| Acute gi blood loss imaging (78278) |
$1,679 |
$1,679 |
4.1× |
| Ankle 2 views (73600) |
$201.50 |
$201.50 |
2.3× |
| Brain imaging, minimum 4 static views; with vascular flow Age Under 21 (78606) |
$193 |
$193 |
0.3× |
| Clavicle complete (73000) |
$198 |
$198 |
2.2× |
| Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Age Under… (74261) |
$1,119 |
$1,119 |
10.5× |
| Computed tomographic (CT) colonography, screening, including image postprocessing (74263) |
$849.50 |
$849.50 |
3.5× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,567 |
$2,567 |
7.2× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$1,739 |
$1,739 |
9.7× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$2,118.50 |
$2,118.50 |
11.8× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$1,725 |
$1,725 |
9.6× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$1,743.50 |
$1,743.50 |
9.7× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$1,527.50 |
$1,527.50 |
8.5× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,649 |
$1,649 |
9.2× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$1,530 |
$1,530 |
8.5× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$275.50 |
$275.50 |
3.1× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$1,868.50 |
$1,868.50 |
10.4× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$1,107 |
$1,107 |
10.4× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,452 |
$1,452 |
8.1× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$1,676 |
$1,676 |
9.4× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,440.50 |
$1,440.50 |
8.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$1,316.50 |
$1,316.50 |
12.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,333.50 |
$1,333.50 |
7.4× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$1,178 |
$1,178 |
11.0× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$1,814 |
$1,814 |
10.1× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$1,552 |
$1,552 |
8.7× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$1,629.50 |
$1,629.50 |
9.1× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,605.50 |
$1,605.50 |
9.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$393 |
$393 |
1.1× |
| CT abdomen and pelvis without contrast (74176) |
$346 |
$346 |
1.4× |
| CT abdomen w & w/o contrast (74170) |
$1,781.50 |
$1,781.50 |
9.9× |
| CT abdomen w/contrast (74160) |
$345 |
$345 |
1.9× |
| CT abdomen w/o contrast (74150) |
$345 |
$345 |
3.2× |
| CT angio hrt w/3d image (75574) |
$380 |
$380 |
1.1× |
| CT cervical spine w/contrast (72126) |
$1,459.50 |
$1,459.50 |
4.1× |
| CT cervical spine w/o contrast (72125) |
$1,325.50 |
$1,325.50 |
12.4× |
| CT chest w/contrast (71260) |
$1,400.50 |
$1,400.50 |
7.8× |
| CT extremity upper w & w/o contrast (73202) |
$1,676 |
$1,676 |
9.4× |
| CT extremity upper w/o contrast (73200) |
$1,107 |
$1,107 |
10.4× |
| CT head/brain with contrast (70460) |
$1,258.50 |
$1,258.50 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,557 |
$1,557 |
8.7× |
| CT heart c+ cardiac strux&morph cgen hrt ds (75573) |
$1,453 |
$1,453 |
4.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,467.50 |
$1,467.50 |
4.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$219 |
$219 |
2.5× |
| CT l-spine w/contrast (72132) |
$1,513.50 |
$1,513.50 |
4.2× |
| CT limited/localized follow up study (76380) |
$654.50 |
$654.50 |
7.4× |
| CT lower extremity w/dye (73701) |
$1,312.50 |
$1,312.50 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$1,315 |
$1,315 |
12.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,575.50 |
$1,575.50 |
8.8× |
| CT neck w/contrast (70491) |
$1,340 |
$1,340 |
7.5× |
| CT neck w/o contrast (70490) |
$1,161.50 |
$1,161.50 |
10.9× |
| CT pelvis w & w/o contrast (72194) |
$345 |
$345 |
1.9× |
| CT pelvis w/o contrast (72192) |
$393 |
$393 |
3.7× |
| CT thoracic spine w/contrast (72129) |
