| Abdomen 2 views (74019) |
$383.25 |
$511 |
3.1× |
| Acute gi blood loss imaging (78278) |
$1,393.50 |
$1,858 |
2.9× |
| Angio Adrenal Bilat Select (75733) |
$4,078.50 |
$5,438 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$4,078.50 |
$5,438 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$1,768.50 |
$2,358 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$2,162.25 |
$2,883 |
0.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,766.25 |
$10,355 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,078.50 |
$5,438 |
1.1× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,937.38 |
$3,916.50 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$3,365.62 |
$4,487.50 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$17,991 |
$23,988 |
2.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$4,561.50 |
$6,082 |
1.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,161.50 |
$2,882 |
0.6× |
| Ankle 2 views (73600) |
$178.50 |
$238 |
1.7× |
| Aortogram thoracic (75605) |
$4,078.50 |
$5,438 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,078.50 |
$5,438 |
1.1× |
| Aortography abdominal serialography rs&i (75625) |
$8,014.50 |
$10,686 |
2.1× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,609.50 |
$2,146 |
0.4× |
| Artery X-Rays Adrenal Gland (75731) |
$4,078.50 |
$5,438 |
1.1× |
| Arthrogram ankle (73615) |
$565.50 |
$754 |
1.4× |
| Arthrogram elbow (73085) |
$303.75 |
$405 |
0.7× |
| Arthrogram hip (73525) |
$1,320.75 |
$1,761 |
3.2× |
| Arthrogram knee (73580) |
$1,117.50 |
$1,490 |
2.7× |
| Arthrogram shoulder (73040) |
$1,320.75 |
$1,761 |
3.2× |
| Arthrogram wrist (73115) |
$1,023 |
$1,364 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$1,393.50 |
$1,858 |
2.9× |
| Bone age studies (77072) |
$384 |
$512 |
3.1× |
| Bone Imaging 3 Phase (78315) |
$1,757.25 |
$2,343 |
3.7× |
| Bone survey infant (77076) |
$326.25 |
$435 |
2.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$4,557.75 |
$6,077 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$300 |
$400 |
2.9× |
| Chest 1 view (71045) |
$300 |
$400 |
2.9× |
| Chest xray 3 views (71047) |
$261 |
$348 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$618 |
$824 |
2.9× |
| Clavicle complete (73000) |
$351 |
$468 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$701.25 |
$935 |
5.6× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$646.50 |
$862 |
3.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,127 |
$2,836 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,341.75 |
$1,789 |
4.7× |
| CT abdomen w contrast (74160) |
$2,581.50 |
$3,442 |
12.3× |
| CT abdomen w wo contrast (74170) |
$1,616.25 |
$2,155 |
7.7× |
| CT abdomen w/o contrast (74150) |
$818.25 |
$1,091 |
6.5× |
| CT angio hrt w/3d image (75574) |
$1,158.75 |
$1,545 |
2.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,236 |
$1,648 |
5.9× |
| CT angiography upper extremity lt (73206) |
$1,043.25 |
$1,391 |
5.0× |
| CT c-spine w/contrast (72126) |
$3,051 |
$4,068 |
7.3× |
| CT c-spine w/o contrast (72125) |
$2,790.75 |
$3,721 |
22.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,273.50 |
$1,698 |
6.1× |
| CT chest w contrast (71260) |
$1,111.50 |
$1,482 |
5.3× |
| CT chest w/wo contrast (71270) |
$1,365 |
$1,820 |
6.5× |
| CT head/brain with contrast (70460) |
$1,691.25 |
$2,255 |
8.0× |
| CT head/brain without and with contrast (70470) |
$1,111.50 |
$1,482 |
5.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$112.50 |
$150 |
1.1× |
| CT iac w contrast (70481) |
$1,338.75 |
$1,785 |
6.4× |
| CT limited/localized follow up study (76380) |
$825.75 |
$1,101 |
7.9× |
| CT lower ext w/o (73700) |
$833.25 |
$1,111 |
6.7× |
| CT lower extremity w wo contrast (73702) |
$1,305 |
$1,740 |
6.2× |
| CT lower extremity w/contrast material (73701) |
$1,111.50 |
$1,482 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,399.50 |
$1,866 |
6.7× |
| CT lumbar spine w/contrast (72132) |
$3,051 |
$4,068 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$2,790.75 |
$3,721 |
22.3× |
| CT maxillofacial w contrast (70487) |
$1,871.25 |
$2,495 |
8.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,193 |
$2,924 |
10.4× |
| CT maxillofacial wo contrast (70486) |
$1,222.50 |
$1,630 |
9.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$897 |
$1,196 |
4.3× |
| CT orbits w/o contrast (70480) |
$1,000.50 |
$1,334 |
8.0× |
