| Acute gi blood loss imaging (78278) |
$812.40 |
$2,031 |
1.9× |
| Angio adrenal bilat select (75733) |
$3,568 |
$8,920 |
1.1× |
| Angio adrenal unilat select (75731) |
$2,099.20 |
$5,248 |
0.6× |
| Angio extremity unilateral (75710) |
$1,930.40 |
$4,826 |
0.6× |
| Angio pulmonary unilateral (75741) |
$1,616.80 |
$4,042 |
0.5× |
| Angiogram extremity bilateral (75716) |
$2,098 |
$5,245 |
0.6× |
| Angiogram pelvic (75736) |
$4,468.40 |
$11,171 |
0.8× |
| Angiography internal mammary rs&i (75756) |
$1,494.80 |
$3,737 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,046 |
$2,615 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,668 |
$9,170 |
0.6× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$1,589.60 |
$3,974 |
0.5× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,598.40 |
$3,996 |
0.5× |
| Ankle 2 views (73600) |
$330.40 |
$826 |
3.6× |
| Barium enema (74270) |
$444.80 |
$1,112 |
2.4× |
| Basic dosimetry (77300) |
$132.80 |
$332 |
0.9× |
| Bilat selctv renal venogram (75833) |
$2,820 |
$7,050 |
0.9× |
| Bone age studies (77072) |
$401.60 |
$1,004 |
3.7× |
| Bone imaging limited area (78300) |
$1,378 |
$3,445 |
3.3× |
| Bone marrow imaging whole body (78104) |
$740 |
$1,850 |
1.8× |
| Bone survey complete (77075) |
$548.80 |
$1,372 |
5.0× |
| Bowel imaging (78290) |
$1,030.80 |
$2,577 |
2.5× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$873.60 |
$2,184 |
1.5× |
| Brain image w/flow 4 + views (78606) |
$1,187.20 |
$2,968 |
2.1× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$367.20 |
$918 |
0.9× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$1,260 |
$3,150 |
3.0× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,283.60 |
$3,209 |
3.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$426.40 |
$1,066 |
2.3× |
| Cisternogram (78630) |
$920.40 |
$2,301 |
1.6× |
| Cisternography, positive contrast, radiological supervision and interpretation Other Diagnostic Radiology FS (70015) |
$926.80 |
$2,317 |
1.1× |
| Clavicle complete (73000) |
$325.60 |
$814 |
3.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,329.20 |
$5,823 |
12.7× |
| Contrast exam abdominl aorta (75625) |
$2,028 |
$5,070 |
0.6× |
Contrast exam thoracic aorta (75605)
unusually low: confirm this is the full procedure |
$2,579.60 |
$6,449 |
0.4× |
| Csf shunt evaluation (78645) |
$864 |
$2,160 |
1.5× |
| CT - st neck w&wo contr (70492) |
$2,101.20 |
$5,253 |
11.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,629.20 |
$11,573 |
12.7× |
| CT abdomen and pelvis without contrast (74176) |
$3,126 |
$7,815 |
12.5× |
| CT abdomen w wo contrast (74170) |
$3,338.80 |
$8,347 |
18.2× |
| CT abdomen w/contrast (74160) |
$3,235.20 |
$8,088 |
17.7× |
| CT abdomen w/o contrast (74150) |
$2,129.20 |
$5,323 |
19.5× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$4,179.60 |
$10,449 |
11.5× |
| CT angio abdom w/o & w/dye (74175) |
$2,094 |
$5,235 |
11.4× |
| CT angio abdominal arteries (75635) |
$2,916.80 |
$7,292 |
15.9× |
| CT angio hrt w/3d image (75574) |
$1,291.60 |
$3,229 |
3.5× |
| CT angiograph pelv w/o&w/dye (72191) |
$2,083.60 |
$5,209 |
11.4× |
| CT cervical spine w/contrast (72126) |
$3,292.40 |
$8,231 |
9.0× |
| CT cervical spine w/o contrast (72125) |
$1,952.40 |
$4,881 |
17.9× |
| CT chest w/contrast (71260) |
$3,094.40 |
$7,736 |
16.9× |
| CT extremity upper w & w/o contrast (73202) |
$3,502 |
$8,755 |
19.1× |
| CT head/brain with contrast (70460) |
$1,796 |
$4,490 |
9.8× |
| CT head/brain without and with contrast (70470) |
$1,971.60 |
$4,929 |
10.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,395 |
$3,487.50 |
3.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$268.80 |
$672 |
3.0× |