$1,518.50 |
$1,518.50 |
8.5× |
| CT thoracic spine w/o contrast (72128) |
$1,329 |
$1,329 |
12.4× |
| CT thorax lung cancer scr c- (71271) |
$171 |
$171 |
1.6× |
| CT thorax w/o contrast (71250) |
$1,224.50 |
$1,224.50 |
11.5× |
| CT upper extremity w/dye (73201) |
$1,262.50 |
$1,262.50 |
3.5× |
| CTA h&n c+ w/noncontrast img (70471) |
$1,471.50 |
$1,471.50 |
4.1× |
| CTA head w contrast (70496) |
$1,471.50 |
$1,471.50 |
8.2× |
| Cystography, minimum of 3 views, radiological supervision and interpretation Age Under 21 (74430) |
$447 |
$447 |
1.3× |
| Doppler fetal mid cerebral artery (76821) |
$378 |
$378 |
3.5× |
| Fetal biophys profile w/o nst (76819) |
$456 |
$456 |
4.3× |
| Fetal biophysical profile non-stress testing (76818) |
$700.50 |
$700.50 |
6.6× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$376.50 |
$376.50 |
1.5× |
| Gated heart planar single (78472) |
$1,241 |
$1,241 |
3.0× |
| Hepatobil syst imag inc gb w/pharma intervenj (78227) |
$1,401.50 |
$1,401.50 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,251.50 |
$1,251.50 |
3.1× |
| Ht muscle image spect sing (78451) |
$2,302 |
$2,302 |
1.7× |
| Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Age Under 21 (78290) |
$855.50 |
$855.50 |
2.1× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,285.50 |
$1,285.50 |
2.3× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,039 |
$1,039 |
1.9× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,001.50 |
$1,001.50 |
1.8× |
| Liver and spleen imaging (78215) |
$1,057 |
$1,057 |
2.6× |
| Lung perfusion imaging (78580) |
$1,350.50 |
$1,350.50 |
3.3× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,112.50 |
$2,112.50 |
5.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Age Under 21 (73719) |
$1,764.50 |
$1,764.50 |
5.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Age Under 21 (73718) |
$1,500 |
$1,500 |
6.2× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,169 |
$2,169 |
6.1× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Age Under 21 (70542) |
$1,626.50 |
$1,626.50 |
4.6× |
| Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Age Under 21 (70540) |
$1,327 |
$1,327 |
5.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Age Under 21 (73219) |
$2,820 |
$2,820 |
7.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,314 |
$3,314 |
9.3× |
| Magnetic resonance angiography, head; with contrast material(s) Age Under 21 (70545) |
$1,428.50 |
$1,428.50 |
4.0× |
| Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further… (70546) |
$2,204.50 |
$2,204.50 |
6.2× |
| Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further… (70549) |
$2,307.50 |
$2,307.50 |
6.5× |
| Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation Age Under 21 (77054) |
$324.50 |
$324.50 |
1.3× |
| Mammary ductogram single (77053) |
$253 |
$253 |
1.0× |
| Mandible min 4v (70110) |
$265 |
$265 |
2.5× |
| MRA head w/o contrast (70544) |
$1,250.50 |
$1,250.50 |
5.1× |
| MRA neck w/ contrast (70548) |
$1,590 |
$1,590 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,526 |
$1,526 |
6.3× |
| MRI abdomen w/contrast (74182) |
$2,069.50 |
$2,069.50 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$1,950 |
$1,950 |
8.0× |
| MRI abdomen w/wo contrast (74183) |
$2,291.50 |
$2,291.50 |
6.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,880 |
$1,880 |
2.3× |
| MRI breast c- bilateral (77047) |
$570.50 |
$570.50 |
2.3× |
| MRI breast without contrast material unilateral (77046) |
$466.50 |
$466.50 |
1.9× |
| MRI c-spine w&w/o cont (72156) |
$2,423.50 |
$2,423.50 |
6.8× |
| MRI cervical spine w/contrast (72142) |
$2,163.50 |
$2,163.50 |
6.1× |
| MRI chest w/contrast (71551) |
$1,509.50 |
$1,509.50 |
1.9× |
| MRI chest w/o contrast (71550) |
$1,390 |
$1,390 |
5.7× |
| MRI chest w/wo contrast (71552) |
$2,413 |
$2,413 |
6.8× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,319 |
