| Acute gi blood loss imaging (78278) |
$546.52 |
$943.50 |
1.3× |
| Ankle 2 views (73600) |
$175.96 |
$265 |
1.9× |
| Cholecystography, oral contrast Age Under 21 (74290) |
$155.20 |
$237.50 |
0.8× |
| Clavicle complete (73000) |
$18.43 |
$36 |
0.2× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,054.46 |
$1,785 |
2.9× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$687.72 |
$1,167 |
3.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,011.82 |
$1,614.50 |
5.5× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$760.98 |
$1,290 |
4.1× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$196.61 |
$384 |
1.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$783.06 |
$1,387.50 |
4.2× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,447.40 |
$2,441.50 |
7.8× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,109.78 |
$1,875 |
6.0× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,357.30 |
$2,286.50 |
7.3× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$105.47 |
$206 |
1.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$128 |
$250 |
0.7× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,430.60 |
$2,409.50 |
7.7× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$901.58 |
$1,593 |
4.9× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$720.29 |
$1,272.50 |
6.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$897.88 |
$1,586.50 |
4.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$727.92 |
$1,288 |
6.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,074.99 |
$1,899 |
5.8× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$744.52 |
$1,319 |
4.0× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,441.33 |
$2,427.50 |
7.8× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$715.24 |
$1,210 |
3.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,001.91 |
$1,695.50 |
2.7× |
| CT abdomen and pelvis without contrast (74176) |
$678.78 |
$1,151.50 |
2.7× |
| CT abdomen w & w/o contrast (74170) |
$646.28 |
$1,094.50 |
3.5× |
| CT abdomen w/contrast (74160) |
$541.32 |
$917.50 |
2.9× |
| CT abdomen w/o contrast (74150) |
$437.40 |
$742.50 |
4.0× |
| CT angio hrt w/3d image (75574) |
$1,092.90 |
$1,742 |
3.0× |
| CT cervical spine w/contrast (72126) |
$1,135.50 |
$1,914 |
3.1× |
| CT cervical spine w/o contrast (72125) |
$909.04 |
$1,532.50 |
8.2× |
| CT chest w/contrast (71260) |
$598.67 |
$1,013.50 |
3.2× |
| CT extremity upper w & w/o contrast (73202) |
$128 |
$250 |
0.7× |
| CT extremity upper w/o contrast (73200) |
$105.47 |
$206 |
1.0× |
| CT head/brain with contrast (70460) |
$561.91 |
$995 |
3.0× |
| CT head/brain without and with contrast (70470) |
$672 |
$1,189.50 |
3.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$815.13 |
$1,299 |
2.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$68.15 |
$113 |
0.7× |
| CT l-spine w/contrast (72132) |
$1,196.58 |
$2,016.50 |
3.3× |
| CT lower extremity w/dye (73701) |
$121.86 |
$238 |
0.7× |
| CT lumbar spine w/o contrast (72131) |
$957.92 |
$1,614.50 |
8.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,079.54 |
$1,907 |
5.8× |
| CT neck w/contrast (70491) |
$621.10 |
$1,100.50 |
3.4× |
| CT neck w/o contrast (70490) |
$501.54 |
$889.50 |
4.5× |
| CT pelvis w & w/o contrast (72194) |
$1,365.55 |
$2,300 |
7.4× |
| CT pelvis w/o contrast (72192) |
$917.60 |
$1,547.50 |
8.3× |
| CT thoracic spine w/contrast (72129) |
$1,205.52 |
$2,031.50 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$965.07 |
$1,626.50 |
8.8× |
| CT thorax lung cancer scr c- (71271) |
$191.50 |
$329 |
1.7× |
| CT thorax w/o contrast (71250) |
$483.12 |
$819 |
4.4× |
| CT upper extremity w/dye (73201) |
$121.86 |
$238 |
0.3× |
| CTA head w contrast (70496) |
$716.89 |
$1,271 |