| CT pelvis w/o contrast (72192) |
$1,105.50 |
$1,474 |
8.8× |
| CT pelvis w/wo contrast (72194) |
$1,152 |
$1,536 |
5.5× |
| CT scan of arm combo (73202) |
$1,135.50 |
$1,514 |
5.4× |
| CT soft tissue neck w contrast (70491) |
$2,091 |
$2,788 |
9.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,227.75 |
$1,637 |
5.8× |
| CT soft tissue neck w/o contrast (70490) |
$724.50 |
$966 |
5.8× |
| CT thoracic spine w/contrast (72129) |
$1,266 |
$1,688 |
6.0× |
| CT thoracic spine w/o contrast (72128) |
$2,165.25 |
$2,887 |
17.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,305 |
$1,740 |
6.2× |
| CT thorax w/o contrast (71250) |
$701.25 |
$935 |
5.6× |
| CT upper ext wo (73200) |
$1,095.75 |
$1,461 |
8.7× |
| CT upper extremity with contrast (73201) |
$935.25 |
$1,247 |
2.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$747 |
$996 |
3.6× |
| Cta Abdomen (74175) |
$1,365 |
$1,820 |
6.5× |
| CTA abdomen pelvis (74174) |
$2,127 |
$2,836 |
5.1× |
| CTA chest (71275) |
$1,431.75 |
$1,909 |
6.8× |
| Cta Head (70496) |
$1,410.75 |
$1,881 |
6.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,899 |
$2,532 |
4.5× |
| Cta Neck (70498) |
$1,311 |
$1,748 |
6.2× |
| Cta Pelvis (72191) |
$1,111.50 |
$1,482 |
5.3× |
| Cystography minimum 3 views rs&i (74430) |
$1,320.75 |
$1,761 |
3.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,004.25 |
$1,339 |
0.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$378.75 |
$505 |
3.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$514.50 |
$686 |
4.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$299.25 |
$399 |
2.9× |
| Echo exam of eye (76529) |
$285 |
$380 |
2.7× |
| Esophagus (74220) |
$646.50 |
$862 |
3.1× |
| Facial bones min 3 views (70150) |
$474 |
$632 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$735.75 |
$981 |
5.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$419.25 |
$559 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$838.50 |
$1,118 |
2.9× |
| Foot 2 views (73620) |
$300 |
$400 |
2.9× |
| Forearm 2 views (73090) |
$307.50 |
$410 |
2.9× |
| Gastric mucosa imaging (78261) |
$634.50 |
$846 |
1.3× |
| Hand 2 views (73120) |
$384 |
$512 |
3.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,078.50 |
$5,438 |
1.1× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,078.50 |
$5,438 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,806.75 |
$2,409 |
2.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,393.50 |
$1,858 |
2.9× |
| Hysterosalpingogram (74740) |
$958.50 |
$1,278 |
3.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$173.25 |
$231 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,217.25 |
$1,623 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,014.75 |
$1,353 |
1.6× |
| Knee 3 views (73562) |
$318.75 |
$425 |
3.1× |
| Liver & spleen imaging static only (78215) |
$617.25 |
$823 |
1.3× |
| Lung perf&ventilat diferentl (78598) |
$753.75 |
$1,005 |
1.2× |
| Lung perfusion differential (78597) |
$483 |
$644 |
1.0× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,045.50 |
$1,394 |
0.3× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,045.50 |
$1,394 |
0.3× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$931.50 |
$1,242 |
0.5× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$931.50 |
$1,242 |
1.2× |
| Lymphoscintigraphy (78195) |
$1,806.75 |
$2,409 |
2.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,812.25 |
$5,083 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,344 |
$1,792 |
3.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,127 |
$2,836 |
5.1× |
| Mammary ductogram or galactogram multiple (77054) |
$374.62 |
$499.50 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$433.50 |
$578 |
1.5× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$154.50 |
$206 |
1.5× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$682.50 |
$910 |
1.5× |
| MRA head w/o contrast (70544) |
$1,434 |
$1,912 |
5.0× |
| MRA neck w contrast (70548) |
$1,944.75 |
$2,593 |
4.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,344 |
$1,792 |
3.2× |
| MRA neck w/o contrast (70547) |
$1,434 |
$1,912 |
5.0× |
| MRI abdomen w contrast (74182) |
$1,937.25 |
$2,583 |
4.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,127 |
$2,836 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,674.75 |
$2,233 |
5.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,812.25 |
