| Abdomen 2 views (74019) |
$640.25 |
$985 |
5.9× |
| Acute gi blood loss imaging (78278) |
$1,450.80 |
$2,232 |
3.5× |
| Ankle 2 views (73600) |
$413.40 |
$636 |
4.5× |
| Arthrogram ankle (73615) |
$612.30 |
$942 |
1.7× |
| Arthrogram elbow (73085) |
$800.15 |
$1,231 |
2.2× |
| Arthrogram hip (73525) |
$1,058.85 |
$1,629 |
2.9× |
| Arthrogram knee (73580) |
$1,218.10 |
$1,874 |
3.3× |
| Arthrogram shoulder (73040) |
$1,155.05 |
$1,777 |
3.2× |
| Arthrogram wrist (73115) |
$941.20 |
$1,448 |
2.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,818.70 |
$2,798 |
4.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,515.80 |
$2,332 |
3.6× |
| Bone &/joint imaging whole body (78306) |
$2,538.25 |
$3,905 |
6.1× |
| Bone age studies (77072) |
$416.65 |
$641 |
3.8× |
| Bone Imaging 3 Phase (78315) |
$2,737.80 |
$4,212 |
6.6× |
| Bone Marrow Imaging Limited Area (78102) |
$911.95 |
$1,403 |
2.2× |
| Bone survey complete (77075) |
$1,233.70 |
$1,898 |
11.3× |
| Bone survey infant (77076) |
$620.75 |
$955 |
5.7× |
| Bowel imaging (78290) |
$1,742 |
$2,680 |
4.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,797.90 |
$2,766 |
3.2× |
| Brain Imaging Vascular Flow Only (78610) |
$1,419.60 |
$2,184 |
2.5× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,303.60 |
$3,544 |
5.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,178.80 |
$3,352 |
5.2× |
| Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or… (78483) |
$3,541.85 |
$5,449 |
6.2× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,132 |
$3,280 |
2.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,132 |
$3,280 |
5.9× |
| Cardiac shunt detection (78428) |
$1,977.95 |
$3,043 |
4.7× |
| Cervical spine 2 or 3 views (72040) |
$663 |
$1,020 |
7.3× |
| Chest 1 view (71045) |
$418.60 |
$644 |
4.6× |
| Chest xray 3 views (71047) |
$681.85 |
$1,049 |
7.5× |
| Cholecystography, oral contrast Non-Facility (74290) |
$581.10 |
$894 |
3.2× |
| Clavicle complete (73000) |
$562.25 |
$865 |
6.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$427.70 |
$658 |
3.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$1,216.80 |
$1,872 |
13.4× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$392.60 |
$604 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,971.90 |
$10,726 |
19.1× |
| CT abdomen and pelvis without contrast (74176) |
$5,537.35 |
$8,519 |
22.2× |
| CT abdomen w contrast (74160) |
$3,341.65 |
$5,141 |
18.2× |
| CT abdomen w wo contrast (74170) |
$3,948.75 |
$6,075 |
21.6× |
| CT abdomen w/o contrast (74150) |
$3,194.75 |
$4,915 |
29.3× |
| CT angio hrt w/3d image (75574) |
$2,103.40 |
$3,236 |
5.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,766.10 |
$5,794 |
20.6× |
| CT angiography upper extremity lt (73206) |
$3,065.40 |
$4,716 |
16.7× |
| CT c-spine w/contrast (72126) |
$3,245.45 |
$4,993 |
8.9× |
| CT c-spine w/o contrast (72125) |
$3,395.60 |
$5,224 |
31.1× |
| CT cervical spine w&w/o contrast (72127) |
$4,158.70 |
$6,398 |
22.7× |
| CT chest w contrast (71260) |
$3,599.05 |
$5,537 |
19.6× |
| CT chest w/wo contrast (71270) |
$3,785.60 |
$5,824 |
20.7× |
| CT colonography w/dye (74262) |
$1,175.20 |
$1,808 |
6.4× |
| CT colonography w/o cntrst (74261) |
$770.90 |
$1,186 |
7.1× |
| CT head/brain with contrast (70460) |
$3,426.80 |
$5,272 |
18.7× |
| CT head/brain without and with contrast (70470) |
$4,335.50 |
$6,670 |
23.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,513.20 |
$2,328 |
4.2× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,262.95 |
$1,943 |
13.9× |
| CT hrt w/3d image congen (75573) |
$1,217.45 |
$1,873 |
3.3× |
| CT iac w contrast (70481) |
$3,848.65 |
$5,921 |
21.0× |
| CT limited/localized follow up study (76380) |
$1,225.90 |
$1,886 |
13.5× |
| CT lower ext w/o (73700) |
$2,312.05 |
$3,557 |
21.2× |
| CT lower extremity w wo contrast (73702) |
$2,962.05 |
$4,557 |
16.2× |
| CT lower extremity w/contrast material (73701) |
$2,622.10 |
$4,034 |
14.3× |
| CT lumbar spine w & w/o contrast (72133) |
$4,265.30 |
$6,562 |
23.3× |
| CT lumbar spine w/contrast (72132) |
$3,625.70 |
$5,578 |
