| Abdomen 2 views (74019) |
$217 |
$542.50 |
2.0× |
| Acute gi blood loss imaging (78278) |
$1,067.60 |
$2,669 |
2.6× |
| Angio Adrenal Bilat Select (75733) |
$5,152 |
$12,880 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$5,152 |
$12,880 |
1.6× |
| Angiography extremity unilateral rs&i (75710) |
$5,152 |
$12,880 |
1.6× |
| Angiography internal mammary rs&i (75756) |
$4,663.80 |
$11,659.50 |
1.4× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,152 |
$12,880 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,152 |
$12,880 |
1.6× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,152 |
$12,880 |
1.6× |
| Angiography Spinal Selective Rs&I (75705) |
$9,020.20 |
$22,550.50 |
1.6× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,020.20 |
$22,550.50 |
1.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,656.20 |
$4,140.50 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,663.80 |
$11,659.50 |
1.4× |
| Ankle 2 views (73600) |
$196.60 |
$491.50 |
2.2× |
| Aortogram thoracic (75605) |
$5,152 |
$12,880 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,152 |
$12,880 |
1.6× |
| Aortography abdominal serialography rs&i (75625) |
$5,152 |
$12,880 |
1.6× |
| Artery X-Rays Adrenal Gland (75731) |
$5,152 |
$12,880 |
1.6× |
| Arthrogram ankle (73615) |
$782.60 |
$1,956.50 |
2.2× |
| Arthrogram elbow (73085) |
$741.60 |
$1,854 |
2.1× |
| Arthrogram hip (73525) |
$819.80 |
$2,049.50 |
2.3× |
| Arthrogram knee (73580) |
$782.60 |
$1,956.50 |
2.2× |
| Arthrogram shoulder (73040) |
$684.40 |
$1,711 |
1.9× |
| Arthrogram wrist (73115) |
$780.60 |
$1,951.50 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$572.40 |
$1,431 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$1,191.80 |
$2,979.50 |
2.9× |
| Bone age studies (77072) |
$293.20 |
$733 |
2.7× |
| Bone Imaging 3 Phase (78315) |
$1,130 |
$2,825 |
2.7× |
| Bone Marrow Imaging Limited Area (78102) |
$572.40 |
$1,431 |
1.4× |
| Bone survey complete (77075) |
$868.20 |
$2,170.50 |
8.0× |
| Bone survey infant (77076) |
$314.40 |
$786 |
2.9× |
| Bowel imaging (78290) |
$772.20 |
$1,930.50 |
1.9× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$1,032.60 |
$2,581.50 |
2.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$778.80 |
$1,947 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$293.20 |
$733 |
3.3× |
| Chest 1 view (71045) |
$283.60 |
$709 |
3.1× |
| Chest xray 3 views (71047) |
$326.20 |
$815.50 |
3.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$379.60 |
$949 |
2.1× |
| Clavicle complete (73000) |
$209 |
$522.50 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$156.40 |
$391 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,026.80 |
$7,567 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,068 |
$5,170 |
8.4× |
| CT abdomen w contrast (74160) |
$1,995.60 |
$4,989 |
11.0× |
| CT abdomen w wo contrast (74170) |
$2,275.20 |
$5,688 |
12.5× |
| CT abdomen w/o contrast (74150) |
$1,823.40 |
$4,558.50 |
16.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,391.60 |
$3,479 |
7.7× |
| CT angiography upper extremity lt (73206) |
$1,391.60 |
$3,479 |
7.7× |
| CT c-spine w/contrast (72126) |
$1,989.80 |
$4,974.50 |
5.5× |
| CT c-spine w/o contrast (72125) |
$1,878.20 |
$4,695.50 |
17.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,114.40 |
$5,286 |
11.7× |
| CT chest w contrast (71260) |
$1,989.80 |
$4,974.50 |
11.0× |
| CT chest w/wo contrast (71270) |
$2,114.40 |
$5,286 |
11.7× |
| CT head/brain with contrast (70460) |
$1,767.80 |
$4,419.50 |
9.7× |
| CT head/brain without and with contrast (70470) |
$1,866.80 |
$4,667 |
10.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$40 |
$100 |
0.4× |
| CT iac w contrast (70481) |
$1,512.80 |
$3,782 |
8.3× |
| CT limited/localized follow up study (76380) |
$636.20 |
$1,590.50 |
7.1× |
| CT lower ext w/o (73700) |
$994.20 |
$2,485.50 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$1,505.80 |
$3,764.50 |
8.3× |
| CT lower extremity w/contrast material (73701) |
$1,187.20 |
$2,968 |
6.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,114.40 |
$5,286 |
11.7× |
| CT lumbar spine w/contrast (72132) |
$1,989.80 |
$4,974.50 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,878.20 |
$4,695.50 |