| CT hrt w/3d image congen (75573) |
$1,131.40 |
$2,828.50 |
3.1× |
| CT lower ext w/wo contrast (73702) |
$3,028 |
$7,570 |
16.5× |
| CT lower extremity w contrast (73701) |
$3,000.80 |
$7,502 |
16.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,023.20 |
$5,058 |
18.5× |
| CT lumbar spine w/contrast (72132) |
$3,772.40 |
$9,431 |
10.4× |
| CT lumbar spine w/o contrast (72131) |
$2,036 |
$5,090 |
18.6× |
| CT lumbar spine w/o then w/ con (72133) |
$6,108 |
$15,270 |
33.3× |
| CT maxillofacial area w/o contrast (70486) |
$1,368.80 |
$3,422 |
12.5× |
| CT maxillofacial w/contrast (70487) |
$1,680.40 |
$4,201 |
9.2× |
| CT maxillofacial w/o then w/ con (70488) |
$2,100 |
$5,250 |
11.5× |
| CT orbit sella ear w/o con (70480) |
$2,060.40 |
$5,151 |
18.9× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$2,869.20 |
$7,173 |
15.7× |
| CT pelvis w & w/o contrast (72194) |
$4,450.40 |
$11,126 |
24.3× |
| CT pelvis w/o contrast (72192) |
$2,329.60 |
$5,824 |
21.3× |
| CT soft tissue neck w/contrast (70491) |
$1,868.40 |
$4,671 |
10.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,542.40 |
$3,856 |
14.1× |
| CT spine cervical w/wo contrast (72127) |
$4,435.20 |
$11,088 |
24.2× |
| CT thoracic spine w/contrast (72129) |
$4,587.60 |
$11,469 |
25.0× |
| CT thoracic spine w/o contrast (72128) |
$3,058.40 |
$7,646 |
28.0× |
| CT thoracic spine w/o then w/ con (72130) |
$6,230.40 |
$15,576 |
34.0× |
| CT thorax w/o contrast (71250) |
$1,956.80 |
$4,892 |
17.9× |
| CT thorax w/o then w/ contrast (71270) |
$3,107.60 |
$7,769 |
17.0× |
| CT upper extremity w/dye (73201) |
$2,918.80 |
$7,297 |
8.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,996.40 |
$4,991 |
18.3× |
| CTA chest w/wo contrast (71275) |
$2,036.80 |
$5,092 |
11.1× |
| CTA head w contrast (70496) |
$1,215.20 |
$3,038 |
6.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$1,948.80 |
$4,872 |
10.6× |
| Cta Neck (70498) |
$1,215.20 |
$3,038 |
6.6× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$1,754 |
$4,385 |
9.6× |
| Dilation ureters/urethra rs&i (74485) |
$1,151.60 |
$2,879 |
0.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (72285) |
$1,033.60 |
$2,584 |
0.5× |
| Diskography lumbar (72295) |
$1,439.60 |
$3,599 |
0.7× |
| Doppler echo fetal spectral display complete (76827) |
$353.20 |
$883 |
3.2× |
| Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study… (76828) |
$249.60 |
$624 |
2.3× |
| Doppler fetal mid cerebral artery (76821) |
$158.40 |
$396 |
1.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$606.80 |
$1,517 |
2.4× |
| Esophogram (74220) |
$436 |
$1,090 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$998.40 |
$2,496 |
9.1× |
| Fetal biophysical profile w/o nst (76819) |
$500.40 |
$1,251 |
4.6× |
| Fetal echo complete (76825) |
$716.40 |
$1,791 |
1.3× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$466.80 |
$1,167 |
1.9× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$898 |
$2,245 |
2.2× |
| Gastric emptying study (78264) |
$388.80 |
$972 |
0.9× |
| Gated heart planar single (78472) |
$1,247.20 |
$3,118 |
3.0× |
| Heart infarct image (78466) |
$367.20 |
$918 |
0.9× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,446.40 |
$6,116 |
0.7× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$3,007.20 |
$7,518 |
0.9× |
| Hepatobil syst image w/drug (78227) |
$1,206 |
$3,015 |
2.1× |
| Hepatobiliary system imaging (78226) |
$680 |
$1,700 |
1.6× |
| Humerus min 2 views (73060) |
$353.20 |
$883 |
3.9× |
| Hysterosalpingography (74740) |
$416 |
$1,040 |
1.7× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$2,083.20 |
$5,208 |
2.9× |
| Ivp (74400) |
$921.20 |
$2,303 |
5.0× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,580.40 |