10.0× |
| CT lumbar spine w/o contrast (72131) |
$3,282.50 |
$5,050 |
30.1× |
| CT maxillofacial w contrast (70487) |
$3,521.70 |
$5,418 |
19.2× |
| CT maxillofacial w/wo contrast (70488) |
$3,688.10 |
$5,674 |
20.1× |
| CT maxillofacial wo contrast (70486) |
$2,984.15 |
$4,591 |
27.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$4,727.45 |
$7,273 |
25.8× |
| CT orbits w/o contrast (70480) |
$3,557.45 |
$5,473 |
32.6× |
| CT pelvis w/o contrast (72192) |
$3,043.95 |
$4,683 |
27.9× |
| CT pelvis w/wo contrast (72194) |
$3,695.90 |
$5,686 |
20.2× |
| CT scan of arm combo (73202) |
$3,011.45 |
$4,633 |
16.4× |
| CT soft tissue neck w contrast (70491) |
$3,583.45 |
$5,513 |
19.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,839.55 |
$5,907 |
21.0× |
| CT soft tissue neck w/o contrast (70490) |
$3,123.90 |
$4,806 |
28.6× |
| CT thoracic spine w/contrast (72129) |
$3,103.75 |
$4,775 |
16.9× |
| CT thoracic spine w/o contrast (72128) |
$3,012.75 |
$4,635 |
27.6× |
| CT thoracic spine w/wo contrast (72130) |
$3,543.80 |
$5,452 |
19.3× |
| CT thorax w/o contrast (71250) |
$2,913.95 |
$4,483 |
26.7× |
| CT unlisted procedure (76497) |
$2,415.40 |
$3,716 |
26.6× |
| CT upper ext wo (73200) |
$2,354.30 |
$3,622 |
21.6× |
| CT upper extremity with contrast (73201) |
$2,701.40 |
$4,156 |
7.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,499.90 |
$3,846 |
13.6× |
| Cta Abdomen (74175) |
$2,372.50 |
$3,650 |
13.0× |
| CTA abdomen pelvis (74174) |
$5,921.50 |
$9,110 |
16.3× |
| CTA chest (71275) |
$4,726.15 |
$7,271 |
25.8× |
| Cta Head (70496) |
$2,639.65 |
$4,061 |
14.4× |
| Cta Neck (70498) |
$5,887.70 |
$9,058 |
32.1× |
| Cta Pelvis (72191) |
$2,387.45 |
$3,673 |
13.0× |
| Cystography minimum 3 views rs&i (74430) |
$818.35 |
$1,259 |
2.2× |
| Diskogram cervical (72285) |
$3,135.92 |
$4,824.50 |
1.5× |
| Diskography lumbar (72295) |
$3,217.18 |
$4,949.50 |
1.6× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$791.05 |
$1,217 |
7.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$564.85 |
$869 |
5.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$588.25 |
$905 |
5.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$546 |
$840 |
5.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$493.35 |
$759 |
5.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$524.55 |
$807 |
2.1× |
| Esophageal motility (78258) |
$1,059.50 |
$1,630 |
2.5× |
| Esophagus (74220) |
$824.85 |
$1,269 |
4.5× |
| Facial bones min 3 views (70150) |
$815.10 |
$1,254 |
7.5× |
| Fetal biophysical profile non-stress testing (76818) |
$1,025.05 |
$1,577 |
9.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$732.55 |
$1,127 |
6.7× |
| Fetal Echo (76825) |
$1,569.10 |
$2,414 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$873.60 |
$1,344 |
3.5× |
| Foot 2 views (73620) |
$434.85 |
$669 |
4.8× |
| Forearm 2 views (73090) |
$560.30 |
$862 |
6.2× |
| Functional MRI brain by phys/psych (70555) |
$1,558.05 |
$2,397 |
6.3× |
| Functional MRI brain by tech (70554) |
$1,558.05 |
$2,397 |
6.3× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$2,379 |
$3,660 |
4.2× |
| Hand 2 views (73120) |
$404.95 |
$623 |
3.7× |
| Heart first pass single,planar (78481) |
$1,648.40 |
$2,536 |
2.9× |
| Heart Infarct Image (78466) |
$940.55 |
$1,447 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,037.75 |
$3,135 |
3.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,037.75 |
$3,135 |
4.9× |
| Hysterosalpingogram (74740) |
$1,124.50 |
$1,730 |
4.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$1,365.65 |
$2,101 |
12.5× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,064.05 |
$1,637 |
2.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,928.55 |
$2,967 |
3.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,234.05 |
$3,437 |
3.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$4,563 |
$7,020 |
8.0× |
| Knee 3 views (73562) |
$562.90 |
$866 |
6.2× |
| Liver & spleen imaging static only (78215) |
$2,200.90 |
$3,386 |
5.3× |
| Liver imaging static only (78201) |
$2,002.65 |
$3,081 |
3.5× |
| Lung perf&ventilat diferentl (78598) |