3.9× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$187.40 |
$286 |
0.5× |
| Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)… (77080) |
$156.10 |
$237.50 |
1.4× |
| Dxa bone density/peripheral (77081) |
$162.41 |
$247 |
1.8× |
| Fetal biophys profile w/o nst (76819) |
$324.42 |
$430 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$357.68 |
$477.50 |
3.2× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$257.19 |
$391 |
1.0× |
| Gated heart planar single (78472) |
$579.02 |
$999.50 |
1.4× |
| Heart infarct image (78466) |
$315.01 |
$544 |
0.7× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$777.42 |
$1,341.50 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$569.90 |
$983.50 |
1.4× |
| Ht muscle image spect sing (78451) |
$1,235.30 |
$2,131.50 |
0.9× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$176.32 |
$305 |
0.4× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$511.38 |
$882.50 |
1.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$330.80 |
$571.50 |
0.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$265.38 |
$459 |
0.5× |
| Liver and spleen imaging; with vascular flow Age Under 21 (78216) |
$214.50 |
$370.50 |
0.5× |
| Lung perf&ventilat diferentl (78598) |
$474.43 |
$819 |
0.8× |
| Lung perfusion imaging (78580) |
$355.02 |
$613 |
0.8× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$225.28 |
$440 |
0.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$171.01 |
$334 |
0.5× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$141.31 |
$276 |
0.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$224.26 |
$438 |
0.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,272.21 |
$1,943.50 |
3.5× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,018.90 |
$1,557 |
4.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$172.03 |
$336 |
0.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$225.28 |
$440 |
0.6× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$944.07 |
$1,386 |
2.6× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$1,134.34 |
$1,666 |
3.1× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$1,945.90 |
$2,848 |
5.3× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$191.98 |
$294.50 |
0.8× |
| Mammary ductogram single (77053) |
$146.26 |
$224.50 |
0.6× |
| Mandible min 4v (70110) |
$171.66 |
$261.50 |
1.6× |
| Mr safety determination physician/other qhp (76016) |
$59.77 |
$97 |
0.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$119.28 |
$186.50 |
1.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$25.23 |
$38 |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$87.52 |
$140.50 |
0.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$181.66 |
$282.50 |
0.7× |
| MRA head w/o contrast (70544) |
$761.48 |
$1,121 |
3.0× |
| MRA neck w/ contrast (70548) |
$1,621.72 |
$2,373.50 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,297.44 |
$1,899 |
5.2× |
| MRI abdomen w/contrast (74182) |
$2,913.36 |
$3,980 |
7.9× |
| MRI abdomen w/o contrast (74181) |
$1,204 |
$1,667.50 |
4.8× |
| MRI abdomen w/wo contrast (74183) |
$3,496.03 |
$4,776 |
9.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$172.03 |
$336 |
0.2× |
| MRI c-spine w&w/o cont (72156) |
$853.08 |
$1,419.50 |
2.3× |
| MRI cervical spine w/contrast (72142) |
$707.87 |
$1,177 |
1.9× |
| MRI chest w/contrast (71551) |
$1,365.84 |
$1,892.50 |
1.7× |
| MRI chest w/o contrast (71550) |
$1,094.93 |
$1,518.50 |
4.4× |
| MRI chest w/wo contrast (71552) |
$1,643.30 |
$2,279.50 |
4.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$225.28 |
$440 |
0.6× |
| MRI joint upr extrem w/dye (73222) |
$172.03 |
$336 |
0.2× |
| MRI joint upr extrem w/o dye (73221) |
$144.38 |
$282 |
0.6× |
| MRI lumbar spine w/contrast (72149) |
$707.62 |
$1,176.50 |
1.9× |
