| Acute gi blood loss imaging (78278) |
$171.60 |
$858 |
0.4× |
| Angio adrenal bilat select (75733) |
$1,176.20 |
$5,881 |
0.4× |
| Angio adrenal unilat select (75731) |
$940.80 |
$4,704 |
0.3× |
| Angio extremity unilateral (75710) |
$2,232.20 |
$11,161 |
0.7× |
| Angio pulmonary unilateral (75741) |
$395.80 |
$1,979 |
0.1× |
| Angiogram extremity bilateral (75716) |
$2,689.20 |
$13,446 |
0.8× |
| Angiogram pelvic (75736) |
$3,584.60 |
$17,923 |
0.6× |
| Angiography internal mammary rs&i (75756) |
$304 |
$1,520 |
0.1× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$459.80 |
$2,299 |
0.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,584.60 |
$17,923 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$735.80 |
$3,679 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$415.40 |
$2,077 |
0.1× |
| Ankle 2 views (73600) |
$227.40 |
$1,137 |
2.5× |
| Arthrography knee lt (73580) |
$344.40 |
$1,722 |
0.9× |
| Arthrography wrist lt (73115) |
$127 |
$635 |
0.3× |
| Barium enema (74270) |
$190 |
$950 |
1.0× |
| Basic dosimetry (77300) |
$212.20 |
$1,061 |
1.5× |
| Bilat selctv renal venogram (75833) |
$1,265.80 |
$6,329 |
0.4× |
| Bone age studies (77072) |
$190.80 |
$954 |
1.7× |
| Bone imaging limited area (78300) |
$112 |
$560 |
0.3× |
| Bone survey complete (77075) |
$184.40 |
$922 |
1.7× |
| Bowel imaging (78290) |
$850.60 |
$4,253 |
2.0× |
| Brain image w/flow 4 + views (78606) |
$1,072.60 |
$5,363 |
1.9× |
| Card MRI w/stress img & dye (75563) |
$1,490.40 |
$7,452 |
1.8× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,490.40 |
$7,452 |
4.1× |
| Cardiac shunt detection (78428) |
$458.20 |
$2,291 |
1.1× |
| Cerebrospinal fluid leakage (78650) |
$220.40 |
$1,102 |
0.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$273.80 |
$1,369 |
1.5× |
| Cisternogram (78630) |
$201.80 |
$1,009 |
0.4× |
| Clavicle complete (73000) |
$191.80 |
$959 |
2.1× |
| Computed tomographic (CT) colonography, screening, including image postprocessing UNSCHEDULED (74263) |
$128.60 |
$643 |
0.5× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,056.20 |
$5,281 |
5.8× |
| Contrast exam abdominl aorta (75625) |
$2,689.20 |
$13,446 |
0.8× |
Contrast exam thoracic aorta (75605)
unusually low: confirm this is the full procedure |
$2,688.80 |
$13,444 |
0.5× |
| Csf shunt evaluation (78645) |
$476.60 |
$2,383 |
0.8× |
| CT - st neck w&wo contr (70492) |
$1,352.40 |
$6,762 |
7.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,305 |
$16,525 |
9.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,785 |
$8,925 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,818.20 |
$9,091 |
9.9× |
| CT abdomen w/contrast (74160) |
$1,454.40 |
$7,272 |
7.9× |
| CT abdomen w/o contrast (74150) |
$1,090.60 |
$5,453 |
10.0× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$1,944 |
$9,720 |
5.3× |
| CT angio abdom w/o & w/dye (74175) |
$1,580.60 |
$7,903 |
8.6× |
| CT angio abdominal arteries (75635) |
$1,284.20 |
$6,421 |
7.0× |
| CT angio hrt w/3d image (75574) |
$381.40 |
$1,907 |
1.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$721.80 |
$3,609 |
3.9× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$1,010.40 |
$5,052 |
5.5× |
| CT cervical spine w/contrast (72126) |
$2,646 |
$13,230 |
7.3× |
| CT cervical spine w/o contrast (72125) |
$1,548 |
$7,740 |
14.2× |
| CT chest w/contrast (71260) |
$1,352.40 |
$6,762 |
7.4× |
| CT extremity upper w & w/o contrast (73202) |
$1,619.80 |
$8,099 |
8.8× |
| CT head/brain with contrast (70460) |
$1,529.80 |
$7,649 |
8.4× |
| CT head/brain without and with contrast (70470) |
$1,541.80 |
$7,709 |
8.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,416.20 |
$7,081 |
3.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$112 |
$560 |
1.2× |
| CT limited/localized follow up study (76380) |
$421 |
$2,105 |
4.6× |
| CT lower ext w/wo contrast (73702) |
$1,619.80 |
$8,099 |