$5,587.40 |
$8,596 |
9.9× |
| Lung perfusion differential (78597) |
$3,835.65 |
$5,901 |
9.2× |
| Lung ventilation imaging (78579) |
$1,736.80 |
$2,672 |
4.2× |
| Lymphoscintigraphy (78195) |
$1,790.75 |
$2,755 |
3.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,842.80 |
$5,912 |
4.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70558) |
$1,678.95 |
$2,583 |
9.2× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70557) |
$1,558.05 |
$2,397 |
2.7× |
| Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial… (70559) |
$2,226.90 |
$3,426 |
12.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,191.50 |
$4,910 |
8.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,708.25 |
$5,705 |
10.2× |
| Magnetic Resonance Elastography (76391) |
$752.70 |
$1,158 |
3.0× |
| Mammary ductogram or galactogram multiple (77054) |
$776.75 |
$1,195 |
3.1× |
| Mammary ductogram or galactogram single (77053) |
$744.25 |
$1,145 |
3.0× |
| Mr safety determination physician/other qhp (76016) |
$242.45 |
$373 |
2.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$67.60 |
$104 |
2.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$252.85 |
$389 |
2.5× |
| Mr safety implt pos&/immoblj (76019) |
$163.80 |
$252 |
2.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$666.25 |
$1,025 |
2.7× |
| MRA head w & w/o contrast (70546) |
$4,244.50 |
$6,530 |
11.7× |
| MRA head w/o contrast (70544) |
$2,825.55 |
$4,347 |
11.3× |
| MRA head with contrast (70545) |
$3,395.60 |
$5,224 |
9.3× |
| MRA neck w contrast (70548) |
$2,213.25 |
$3,405 |
6.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,765.10 |
$4,254 |
7.6× |
| MRA neck w/o contrast (70547) |
$1,846.65 |
$2,841 |
7.4× |
| MRI abdomen w contrast (74182) |
$3,765.45 |
$5,793 |
10.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,013.75 |
$6,175 |
11.0× |
| MRI abdomen w/o contrast (74181) |
$3,647.80 |
$5,612 |
14.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,427.80 |
$6,812 |
5.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,699.20 |
$8,768 |
15.6× |
| MRI bone marrow blood supply (77084) |
$893.10 |
$1,374 |
3.6× |
| MRI breast w/o contrast bilateral (77047) |
$3,578.25 |
$5,505 |
14.4× |
| MRI breast wo contrast unilateral (77046) |
$2,733.25 |
$4,205 |
11.0× |
| MRI c-spine with contrast (72142) |
$3,950.70 |
$6,078 |
10.8× |
| MRI cardiac w/o cont stress (75559) |
$1,392.95 |
$2,143 |
2.4× |
| MRI cardiac w/o contrast (75557) |
$1,392.95 |
$2,143 |
5.6× |
| MRI cervical spine w/o contrast (72141) |
$3,811.60 |
$5,864 |
15.3× |
| MRI chest w/o & w/contrast material (71552) |
$4,551.30 |
$7,002 |
12.5× |
| MRI chest w/o contrast (71550) |
$3,596.45 |
$5,533 |
14.4× |
| MRI chest with contrast (71551) |
$3,656.90 |
$5,626 |
4.5× |
| MRI fetal sngl/1st gestation (74712) |
$3,249.35 |
$4,999 |
13.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,081.65 |
$4,741 |
8.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,580.20 |
$5,508 |
9.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,958.15 |
$4,551 |
11.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,413.15 |
$5,251 |
13.7× |
| MRI orbit face neck w contrast (70542) |
$3,835 |
$5,900 |
10.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,258.80 |
$6,552 |
11.7× |
| MRI pelvis w/contrast (72196) |
$3,424.20 |
$5,268 |
9.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,604.25 |
$5,545 |
9.9× |
| MRI pelvis w/o contrast (72195) |
$3,249.35 |
$4,999 |
13.0× |
| MRI spectroscopy (76390) |
$2,882.75 |
$4,435 |
31.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,778.80 |
$7,352 |
13.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,028.70 |
$6,198 |
11.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,846.40 |
$7,456 |
13.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$4,122.95 |
$6,343 |
11.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,832.10 |
$7,434 |
13.3× |
| MRI temporomandibular joint (70336) |
$3,744.65 |
$5,761 |
15.0× |
| MRI thoracic spine w/o contrast (72146) |
$3,775.20 |
$5,808 |
15.2× |
| MRI up ext w/o contrast (73218) |
