| Abdomen 2 views (74019) |
$232.50 |
$465 |
2.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,001 |
$2,002 |
2.5× |
| Acute venous thrombus image (78456) |
$1,431.50 |
$2,863 |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,643.50 |
$5,287 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$3,047 |
$6,094 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,811 |
$5,622 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$1,999 |
$3,998 |
0.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,811 |
$5,622 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,528 |
$5,056 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,888.50 |
$3,777 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$2,811 |
$5,622 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,047 |
$6,094 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,045.50 |
$4,091 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,637 |
$3,274 |
0.5× |
| Ankle 2 views (73600) |
$209.75 |
$419.50 |
2.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$411 |
$822 |
1.2× |
| Aortogram thoracic (75605) |
$7,027.50 |
$14,055 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,014.50 |
$4,029 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,902.50 |
$3,805 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$2,144 |
$4,288 |
0.7× |
| Arthrogram elbow (73085) |
$615.50 |
$1,231 |
1.8× |
| Arthrogram hip (73525) |
$615.50 |
$1,231 |
1.8× |
| Arthrogram shoulder (73040) |
$615.50 |
$1,231 |
1.8× |
| Arthrogram wrist (73115) |
$615.50 |
$1,231 |
1.8× |
| Arthrography knee lt (73580) |
$615.50 |
$1,231 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,087.50 |
$2,175 |
2.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,178.50 |
$2,357 |
2.9× |
| Bone &/joint imaging whole body (78306) |
$1,624 |
$3,248 |
4.1× |
| Bone age studies (77072) |
$191 |
$382 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,624 |
$3,248 |
4.1× |
| Bone Marrow Imaging Limited Area (78102) |
$905.50 |
$1,811 |
2.3× |
| Bone survey complete (77075) |
$468 |
$936 |
4.5× |
| Brain image w/flow 4 + views (78606) |
$2,046.50 |
$4,093 |
3.8× |
| Brain Imaging Vascular Flow Only (78610) |
$1,200.50 |
$2,401 |
2.2× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$51 |
$102 |
4.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$972 |
$1,944 |
2.4× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,116 |
$2,232 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$275.50 |
$551 |
3.2× |
| Chest 1 view (71045) |
$193 |
$386 |
2.2× |
| Chest 3 views (71047) |
$275.50 |
$551 |
3.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$377.50 |
$755 |
2.1× |
| Clavicle complete (73000) |
$193 |
$386 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$183 |
$366 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,988.50 |
$5,977 |
8.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,109 |
$4,218 |
8.8× |
| CT abdomen w contrast (74160) |
$1,479.50 |
$2,959 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,700.75 |
$3,401.50 |
9.7× |
| CT abdomen w/o contrast (74150) |
$1,144.50 |
$2,289 |
10.9× |
| CT angio hrt w/3d image (75574) |
$906.50 |
$1,813 |
2.6× |
| CT angiography upper extremity lt (73206) |
$1,379 |
$2,758 |
7.9× |
| CT c-spine w/o contrast (72125) |
$1,196 |
$2,392 |
11.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,760.50 |
$3,521 |
10.0× |
| CT cervical spine with contrast (72126) |
$1,479.50 |
$2,959 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,611.50 |
$3,223 |
9.2× |
| CT chest with contrast (71260) |
$1,318 |
$2,636 |
7.5× |
| CT colonography screening (74263) |
$1,191.50 |
$2,383 |
5.0× |
| CT colonography w/o cntrst (74261) |
$1,178.50 |
$2,357 |
11.3× |
| CT head/brain with contrast (70460) |
$1,173.50 |
$2,347 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,347.50 |
$2,695 |
7.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$455 |
$910 |
1.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$113.64 |
$227.27 |
1.3× |
| CT hrt w/3d image congen (75573) |
$492.50 |
$985 |
1.4× |
| CT iac w contrast (70481) |
$1,318 |
$2,636 |
7.5× |
| CT lower ext w/o (73700) |
$1,070.50 |
$2,141 |
10.2× |
| CT lower extremity w wo contrast (73702) |
$1,550 |
$3,100 |
8.8× |
| CT lower extremity with contrast (73701) |
$1,401.50 |
$2,803 |
8.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,967 |
