| Abdomen 2 views (74019) |
$225 |
$375 |
1.8× |
| Acute gi blood loss imaging (78278) |
$739.80 |
$1,233 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,617.40 |
$6,029 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,941.20 |
$4,902 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$2,913 |
$4,855 |
0.8× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,908.20 |
$4,847 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,968.20 |
$4,947 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,274.80 |
$5,458 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,431.20 |
$9,052 |
0.8× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,316.40 |
$2,194 |
0.4× |
| Ankle 2 views (73600) |
$187.80 |
$313 |
1.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,117.60 |
$5,196 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$3,138 |
$5,230 |
0.8× |
| Arthrogram ankle (73615) |
$624 |
$1,040 |
1.5× |
| Arthrogram elbow (73085) |
$544.80 |
$908 |
1.3× |
| Arthrogram hip (73525) |
$544.80 |
$908 |
1.3× |
| Arthrogram knee (73580) |
$535.80 |
$893 |
1.3× |
| Arthrogram shoulder (73040) |
$675.60 |
$1,126 |
1.6× |
| Arthrogram wrist (73115) |
$535.80 |
$893 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$739.80 |
$1,233 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$757.20 |
$1,262 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$951.60 |
$1,586 |
2.0× |
| Bone age studies (77072) |
$225 |
$375 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,000.80 |
$1,668 |
2.1× |
| Bone Marrow Imaging Limited Area (78102) |
$721.80 |
$1,203 |
1.5× |
| Bone survey complete (77075) |
$542.40 |
$904 |
4.4× |
| Bone survey infant (77076) |
$320.40 |
$534 |
2.6× |
| Bowel imaging (78290) |
$828.60 |
$1,381 |
1.8× |
| Brain imaging < 4 static views (78600) |
$739.80 |
$1,233 |
1.6× |
| Brain Imaging Vascular Flow Only (78610) |
$969 |
$1,615 |
1.5× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$969 |
$1,615 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$723 |
$1,205 |
1.5× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,653 |
$2,755 |
1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,134.20 |
$3,557 |
5.2× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$969 |
$1,615 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$283.80 |
$473 |
2.8× |
| Chest 1 view (71045) |
$219 |
$365 |
2.1× |
| Chest xray 3 views (71047) |
$289.80 |
$483 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$440.40 |
$734 |
2.1× |
| Clavicle complete (73000) |
$225 |
$375 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$370.80 |
$618 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,925.60 |
$4,876 |
7.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,410.20 |
$4,017 |
8.6× |
| CT abdomen w contrast (74160) |
$1,589.40 |
$2,649 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,585.20 |
$2,642 |
7.7× |
| CT abdomen w/o contrast (74150) |
$1,291.20 |
$2,152 |
10.5× |
| CT angio hrt w/3d image (75574) |
$1,438.20 |
$2,397 |
3.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,601.70 |
$2,669.50 |
7.7× |
| CT angiography upper extremity lt (73206) |
$1,330.80 |
$2,218 |
6.4× |
| CT c-spine w/contrast (72126) |
$1,465.80 |
$2,443 |
3.6× |
| CT c-spine w/o contrast (72125) |
$1,382.40 |
$2,304 |
11.2× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,399.20 |
$2,332 |
6.8× |
| CT chest w contrast (71260) |
$1,570.20 |
$2,617 |
7.6× |
| CT chest w/wo contrast (71270) |
$2,028 |
$3,380 |
9.8× |
| CT head/brain with contrast (70460) |
$1,408.20 |
$2,347 |
6.8× |
| CT head/brain without and with contrast (70470) |
$1,509 |
$2,515 |
7.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$642.60 |
$1,071 |
1.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$142.80 |
$238 |
1.4× |
| CT hrt w/3d image congen (75573) |
$651.60 |
$1,086 |
1.6× |
| CT iac w contrast (70481) |
$1,368 |
$2,280 |
6.6× |
| CT lower ext w/o (73700) |
$1,194.60 |
$1,991 |
9.7× |
| CT lower extremity w wo contrast (73702) |
$1,571.40 |
$2,619 |
7.6× |
| CT lower extremity w/contrast material (73701) |
$1,450.80 |
$2,418 |
7.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,541.40 |
$2,569 |
7.4× |
| CT lumbar spine w/contrast (72132) |
$1,657.80 |
$2,763 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,205.40 |
$2,009 |
9.8× |
| CT maxillofacial w contrast (70487) |
$1,279.80 |
$2,133 |
6.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,530 |
$2,550 |
7.4× |
| CT maxillofacial wo contrast (70486) |
$1,159.20 |
$1,932 |