$2,775.50 |
$4,270 |
11.1× |
| MRI upper ext joint w/o contrast (73221) |
$3,305.25 |
$5,085 |
13.3× |
| MRI, joint upper extrem combo (73223) |
$4,485 |
$6,900 |
12.3× |
| Myelogram Cervical (72240) |
$2,490.15 |
$3,831 |
3.0× |
| Myelogram Lumbar (72265) |
$2,450.50 |
$3,770 |
3.0× |
| Myelogram thoracic (72255) |
$1,922.70 |
$2,958 |
2.3× |
| Myelography 2 or more regions (72270) |
$2,815.80 |
$4,332 |
3.4× |
| Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique Non-Facility (78468) |
$1,238.90 |
$1,906 |
2.2× |
| Myocardial infarct spect (78469) |
$1,682.85 |
$2,589 |
3.0× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$2,402.72 |
$3,696.50 |
1.8× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$3,111.22 |
$4,786.50 |
2.3× |
| Myocardial Spect Multiple Studies (78452) |
$5,592.60 |
$8,604 |
4.1× |
| Myocardial spect single study at rest or stress (78451) |
$3,350.75 |
$5,155 |
2.5× |
| N-invas est c ffr sw aly CTA (75580) |
$2,885.35 |
$4,439 |
3.2× |
| Neck soft tissue (70360) |
$596.70 |
$918 |
6.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$1,082.90 |
$1,666 |
2.6× |
| Nm bone marrow multi (78103) |
$1,026.35 |
$1,579 |
2.5× |
| Nm bone marrow wb (78104) |
$1,148.55 |
$1,767 |
2.8× |
| Nm cardiac blood pool multiple (78473) |
$2,194.40 |
$3,376 |
5.3× |
| Nm cisternogram (78630) |
$1,679.60 |
$2,584 |
3.0× |
| Nm gastric emptying study (78264) |
$1,968.20 |
$3,028 |
4.7× |
| Nm gastroesophageal reflux study (78262) |
$1,103.05 |
$1,697 |
2.6× |
| Nm kidney scan w/flow (78701) |
$1,344.20 |
$2,068 |
3.2× |
| Nm peritoneal-venous shunt patency (78291) |
$1,760.20 |
$2,708 |
4.2× |
| Noncardiac Vascular Flow Imaging (78445) |
$1,276.60 |
$1,964 |
3.1× |
| Nonvascular shunt X-ray (75809) |
$497.90 |
$766 |
4.6× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,759.55 |
$2,707 |
4.2× |
| Nuclear Rx Oral Admin (79005) |
$3,308.50 |
$5,090 |
13.6× |
| Ob us nuchal meas 1 gest (76813) |
$447.85 |
$689 |
4.1× |
| Osseous survey limited (77074) |
$818.35 |
$1,259 |
7.5× |
| Parathyrd planar w/spect&CT (78072) |
$2,429.70 |
$3,738 |
4.3× |
| Parathyroid Planar Imaging (78070) |
$1,995.50 |
$3,070 |
4.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,694.55 |
$2,607 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$650.65 |
$1,001 |
6.0× |
| PET image w/CT, skull-thigh (78815) |
$5,567.25 |
$8,565 |
3.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$2,084.55 |
$3,207 |
5.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$3,835.65 |
$5,901 |
6.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,289.60 |
$1,984 |
2.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$599.30 |
$922 |
6.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$492.70 |
$758 |
5.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$598 |
$920 |
6.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$433.55 |
$667 |
4.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$827.45 |
$1,273 |
7.6× |
| Radex fingr minimum 2 views (73140) |
$472.55 |
$727 |
5.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$600.60 |
$924 |
6.6× |
| Radex Hand Minimum 3 Views (73130) |
$580.45 |
$893 |
6.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$414.70 |
$638 |
4.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$895.05 |
$1,377 |
8.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$828.75 |
$1,275 |
7.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,898.65 |
$2,921 |
17.4× |
| Radex Humerus Minimum 2 Views (73060) |
$581.10 |
$894 |
6.4× |
| Radex Kne 1/2 Views (73560) |
$460.85 |
$709 |
5.1× |
| Radex Kne Compl 4/More Views (73564) |
$662.35 |
$1,019 |
6.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$849.55 |
$1,307 |
7.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$644.80 |
$992 |
7.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$839.15 |
$1,291 |
7.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$644.80 |
$992 |
7.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$372.45 |
$573 |
4.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$456.95 |