$5,083 |
4.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,127 |
$2,836 |
5.1× |
| MRI breast w/o contrast bilateral (77047) |
$2,965.50 |
$3,954 |
10.4× |
| MRI breast wo contrast unilateral (77046) |
$2,361 |
$3,148 |
8.3× |
| MRI c-spine with contrast (72142) |
$2,009.25 |
$2,679 |
4.8× |
| MRI cervical spine w/o contrast (72141) |
$1,674.75 |
$2,233 |
5.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,127 |
$2,836 |
5.1× |
| MRI chest w/o contrast (71550) |
$1,674.75 |
$2,233 |
5.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,937.25 |
$2,583 |
4.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,127 |
$2,836 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,652.25 |
$2,203 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,652.25 |
$2,203 |
5.8× |
| MRI orbit face neck w contrast (70542) |
$1,344 |
$1,792 |
3.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,127 |
$2,836 |
5.1× |
| MRI pelvis w/contrast (72196) |
$1,344 |
$1,792 |
3.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,358 |
$3,144 |
5.6× |
| MRI pelvis w/o contrast (72195) |
$1,805.25 |
$2,407 |
6.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,831.25 |
$3,775 |
6.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,983 |
$2,644 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,127 |
$2,836 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,009.25 |
$2,679 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,831.25 |
$3,775 |
6.8× |
| MRI temporomandibular joint (70336) |
$1,479.75 |
$1,973 |
5.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,827 |
$2,436 |
6.4× |
| MRI up ext w/o contrast (73218) |
$1,652.25 |
$2,203 |
5.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,553.25 |
$2,071 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$1,937.25 |
$2,583 |
4.6× |
| Myelogram Cervical (72240) |
$1,068 |
$1,424 |
1.1× |
| Myelogram Lumbar (72265) |
$1,068 |
$1,424 |
1.1× |
| Myelogram thoracic (72255) |
$1,068 |
$1,424 |
1.1× |
| Myelography 2 or more regions (72270) |
$1,068 |
$1,424 |
1.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,814.75 |
$3,753 |
1.8× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$2,814.75 |
$3,753 |
1.6× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$2,814.75 |
$3,753 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$6,775.50 |
$9,034 |
4.4× |
| Myocardial spect single study at rest or stress (78451) |
$4,047 |
$5,396 |
2.6× |
| Neck soft tissue (70360) |
$300 |
$400 |
2.9× |
| Nm cardiac blood pool multiple (78473) |
$744 |
$992 |
1.6× |
| Nm gastric emptying study (78264) |
$1,393.50 |
$1,858 |
2.9× |
| Nm gastroesophageal reflux study (78262) |
$885 |
$1,180 |
1.8× |
| Nonvascular shunt X-ray (75809) |
$330 |
$440 |
2.6× |
| Nuclear Rx Oral Admin (79005) |
$615 |
$820 |
2.2× |
| Osseous survey limited (77074) |
$359.25 |
$479 |
2.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,226.75 |
$2,969 |
3.4× |
| Parathyroid Planar Imaging (78070) |
$552.75 |
$737 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$900 |
$1,200 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$384 |
$512 |
3.1× |
| Perineogram (74775) |
$315.75 |
$421 |
1.1× |
| Peritoneogram after injection (74190) |
$1,693.25 |
$2,257.67 |
2.6× |
| PET image w/CT, skull-thigh (78815) |
$5,716.50 |
$7,622 |
3.3× |
| PET imaging CT for attenuation limited area (78814) |
$4,332.75 |
$5,777 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$7,220.25 |
$9,627 |
4.2× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,478.75 |
$3,305 |
0.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,478.75 |
$3,305 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,393.50 |
$1,858 |
2.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,257.75 |
$1,677 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,805.25 |
$2,407 |
2.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$351 |
$468 |
3.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$351 |
$468 |
3.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$351 |
$468 |
3.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$300 |
$400 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$384 |
$512 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$438.75 |
$585 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$357 |
$476 |
3.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$351 |