9.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,471.20 |
$2,452 |
7.1× |
| CT orbits w/o contrast (70480) |
$1,194.60 |
$1,991 |
9.7× |
| CT pelvis w/o contrast (72192) |
$1,194.60 |
$1,991 |
9.7× |
| CT pelvis w/wo contrast (72194) |
$1,571.40 |
$2,619 |
7.6× |
| CT scan of arm combo (73202) |
$1,541.40 |
$2,569 |
7.4× |
| CT soft tissue neck w contrast (70491) |
$1,381.20 |
$2,302 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,564.80 |
$2,608 |
7.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,312.20 |
$2,187 |
10.6× |
| CT thoracic spine w/contrast (72129) |
$1,448.40 |
$2,414 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$1,320.60 |
$2,201 |
10.7× |
| CT thorax w/o contrast (71250) |
$1,331.10 |
$2,218.50 |
10.8× |
| CT upper ext wo (73200) |
$1,194.60 |
$1,991 |
9.7× |
| CT upper extremity with contrast (73201) |
$1,450.80 |
$2,418 |
3.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,697.40 |
$2,829 |
8.2× |
| Cta Abdomen (74175) |
$1,761.30 |
$2,935.50 |
8.5× |
| CTA abdomen pelvis (74174) |
$2,842.20 |
$4,737 |
6.9× |
| CTA chest (71275) |
$1,739.70 |
$2,899.50 |
8.4× |
| Cta Head (70496) |
$1,975.20 |
$3,292 |
9.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,399.20 |
$2,332 |
3.4× |
| Cta Neck (70498) |
$2,133.60 |
$3,556 |
10.3× |
| Cta Pelvis (72191) |
$1,781.70 |
$2,969.50 |
8.6× |
| Cystography minimum 3 views rs&i (74430) |
$454.20 |
$757 |
1.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$409.20 |
$682 |
3.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$417.60 |
$696 |
3.4× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$368.40 |
$614 |
3.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$249.60 |
$416 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$146.40 |
$244 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$390 |
$650 |
1.4× |
| Esophagus (74220) |
$252 |
$420 |
1.2× |
| Facial bones min 3 views (70150) |
$301.80 |
$503 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$411.30 |
$685.50 |
3.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$333.90 |
$556.50 |
2.7× |
| Fetal Echo (76825) |
$510.90 |
$851.50 |
0.8× |
| Fluoroscopy up to 1 hr (76000) |
$435 |
$725 |
1.5× |
| Foot 2 views (73620) |
$204.60 |
$341 |
2.0× |
| Forearm 2 views (73090) |
$225 |
$375 |
2.2× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$739.80 |
$1,233 |
1.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$969 |
$1,615 |
1.5× |
| Hand 2 views (73120) |
$225 |
$375 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$969 |
$1,615 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$723 |
$1,205 |
1.5× |
| Hysterosalpingogram (74740) |
$543.60 |
$906 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$180.60 |
$301 |
1.5× |
| Kidney imaging morphology (78700) |
$749.40 |
$1,249 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,052.40 |
$1,754 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,167 |
$1,945 |
1.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,294.80 |
$2,158 |
2.0× |
| Knee 3 views (73562) |
$288 |
$480 |
2.8× |
| Liver & spleen imaging static only (78215) |
$739.80 |
$1,233 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$855.60 |
$1,426 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$1,052.40 |
$1,754 |
1.6× |
| Lung perfusion differential (78597) |
$749.40 |
$1,249 |
1.6× |
| Lung ventilation imaging (78579) |
$739.80 |
$1,233 |
1.6× |
| Lymphoscintigraphy (78195) |
$984.30 |
$1,640.50 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,753.80 |
$2,923 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,509.60 |
$2,516 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,818.60 |
$3,031 |
4.4× |
| Mammary ductogram or galactogram multiple (77054) |
$427.20 |
$712 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$340.80 |
$568 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$231 |
$385 |
2.2× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$64.20 |
$107 |
1.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$240 |
$400 |
2.1× |
| Mr safety implt pos&/immoblj (76019) |
$172.80 |
$288 |
2.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$632.40 |
$1,054 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,188.80 |
$3,648 |
5.3× |
| MRA head w/o contrast (70544) |
$1,749.60 |
$2,916 |
6.2× |
| MRA head with contrast (70545) |
$1,962 |
$3,270 |
4.8× |
| MRA neck w contrast (70548) |
$1,854.60 |
$3,091 |
4.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,188.80 |
$3,648 |
5.3× |
| MRA neck w/o contrast (70547) |
$1,812 |
$3,020 |