8.8× |
| CT lower extremity w contrast (73701) |
$1,457.80 |
$7,289 |
8.0× |
| CT lower extremity w/o contrast unilateral (73700) |
$852.40 |
$4,262 |
7.8× |
| CT lumbar spine w/contrast (72132) |
$2,557.80 |
$12,789 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$1,496 |
$7,480 |
13.7× |
| CT lumbar spine w/o then w/ con (72133) |
$2,842.40 |
$14,212 |
15.5× |
| CT maxillofacial area w/o contrast (70486) |
$867.40 |
$4,337 |
7.9× |
| CT maxillofacial w/contrast (70487) |
$1,049.40 |
$5,247 |
5.7× |
| CT maxillofacial w/o then w/ con (70488) |
$1,257 |
$6,285 |
6.9× |
| CT orbit sella ear w/o con (70480) |
$908.40 |
$4,542 |
8.3× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$1,172.60 |
$5,863 |
6.4× |
| CT pelvis w & w/o contrast (72194) |
$2,413.20 |
$12,066 |
13.2× |
| CT pelvis w/o contrast (72192) |
$1,270 |
$6,350 |
11.6× |
| CT soft tissue neck w/contrast (70491) |
$1,136.80 |
$5,684 |
6.2× |
| CT soft tissue neck w/o contrast (70490) |
$943.20 |
$4,716 |
8.6× |
| CT spine cervical w/wo contrast (72127) |
$2,940 |
$14,700 |
16.1× |
| CT thoracic spine w/contrast (72129) |
$2,349 |
$11,745 |
12.8× |
| CT thoracic spine w/o contrast (72128) |
$1,373.60 |
$6,868 |
12.6× |
| CT thoracic spine w/o then w/ con (72130) |
$2,609.40 |
$13,047 |
14.2× |
| CT thorax lung cancer scr c- (71271) |
$225 |
$1,125 |
2.1× |
| CT thorax w/o contrast (71250) |
$1,123 |
$5,615 |
10.3× |
| CT thorax w/o then w/ contrast (71270) |
$1,501.20 |
$7,506 |
8.2× |
| CT upper extremity w/dye (73201) |
$1,457.80 |
$7,289 |
4.0× |
| CT upper extremity w/o contrast rt (73200) |
$852.40 |
$4,262 |
7.8× |
| CTA chest w/wo contrast (71275) |
$2,073.80 |
$10,369 |
11.3× |
| CTA head w contrast (70496) |
$1,460.20 |
$7,301 |
8.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,647 |
$13,235 |
7.3× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,974 |
$9,870 |
10.8× |
| Cta Neck (70498) |
$2,069 |
$10,345 |
11.3× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$1,774.80 |
$8,874 |
9.7× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$746.10 |
$3,730.50 |
0.4× |
| Diskography lumbar (72295) |
$2,044 |
$10,220 |
1.0× |
| Doppler echo fetal spectral display complete (76827) |
$164.80 |
$824 |
1.5× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$220 |
$1,100 |
2.0× |
| Doppler fetal mid cerebral artery (76821) |
$161.40 |
$807 |
1.5× |
| Dxa bone density study axial skeleton (77085) |
$245 |
$1,225 |
2.2× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$330.60 |
$1,653 |
1.3× |
| Esophageal motility (78258) |
$109.20 |
$546 |
0.3× |
| Esophogram (74220) |
$280.40 |
$1,402 |
1.5× |
| Fetal biophysical profile non-stress testing (76818) |
$318.80 |
$1,594 |
2.9× |
| Fetal biophysical profile w/o nst (76819) |
$307.40 |
$1,537 |
2.8× |
| Fetal echo complete (76825) |
$248.20 |
$1,241 |
0.4× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$351 |
$1,755 |
1.4× |
| Gastric emptying study (78264) |
$823 |
$4,115 |
2.0× |
| Gastroesophageal reflux study (78262) |
$109.20 |
$546 |
0.3× |
| Gated heart planar single (78472) |
$746.80 |
$3,734 |
1.8× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$940.80 |
$4,704 |
0.3× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$940.80 |
$4,704 |
0.3× |
| Hepatobil syst image w/drug (78227) |
$851.20 |
$4,256 |
1.5× |
| Hepatobiliary system imaging (78226) |
$621 |
$3,105 |
1.5× |
| Humerus min 2 views (73060) |
$225.80 |
$1,129 |
2.5× |
| Hysterosalpingography (74740) |
$563.20 |
$2,816 |
2.3× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$1,310.80 |
$6,554 |
3.1× |
Intraoperative radiation treatment delivery, electrons, single treatment session 2nd-5th Sessions (77425)
likely a partial charge, not the full procedure |
$1,580 |
$7,900 |
0.2× |
Intraoperative radiation treatment delivery, x-ray, single treatment session 2nd-5th Sessions (77424)