$3,951 |
2.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,449.20 |
$3,623 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,556.80 |
$3,892 |
2.7× |
| Kidney w vascular flow (78701) |
$1,033.20 |
$2,583 |
2.5× |
| Liver & spleen; static only (78215) |
$788.80 |
$1,972 |
1.9× |
| Liver & spleen; w vasc flow (78216) |
$777.60 |
$1,944 |
1.9× |
| Liver imaging w/vascular flow (78202) |
$476.40 |
$1,191 |
0.8× |
| Lung perf&ventilat diferentl (78598) |
$473.60 |
$1,184 |
0.8× |
| Lung ventilat&perfus imaging (78582) |
$954.40 |
$2,386 |
1.7× |
| Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75807) |
$3,501.60 |
$8,754 |
1.1× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$3,501.60 |
$8,754 |
1.1× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$2,791.20 |
$6,978 |
7.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,162.40 |
$7,906 |
8.7× |
| Mr safety determination physician/other qhp (76016) |
$93.20 |
$233 |
1.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$63.20 |
$158 |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$26 |
$65 |
0.9× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$96.80 |
$242 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$255.60 |
$639 |
1.0× |
| MRA head w & w/o contrast (70546) |
$2,156 |
$5,390 |
5.9× |
| MRA head w/o contrast (70544) |
$1,627.60 |
$4,069 |
6.5× |
| MRA neck w/contrast (70548) |
$1,894.40 |
$4,736 |
5.2× |
| MRA neck w/o contrast (70547) |
$1,701.60 |
$4,254 |
6.8× |
| MRA neck w/wo contrast (70549) |
$2,373.60 |
$5,934 |
6.5× |
| MRI abdomen w/contrast (74182) |
$2,893.20 |
$7,233 |
7.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,679.60 |
$9,199 |
10.1× |
| MRI abdomen w/o contrast (74181) |
$2,075.20 |
$5,188 |
8.3× |
| MRI any jnt lwr ext with con lt (73722) |
$2,771.60 |
$6,929 |
3.4× |
| MRI cardiac w/o contrast (75557) |
$994.80 |
$2,487 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$1,835.20 |
$4,588 |
7.4× |
| MRI cervical spine with contrast (72142) |
$1,858 |
$4,645 |
5.1× |
| MRI chest w & w/o contrast (71552) |
$2,206.80 |
$5,517 |
6.1× |
| MRI chest w/o contrast (71550) |
$2,034.80 |
$5,087 |
8.2× |
| MRI joint upper ext w/contrast (73222) |
$2,066.80 |
$5,167 |
2.5× |
| MRI joint upr extr w/o&w/dye (73223) |
$2,362.40 |
$5,906 |
6.5× |
| MRI joint upr extrem w/o dye (73221) |
$1,969.60 |
$4,924 |
7.9× |
| Mri Lower Extremity W/O Dye (73718) |
$1,866 |
$4,665 |
7.5× |
| MRI lumbar spine with contrast (72149) |
$2,186 |
$5,465 |
6.0× |
| MRI lumbar w/wo contrast (72158) |
$2,632.40 |
$6,581 |
7.2× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,440.80 |
$6,102 |
6.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,813.60 |
$4,534 |
5.0× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$2,396.40 |
$5,991 |
6.6× |
| MRI orbit/face/neck w/o contrast (70540) |
$1,636 |
$4,090 |
6.6× |
| MRI pelvis w/ contrast (72196) |
$1,468.80 |
$3,672 |
4.0× |
| MRI pelvis w/o contrast (72195) |
$1,178 |
$2,945 |
4.7× |
| MRI pelvis w/wo contrast (72197) |
$2,073.20 |
$5,183 |
5.7× |
| MRI spectroscopy (76390) |
$992.40 |
$2,481 |
10.9× |
| MRI spine cervical wo/w contrast (72156) |
$2,980.40 |
$7,451 |
8.2× |
| MRI spine thoracic w/contrast (72147) |
$2,508 |
$6,270 |
6.9× |
| MRI thoracic spine w wo contrast (72157) |
$2,632.40 |
$6,581 |
7.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,816.40 |
$4,541 |
7.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,816.40 |
$4,541 |
7.3× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$2,964.40 |
$7,411 |
8.1× |
| Myelography 2 or more regions (72270) |
$1,090 |
$2,725 |
1.3× |
| Myelography lumbosacral (72265) |
$926.80 |
$2,317 |
1.1× |