6.4× |
| MRI abdomen w contrast (74182) |
$1,953.60 |
$3,256 |
4.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,316 |
$3,860 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,947 |
$3,245 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,627.80 |
$2,713 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,956 |
$3,260 |
4.7× |
| MRI breast w/o contrast bilateral (77047) |
$2,031.60 |
$3,386 |
7.2× |
| MRI breast wo contrast unilateral (77046) |
$1,410 |
$2,350 |
5.0× |
| MRI c-spine with contrast (72142) |
$1,512.60 |
$2,521 |
3.7× |
| MRI cardiac w/o cont stress (75559) |
$1,443.60 |
$2,406 |
2.2× |
| MRI cardiac w/o contrast (75557) |
$1,620.60 |
$2,701 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,509.60 |
$2,516 |
5.4× |
| MRI chest w/o & w/contrast material (71552) |
$1,956.60 |
$3,261 |
4.7× |
| MRI chest w/o contrast (71550) |
$1,716.90 |
$2,861.50 |
6.1× |
| MRI chest with contrast (71551) |
$1,704.60 |
$2,841 |
1.8× |
| MRI fetal sngl/1st gestation (74712) |
$1,285.80 |
$2,143 |
4.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,627.80 |
$2,713 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,856.40 |
$3,094 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,472.70 |
$2,454.50 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,620.60 |
$2,701 |
5.7× |
| MRI orbit face neck w contrast (70542) |
$1,539.60 |
$2,566 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,851.60 |
$3,086 |
4.5× |
| MRI pelvis w/contrast (72196) |
$1,906.80 |
$3,178 |
4.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,347.20 |
$3,912 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,992 |
$3,320 |
7.1× |
| MRI spectroscopy (76390) |
$1,412.40 |
$2,354 |
13.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,786.20 |
$2,977 |
4.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,816.80 |
$3,028 |
4.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,123.40 |
$3,539 |
5.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,560 |
$2,600 |
3.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,875.60 |
$3,126 |
4.6× |
| MRI temporomandibular joint (70336) |
$1,443.60 |
$2,406 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,578 |
$2,630 |
5.6× |
| MRI up ext w/o contrast (73218) |
$1,370.10 |
$2,283.50 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,808.40 |
$3,014 |
6.4× |
| MRI, joint upper extrem combo (73223) |
$1,909.80 |
$3,183 |
4.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,442.60 |
$4,071 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,349.60 |
$3,916 |
1.5× |
| Neck soft tissue (70360) |
$220.80 |
$368 |
2.1× |
| Nm bone marrow multi (78103) |
$739.80 |
$1,233 |
1.6× |
| Nm cardiac blood pool multiple (78473) |
$855.60 |
$1,426 |
1.8× |
| Nm csf leak detection (78650) |
$2,527.20 |
$4,212 |
1.7× |
| Nm gastric emptying study (78264) |
$818.40 |
$1,364 |
1.7× |
| Nm gastroesophageal reflux study (78262) |
$739.80 |
$1,233 |
1.6× |
| Nm kidney scan w/flow (78701) |
$1,357.20 |
$2,262 |
2.9× |
| Noncardiac Vascular Flow Imaging (78445) |
$739.80 |
$1,233 |
1.6× |
| Nonvascular shunt X-ray (75809) |
$495.60 |
$826 |
4.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,847.40 |
$3,079 |
3.9× |
| Nuclear Rx Oral Admin (79005) |
$500.40 |
$834 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$153.60 |
$256 |
1.2× |
| Osseous survey limited (77074) |
$294 |
$490 |
2.4× |
| Parathyroid Planar Imaging (78070) |
$818.40 |
$1,364 |
1.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$739.80 |
$1,233 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$185.40 |
$309 |
1.5× |
| Perineogram (74775) |
$506.40 |
$844 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$749.40 |
$1,249 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$969 |
$1,615 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$516 |
$860 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$277.20 |
$462 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$171 |
$285 |
1.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$281.10 |
$468.50 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$233.40 |
$389 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$358.20 |
$597 |
2.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$465 |
$775 |
3.8× |
| Radex fingr minimum 2 views (73140) |
$162.60 |
$271 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$258 |
$430 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$294 |
$490 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$198.60 |
$331 |