likely a partial charge, not the full procedure |
$1,580 |
$7,900 |
0.2× |
| Ivp (74400) |
$835 |
$4,175 |
4.6× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,500.20 |
$7,501 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$933.60 |
$4,668 |
1.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$691.60 |
$3,458 |
1.2× |
| Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Age Under 21 (78140) |
$185 |
$925 |
0.4× |
| Liver & spleen; static only (78215) |
$202.80 |
$1,014 |
0.5× |
| Lung perf&ventilat diferentl (78598) |
$1,005.80 |
$5,029 |
1.8× |
| Lung perfusion differential (78597) |
$654.60 |
$3,273 |
1.6× |
| Lung ventilat&perfus imaging (78582) |
$958.80 |
$4,794 |
1.7× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,149.40 |
$5,747 |
0.7× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$814.80 |
$4,074 |
1.2× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$1,181.80 |
$5,909 |
0.4× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$814.80 |
$4,074 |
0.2× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,560.60 |
$7,803 |
4.3× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,516 |
$7,580 |
4.2× |
| Mammary ductogram multiple ducts (77054) |
$192.20 |
$961 |
0.8× |
| Mammary ductogram single (77053) |
$149.80 |
$749 |
0.6× |
| Mr safety determination physician/other qhp (76016) |
$46.80 |
$234 |
0.5× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$31.60 |
$158 |
0.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$13 |
$65 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$48.80 |
$244 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$128.40 |
$642 |
0.5× |
| MRA head w & w/o contrast (70546) |
$1,928.40 |
$9,642 |
5.3× |
| MRA head w/contrast (70545) |
$1,595.20 |
$7,976 |
4.4× |
| MRA head w/o contrast (70544) |
$1,190.40 |
$5,952 |
4.8× |
| MRA neck w/contrast (70548) |
$1,237.20 |
$6,186 |
3.4× |
| MRA neck w/o contrast (70547) |
$924.20 |
$4,621 |
3.7× |
| MRA neck w/wo contrast (70549) |
$1,490.40 |
$7,452 |
4.1× |
| MRI abdomen w/contrast (74182) |
$1,424.60 |
$7,123 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,722.40 |
$8,612 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$1,063.20 |
$5,316 |
4.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,291 |
$6,455 |
1.6× |
| MRI breast without contrast bilateral (77047) |
$1,178.20 |
$5,891 |
4.7× |
| MRI breast without contrast material unilateral (77046) |
$1,178.20 |
$5,891 |
4.7× |
| MRI cardiac w/o contrast (75557) |
$1,297 |
$6,485 |
5.2× |
| MRI cervical spine w/o contrast (72141) |
$1,504 |
$7,520 |
6.0× |
| MRI cervical spine with contrast (72142) |
$2,015.20 |
$10,076 |
5.5× |
| MRI chest w & w/o contrast (71552) |
$1,967 |
$9,835 |
5.4× |
| MRI chest w/contrast (71551) |
$1,632.40 |
$8,162 |
2.0× |
| MRI chest w/o contrast (71550) |
$1,219.40 |
$6,097 |
4.9× |
| MRI elastography (76391) |
$154.80 |
$774 |
0.6× |
| MRI fetal sngl/1st gestation (74712) |
$837 |
$4,185 |
3.4× |
| MRI joint upper ext w/contrast (73222) |
$1,835.20 |
$9,176 |
2.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,219.60 |
$11,098 |
6.1× |
| MRI joint upr extrem w/o dye (73221) |
$1,369.60 |
$6,848 |
5.5× |
| Mri Lower Extremity W/O Dye (73718) |
$940.40 |
$4,702 |
3.8× |
| MRI lumbar spine with contrast (72149) |
$1,842.60 |
$9,213 |
5.1× |
| MRI lumbar w/wo contrast (72158) |
$1,810 |
$9,050 |
5.0× |
| MRI lwr ext w/o jnts with con rt (73719) |
$1,258.40 |
$6,292 |
3.5× |
| MRI orbit/face/neck w/contrast (70542) |
$1,373.60 |
$6,868 |
3.8× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,654.20 |
$8,271 |
4.5× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,026.20 |
$5,131 |
4.1× |
| MRI pelvis w/ contrast (72196) |
$1,237.20 |
$6,186 |
3.4× |
| MRI pelvis w/o contrast (72195) |
$924.20 |
$4,621 |
3.7× |
| MRI pelvis w/wo contrast (72197) |
$1,490.40 |
$7,452 |
4.1× |