| Myocardial spect single study at rest or stress (78451) |
$1,823.60 |
$4,559 |
1.3× |
| N-invas est c ffr augmnt sw alys CTA i&r phy/qhp (75580) |
$1,796 |
$4,490 |
2.0× |
| Nm bone 3 phase (78315) |
$2,015.60 |
$5,039 |
4.8× |
| Nm bone imaging whole body (78306) |
$1,907.20 |
$4,768 |
4.6× |
| Nm bone marrow scan limited (78102) |
$720.40 |
$1,801 |
1.7× |
| Nm bone multi (78305) |
$1,786 |
$4,465 |
4.3× |
| Nm heart perfusion spect stress rest (78452) |
$2,515.20 |
$6,288 |
1.9× |
| Nm kidney imaging morphology (78700) |
$1,148.80 |
$2,872 |
2.8× |
| Nm lymph system (78195) |
$834 |
$2,085 |
1.5× |
| Nm myocard infarct spect (78469) |
$722.40 |
$1,806 |
1.3× |
| Nm thyroid imaging only (78013) |
$388.80 |
$972 |
0.9× |
| Nose to rectum for fb child (76010) |
$208 |
$520 |
2.3× |
| Nuclear medicine study of heart pumping function by labeling red blood cells with measurement of internal blood volume… (78494) |
$367.20 |
$918 |
0.9× |
| Nuclear rx IV admin (79101) |
$481.60 |
$1,204 |
2.0× |
| Ob us < 14 wks single fetus (76801) |
$866.40 |
$2,166 |
7.9× |
| Ob us nuchal meas 1 gest (76813) |
$254.40 |
$636 |
2.3× |
| Oral radiopharm rx (79005) |
$2,383.60 |
$5,959 |
9.8× |
| Parathyroid imaging (78070) |
$1,281.60 |
$3,204 |
3.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,365.60 |
$3,414 |
3.3× |
| Peritoneal-venous shunt patency test (78291) |
$367.20 |
$918 |
0.9× |
| Peritoneogram rs&i (74190) |
$271.20 |
$678 |
0.5× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,032.80 |
$5,082 |
0.6× |
| Pulmonary perfusion imaging particulate (78580) |
$841.20 |
$2,103 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$375.20 |
$938 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$216.80 |
$542 |
2.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$208.40 |
$521 |
2.3× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$286.80 |
$717 |
3.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$332.80 |
$832 |
3.0× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$550.40 |
$1,376 |
5.0× |
| Radex spine cervical 2 or 3 views (72040) |
$538.80 |
$1,347 |
5.9× |
| Radex spine cervical 4 or 5 views (72050) |
$702.80 |
$1,757 |
6.4× |
| Radex spine cervical 6 or more views (72052) |
$780.80 |
$1,952 |
7.2× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$312 |
$780 |
3.4× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$157.20 |
$393 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$531.20 |
$1,328 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$412.40 |
$1,031 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$354 |
$885 |
3.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$616.40 |
$1,541 |
5.6× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$249.60 |
$624 |
2.3× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$623.60 |
$1,559 |
5.7× |
| Renal cyst study (74470) |
$591.20 |
$1,478 |
1.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,207.60 |
$3,019 |
2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,109.20 |
$2,773 |
2.7× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$2,844.80 |
$7,112 |
5.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,843 |
$7,107.50 |
5.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,768.40 |
$4,421 |
3.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,289.60 |
$5,724 |
1.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$512 |
$1,280 |
2.1× |
Selective spinal angiogram (75705)
unusually low: confirm this is the full procedure |
$2,445.20 |
$6,113 |
0.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$601.60 |
$1,504 |
5.5× |
| Small bowel series (74250) |
$515.60 |
$1,289 |
2.8× |
| Splenoportography (75810) |
$2,094 |