$3,934 |
11.2× |
| CT lumbar spine w/o contrast (72131) |
$1,273.50 |
$2,547 |
12.2× |
| CT lumbar spine with contrast (72132) |
$1,577.50 |
$3,155 |
4.5× |
| CT maxillofacial w contrast (70487) |
$1,006.50 |
$2,013 |
5.7× |
| CT maxillofacial w/o contrast (70486) |
$942.75 |
$1,885.50 |
9.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,585 |
$3,170 |
9.0× |
| CT neck soft tissue w contrast (70491) |
$1,369.50 |
$2,739 |
7.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,430.50 |
$2,861 |
8.1× |
| CT orbits w/o contrast (70480) |
$1,167 |
$2,334 |
11.1× |
| CT pelvis w & w/o contrast (72194) |
$1,388.75 |
$2,777.50 |
7.9× |
| CT pelvis w/o contrast (72192) |
$1,069.50 |
$2,139 |
10.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$225.50 |
$451 |
2.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,512.50 |
$3,025 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,113.50 |
$2,227 |
10.6× |
| CT thoracic spine w/contrast (72129) |
$1,322 |
$2,644 |
7.5× |
| CT thoracic spine w/o contrast (72128) |
$1,027.50 |
$2,055 |
9.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,472 |
$2,944 |
8.4× |
| CT thorax w/o contrast (71250) |
$903.25 |
$1,806.50 |
8.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,502 |
$3,004 |
8.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,227.50 |
$2,455 |
11.7× |
| CT upper extremity with contrast (73201) |
$1,379 |
$2,758 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,663.50 |
$3,327 |
9.5× |
| Cta Abdomen (74175) |
$1,266.50 |
$2,533 |
7.2× |
| CTA abdomen pelvis (74174) |
$2,452 |
$4,904 |
7.0× |
| CTA chest (71275) |
$1,593.50 |
$3,187 |
9.1× |
| Cta Head (70496) |
$1,586 |
$3,172 |
9.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,393 |
$2,786 |
7.9× |
| Cta Neck (70498) |
$1,677.50 |
$3,355 |
9.5× |
| Cta Pelvis (72191) |
$1,641.50 |
$3,283 |
9.3× |
| Cystography minimum 3 views rs&i (74430) |
$275.50 |
$551 |
0.8× |
| Dacryocystography (70170) |
$350.50 |
$701 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$202 |
$404 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$207.50 |
$415 |
2.4× |
| Dxa bone density study axial skeleton (77085) |
$145.50 |
$291 |
1.4× |
| Echoencephalography real time imaging (76506) |
$446.50 |
$893 |
4.3× |
| Esophagus (74220) |
$352 |
$704 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$427.50 |
$855 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$372 |
$744 |
3.6× |
| Fluoroscopy up to 1 hr (76000) |
$469 |
$938 |
2.0× |
| Foot 2 views (73620) |
$209.75 |
$419.50 |
2.4× |
| Forearm 2 views (73090) |
$209.75 |
$419.50 |
2.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$3,356.50 |
$6,713 |
6.2× |
| Gated Heart Planar Single (78472) |
$1,404.50 |
$2,809 |
3.5× |
| Hand 2 views (73120) |
$209.75 |
$419.50 |
2.0× |
| Hand 3 views (73130) |
$275.50 |
$551 |
3.2× |
| Heart Infarct Image (78466) |
$1,229.50 |
$2,459 |
3.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,782 |
$3,564 |
3.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,750.50 |
$3,501 |
4.4× |
| Ht muscle image spect sing (78451) |
$2,096.50 |
$4,193 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$209.75 |
$419.50 |
2.4× |
| Hysterosalpingogram (74740) |
$587 |
$1,174 |
2.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$172.25 |
$344.50 |
1.6× |
| Kidney imaging morphology (78700) |
$1,081.50 |
$2,163 |
2.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,154.50 |
$2,309 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,289 |
$2,578 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,311 |
$4,622 |
4.2× |
| Knee 3 views (73562) |
$275.50 |
$551 |
3.2× |
| Liver & spleen imaging static only (78215) |
$769.50 |
$1,539 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$801.50 |
$1,603 |
2.0× |
| Liver imaging w/vascular flow (78202) |
$861.50 |
$1,723 |
1.6× |
| Lung perf&ventilat diferentl (78598) |
$1,423 |
$2,846 |
2.6× |
| Lung perfusion differential (78597) |
$1,233 |
$2,466 |
3.1× |
| Lung Ventilation Imaging (78579) |
$1,233 |
$2,466 |
3.1× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$808 |
$1,616 |
0.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,637 |
$3,274 |
0.5× |
| Lymphoscintigraphy (78195) |
$1,373.50 |
$2,747 |
2.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$127.50 |
$255 |
1.5× |
| Meckels Diverticulum (78290) |
$769.50 |
$1,539 |
1.9× |