$2,319 |
6.5× |
| MRI joint upr extrem w/dye (73222) |
$1,837 |
$1,837 |
2.3× |
| MRI joint upr extrem w/o dye (73221) |
$1,660 |
$1,660 |
6.8× |
| MRI lumbar spine w/contrast (72149) |
$2,113.50 |
$2,113.50 |
5.9× |
| MRI lumbar spine w/wo contrast (72158) |
$2,418 |
$2,418 |
6.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,737 |
$2,737 |
7.7× |
| MRI pelvis w & w/o contrast (72197) |
$2,404.50 |
$2,404.50 |
6.7× |
| MRI pelvis w/contrast (72196) |
$1,583.50 |
$1,583.50 |
4.4× |
| MRI pelvis w/o contrast (72195) |
$2,129 |
$2,129 |
8.7× |
| MRI spine cervical w/o contrast (72141) |
$1,734 |
$1,734 |
7.1× |
| MRI t-spine w&w/o cont (72157) |
$2,557.50 |
$2,557.50 |
7.2× |
| MRI thoracic spine w/contrast (72147) |
$2,126.50 |
$2,126.50 |
6.0× |
| MRI thoracic spine w/o contrst (72146) |
$1,711.50 |
$1,711.50 |
7.0× |
| MRI tmj (70336) |
$1,391 |
$1,391 |
5.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,418 |
$2,418 |
9.9× |
| Myocardial spect multiple studies (78452) |
$2,516.50 |
$2,516.50 |
1.9× |
| Nm bone 3 phase (78315) |
$1,335.50 |
$1,335.50 |
3.3× |
| Nm bone imaging whole body (78306) |
$1,207 |
$1,207 |
3.0× |
| Nm gastric emptying (78264) |
$929 |
$929 |
2.3× |
| Nm lung ventilation imaging (78579) |
$1,109 |
$1,109 |
2.7× |
| Nm lymph system (78195) |
$1,465.50 |
$1,465.50 |
2.6× |
| Nuclear medicine study of bone and/or joint limited area (78300) |
$942.50 |
$942.50 |
2.3× |
| Nuclear medicine study of salivary gland with serial images (78231) |
$571.50 |
$571.50 |
1.4× |
| Ob us limited fetus(s) (76815) |
$325.50 |
$325.50 |
3.0× |
| Optic foramina (70190) |
$177 |
$177 |
2.0× |
| Parathyroid planar imaging (78070) |
$1,363.50 |
$1,363.50 |
3.3× |
| Pulmonary ventilation & perfusion imaging (78582) |
$1,536 |
$1,536 |
2.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$553.50 |
$553.50 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 1 vw (72081) |
$353.50 |
$353.50 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$478.50 |
$478.50 |
4.5× |
| Radex hip unilateral with pelvis 1 view (73501) |
$539 |
$539 |
6.1× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$385.50 |
$385.50 |
4.3× |
| Radex spine cervical 2 or 3 views (72040) |
$241 |
$241 |
2.7× |
| Radex spine cervical 4 or 5 views (72050) |
$326.50 |
$326.50 |
3.1× |
| Radex spine cervical 6 or more views (72052) |
$434 |
$434 |
4.1× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$230.50 |
$230.50 |
2.6× |
| Radiologic exam chest 3 views (71047) |
$248.50 |
$248.50 |
2.8× |
| Radiologic exam chest 4+ views (71048) |
$214 |
$214 |
2.0× |
| Radiologic exam colon double contrast study (74280) |
$711.50 |
$711.50 |
4.0× |
| Radiologic exam colon single contrast study (74270) |
$546 |
$546 |
3.0× |
| Radiologic exam esophagus single contrast study (74220) |
$355.50 |
$355.50 |
2.0× |
| Radiologic exam small int single contrast study (74250) |
$425 |
$425 |
2.4× |
| Radiologic exam swallow function contrast study (74230) |
$412 |
$412 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$213.50 |
$213.50 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$606.50 |
$606.50 |
3.4× |
| Radiologic examination femur 1 view (73551) |
$277 |
$277 |
3.1× |
| Radiologic examination femur minimum 2 views (73552) |
$605 |
$605 |
6.8× |
| Radiologic examination from nose to rectum for foreign body, single view, child Age Under 21 (76010) |
$184.50 |
$184.50 |
2.1× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$214 |
$214 |
2.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$340 |
$340 |
3.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$184.50 |
$184.50 |
2.1× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$203 |
$203 |
2.3× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$257 |
$257 |
2.9× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$203 |
$203 |