$468 |
3.4× |
| Radex Hand Minimum 3 Views (73130) |
$307.50 |
$410 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$300 |
$400 |
2.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$384 |
$512 |
3.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$384 |
$512 |
3.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$438.75 |
$585 |
3.5× |
| Radex Humerus Minimum 2 Views (73060) |
$351 |
$468 |
3.4× |
| Radex Kne 1/2 Views (73560) |
$300 |
$400 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$609.75 |
$813 |
4.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$474 |
$632 |
3.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$300 |
$400 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$384 |
$512 |
3.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$351 |
$468 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$405.75 |
$541 |
3.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$384 |
$512 |
3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$527.25 |
$703 |
5.1× |
| Radex Toe Minimum 2 Views (73660) |
$300 |
$400 |
2.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$203.62 |
$271.50 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$300 |
$400 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$591.75 |
$789 |
4.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$358.50 |
$478 |
3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$408 |
$544 |
3.3× |
| Radiologic exam chest 2 views (71046) |
$308.25 |
$411 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$512.25 |
$683 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$410.25 |
$547 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$570 |
$760 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$646.50 |
$862 |
3.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$351 |
$468 |
3.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$384 |
$512 |
3.1× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$217.50 |
$290 |
1.7× |
| Radiological examination surgical specimen (76098) |
$1,779 |
$2,372 |
2.7× |
| Renal Cyst Study (74470) |
$330 |
$440 |
0.5× |
| Ribs bilateral 3 views (71110) |
$384 |
$512 |
3.1× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,489 |
$4,652 |
5.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,700 |
$3,600 |
4.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,489 |
$4,652 |
5.4× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$6,719.25 |
$8,959 |
4.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$673.50 |
$898 |
2.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$594 |
$792 |
2.1× |
| Scapula (73010) |
$351 |
$468 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$110.25 |
$147 |
4.7× |
| Sella turcica (70240) |
$98.25 |
$131 |
0.9× |
| Shoulder 1 view (73020) |
$178.50 |
$238 |
1.7× |
| Sialogram (70390) |
$958.50 |
$1,278 |
3.4× |
| Small bowel series (74250) |
$744 |
$992 |
3.5× |
| Spine thoracic 3 views (72072) |
$384 |
$512 |
3.1× |
| Superior sagittal sinus venogram (75870) |
$2,162.25 |
$2,883 |
0.6× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$786.75 |
$1,049 |
2.8× |
| Thoracolumbar 2 views (72080) |
$300 |
$400 |
2.9× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,806.75 |
$2,409 |
2.8× |
| Thyroid imaging w/blood flow (78013) |
$420 |
$560 |
0.9× |
| Thyroid uptake measurement (78012) |
$560.25 |
$747 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,393.50 |
$1,858 |
2.9× |
| Ultrasound breast complete (76641) |
$213 |
$284 |
1.7× |
| Ultrasound Exam Aaa Screen (76706) |
$476.25 |
$635 |
3.8× |
| Ultrasound, abdomen limited (76705) |
$419.25 |
$559 |
3.3× |
| Umbilical-artery Doppler (OB) (76820) |
$271.50 |
$362 |
2.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$351 |
$468 |
3.4× |
| Unlisted magnetic resonance procedure (76498) |
$310.50 |
$414 |
3.0× |
| Unlisted ultrasound procedure (76999) |
$421.50 |
$562 |
4.0× |
| Urethrocystogram voiding (74455) |
$801.75 |
$1,069 |
2.8× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$296.25 |
$395 |
1.4× |
| Us breast unilateral limited (76642) |
$307.50 |
$410 |
2.9× |
| Us chest (76604) |
$405.75 |
$541 |
3.2× |
| Us compl joint r-t w/image documentation (76881) |
$380.25 |
$507 |
3.0× |
| Us elastography parenchyma (76981) |
$817.50 |
$1,090 |
6.5× |
| Us encephalogram (76506) |
$924.75 |
$1,233 |
7.4× |