| MRI lumbar spine w/wo contrast (72158) |
$853.08 |
$1,419.50 |
2.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,531.42 |
$2,341.50 |
4.2× |
| MRI pelvis w & w/o contrast (72197) |
$1,192.31 |
$1,662.50 |
3.2× |
| MRI pelvis w/contrast (72196) |
$991.32 |
$1,381 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$795.18 |
$1,109 |
3.2× |
| MRI spine cervical w/o contrast (72141) |
$567.78 |
$944.50 |
2.3× |
| MRI t-spine w&w/o cont (72157) |
$853.08 |
$1,419.50 |
2.3× |
| MRI thoracic spine w/contrast (72147) |
$707.62 |
$1,176.50 |
1.9× |
| MRI thoracic spine w/o contrst (72146) |
$567.78 |
$944.50 |
2.3× |
| MRI tmj (70336) |
$1,172.41 |
$1,624.50 |
4.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$142.34 |
$278 |
0.6× |
| Myocardial spect multiple studies (78452) |
$1,591.26 |
$2,745.50 |
1.2× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$2,260.66 |
$3,242.50 |
2.5× |
| Nm bone 3 phase (78315) |
$833.60 |
$1,438.50 |
2.0× |
| Nm bone imaging whole body (78306) |
$724.38 |
$1,250 |
1.7× |
| Nm gastric emptying (78264) |
$645.56 |
$1,114 |
1.5× |
| Nm lung ventilation imaging (78579) |
$250.79 |
$433 |
0.6× |
| Nm lymph system (78195) |
$525.51 |
$907.50 |
0.9× |
| Nm salivary gland (78230) |
$274.01 |
$473 |
0.6× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$343.49 |
$593 |
0.8× |
| Nuclear medicine study of bone and/or joint multiple areas (78305) |
$410.34 |
$708.50 |
1.0× |
| Ob us limited fetus(s) (76815) |
$225.14 |
$300.50 |
2.0× |
| Ob us nuchal meas 1 gest (76813) |
$194.96 |
$271 |
1.8× |
| Parathyroid planar imaging (78070) |
$356.43 |
$615.50 |
0.8× |
| Pulmonary ventilation & perfusion imaging (78582) |
$558.94 |
$965 |
1.0× |
| Quant differential pulm perfusion w/wo imaging (78597) |
$296.16 |
$511.50 |
0.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$251.20 |
$384.50 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$122.38 |
$187.50 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$174.04 |
$266 |
1.6× |
| Radex hip unilateral with pelvis 1 view (73501) |
$78.49 |
$120.50 |
0.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$143.92 |
$219.50 |
1.6× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$179.74 |
$274 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$96.78 |
$148.50 |
0.9× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$242.18 |
$368.50 |
2.2× |
| Radex spine cervical 2 or 3 views (72040) |
$162.18 |
$247 |
1.8× |
| Radex spine cervical 4 or 5 views (72050) |
$222.23 |
$338 |
2.0× |
| Radex spine cervical 6 or more views (72052) |
$261.50 |
$397.50 |
2.4× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$92.88 |
$142.50 |
1.0× |
| Radiologic exam abdomen 3+ views (74021) |
$148.60 |
$227 |
1.3× |
| Radiologic exam chest 3 views (71047) |
$145.70 |
$252.50 |
1.6× |
| Radiologic exam chest 4+ views (71048) |
$165 |
$286 |
1.5× |
| Radiologic exam colon double contrast study (74280) |
$369.34 |
$571 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$330.50 |
$510 |
1.8× |
| Radiologic exam esophagus single contrast study (74220) |
$160.96 |
$249.50 |
0.9× |
| Radiologic exam small int single contrast study (74250) |
$221.70 |
$343.50 |
1.2× |
| Radiologic exam swallow function contrast study (74230) |
$218.26 |
$335 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$317.30 |
$488.50 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$242.62 |
$375 |
1.3× |
| Radiologic examination femur 1 view (73551) |
$18.43 |
$36 |
0.2× |
| Radiologic examination femur minimum 2 views (73552) |
$19.46 |
$38 |
0.2× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$50.02 |
$77.50 |
0.5× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$19.46 |
$38 |
0.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$172.12 |
