted nervous system procedure, diagnostic nuclear medicine UNSCHEDULED (78699) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted Procedure Clinical Brachytherapy (77799) |
$471.90 |
$471.90 |
4.6× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$1,416.80 |
$1,416.80 |
3.5× |
| Unlisted Ultrasound Procedure (76999) |
$306.90 |
$306.90 |
3.5× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$311.55 |
$311.55 |
3.3× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,416.80 |
$1,416.80 |
3.5× |
| Urethrocystography retrograde rs&i (74450) |
$897.60 |
$897.60 |
3.7× |
| Urethrocystography voiding (74455) |
$897.60 |
$897.60 |
3.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$541.55 |
$541.55 |
3.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$701.80 |
$701.80 |
4.0× |
| Us abdl aorta screen aaa (76706) |
$431.20 |
$431.20 |
4.1× |
| Us breast unilateral complete (76641) |
$431.20 |
$431.20 |
4.1× |
| Us breast unilateral limited (76642) |
$306.90 |
$306.90 |
3.5× |
| Us chest (76604) |
$395.30 |
$395.30 |
3.8× |
| Us compl joint r-t w/image documentation (76881) |
$431.20 |
$431.20 |
4.1× |
| Us elastography parenchyma (76981) |
$431.20 |
$431.20 |
4.1× |
| Us guided compression repair (76936) |
$974.60 |
$974.60 |
4.5× |
| Us kidney transplant (76776) |
$431.20 |
$431.20 |
4.1× |
| Us pelvic non ob complete (76856) |
$603.94 |
$603.94 |
5.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$394.28 |
$394.28 |
3.8× |
| Us retroperitoneal complete (76770) |
$427.90 |
$427.90 |
4.1× |
| Us retroperitoneal limited (76775) |
$431.20 |
$431.20 |
4.1× |
| Us scrotum and contents (76870) |
$600.55 |
$600.55 |
5.7× |
| Us soft tissue head/neck (76536) |
$572.74 |
$572.74 |
5.5× |
| Us spinal canal and contents (76800) |
$431.20 |
$431.20 |
4.1× |
| Us transrectal (76872) |
$431.20 |
$431.20 |
4.1× |
| Us transrectal prostate volume (76873) |
$431.20 |
$431.20 |
4.1× |
| Us xtr non-vasc lmtd (76882) |
$431.20 |
$431.20 |
4.1× |
| Us, eye b-scan (76512) |
$431.20 |
$431.20 |
4.1× |
| Vascular flow imaging (78445) |
$1,416.80 |
$1,416.80 |
3.5× |
| Wrist 2 views (73100) |
$150.43 |
$150.43 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$223.48 |
$223.48 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$226.38 |
$226.38 |
2.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$157.08 |
$157.08 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$701.80 |
$701.80 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$137.41 |
$137.41 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$165.22 |
$165.22 |
1.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$329.25 |
$329.25 |
3.1× |
| X-ray exam hip uni 1 view (73501) |
$144.49 |
$144.49 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$201.05 |
$201.05 |
2.3× |
| X-ray exam hip uni 4/> views (73503) |
$431.20 |
$431.20 |
4.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$237.16 |
$237.16 |
2.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$275.39 |
$275.39 |
2.6× |
| X-ray exam of femur 1 (73551) |
$134.90 |
$134.90 |
1.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$701.80 |
$701.80 |
4.0× |
| X-ray eye for foreign body (70030) |
$136.18 |
$136.18 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$207.85 |
$207.85 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$147.31 |
$147.31 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$306.90 |
$306.90 |
3.5× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$6,820 |
$6,820 |
3.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$135.82 |
$135.82 |
1.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$701.80 |
$701.80 |
4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$306.90 |
$306.90 |
3.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$204.42 |
$204.42 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$165.08 |
$165.08 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$197.91 |
$197.91 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$361.54 |
$361.54 |
3.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$250.22 |
$250.22 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$160.29 |
$160.29 |
1.8× |
| X-ray of voice box or throat (70370) |
$394.32 |
$394.32 |
4.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$297 |
$297 |
2.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$204.42 |
$204.42 |
1.9× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$1,854.60 |
$1,854.60 |
3.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,469.60 |
$1,469.60 |
4.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$157.16 |
$157.16 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$167.09 |
$167.09 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$297 |
$297 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$142.34 |
$142.34 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$150.43 |
$150.43 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$188.23 |
$188.23 |
2.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$150.48 |
$150.48 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$229.28 |
$229.28 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$180.04 |
$180.04 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$116.16 |
$116.16 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$158.67 |
$158.67 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$297 |
$297 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$165.30 |
$165.30 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$215.95 |
$215.95 |
2.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$142.29 |
$142.29 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$176.70 |
$176.70 |
2.0× |
| Xr arthrogram ankle (73615) |
$422.56 |
$422.56 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$325.60 |
$325.60 |
3.1× |
| Xr chest 4+ views (71048) |
$224.31 |
$224.31 |
2.1× |
| Xr Cholecystography Oral Contrast (74290) |
$701.80 |
$701.80 |
4.0× |
| Xr finger(s) 2+ views (73140) |
$152.10 |
$152.10 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$143.16 |
$143.16 |
1.4× |
| Xr optic foramina (70190) |
$150.20 |
$150.20 |
1.7× |
| Xr shoulder 1 view (73020) |
$114.57 |
$114.57 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$256.91 |
$256.91 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$134.15 |
$134.15 |
1.5× |
| Xr tmj bilateral (70330) |
$297 |
$297 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$102.96 |
$102.96 |
1.2× |