| MRI spine cervical wo/w contrast (72156) |
$1,721.40 |
$8,607 |
4.7× |
| MRI spine thoracic w/contrast (72147) |
$2,131.40 |
$10,657 |
5.9× |
| MRI thoracic spine w wo contrast (72157) |
$2,045.80 |
$10,229 |
5.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,590.60 |
$7,953 |
6.4× |
| MRI tmj (70336) |
$722.20 |
$3,611 |
2.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,278.20 |
$6,391 |
5.1× |
| Mri Upper Extremity W/Dye (73219) |
$1,711.60 |
$8,558 |
4.7× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$2,062.20 |
$10,311 |
5.7× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78491) |
$597.40 |
$2,987 |
0.4× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78492) |
$752.60 |
$3,763 |
0.5× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$1,544.80 |
$7,724 |
1.1× |
| Myocardial perfusion planar multiple studies (78454) |
$1,861.80 |
$9,309 |
1.4× |
| Myocardial spect single study at rest or stress (78451) |
$1,544.80 |
$7,724 |
1.1× |
| Myocrd img PET metab eval single study (78459) |
$756 |
$3,780 |
0.6× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,578.60 |
$7,893 |
1.8× |
| Nm bone 3 phase (78315) |
$215 |
$1,075 |
0.5× |
| Nm bone imaging whole body (78306) |
$154.60 |
$773 |
0.4× |
| Nm bone marrow scan limited (78102) |
$514 |
$2,570 |
1.2× |
| Nm heart perfusion spect stress rest (78452) |
$1,861.80 |
$9,309 |
1.4× |
| Nm kidney function (78725) |
$767.60 |
$3,838 |
1.8× |
| Nm liver image static only (78201) |
$781 |
$3,905 |
1.4× |
| Nm lymph system (78195) |
$646.40 |
$3,232 |
1.1× |
| Nm myocard infarct spect (78469) |
$130.80 |
$654 |
0.2× |
| Nm thyroid imaging only (78013) |
$731 |
$3,655 |
1.8× |
| Nose to rectum for fb child (76010) |
$117 |
$585 |
1.3× |
| Nuclear medicine study of brain, 4 static views or more (78605) |
$633.20 |
$3,166 |
1.1× |
| Nuclear rx IV admin (79101) |
$100.20 |
$501 |
0.4× |
| Ob us < 14 wks single fetus (76801) |
$211.60 |
$1,058 |
1.9× |
| Ob us nuchal meas 1 gest (76813) |
$199.80 |
$999 |
1.8× |
| Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) Age Under 21 (76512) |
$190.40 |
$952 |
1.7× |
| Oral radiopharm rx (79005) |
$100.20 |
$501 |
0.4× |
| Orthopantogram (70355) |
$144.20 |
$721 |
1.6× |
| Parathyrd planar w/spect&CT (78072) |
$1,346 |
$6,730 |
2.4× |
| Parathyroid imaging (78070) |
$154.40 |
$772 |
0.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,050 |
$5,250 |
2.5× |
| Peritoneal-venous shunt patency test (78291) |
$109.20 |
$546 |
0.3× |
| Peritoneogram rs&i (74190) |
$331.60 |
$1,658 |
0.6× |
| PET brain metabolic eval (78608) |
$2,751 |
$13,755 |
1.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,667.60 |
$13,338 |
1.8× |
| PET imaging CT for attenuation limited area (78814) |
$2,400.80 |
$12,004 |
1.6× |
| PET imaging for CT attenuation whole body (78816) |
$2,721.40 |
$13,607 |
1.8× |
| PET imaging limited area chest head/neck (78811) |
$1,403.80 |
$7,019 |
1.0× |
| PET imaging whole body (78813) |
$1,416.20 |
$7,081 |
0.9× |
| Positron emission tomography (PET) imaging; skull base to mid-thigh Age Under 21 (78812) |
$1,361.80 |
$6,809 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$331.60 |
$1,658 |
0.1× |
| Pulmonary perfusion imaging particulate (78580) |
$599.80 |
$2,999 |
1.4× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$510.20 |
$2,551 |
0.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$314.20 |
$1,571 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$332.80 |
$1,664 |
3.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$465.80 |
$2,329 |
4.3× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$332.80 |
$1,664 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$332.80 |
$1,664 |
3.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$91.20 |
$456 |
1.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$108 |
$540 |
1.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$108 |