| Us hips infant static (76886) |
$341.25 |
$455 |
3.3× |
| Us infant hips w manipulation (76885) |
$429 |
$572 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$384 |
$512 |
3.1× |
| Us ob detailed single fetus (76811) |
$795.75 |
$1,061 |
2.8× |
| Us ob limited (76815) |
$405.75 |
$541 |
3.2× |
| Us ob transvaginal (76817) |
$994.50 |
$1,326 |
7.9× |
| Us pelvic non ob complete (76856) |
$772.50 |
$1,030 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$360 |
$480 |
2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$506.25 |
$675 |
4.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$582 |
$776 |
4.6× |
| Us retroperitoneal complete (76770) |
$419.25 |
$559 |
3.3× |
| Us retroperitoneal limited (76775) |
$384 |
$512 |
3.1× |
| Us scrotum and contents (76870) |
$898.50 |
$1,198 |
7.2× |
| Us soft tissue head/neck (76536) |
$566.25 |
$755 |
4.5× |
| Us spinal canal and contents (76800) |
$500.25 |
$667 |
4.0× |
| Us transrectal (76872) |
$384 |
$512 |
3.1× |
| Us, eye b-scan (76512) |
$360 |
$480 |
2.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$297.75 |
$397 |
2.4× |
| Venogram adrenal unilat (75840) |
$3,244.88 |
$4,326.50 |
0.9× |
| Venogram extremity bilateral (75822) |
$1,474.50 |
$1,966 |
0.8× |
| Venogram Extremity Unilateral (75820) |
$1,753.88 |
$2,338.50 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,978 |
$5,304 |
1.1× |
| Venography caval superior serialography rs&i (75827) |
$1,768.50 |
$2,358 |
0.9× |
| Venography Orbital Rs&I (75880) |
$1,320.75 |
$1,761 |
1.8× |
| Venography Renal Bilateral (75833) |
$4,078.50 |
$5,438 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$2,923.50 |
$3,898 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,411.25 |
$3,215 |
0.6× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$2,162.25 |
$2,883 |
2.9× |
| Venous sampling by catheter (75893) |
$4,078.50 |
$5,438 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$138 |
$184 |
1.3× |
| Wrist 2 views (73100) |
$300 |
$400 |
2.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$477.75 |
$637 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$474 |
$632 |
4.5× |
| X-ray b.e. reductn intuss (74283) |
$198.75 |
$265 |
0.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,014.75 |
$1,353 |
4.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$300 |
$400 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$300 |
$400 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$621 |
$828 |
5.0× |
| X-ray exam of femur 2/> (73552) |
$300 |
$400 |
2.9× |
| X-ray eye for foreign body (70030) |
$285.75 |
$381 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$198 |
$264 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$137.25 |
$183 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$219.75 |
$293 |
2.1× |
| X-ray leg, infant (73592) |
$300 |
$400 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$474 |
$632 |
3.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$774 |
$1,032 |
6.2× |
| X-ray nose-rectum child f.b. (76010) |
$309.75 |
$413 |
3.0× |
| X-ray retrograde pyelogram (74420) |
$1,320.75 |
$1,761 |
3.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300 |
$400 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$384 |
$512 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$384 |
$512 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$386.25 |
$515 |
3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$474 |
$632 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$527.25 |
$703 |
5.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$898.50 |
$1,198 |
7.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$624.75 |
$833 |
5.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$361.50 |
$482 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$300 |
$400 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$178.50 |
$238 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$351 |
$468 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$399.75 |
$533 |
3.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$145.50 |
$194 |
1.2× |
| Xr bone length studies (77073) |
$384 |
$512 |
3.1× |
| Xr c-spine 4 or 5 views (72050) |
$399.75 |
$533 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$774 |
$1,032 |
6.2× |
| Xr chest 4+ views (71048) |
$164.25 |
$219 |
1.3× |
| Xr urogram antegrade (74425) |
$393 |
$524 |
0.9× |