17.4× |
| CT maxillofacial w contrast (70487) |
$1,512.80 |
$3,782 |
8.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,622.40 |
$4,056 |
8.9× |
| CT maxillofacial wo contrast (70486) |
$1,294.20 |
$3,235.50 |
12.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,622.40 |
$4,056 |
8.9× |
| CT orbits w/o contrast (70480) |
$1,294.20 |
$3,235.50 |
12.0× |
| CT pelvis w/o contrast (72192) |
$1,611.40 |
$4,028.50 |
14.9× |
| CT pelvis w/wo contrast (72194) |
$1,958.80 |
$4,897 |
10.8× |
| CT scan of arm combo (73202) |
$1,505.80 |
$3,764.50 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$1,438.40 |
$3,596 |
7.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,643.20 |
$4,108 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,170 |
$2,925 |
10.8× |
| CT thoracic spine w/contrast (72129) |
$1,989.80 |
$4,974.50 |
11.0× |
| CT thoracic spine w/o contrast (72128) |
$1,878.20 |
$4,695.50 |
17.4× |
| CT thoracic spine w/wo contrast (72130) |
$2,114.40 |
$5,286 |
11.7× |
| CT thorax w/o contrast (71250) |
$1,878.20 |
$4,695.50 |
17.4× |
| CT unlisted procedure (76497) |
$1,282.20 |
$3,205.50 |
14.2× |
| CT upper ext wo (73200) |
$1,201 |
$3,002.50 |
11.1× |
| CT upper extremity with contrast (73201) |
$1,342.20 |
$3,355.50 |
3.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,461 |
$3,652.50 |
8.1× |
| Cta Abdomen (74175) |
$1,461 |
$3,652.50 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,838 |
$7,095 |
7.9× |
| CTA chest (71275) |
$2,357.60 |
$5,894 |
13.0× |
| Cta Head (70496) |
$1,250.80 |
$3,127 |
6.9× |
| Cta Neck (70498) |
$1,250.80 |
$3,127 |
6.9× |
| Cta Pelvis (72191) |
$1,461 |
$3,652.50 |
8.1× |
| Cystography minimum 3 views rs&i (74430) |
$431.80 |
$1,079.50 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,369 |
$5,922.50 |
1.1× |
| Diskogram cervical (72285) |
$5,520.20 |
$13,800.50 |
2.7× |
| Diskography lumbar (72295) |
$5,520.20 |
$13,800.50 |
2.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$196.60 |
$491.50 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$553.20 |
$1,383 |
5.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$146 |
$365 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$192.40 |
$481 |
1.8× |
| Esophagus (74220) |
$375.40 |
$938.50 |
2.1× |
| Facial bones min 3 views (70150) |
$484.20 |
$1,210.50 |
4.5× |
| Fetal biophysical profile non-stress testing (76818) |
$963.60 |
$2,409 |
8.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$265.60 |
$664 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$331.20 |
$828 |
1.3× |
| Foot 2 views (73620) |
$196.60 |
$491.50 |
2.2× |
| Forearm 2 views (73090) |
$209 |
$522.50 |
2.3× |
| Hand 2 views (73120) |
$196.60 |
$491.50 |
1.8× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$5,152 |
$12,880 |
1.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$5,152 |
$12,880 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,434.60 |
$3,586.50 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,035.40 |
$2,588.50 |
2.5× |
| Hysterosalpingogram (74740) |
$605 |
$1,512.50 |
2.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$922.20 |
$2,305.50 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,033 |
$2,582.50 |
1.8× |
| Knee 3 views (73562) |
$272.20 |
$680.50 |
3.0× |
| Liver & spleen imaging static only (78215) |
$1,037.20 |
$2,593 |
2.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$622.60 |
$1,556.50 |
1.5× |
| Liver imaging static only (78201) |
$589.80 |
$1,474.50 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$1,096 |
$2,740 |
2.0× |
| Lymphoscintigraphy (78195) |
$765.80 |
$1,914.50 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,813.40 |
$4,533.50 |
2.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,749.80 |
$4,374.50 |
4.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,813.40 |
$4,533.50 |
5.0× |
| Mammary ductogram or galactogram multiple (77054) |
$719.40 |
$1,798.50 |
2.9× |
| Mammary ductogram or galactogram single (77053) |
$719.40 |
$1,798.50 |
2.9× |
| Mr safety determination physician/other qhp (76016) |
$143.40 |
$358.50 |
1.6× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$38.40 |
$96 |
1.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$149.40 |
$373.50 |
1.5× |