$5,235 |
0.6× |
| Superior sagittal sinus venogram (75870) |
$1,580.40 |
$3,951 |
0.5× |
| Testicular imaging w/flow (78761) |
$682.40 |
$1,706 |
1.6× |
| Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Age Under 21 (78016) |
$367.20 |
$918 |
0.9× |
| Thyroid met imaging body (78018) |
$1,630.40 |
$4,076 |
2.9× |
| Thyroid uptake single/multiple quant measurement (78012) |
$502.40 |
$1,256 |
1.2× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,308.80 |
$3,272 |
3.1× |
| Ultrasound breast limited (76642) |
$312 |
$780 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$817.60 |
$2,044 |
7.5× |
| Umbilical-artery Doppler (OB) (76820) |
$158.40 |
$396 |
1.5× |
| Unlisted diagnostic radiographic procedure (76499) |
$556.40 |
$1,391 |
6.1× |
| Urethrocystography voiding (74455) |
$625.60 |
$1,564 |
2.5× |
| Urography antegrade (74425) |
$490.40 |
$1,226 |
1.3× |
| Urography retrograde w/wo kub (74420) |
$699.20 |
$1,748 |
1.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$264.40 |
$661 |
2.4× |
| Us breast uni real time with image complete (76641) |
$430 |
$1,075 |
3.9× |
| Us chest (76604) |
$438 |
$1,095 |
4.0× |
| Us encephalogram (76506) |
$914.80 |
$2,287 |
8.4× |
| Us guided compression repair (76936) |
$411.20 |
$1,028 |
1.8× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$664 |
$1,660 |
7.3× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$99.20 |
$248 |
1.1× |
| Us kidney transplanted (76776) |
$589.20 |
$1,473 |
5.4× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$386.80 |
$967 |
3.5× |
| Us ob detailed single fetus (76811) |
$664.80 |
$1,662 |
2.7× |
| Us ob followup per fetus (76816) |
$564.40 |
$1,411 |
5.2× |
| Us ob limited 1 or more fetuses (76815) |
$438.80 |
$1,097 |
4.0× |
| Us obstetric transvaginal (76817) |
$522.40 |
$1,306 |
4.8× |
| Us pelvic limited or f/u non-ob (76857) |
$358.40 |
$896 |
3.3× |
| Us pelvis complete (76856) |
$1,264.40 |
$3,161 |
11.6× |
| Us retroperitoneal complete (76770) |
$629.60 |
$1,574 |
5.8× |
| Us retroperitoneal limited (76775) |
$491.60 |
$1,229 |
4.5× |
| Us scrotum (76870) |
$978.40 |
$2,446 |
9.0× |
| Us soft tissue head/neck (76536) |
$800.80 |
$2,002 |
7.3× |
| Us spinal canal (76800) |
$770.80 |
$1,927 |
7.1× |
| Vein X-ray liver w/hemodynam (75885) |
$858.40 |
$2,146 |
0.3× |
| Venogram epidural (75872) |
$5,916.80 |
$14,792 |
9.0× |
| Venogram extremity bilateral (75822) |
$1,338 |
$3,345 |
0.8× |
| Venogram ivc w serialography (75825) |
$2,042.80 |
$5,107 |
0.6× |
| Venogram svc w serialography (75827) |
$1,235.60 |
$3,089 |
0.8× |
| Venography adrenal unilateral selective rs&i (75840) |
$5,916.80 |
$14,792 |
1.8× |
| Venography ext unilateral (75820) |
$782 |
$1,955 |
0.5× |
| Venography renal unilateral selective rs&i (75831) |
$1,733.20 |
$4,333 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$630.40 |
$1,576 |
0.2× |
| Venography, orbital, radiological supervision and interpretation Other Diagnostic Radiology FS (75880) |
$5,916.80 |
$14,792 |
9.0× |
| Venous sampling by catheter (75893) |
$5,916.80 |
$14,792 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$391.20 |
$978 |
4.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$293.60 |
$734 |
3.2× |
| X-ray aorta leg arteries (75630) |
$2,091.20 |
$5,228 |
0.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$554 |
$1,385 |
3.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$512.80 |
$1,282 |
5.6× |
| X-ray exam hips bi 3-4 views (73522) |
$375.20 |
$938 |
3.4× |
| X-ray exam of finger(s) (73140) |
$288.80 |
$722 |
3.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$722 |
$1,805 |
7.9× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$338 |
$845 |