$540 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$145 |
$725 |
1.3× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$145 |
$725 |
1.3× |
| Radex spine cervical 2 or 3 views (72040) |
$318 |
$1,590 |
3.5× |
| Radex spine cervical 4 or 5 views (72050) |
$403.40 |
$2,017 |
3.7× |
| Radex spine cervical 6 or more views (72052) |
$518.40 |
$2,592 |
4.7× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$241.20 |
$1,206 |
2.7× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$277.80 |
$1,389 |
2.5× |
| Radiologic exam esophagus double contrast study (74221) |
$280.40 |
$1,402 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$312.40 |
$1,562 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$386.20 |
$1,931 |
2.1× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$117 |
$585 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$233.80 |
$1,169 |
2.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$324 |
$1,620 |
3.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$85.40 |
$427 |
0.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$384.60 |
$1,923 |
3.5× |
| Radiologic examination, teeth; partial examination, less than full mouth Other Diagnostic Radiology FS (70310) |
$89 |
$445 |
0.4× |
| Radiopharmaceutical therapy, by interstitial radioactive colloid administration UNSCHEDULED (79300) |
$63.40 |
$317 |
0.3× |
| Radiopharmaceutical therapy, by intra-articular administration Age Under 21 (79440) |
$128.20 |
$641 |
0.5× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$128.20 |
$641 |
0.5× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion UNSCHEDULED (79403) |
$128.20 |
$641 |
0.5× |
| Renal cyst study (74470) |
$221.40 |
$1,107 |
0.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$459.60 |
$2,298 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$598 |
$2,990 |
1.4× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$1,389.80 |
$6,949 |
2.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$792.20 |
$3,961 |
1.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$834.20 |
$4,171 |
1.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,121 |
$5,605 |
0.8× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$1,121 |
$5,605 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$834.20 |
$4,171 |
0.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$324 |
$1,620 |
1.3× |
| Saline infused sonohysterogram (76831) |
$336 |
$1,680 |
1.3× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$14.50 |
$72.50 |
0.6× |
Selective spinal angiogram (75705)
likely a partial charge, not the full procedure |
$1,153.80 |
$5,769 |
0.2× |
| Shoulder arthrogram (73040) |
$184.40 |
$922 |
0.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$301.80 |
$1,509 |
2.8× |
| Small bowel series (74250) |
$333.40 |
$1,667 |
1.8× |
| Special treatment procedure (77470) |
$728 |
$3,640 |
1.3× |
| Splenoportography (75810) |
$940.80 |
$4,704 |
0.3× |
| Superior sagittal sinus venogram (75870) |
$809.20 |
$4,046 |
0.2× |
| Surface application of low dose rate radionuclide source 2nd-5th Sessions (77789) |
$40.80 |
$204 |
0.4× |
| Therapeutic enema barium or air (74283) |
$190 |
$950 |
1.0× |
| Thyroid met imaging body (78018) |
$817.40 |
$4,087 |
1.4× |
| Thyroid uptake single/multiple quant measurement (78012) |
$48.60 |
$243 |
0.1× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$848.80 |
$4,244 |
2.0× |
| Ultrasound breast limited (76642) |
$261.80 |
$1,309 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$330.40 |
$1,652 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$171.20 |
$856 |
1.6× |
| Unlisted CT procedure (76497) |
$120.20 |
$601 |
1.3× |
| Unlisted magnetic resonance procedure (76498) |
$1,392.80 |
$6,964 |
15.3× |
| Urea breath test, C-14 (isotopic); acquisition for analysis Other Outpatient (78267) |
$21.60 |
$108 |
2.0× |