1.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$312 |
$520 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$300 |
$500 |
2.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$592.80 |
$988 |
4.8× |
| Radex Humerus Minimum 2 Views (73060) |
$180 |
$300 |
1.8× |
| Radex Kne 1/2 Views (73560) |
$216 |
$360 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$335.40 |
$559 |
2.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$476.40 |
$794 |
3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$282.60 |
$471 |
2.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$301.20 |
$502 |
2.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$263.70 |
$439.50 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$216.60 |
$361 |
2.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$207.60 |
$346 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$513.60 |
$856 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$172.80 |
$288 |
1.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$282 |
$470 |
2.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$276 |
$460 |
2.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$526.80 |
$878 |
4.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$219 |
$365 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$252 |
$420 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$254.40 |
$424 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$512.40 |
$854 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$336.60 |
$561 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$336.60 |
$561 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$252 |
$420 |
1.2× |
| Radiologic examination femur 1 view (73551) |
$219 |
$365 |
2.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$177.60 |
$296 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$225 |
$375 |
2.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$337.80 |
$563 |
2.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$169.20 |
$282 |
1.4× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$202.20 |
$337 |
2.0× |
| Radiological examination surgical specimen (76098) |
$589.80 |
$983 |
0.9× |
| Ribs bilateral 3 views (71110) |
$356.40 |
$594 |
2.9× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$739.80 |
$1,233 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$855.60 |
$1,426 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,329.20 |
$3,882 |
3.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,263.80 |
$3,773 |
3.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,893.60 |
$3,156 |
3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,584.20 |
$4,307 |
1.7× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,665.80 |
$4,443 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$231.60 |
$386 |
1.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$516 |
$860 |
1.8× |
| Salivary gland imaging (78230) |
$739.80 |
$1,233 |
1.6× |
| Scapula (73010) |
$222 |
$370 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$58.50 |
$97.50 |
2.5× |
| Sella turcica (70240) |
$410.40 |
$684 |
4.0× |
| Shoulder 1 view (73020) |
$180.60 |
$301 |
1.8× |
| Sialogram (70390) |
$289.80 |
$483 |
1.0× |
| Small bowel series (74250) |
$537 |
$895 |
2.6× |
| Spine thoracic 3 views (72072) |
$303 |
$505 |
2.5× |
| Spleen imaging only (78185) |
$756 |
$1,260 |
1.6× |
| Testicular Imaging With Vascular Flow (78761) |
$739.80 |
$1,233 |
1.6× |
| Thoracolumbar 2 views (72080) |
$240.60 |
$401 |
2.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,052.40 |
$1,754 |
1.6× |
| Thyroid imaging w/blood flow (78013) |
$723 |
$1,205 |
1.5× |
| Thyroid uptake measurement (78012) |
$739.80 |
$1,233 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,027.20 |
$1,712 |
2.2× |
| Tmj unilateral (70328) |
$255.60 |
$426 |
2.5× |
| Tomogram (76100) |
$352.20 |
$587 |
2.9× |
| Ultrasound breast complete (76641) |
$326.40 |
$544 |
2.6× |
| Ultrasound elastography first target lesion (76982) |
$311.40 |
$519 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$191.40 |
$319 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$329.40 |
$549 |
2.7× |
| Umbilical-artery Doppler (OB) (76820) |
$378 |
$630 |
3.1× |
| Unlisted magnetic resonance procedure (76498) |
$4,044.60 |
$6,741 |
39.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$739.80 |
$1,233 |
1.6× |
| Unlisted ultrasound procedure (76999) |
$407.40 |
$679 |
4.0× |
| Ureteral reflux study (78740) |
$739.80 |
$1,233 |
1.6× |
| Urethrocystogram voiding (74455) |
$549 |
$915 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$610.80 |