$703 |
4.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$806 |
$1,240 |
8.9× |
| Radex Toe Minimum 2 Views (73660) |
$456.95 |
$703 |
5.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$372.45 |
$573 |
3.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$640.25 |
$985 |
7.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$827.45 |
$1,273 |
7.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$575.90 |
$886 |
6.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$674.70 |
$1,038 |
6.2× |
| Radiologic exam chest 2 views (71046) |
$497.25 |
$765 |
5.5× |
| Radiologic exam colon single contrast study (74270) |
$1,249.30 |
$1,922 |
6.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$824.85 |
$1,269 |
4.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,274 |
$1,960 |
7.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,180.40 |
$1,816 |
6.4× |
| Radiologic examination femur 1 view (73551) |
$504.40 |
$776 |
5.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$583.05 |
$897 |
6.4× |
| Radiological examination surgical specimen (76098) |
$336.38 |
$517.50 |
0.6× |
| Radiopharm Dacryocystography (78660) |
$813.15 |
$1,251 |
1.9× |
| Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion Non-Facility (79403) |
$342.55 |
$527 |
1.4× |
| Ribs bilateral 3 views (71110) |
$908.05 |
$1,397 |
8.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,539.85 |
$2,369 |
3.7× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,309.45 |
$3,553 |
5.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,043 |
$6,220 |
7.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,043 |
$6,220 |
7.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,182.75 |
$6,435 |
7.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,152.20 |
$6,388 |
3.1× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,708.60 |
$7,244 |
3.2× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,152.20 |
$6,388 |
3.1× |
| Rp Therapy Intravenous Administration (79101) |
$3,006.90 |
$4,626 |
12.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,237.60 |
$1,904 |
5.0× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$1,112.80 |
$1,712 |
2.7× |
| Scapula (73010) |
$611.65 |
$941 |
5.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$162.50 |
$250 |
7.0× |
| Shoulder 1 view (73020) |
$438.75 |
$675 |
4.8× |
| Small bowel series (74250) |
$1,032.20 |
$1,588 |
5.6× |
| Spine thoracic 3 views (72072) |
$739.05 |
$1,137 |
6.8× |
| Spleen imaging only (78185) |
$1,203.80 |
$1,852 |
2.9× |
| Tbs technical calculation only (77091) |
$253.50 |
$390 |
2.8× |
| Testicular Imaging With Vascular Flow (78761) |
$2,331.55 |
$3,587 |
5.6× |
| Thoracolumbar 2 views (72080) |
$193.70 |
$298 |
2.1× |
| Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Non-Facility (78015) |
$1,028.30 |
$1,582 |
2.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,985.75 |
$3,055 |
3.5× |
| Thyroid imaging w/blood flow (78013) |
$1,219.40 |
$1,876 |
2.9× |
| Thyroid uptake measurement (78012) |
$770.25 |
$1,185 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,890.85 |
$2,909 |
4.5× |
| Tomogram (76100) |
$1,197.30 |
$1,842 |
11.0× |
| Ultrasound breast complete (76641) |
$537.22 |
$826.50 |
4.9× |
| Ultrasound elastography first target lesion (76982) |
$404.30 |
$622 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$494 |
$760 |
4.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$724.75 |
$1,115 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$1,167.40 |
$1,796 |
10.7× |
| Umbilical-artery Doppler (OB) (76820) |
$588.25 |
$905 |
5.4× |
| Unlisted magnetic resonance procedure (76498) |
$202.80 |
$312 |
2.2× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$272.35 |
$419 |
24.6× |
| Ureteral reflux study (78740) |
$1,423.50 |
$2,190 |
3.4× |
| Urethrocystogram voiding (74455) |
$1,046.50 |
$1,610 |
4.2× |
| Urethrocystography retrograde rs&i (74450) |
$1,104.35 |
$1,699 |
4.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,518.40 |
$2,336 |
8.3× |
| Us breast unilateral limited (76642) |
$429.65 |
$661 |