| Mr safety implt pos&/immoblj (76019) |
$96.60 |
$241.50 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$392.20 |
$980.50 |
1.6× |
| MRA head w & w/o contrast (70546) |
$2,891.80 |
$7,229.50 |
8.0× |
| MRA head w/o contrast (70544) |
$1,482.40 |
$3,706 |
6.0× |
| MRA head with contrast (70545) |
$1,482.40 |
$3,706 |
4.1× |
| MRA neck w contrast (70548) |
$1,482.40 |
$3,706 |
4.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,891.80 |
$7,229.50 |
8.0× |
| MRA neck w/o contrast (70547) |
$1,482.40 |
$3,706 |
6.0× |
| MRI abdomen w contrast (74182) |
$1,819.20 |
$4,548 |
5.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,353.20 |
$8,383 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$1,699.20 |
$4,248 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,813.40 |
$4,533.50 |
2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,346.60 |
$8,366.50 |
9.3× |
| MRI breast w/o contrast bilateral (77047) |
$3,365.80 |
$8,414.50 |
13.6× |
| MRI breast wo contrast unilateral (77046) |
$2,669 |
$6,672.50 |
10.8× |
| MRI c-spine with contrast (72142) |
$1,900.40 |
$4,751 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,699.20 |
$4,248 |
6.9× |
| MRI chest w/o & w/contrast material (71552) |
$3,328.60 |
$8,321.50 |
9.2× |
| MRI chest w/o contrast (71550) |
$1,699.20 |
$4,248 |
6.9× |
| MRI chest with contrast (71551) |
$1,819.20 |
$4,548 |
2.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,749.80 |
$4,374.50 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,813.40 |
$4,533.50 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,512 |
$3,780 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,015.20 |
$5,038 |
8.2× |
| MRI orbit face neck w contrast (70542) |
$2,050 |
$5,125 |
5.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,233.80 |
$8,084.50 |
9.0× |
| MRI pelvis w/contrast (72196) |
$2,086 |
$5,215 |
5.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,353.20 |
$8,383 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$1,521.20 |
$3,803 |
6.2× |
| MRI spectroscopy (76390) |
$2,222.60 |
$5,556.50 |
24.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,397.20 |
$8,493 |
9.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,196.60 |
$5,491.50 |
6.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,397.20 |
$8,493 |
9.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,900.40 |
$4,751 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,397.20 |
$8,493 |
9.4× |
| MRI temporomandibular joint (70336) |
$2,086 |
$5,215 |
8.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,761.20 |
$4,403 |
7.1× |
| MRI up ext w/o contrast (73218) |
$1,512 |
$3,780 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,699.20 |
$4,248 |
6.9× |
| MRI, joint upper extrem combo (73223) |
$3,346.60 |
$8,366.50 |
9.3× |
| Myocardial Spect Multiple Studies (78452) |
$2,358.80 |
$5,897 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,358.80 |
$5,897 |
1.8× |
| Neck soft tissue (70360) |
$118 |
$295 |
1.3× |
| Nm bone marrow wb (78104) |
$572.40 |
$1,431 |
1.4× |
| Nm cisternogram (78630) |
$1,267 |
$3,167.50 |
2.3× |
| Nm gastric emptying study (78264) |
$1,012.40 |
$2,531 |
2.4× |
| Nonvascular shunt X-ray (75809) |
$174.40 |
$436 |
1.6× |
| Nuclear Rx Oral Admin (79005) |
$586.60 |
$1,466.50 |
2.4× |
| Ob us nuchal meas 1 gest (76813) |
$227 |
$567.50 |
2.1× |
| Osseous survey limited (77074) |
$182 |
$455 |
1.7× |
| Parathyroid Planar Imaging (78070) |
$572.40 |
$1,431 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,229.40 |
$3,073.50 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$293.20 |
$733 |
2.7× |
| Peritoneogram after injection (74190) |
$1,479.40 |
$3,698.50 |
2.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$5,152 |
$12,880 |
1.6× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,126 |
$5,315 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,096 |
$2,740 |
2.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,096 |
$2,740 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$605 |
$1,512.50 |
1.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$293.20 |
$733 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$209 |
$522.50 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$293.20 |