$1,018 |
2.2× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$784.20 |
$1,307 |
3.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$675.60 |
$1,126 |
3.3× |
| Us breast unilateral limited (76642) |
$273.60 |
$456 |
2.7× |
| Us chest (76604) |
$336.60 |
$561 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$391.80 |
$653 |
3.2× |
| Us elastography parenchyma (76981) |
$247.20 |
$412 |
2.0× |
| Us encephalogram (76506) |
$407.40 |
$679 |
3.3× |
| Us hips infant static (76886) |
$407.40 |
$679 |
4.0× |
| Us infant hips w manipulation (76885) |
$439.20 |
$732 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$261 |
$435 |
2.1× |
| Us ob detailed single fetus (76811) |
$562.80 |
$938 |
2.0× |
| Us ob limited (76815) |
$334.50 |
$557.50 |
2.7× |
| Us ob transvaginal (76817) |
$312 |
$520 |
2.5× |
| Us pelvic non ob complete (76856) |
$487.20 |
$812 |
3.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$267.90 |
$446.50 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$445.20 |
$742 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$403.80 |
$673 |
3.3× |
| Us retroperitoneal complete (76770) |
$473.40 |
$789 |
3.8× |
| Us retroperitoneal limited (76775) |
$328.50 |
$547.50 |
2.7× |
| Us scrotum and contents (76870) |
$357.60 |
$596 |
2.9× |
| Us soft tissue head/neck (76536) |
$410.10 |
$683.50 |
3.3× |
| Us spinal canal and contents (76800) |
$407.40 |
$679 |
3.3× |
| Us transrectal (76872) |
$298.20 |
$497 |
2.4× |
| Us, eye b-scan (76512) |
$218.40 |
$364 |
1.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$291 |
$485 |
2.4× |
| Venogram extremity bilateral (75822) |
$931.20 |
$1,552 |
0.5× |
| Venogram Extremity Unilateral (75820) |
$809.40 |
$1,349 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$3,173.40 |
$5,289 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$948 |
$1,580 |
0.5× |
| Venography Renal Bilateral (75833) |
$3,274.80 |
$5,458 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$3,274.80 |
$5,458 |
0.9× |
| Venous sampling by catheter (75893) |
$5,437.20 |
$9,062 |
0.8× |
| Wrist 2 views (73100) |
$226.80 |
$378 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$432 |
$720 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$467.40 |
$779 |
4.5× |
| X-ray b.e. reductn intuss (74283) |
$627.60 |
$1,046 |
3.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$504.60 |
$841 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$197.40 |
$329 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$282 |
$470 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$491.40 |
$819 |
4.0× |
| X-ray exam of femur 2/> (73552) |
$249 |
$415 |
2.4× |
| X-ray eye for foreign body (70030) |
$212.40 |
$354 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$231.60 |
$386 |
2.3× |
| X-ray IV pyelogram (ivp) (74400) |
$627.60 |
$1,046 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$294 |
$490 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$225 |
$375 |
2.2× |
| X-ray leg, infant (73592) |
$225 |
$375 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$210 |
$350 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$388.80 |
$648 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$225 |
$375 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$405 |
$675 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$727.80 |
$1,213 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$234.60 |
$391 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$265.20 |
$442 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$442.20 |
$737 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$241.20 |
$402 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$232.20 |
$387 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$294 |
$490 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$495.60 |
$826 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$308.40 |
$514 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$199.20 |
$332 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$101.40 |
$169 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$233.40 |
$389 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$233.40 |
$389 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$486 |
$810 |
3.9× |
| Xr bone length studies (77073) |
$330 |
$550 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$321.60 |
$536 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$342.60 |
$571 |
2.8× |
| Xr chest 4+ views (71048) |
$344.40 |
$574 |
2.8× |
| Xr urogram antegrade (74425) |
$561 |
$935 |
1.4× |