2.3× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$206 |
$206 |
2.3× |
| Radiologic examination, internal auditory meati, complete Age Under 21 (70134) |
$321.50 |
$321.50 |
0.6× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$206 |
$206 |
2.3× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$254 |
$254 |
2.4× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$210.50 |
$210.50 |
2.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$329 |
$329 |
3.1× |
| Radiologic examination, mastoids; less than 3 views per side Age Under 21 (70120) |
$177 |
$177 |
1.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$202 |
$202 |
2.3× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$343 |
$343 |
3.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$264 |
$264 |
2.5× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$184.50 |
$184.50 |
1.7× |
| Radiologic examination, shoulder, arthrography, radiological supervision and interpretation Age Under 21 (73040) |
$698.50 |
$698.50 |
2.0× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$235.50 |
$235.50 |
2.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Age Under 21 (76100) |
$428 |
$428 |
4.0× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$195.50 |
$195.50 |
2.2× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$290 |
$290 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$246.50 |
$246.50 |
2.3× |
| Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views Age Under 21 (72120) |
$267 |
$267 |
2.5× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$468 |
$468 |
4.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$210 |
$210 |
2.4× |
| Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction Age Under 21 (73050) |
$229.50 |
$229.50 |
2.6× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$198 |
$198 |
2.2× |
| Radiologic examination; lower extremity, infant, minimum of 2 views Age Under 21 (73592) |
$156 |
$156 |
1.8× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$276 |
$276 |
2.6× |
| Radiologic examination; sternoclavicular joint or joints, minimum of 3 views Age Under 21 (71130) |
$225.50 |
$225.50 |
2.5× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$161.50 |
$161.50 |
1.8× |
| Radiologic examination; upper extremity, infant, minimum of 2 views Age Under 21 (73092) |
$117 |
$117 |
1.1× |
| Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s)… (78803) |
$272.50 |
$272.50 |
0.5× |
| Radiopharmaceutical therapy, by oral administration Age Under 21 (79005) |
$1,242 |
$1,242 |
5.2× |
| Review by radiologist of urinary bladder and urethra images with contrast and after passing urine (74455) |
$445 |
$445 |
1.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$824 |
$824 |
2.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,014 |
$1,014 |
2.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$170 |
$170 |
0.3× |
| Scapula complete (73010) |
$208 |
$208 |
1.9× |
| Screening digital breast tomosynthesis bi (77063) |
$93 |
$93 |
— |
| Testicular imaging with vascular flow Age Under 21 (78761) |
$188 |
$188 |
0.5× |
| Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium… (74283) |
$512 |
$512 |
2.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$803.50 |
$803.50 |
2.0× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$863 |
$863 |
2.1× |
| Ultrasound breast limited (76642) |
$606 |
$606 |
6.8× |
| Ultrasound, abdomen limited (76705) |
$468 |
$468 |
4.4× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$348 |
$348 |
3.3× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$489 |
$489 |
4.6× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal… (76811) |
$528 |
$528 |
2.2× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$379 |
$379 |
3.5× |
| Umbilical-artery Doppler (OB) (76820) |
$374 |
$374 |
3.5× |
| Unlisted CT procedure (76497) |
$211 |
$211 |
2.4× |
| Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Age Under 21 (76498) |
$579 |
$579 |
6.5× |
| Ureteral reflux study (78740) |
$187 |
$187 |
0.5× |
| Urethrocystography retrograde rs&i (74450) |
$481 |
$481 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography Age Under 21 (74400) |
$571.50 |
$571.50 |
3.2× |
| Urography antegrade rs&i (74425) |
$461 |
$461 |
1.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$390 |
$390 |
3.7× |
| Us chest (76604) |
$406 |
$406 |
3.8× |
| Us compl joint r-t w/image documentation (76881) |
$470 |
$470 |
4.4× |
| Us elastography organ (76981) |
$286 |
$286 |
2.7× |
| Us encephalogram (76506) |
$439 |
$439 |
4.1× |
| Us exam, pelvic, limited (76857) |
$395 |
$395 |
3.7× |
| Us guided compression repair (76936) |
$688 |
$688 |
3.1× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$383 |
$383 |
4.3× |
| US OB Follow-Up/Repeat (76816) |
$254 |
$254 |
2.4× |
| Us ob transvaginal (76817) |
$469 |
$469 |
4.4× |
| Us retroperitoneal complete (76770) |
$518 |
$518 |
4.8× |
| Us retroperitoneal ltd (76775) |
$532.50 |
$532.50 |
5.0× |
| Us scrotum (76870) |
$480 |
$480 |
4.5× |
| Us soft tissue head/neck (76536) |
$456.50 |
$456.50 |
4.3× |
| Us spinal canal (76800) |
$436.50 |
$436.50 |
4.1× |
| Use 1st target lesion (76982) |
$192.50 |
$192.50 |
1.8× |
| X-ray exam hips bi 3-4 views (73522) |
$385.50 |
$385.50 |
3.6× |
| X-ray exam of finger(s) (73140) |
$160.50 |
$160.50 |
1.8× |
| X-ray exam of knee 1 or 2 (73560) |
$206.50 |
$206.50 |
2.3× |
| X-ray exam ribs bil 3 views (71110) |
$517.50 |
$517.50 |
4.8× |
| X-ray heel (73650) |
$169.50 |
$169.50 |
1.9× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$255 |
$255 |
2.4× |
| X-ray retrograde pyelogram (74420) |
$865 |
$865 |
2.4× |
| Xr abdomen 1 view (74018) |
$197.50 |
$197.50 |
2.2× |
| Xr abdomen 2 views (74019) |
$279.50 |
$279.50 |
2.6× |
| Xr arthrogram knee (73580) |
$543 |
$543 |
1.5× |
| Xr arthrogram wrist (73115) |
$470 |
$470 |
1.3× |
| Xr bone age studies (77072) |
$202 |
$202 |
1.9× |
| Xr bone length study (77073) |
$213.50 |
$213.50 |
2.0× |
| Xr bone survey infant (77076) |
$105 |
$105 |
1.0× |
| Xr bone survey ltd (77074) |
$403.50 |
$403.50 |
3.8× |
| Xr chest 1 view (71045) |
$169 |
$169 |
1.9× |
| Xr chest 2 views (71046) |
$220 |
$220 |
2.5× |
| Xr eye foreign body (70030) |
$224.50 |
$224.50 |
2.5× |
| Xr facial bones 3+ views (70150) |
$353 |
$353 |
3.3× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$175 |
$175 |
2.0× |
| Xr forearm 2 views (73090) |
$182.50 |
$182.50 |
2.1× |
| Xr hand 2v (73120) |
$177.50 |
$177.50 |
1.7× |
| Xr hysterosalpingogram (74740) |
$473 |
$473 |
1.9× |
| Xr neck soft tissue (70360) |
$163.50 |
$163.50 |
1.8× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$223.50 |
$223.50 |
2.5× |
| Xr osseous survey complete (77075) |
$736.50 |
$736.50 |
6.9× |
| Xr pelvis 1-2 views (72170) |
$56 |
$56 |
0.5× |
| Xr pelvis min 3 view (72190) |
$244 |
$244 |
2.3× |
| Xr peritoneogram (74190) |
$92 |
$92 |
0.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$216 |
$216 |
2.4× |
| Xr sella turcica (70240) |
$138.50 |
$138.50 |
1.6× |
| Xr shoulder 1 view (73020) |
$177 |
$177 |
2.0× |
| Xr sialogram (70390) |
$405.50 |
$405.50 |
1.7× |
| Xr sinuses 3+ views (70220) |
$359.50 |
$359.50 |
4.0× |
| Xr skull min 4 view (70260) |
$413.50 |
$413.50 |
3.9× |
| Xr spine 1 view (72020) |
$155 |
$155 |
1.7× |
| Xr spine thoracic 3v (72072) |
$276 |
$276 |
2.6× |
| Xr sternum 2+ views (71120) |
$264 |
$264 |
3.0× |
| Xr surgical specimen (76098) |
$304.50 |
$304.50 |
0.5× |
| Xr t-spine 2 views (72070) |
$227.50 |
$227.50 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$210 |
$210 |
2.4× |
| Xr tmj bilateral (70330) |
$342 |
$342 |
3.8× |
| Xr tmj unilateral (70328) |
$182.50 |
$182.50 |
2.1× |
| Xr wrist 2 views (73100) |
$177.50 |
$177.50 |
2.0× |