$733 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$346.60 |
$866.50 |
3.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$346.60 |
$866.50 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$209 |
$522.50 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$293.20 |
$733 |
3.3× |
| Radex Hand Minimum 3 Views (73130) |
$293.20 |
$733 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$199.40 |
$498.50 |
2.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$406.80 |
$1,017 |
3.8× |
| Radex Humerus Minimum 2 Views (73060) |
$293.20 |
$733 |
3.3× |
| Radex Kne 1/2 Views (73560) |
$183.60 |
$459 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$272.20 |
$680.50 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$484.20 |
$1,210.50 |
4.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$293.20 |
$733 |
3.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$396.40 |
$991 |
4.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$293.20 |
$733 |
3.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$294.40 |
$736 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$484.20 |
$1,210.50 |
5.4× |
| Radex Toe Minimum 2 Views (73660) |
$209 |
$522.50 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$210 |
$525 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$293.20 |
$733 |
3.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$190.20 |
$475.50 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$253 |
$632.50 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$306 |
$765 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$440.20 |
$1,100.50 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$578.20 |
$1,445.50 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$578.20 |
$1,445.50 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$199.40 |
$498.50 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$209 |
$522.50 |
2.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$169.40 |
$423.50 |
1.6× |
| Radiological examination surgical specimen (76098) |
$1,128.60 |
$2,821.50 |
2.0× |
| Ribs bilateral 3 views (71110) |
$484.20 |
$1,210.50 |
4.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$555.20 |
$1,388 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$555.20 |
$1,388 |
1.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,924.20 |
$4,810.50 |
3.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,657.80 |
$4,144.50 |
3.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,657.80 |
$4,144.50 |
3.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$430.60 |
$1,076.50 |
1.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,057.20 |
$2,643 |
4.3× |
| Scapula (73010) |
$293.20 |
$733 |
2.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$49.40 |
$123.50 |
2.1× |
| Shoulder 1 view (73020) |
$200.40 |
$501 |
2.2× |
| Sialogram (70390) |
$531.40 |
$1,328.50 |
2.2× |
| Small bowel series (74250) |
$372.60 |
$931.50 |
2.1× |
| Spine thoracic 3 views (72072) |
$330 |
$825 |
3.1× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$833.60 |
$2,084 |
3.4× |
| Thoracolumbar 2 views (72080) |
$330 |
$825 |
3.7× |
| Thyroid imaging w/blood flow (78013) |
$702.80 |
$1,757 |
1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$799.80 |
$1,999.50 |
1.9× |
| Ultrasound breast complete (76641) |
$197 |
$492.50 |
1.8× |
| Ultrasound Exam Aaa Screen (76706) |
$261.80 |
$654.50 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$671 |
$1,677.50 |
6.2× |
| Umbilical-artery Doppler (OB) (76820) |
$266 |
$665 |
2.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$1,179.20 |
$2,948 |
13.1× |
| Unlisted fluoroscopic procedure (76496) |
$320.20 |
$800.50 |
3.6× |
| Unlisted magnetic resonance procedure (76498) |
$378 |
$945 |
4.2× |
| Urethrocystogram voiding (74455) |
$605 |
$1,512.50 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$431.80 |
$1,079.50 |
1.7× |
| Us breast unilateral limited (76642) |
$160.60 |
$401.50 |
1.8× |
| Us chest (76604) |
$228.40 |
$571 |
2.1× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$865.40 |
$2,163.50 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$403 |
$1,007.50 |
3.7× |
| Us elastography parenchyma (76981) |
$556 |
$1,390 |
5.1× |
| Us encephalogram (76506) |