| Urea breath test, C-14 (isotopic); analysis Other Outpatient (78268) |
$171.40 |
$857 |
1.8× |
| Ureteral reflux study (78740) |
$361.40 |
$1,807 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$99.20 |
$496 |
0.4× |
| Urethrocystography voiding (74455) |
$552.60 |
$2,763 |
2.2× |
| Urography antegrade (74425) |
$417.60 |
$2,088 |
1.1× |
| Urography retrograde w/wo kub (74420) |
$417.60 |
$2,088 |
1.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$311.70 |
$1,558.50 |
2.9× |
| Us breast uni real time with image complete (76641) |
$340.20 |
$1,701 |
3.1× |
| Us chest (76604) |
$310.20 |
$1,551 |
2.8× |
| Us compl joint r-t w/image documentation (76881) |
$350.60 |
$1,753 |
3.2× |
| Us elastography parenchyma (76981) |
$318.80 |
$1,594 |
2.9× |
| Us encephalogram (76506) |
$310.20 |
$1,551 |
2.8× |
| Us guided compression repair (76936) |
$255.80 |
$1,279 |
1.1× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$131.20 |
$656 |
1.4× |
| Us kidney transplanted (76776) |
$221.20 |
$1,106 |
2.0× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$225.80 |
$1,129 |
2.1× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$350.60 |
$1,753 |
3.2× |
| Us ob detailed single fetus (76811) |
$336 |
$1,680 |
1.3× |
| Us ob followup per fetus (76816) |
$513.40 |
$2,567 |
4.7× |
| Us ob limited 1 or more fetuses (76815) |
$394.20 |
$1,971 |
3.6× |
| Us obstetric transvaginal (76817) |
$442.20 |
$2,211 |
4.1× |
| Us pelvic limited or f/u non-ob (76857) |
$275 |
$1,375 |
2.5× |
| Us pelvis complete (76856) |
$421.60 |
$2,108 |
3.9× |
| Us retroperitoneal complete (76770) |
$239.20 |
$1,196 |
2.2× |
| Us retroperitoneal limited (76775) |
$196.40 |
$982 |
1.8× |
| Us scrotum (76870) |
$393.60 |
$1,968 |
3.6× |
| Us soft tissue head/neck (76536) |
$403 |
$2,015 |
3.7× |
| Us spinal canal (76800) |
$210.40 |
$1,052 |
1.9× |
| Us transrectal (76872) |
$324.30 |
$1,621.50 |
3.0× |
| Us transrectal prostate volume (76873) |
$347.80 |
$1,739 |
3.2× |
| Us unlstd proc (76999) |
$158.30 |
$791.50 |
1.7× |
| Vein X-ray liver w/hemodynam (75885) |
$329 |
$1,645 |
0.1× |
| Venogram epidural (75872) |
$304 |
$1,520 |
0.5× |
| Venogram extremity bilateral (75822) |
$1,365 |
$6,825 |
0.8× |
| Venogram ivc w serialography (75825) |
$1,261.40 |
$6,307 |
0.4× |
| Venogram svc w serialography (75827) |
$1,261.40 |
$6,307 |
0.8× |
| Venography adrenal unilateral selective rs&i (75840) |
$940.80 |
$4,704 |
0.3× |
| Venography ext unilateral (75820) |
$1,092 |
$5,460 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,092 |
$5,460 |
0.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$809.20 |
$4,046 |
0.2× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$304 |
$1,520 |
0.5× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,231.80 |
$6,159 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$114.80 |
$574 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$246.60 |
$1,233 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$264.40 |
$1,322 |
2.9× |
| X-ray aorta leg arteries (75630) |
$3,172.60 |
$15,863 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$265 |
$1,325 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$277 |
$1,385 |
3.0× |
| X-ray exam hips bi 3-4 views (73522) |
$145 |
$725 |
1.3× |
| X-ray exam of finger(s) (73140) |
$215 |
$1,075 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$273.60 |
$1,368 |
3.0× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$254 |
$1,270 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$288.60 |
$1,443 |
3.2× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$235.40 |
$1,177 |
2.2× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$277 |
$1,385 |
3.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$236 |
$1,180 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$116.20 |
$581 |
1.3× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$277.20 |
$1,386 |