$263 |
1.6× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$258.96 |
$390 |
2.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$19.46 |
$38 |
0.2× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$135.52 |
$206.50 |
1.5× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$18.43 |
$36 |
0.2× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$19.46 |
$38 |
0.2× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$172.48 |
$264 |
0.3× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$179.50 |
$272.50 |
2.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$24.58 |
$48 |
0.2× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$160.90 |
$244.50 |
1.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$119.08 |
$181.50 |
1.3× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$194.96 |
$297.50 |
1.8× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$155.24 |
$237 |
1.4× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$58.37 |
$114 |
0.2× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$20.48 |
$40 |
0.2× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$96.83 |
$148 |
1.1× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$141.82 |
$216 |
1.3× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$130.64 |
$199.50 |
1.2× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$291.06 |
$442 |
2.6× |
| Radiologic examination, spine; thoracic, minimum of 4 views Age Under 21 (72074) |
$201.87 |
$307 |
1.8× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$19.46 |
$38 |
0.2× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$130.28 |
$198.50 |
1.4× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$284.19 |
$428 |
3.1× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$180.06 |
$274.50 |
1.6× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$128.32 |
$196 |
1.4× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$14.34 |
$28 |
0.2× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$506.46 |
$874.50 |
0.9× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$275.96 |
$419.50 |
1.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$797.50 |
$1,375 |
1.4× |
| Saline infusion sonohysterography (SIS), including color flow Doppler, when performed Age Under 21 (76831) |
$262 |
$349 |
1.0× |
| Scapula complete (73010) |
$19.46 |
$38 |
0.2× |
| Screening digital breast tomosynthesis bi (77063) |
$35.86 |
$55.50 |
— |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$196.04 |
$307.50 |
1.8× |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$287.46 |
$496.50 |
0.7× |
| Thyroid imaging with vascular flow (78013) |
$292.35 |
$504.50 |
0.7× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$397.82 |
$686.50 |
0.9× |
| Ultrasound breast limited (76642) |
$253.18 |
$343 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$362.40 |
$475.50 |
3.3× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$241.04 |
$318 |
2.2× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$425.20 |
$558 |
3.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$292.72 |
$409 |
1.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$373.94 |
$497.50 |
3.4× |
| Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation Age Under 21 (76776) |
$204.46 |
$276 |
1.9× |
| Umbilical-artery Doppler (OB) (76820) |
$129.77 |
$175.50 |
1.2× |
| Ureteral reflux study (78740) |
$260.32 |
$449.50 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$524.74 |
$796 |
2.8× |
| Us abdominal aorta real time screen study aaa (76706) |
$164.16 |
$220.50 |
1.5× |
| Us breast uni real time with image complete (76641) |
$304.70 |
$410.50 |
2.8× |
| Us chest (76604) |
$246.72 |
$327 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$370.70 |
$487 |
3.4× |