4.7× |
| Us chest (76604) |
$705.25 |
$1,085 |
6.5× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$1,672.45 |
$2,573 |
7.4× |
| Us compl joint r-t w/image documentation (76881) |
$391.30 |
$602 |
3.6× |
| Us elastography parenchyma (76981) |
$404.30 |
$622 |
3.7× |
| Us encephalogram (76506) |
$936.65 |
$1,441 |
8.6× |
| Us hips infant static (76886) |
$616.20 |
$948 |
6.8× |
| Us infant hips w manipulation (76885) |
$1,032.85 |
$1,589 |
11.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$252.20 |
$388 |
2.3× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$328.90 |
$506 |
3.0× |
| Us ob detailed single fetus (76811) |
$922.35 |
$1,419 |
3.7× |
| Us ob limited (76815) |
$588.25 |
$905 |
5.4× |
| Us ob transvaginal (76817) |
$1,086.80 |
$1,672 |
10.0× |
| Us pelvic non ob complete (76856) |
$1,264.25 |
$1,945 |
11.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$1,123.85 |
$1,729 |
10.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$748.15 |
$1,151 |
6.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$732.55 |
$1,127 |
6.7× |
| Us retroperitoneal complete (76770) |
$1,302.60 |
$2,004 |
11.9× |
| Us retroperitoneal limited (76775) |
$1,166.10 |
$1,794 |
10.7× |
| Us scrotum and contents (76870) |
$869.05 |
$1,337 |
8.0× |
| Us soft tissue head/neck (76536) |
$718.25 |
$1,105 |
6.6× |
| Us transrectal (76872) |
$1,300 |
$2,000 |
11.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$494 |
$760 |
4.5× |
| Whole blood volume determination, including separate measurement of plasma volume and red cell volume… (78122) |
$704.60 |
$1,084 |
1.2× |
| Wrist 2 views (73100) |
$437.45 |
$673 |
4.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$761.15 |
$1,171 |
7.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$379.60 |
$584 |
4.2× |
| X-ray b.e. reductn intuss (74283) |
$1,702.35 |
$2,619 |
9.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,702.35 |
$2,619 |
9.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$438.75 |
$675 |
4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$666.90 |
$1,026 |
7.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$1,334.45 |
$2,053 |
12.2× |
| X-ray exam of femur 2/> (73552) |
$627.90 |
$966 |
6.9× |
| X-ray eye for foreign body (70030) |
$408.20 |
$628 |
4.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$501.80 |
$772 |
5.5× |
| X-ray IV pyelogram (ivp) (74400) |
$1,416.35 |
$2,179 |
7.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$624 |
$960 |
6.9× |
| X-ray leg, infant (73592) |
$163.15 |
$251 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$691.60 |
$1,064 |
6.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,235.65 |
$1,901 |
11.3× |
| X-ray nose-rectum child f.b. (76010) |
$332.15 |
$511 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$919.75 |
$1,415 |
8.4× |
| X-ray retrograde pyelogram (74420) |
$1,134.25 |
$1,745 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$736.45 |
$1,133 |
8.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$821.60 |
$1,264 |
7.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$881.40 |
$1,356 |
8.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$765.70 |
$1,178 |
7.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$652.60 |
$1,004 |
7.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$905.45 |
$1,393 |
10.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$910 |
$1,400 |
8.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$549.25 |
$845 |
5.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,199.25 |
$1,845 |
6.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$484.90 |
$746 |
5.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$316.55 |
$487 |
3.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$627.90 |
$966 |
6.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$724.75 |
$1,115 |
6.6× |
| Xr bone length studies (77073) |
$631.80 |
$972 |
5.8× |
| Xr c-spine 4 or 5 views (72050) |
$880.10 |
$1,354 |
8.1× |
| Xr c-spine 6 or more views (72052) |
$994.50 |
$1,530 |
9.1× |
| Xr chest 4+ views (71048) |
$905.45 |
$1,393 |
8.3× |