3.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$323.40 |
$1,617 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$263.40 |
$1,317 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$329.80 |
$1,649 |
3.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$584.20 |
$2,921 |
5.4× |
| X-ray perineogram (74775) |
$206.80 |
$1,034 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$302.40 |
$1,512 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$495 |
$2,475 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$218 |
$1,090 |
2.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$208 |
$1,040 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$183.40 |
$917 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$277 |
$1,385 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$185.40 |
$927 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$343 |
$1,715 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$271 |
$1,355 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$350.60 |
$1,753 |
3.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$122.40 |
$612 |
1.3× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$235 |
$1,175 |
2.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$275.80 |
$1,379 |
3.0× |
| Xr abdomen 1 view (74018) |
$162.20 |
$811 |
1.8× |
| Xr abdomen 2 views (74019) |
$271 |
$1,355 |
2.5× |
| Xr abdomen 3 views (74021) |
$405.60 |
$2,028 |
3.7× |
| Xr arthrogram ankle (73615) |
$127 |
$635 |
0.3× |
| Xr arthrogram elbow (73085) |
$127 |
$635 |
0.3× |
| Xr arthrogram hip (73525) |
$160.20 |
$801 |
0.4× |
| Xr bone density appendicular (77081) |
$103.60 |
$518 |
1.1× |
| Xr bone density axial (77080) |
$257.80 |
$1,289 |
2.4× |
| Xr bone length study (77073) |
$54 |
$270 |
0.5× |
| Xr bone survey infant (77076) |
$186.40 |
$932 |
1.7× |
| Xr bone survey limited (77074) |
$123.40 |
$617 |
1.1× |
| Xr chest 1 view (71045) |
$143.60 |
$718 |
1.6× |
| Xr chest 2 views (71046) |
$186 |
$930 |
2.0× |
| Xr chest 3 views (71047) |
$231.60 |
$1,158 |
2.5× |
| Xr cystogram 3+ views (74430) |
$304.40 |
$1,522 |
0.8× |
| Xr eye foreign body (70030) |
$208.40 |
$1,042 |
2.3× |
| Xr facial bones 3 views (70150) |
$391 |
$1,955 |
3.6× |
| Xr joint survey 1 view (77077) |
$123.40 |
$617 |
1.1× |
| Xr lower extremity 2 views infant (73592) |
$87.80 |
$439 |
1.0× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$387.60 |
$1,938 |
3.6× |
| Xr mandible 4 views (70110) |
$164 |
$820 |
1.5× |
| Xr nasal bones (70160) |
$198 |
$990 |
2.2× |
| Xr pelvis 3 views (72190) |
$265.60 |
$1,328 |
2.4× |
| Xr sialogram (70390) |
$108.80 |
$544 |
0.4× |
| Xr spine 1 view (72020) |
$220.20 |
$1,101 |
2.4× |
| Xr sternum 2 views (71120) |
$297 |
$1,485 |
3.3× |
| Xr surgical specimen (76098) |
$264 |
$1,320 |
0.5× |
| Xr upper extremity 2 views infant (73092) |
$156 |
$780 |
1.4× |
| Xray elbow 2 views (73070) |
$235.40 |
$1,177 |
2.6× |
| Xray forearm 2 views (73090) |
$251.60 |
$1,258 |
2.8× |
| Xray knee 1 or 2 views rt (73560) |
$228.80 |
$1,144 |
2.5× |
| Xray neck soft tissue (70360) |
$152.20 |
$761 |
1.7× |
| Xray orbits complete min 4 views (70200) |
$346.20 |
$1,731 |
3.2× |
| Xray pelvis 1 or 2 views (72170) |
$177 |
$885 |
1.6× |
| Xray ribs bilateral 3 views (71110) |
$370.80 |
$1,854 |
3.4× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$363.60 |
$1,818 |
3.3× |
| Xray scapula complete (73010) |
$196.60 |
$983 |
1.8× |
| Xray shoulder 1 view (73020) |
$213 |
$1,065 |
2.3× |
| Xray sinuses paranasal <3 views (70210) |
$146.80 |
$734 |
1.6× |
| Xray spine thoracic 2 views (72070) |
$290.20 |
$1,451 |
2.7× |
| Xray spine thoracic 3 views (72072) |
$323.40 |
$1,617 |
3.0× |
| Xray tibia-fibula 2 views bil (73590) |
$252 |
$1,260 |
2.8× |
| Xray tmj open - closed unilat (70328) |
$186.80 |
$934 |
2.1× |
| Xray tmj's bilateral open-clsc (70330) |
$193.40 |
$967 |
2.1× |