| Us elastography organ (76981) |
$133.24 |
$181.50 |
1.2× |
| Us exam, pelvic, limited (76857) |
$311.41 |
$408.50 |
2.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$173.30 |
$235.50 |
1.9× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$128.56 |
$176 |
1.4× |
| US OB Follow-Up/Repeat (76816) |
$423 |
$543 |
3.8× |
| Us ob transvaginal (76817) |
$288.08 |
$383 |
2.6× |
| Us retroperitoneal complete (76770) |
$419.47 |
$551.50 |
3.8× |
| Us retroperitoneal ltd (76775) |
$146.62 |
$198.50 |
1.3× |
| Us scrotum (76870) |
$391.34 |
$513.50 |
3.5× |
| Us soft tissue head/neck (76536) |
$377.48 |
$494.50 |
3.4× |
| Us spinal canal (76800) |
$189.24 |
$263.50 |
1.7× |
| Use 1st target lesion (76982) |
$116.88 |
$160.50 |
1.1× |
| Venography, extremity, bilateral, radiological supervision and interpretation Age Under 21 (75822) |
$289.34 |
$448 |
0.2× |
| Venography, extremity, unilateral, radiological supervision and interpretation Age Under 21 (75820) |
$242.28 |
$373 |
0.1× |
| X-ray exam hips bi 3-4 views (73522) |
$155.68 |
$238 |
1.4× |
| X-ray exam of finger(s) (73140) |
$15.36 |
$30 |
0.2× |
| X-ray exam of knee 1 or 2 (73560) |
$18.43 |
$36 |
0.2× |
| X-ray exam ribs bil 3 views (71110) |
$159.66 |
$244 |
1.4× |
| X-ray exam ribs uni 2 views (71100) |
$136.62 |
$208.50 |
1.5× |
| X-ray heel (73650) |
$17.41 |
$34 |
0.2× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$180.78 |
$275 |
1.6× |
| X-ray retrograde pyelogram (74420) |
$298.50 |
$455.50 |
0.8× |
| Xr abdomen 1 view (74018) |
$79.56 |
$122 |
0.9× |
| Xr abdomen 2 views (74019) |
$141.27 |
$215.50 |
1.3× |
| Xr arthrogram elbow (73085) |
$61.44 |
$120 |
0.2× |
| Xr arthrogram hip (73525) |
$62.46 |
$122 |
0.2× |
| Xr arthrogram knee (73580) |
$61.44 |
$120 |
0.2× |
| Xr arthrogram wrist (73115) |
$59.39 |
$116 |
0.2× |
| Xr bone age studies (77072) |
$84.80 |
$130 |
0.8× |
| Xr bone length study (77073) |
$196.34 |
$299 |
1.8× |
| Xr bone survey infant (77076) |
$183.44 |
$284.50 |
1.7× |
| Xr bone survey ltd (77074) |
$120.34 |
$186.50 |
1.1× |
| Xr chest 1 view (71045) |
$68.78 |
$119.50 |
0.7× |
| Xr chest 2 views (71046) |
$140.10 |
$242.50 |
1.5× |
| Xr eye foreign body (70030) |
$18.43 |
$36 |
0.2× |
| Xr facial bones 3+ views (70150) |
$159.22 |
$243 |
1.4× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$205.84 |
$310 |
2.2× |
| Xr forearm 2 views (73090) |
$213.81 |
$322 |
2.3× |
| Xr hand 2v (73120) |
$152.06 |
$229 |
1.4× |
| Xr hysterosalpingogram (74740) |
$185.62 |
$284 |
0.7× |
| Xr myelogram c-spine (72240) |
$773.10 |
$1,188 |
0.9× |
| Xr myelogram l-spine (72265) |
$777.43 |
$1,192 |
0.9× |
| Xr myelogram t-spine (72255) |
$629.07 |
$972 |
0.8× |
| Xr neck soft tissue (70360) |
$108.12 |
$165 |
1.2× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$20.48 |
$40 |
0.2× |
| Xr osseous survey complete (77075) |
$178.52 |
$275.50 |
1.6× |
| Xr pelvis 1-2 views (72170) |
$86.87 |
$133 |
0.8× |
| Xr pelvis min 3 view (72190) |
$129.50 |
$198 |
1.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$110.44 |
$168.50 |
1.2× |
| Xr sella turcica (70240) |
$65.14 |
$100.50 |
0.7× |
| Xr shoulder 1 view (73020) |
$16.38 |
$32 |
0.2× |
| Xr sinuses 3+ views (70220) |
$150.56 |
$229.50 |
1.6× |
| Xr skull min 4 view (70260) |
$164.38 |
$251 |
1.5× |
| Xr spine 1 view (72020) |
$113.91 |
$173.50 |
1.2× |
| Xr spine thoracic 3v (72072) |
$175.80 |
$267.50 |
1.6× |
| Xr sternum 2+ views (71120) |
$82.40 |
$126.50 |
0.9× |
| Xr surgical specimen (76098) |
$94.10 |
$145.50 |
0.2× |
| Xr t-spine 2 views (72070) |
$169.05 |
$257 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$176.62 |
$266 |
1.9× |
| Xr tmj bilateral (70330) |
$136.14 |
$208 |
1.5× |
| Xr wrist 2 views (73100) |
$205.84 |
$310 |
2.2× |