3.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$569.60 |
$1,424 |
6.3× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$308 |
$770 |
2.8× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$505.20 |
$1,263 |
5.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$472 |
$1,180 |
5.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$314.40 |
$786 |
3.5× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$449.20 |
$1,123 |
4.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$511.60 |
$1,279 |
4.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$318 |
$795 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$476 |
$1,190 |
4.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$490.80 |
$1,227 |
5.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$758 |
$1,895 |
6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$192 |
$480 |
1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$203.20 |
$508 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$495.20 |
$1,238 |
5.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$530 |
$1,325 |
5.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$633.20 |
$1,583 |
7.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$910.40 |
$2,276 |
8.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$392.80 |
$982 |
3.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$330.80 |
$827 |
3.6× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$341.20 |
$853 |
3.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$520 |
$1,300 |
5.7× |
| Xr abdomen 1 view (74018) |
$336 |
$840 |
3.7× |
| Xr abdomen 2 views (74019) |
$438.40 |
$1,096 |
4.0× |
| Xr abdomen 3 views (74021) |
$451.60 |
$1,129 |
4.1× |
| Xr arthrogram ankle (73615) |
$1,900 |
$4,750 |
5.2× |
| Xr arthrogram hip (73525) |
$346 |
$865 |
0.9× |
| Xr bone survey infant (77076) |
$543.60 |
$1,359 |
5.0× |
| Xr chest 1 view (71045) |
$226 |
$565 |
2.5× |
| Xr chest 2 views (71046) |
$157.20 |
$393 |
1.7× |
| Xr chest 3 views (71047) |
$146.80 |
$367 |
1.6× |
| Xr cystogram 3+ views (74430) |
$439.20 |
$1,098 |
1.2× |
| Xr eye foreign body (70030) |
$172.80 |
$432 |
1.9× |
| Xr facial bones 3 views (70150) |
$752.40 |
$1,881 |
6.9× |
| Xr lower extremity 2 views infant (73592) |
$535.20 |
$1,338 |
5.9× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$504 |
$1,260 |
4.6× |
| Xr mandible 4 views (70110) |
$503.60 |
$1,259 |
4.6× |
| Xr nasal bones (70160) |
$423.60 |
$1,059 |
4.7× |
| Xr pelvis 3 views (72190) |
$373.20 |
$933 |
3.4× |
| Xr spine 1 view (72020) |
$312 |
$780 |
3.4× |
| Xr sternum 2 views (71120) |
$530 |
$1,325 |
5.8× |
| Xr surgical specimen (76098) |
$187.20 |
$468 |
0.3× |
| Xr upper extremity 2 views infant (73092) |
$406 |
$1,015 |
3.7× |
| Xray elbow 2 views (73070) |
$358.40 |
$896 |
3.9× |
| Xray forearm 2 views (73090) |
$450.40 |
$1,126 |
5.0× |
| Xray knee 1 or 2 views rt (73560) |
$341.20 |
$853 |
3.8× |
| Xray neck soft tissue (70360) |
$376.40 |
$941 |
4.1× |
| Xray orbits complete min 4 views (70200) |
$780.80 |
$1,952 |
7.2× |
| Xray pelvis 1 or 2 views (72170) |
$341.20 |
$853 |
3.1× |
| Xray ribs bilateral 3 views (71110) |
$418.80 |
$1,047 |
3.8× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$613.20 |
$1,533 |
5.6× |
| Xray scapula complete (73010) |
$482.40 |
$1,206 |
4.4× |
| Xray shoulder 1 view (73020) |
$244.40 |
$611 |
2.7× |
| Xray sinuses paranasal <3 views (70210) |
$503.60 |
$1,259 |
5.5× |
| Xray spine thoracic 2 views (72070) |
$578.80 |
$1,447 |
5.3× |
| Xray spine thoracic 3 views (72072) |
$610.40 |
$1,526 |
5.6× |
| Xray tibia-fibula 2 views bil (73590) |
$409.20 |
$1,023 |
4.5× |
| Xray tmj's bilateral open-clsc (70330) |
$419.60 |
$1,049 |
4.6× |