| MRA head w & w/o contrast (70546) |
$2,430 |
$4,860 |
7.0× |
| MRA head w/o contrast (70544) |
$1,806.50 |
$3,613 |
7.6× |
| MRA head with contrast (70545) |
$2,182 |
$4,364 |
6.2× |
| MRA neck w contrast (70548) |
$2,106 |
$4,212 |
6.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,348 |
$4,696 |
6.7× |
| MRA neck w/o contrast (70547) |
$1,608.50 |
$3,217 |
6.7× |
| MRI abdomen w contrast (74182) |
$2,004.50 |
$4,009 |
5.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,735.50 |
$5,471 |
7.8× |
| MRI abdomen w/o contrast (74181) |
$1,800 |
$3,600 |
7.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,820.50 |
$3,641 |
2.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,977 |
$3,954 |
2.5× |
| MRI c-spine with contrast (72142) |
$2,175 |
$4,350 |
6.2× |
| MRI cervical spine w/o contrast (72141) |
$1,996.50 |
$3,993 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,311 |
$4,622 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,635.50 |
$3,271 |
6.8× |
| MRI chest with contrast (71551) |
$1,714.50 |
$3,429 |
2.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,899 |
$3,798 |
5.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,845 |
$3,690 |
5.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,737.50 |
$3,475 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,665 |
$3,330 |
7.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,295.50 |
$4,591 |
6.6× |
| MRI orbit/face/neck w/contrast (70542) |
$1,875.50 |
$3,751 |
5.4× |
| MRI pelvis w contrast (72196) |
$1,796.50 |
$3,593 |
5.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,517 |
$5,034 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$1,665 |
$3,330 |
7.0× |
| MRI scan of arm joint before and after contrast (73223) |
$2,487 |
$4,974 |
7.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,139.50 |
$4,279 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,535.50 |
$5,071 |
7.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,175 |
$4,350 |
6.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,535.50 |
$5,071 |
7.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,175 |
$4,350 |
6.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,535.50 |
$5,071 |
7.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,996.50 |
$3,993 |
8.4× |
| MRI tmj (70336) |
$1,737.25 |
$3,474.50 |
7.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,737.50 |
$3,475 |
7.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,096.50 |
$4,193 |
6.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,554.50 |
$3,109 |
6.5× |
| Myelogram Lumbar (72265) |
$965 |
$1,930 |
1.2× |
| Myelogram thoracic (72255) |
$2,415.50 |
$4,831 |
3.1× |
| Myelography 2 or more regions (72270) |
$1,107.50 |
$2,215 |
1.4× |
| Myocardial Spect Multiple Studies (78452) |
$3,698 |
$7,396 |
2.9× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,896.50 |
$3,793 |
1.3× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,925.50 |
$5,851 |
1.3× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$2,399.50 |
$4,799 |
2.8× |
| Neck soft tissue (70360) |
$219.50 |
$439 |
2.5× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$461 |
$922 |
1.2× |
| Nm bone marrow multiple (78103) |
$1,016.50 |
$2,033 |
2.5× |
| Nm cisternogram (78630) |
$1,665 |
$3,330 |
3.1× |
| Nm csf leak detection (78650) |
$2,046.50 |
$4,093 |
1.6× |
| Nm gastric emptying study (78264) |
$1,555.50 |
$3,111 |
3.9× |
| Nm gastroesophageal reflux study (78262) |
$803.50 |
$1,607 |
2.0× |
| Nm peritoneal-venous shunt patency (78291) |
$756 |
$1,512 |
1.9× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$3,676 |
$7,352 |
2.8× |
| Nuclear medicine of heart pumping function (78473) |
$972 |
$1,944 |
2.4× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$2,083.50 |
$4,167 |
1.6× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,598 |
$3,196 |
4.0× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$866 |
$1,732 |
2.2× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$1,021.50 |
$2,043 |
2.6× |
| Nuclear Rx Oral Admin (79005) |
$841 |
$1,682 |
3.6× |
| Nuclr Rx Interstit Colloid (79300) |
$945.50 |
$1,891 |
4.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$269 |
$538 |
2.6× |
| Orthopantogram (70355) |
$252.50 |
$505 |
2.9× |
| Osseous survey infant (77076) |
$229 |
$458 |
2.2× |
| Osseous survey limited (77074) |
$182.50 |
$365 |
1.7× |
| Parathyrd planar w/spect&CT (78072) |