$228.40 |
$571 |
2.1× |
| Us infant hips w manipulation (76885) |
$484.60 |
$1,211.50 |
5.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$218.80 |
$547 |
2.0× |
| Us ob detailed single fetus (76811) |
$682.60 |
$1,706.50 |
2.8× |
| Us ob limited (76815) |
$265.60 |
$664 |
2.5× |
| Us ob transvaginal (76817) |
$446.20 |
$1,115.50 |
4.1× |
| Us pelvic non ob complete (76856) |
$666.80 |
$1,667 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$268.40 |
$671 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$265.60 |
$664 |
2.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$195.80 |
$489.50 |
1.8× |
| Us retroperitoneal complete (76770) |
$936.80 |
$2,342 |
8.7× |
| Us retroperitoneal limited (76775) |
$741.60 |
$1,854 |
6.9× |
| Us scrotum and contents (76870) |
$877.40 |
$2,193.50 |
8.1× |
| Us soft tissue head/neck (76536) |
$620 |
$1,550 |
5.7× |
| Us spinal canal and contents (76800) |
$202.40 |
$506 |
1.9× |
| Us transrectal (76872) |
$265.60 |
$664 |
2.5× |
| Us transrectal prostate volume (76873) |
$322 |
$805 |
3.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$319.80 |
$799.50 |
3.0× |
| Venogram adrenal unilat (75840) |
$5,152 |
$12,880 |
1.6× |
| Venogram extremity bilateral (75822) |
$1,479.40 |
$3,698.50 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,656.20 |
$4,140.50 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$5,152 |
$12,880 |
1.6× |
| Venography caval superior serialography rs&i (75827) |
$3,735 |
$9,337.50 |
2.3× |
| Venography Renal Bilateral (75833) |
$5,152 |
$12,880 |
1.6× |
| Venography renal unilateral selective rs&i (75831) |
$5,152 |
$12,880 |
1.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,663.80 |
$11,659.50 |
1.4× |
| Venous sampling by catheter (75893) |
$5,152 |
$12,880 |
0.9× |
| Vertebral fracture assessment via dxa (77086) |
$157.60 |
$394 |
1.8× |
| Wrist 2 views (73100) |
$196.60 |
$491.50 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$292.60 |
$731.50 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$389.60 |
$974 |
4.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$494.60 |
$1,236.50 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$209 |
$522.50 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$304.80 |
$762 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$406.80 |
$1,017 |
3.8× |
| X-ray exam of femur 2/> (73552) |
$293.20 |
$733 |
3.3× |
| X-ray eye for foreign body (70030) |
$105.80 |
$264.50 |
1.2× |
| X-ray IV pyelogram (ivp) (74400) |
$500 |
$1,250 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$183.60 |
$459 |
2.0× |
| X-ray leg, infant (73592) |
$272.20 |
$680.50 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$394.20 |
$985.50 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$862.80 |
$2,157 |
8.0× |
| X-ray nose-rectum child f.b. (76010) |
$331.20 |
$828 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$484.20 |
$1,210.50 |
4.5× |
| X-ray retrograde pyelogram (74420) |
$605 |
$1,512.50 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$293.20 |
$733 |
3.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$293.20 |
$733 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$484.20 |
$1,210.50 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$389.60 |
$974 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$293.20 |
$733 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$484.20 |
$1,210.50 |
5.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$484.20 |
$1,210.50 |
4.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$243.80 |
$609.50 |
2.3× |
| X-Ray Small Bowel Enteroclysis (74251) |
$321.20 |
$803 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$148.40 |
$371 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$389.60 |
$974 |
4.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$293.20 |
$733 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$330 |
$825 |
3.1× |
| Xr bone length studies (77073) |
$484.20 |
$1,210.50 |
4.5× |
| Xr c-spine 4 or 5 views (72050) |
$484.20 |
$1,210.50 |
4.5× |
| Xr c-spine 6 or more views (72052) |
$530.20 |
$1,325.50 |
4.9× |
| Xr chest 4+ views (71048) |
$348.80 |
$872 |
3.2× |
| Xr urogram antegrade (74425) |
$605 |
$1,512.50 |
1.7× |