$2,773.50 |
$5,547 |
5.1× |
| Parathyrd planar w/wo subtrj (78071) |
$923 |
$1,846 |
2.3× |
| Parathyroid imaging (78070) |
$978 |
$1,956 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$229 |
$458 |
2.2× |
| Perineogram (74775) |
$455.50 |
$911 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,115 |
$4,230 |
6.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,009 |
$2,018 |
2.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,404.50 |
$2,809 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$520.50 |
$1,041 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$267 |
$534 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$267 |
$534 |
2.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$233.50 |
$467 |
2.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$275.50 |
$551 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$267 |
$534 |
2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$293 |
$586 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$271.50 |
$543 |
3.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$229 |
$458 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$610 |
$1,220 |
3.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$352 |
$704 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$483.50 |
$967 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$536.25 |
$1,072.50 |
3.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$229 |
$458 |
2.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$69 |
$138 |
0.8× |
| Radiological examination surgical specimen (76098) |
$444.50 |
$889 |
0.8× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$1,380 |
$2,760 |
5.9× |
| Ribs bilateral 3 views (71110) |
$275.50 |
$551 |
2.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,058.50 |
$2,117 |
2.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,547.50 |
$3,095 |
2.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,431.50 |
$2,863 |
2.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,354 |
$2,708 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,492 |
$2,984 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,354 |
$2,708 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,380 |
$2,760 |
5.9× |
| Rp Therapy Intravenous Administration (79101) |
$841 |
$1,682 |
3.6× |
| Sacroiliac Joints < 3 Views (72200) |
$275.50 |
$551 |
2.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$421 |
$842 |
1.8× |
| Salivary gland imaging (78230) |
$803.50 |
$1,607 |
2.0× |
| Scanogram (77073) |
$185.50 |
$371 |
1.8× |
| Scapula complete (73010) |
$275.50 |
$551 |
2.6× |
| Screening digital breast tomosynthesis (77063) |
$86.50 |
$173 |
3.7× |
| Sella turcica (70240) |
$129.50 |
$259 |
1.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$185.50 |
$371 |
1.8× |
| Sialogram (70390) |
$373 |
$746 |
1.6× |
| Small bowel series (74250) |
$493 |
$986 |
2.8× |
| Spine thoracic 3 views (72072) |
$275.50 |
$551 |
2.6× |
| Spleen imaging only (78185) |
$1,016.50 |
$2,033 |
2.5× |
| Testicular Imaging With Vascular Flow (78761) |
$1,062 |
$2,124 |
2.7× |
| Therapeutic Enema (74283) |
$605.50 |
$1,211 |
3.4× |
| Thoracolumbar 2 views (72080) |
$229 |
$458 |
2.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,500 |
$3,000 |
2.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$655 |
$1,310 |
1.6× |
| Thyroid uptake measurement (78012) |
$462.50 |
$925 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$707.50 |
$1,415 |
1.8× |
| Tmj unilateral (70328) |
$193 |
$386 |
2.2× |
| Tomogram (76100) |
$216.50 |
$433 |
2.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,944 |
$3,888 |
3.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$856 |
$1,712 |
2.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$679.50 |
$1,359 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$503.50 |
$1,007 |
4.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$774 |
$1,548 |
8.9× |
| Unlisted Ultrasound Procedure (76999) |
$150.50 |
$301 |
1.7× |
| Upper Extremity Infant (73092) |
$229 |
$458 |
2.2× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,062 |
$2,124 |
2.7× |
| Urethrocystography retrograde rs&i (74450) |
$410 |
$820 |
1.7× |
| Urethrocystography voiding (74455) |
$564 |
$1,128 |
2.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$412.50 |
$825 |
2.3× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$442 |
$884 |
2.5× |
| Us abdl aorta screen aaa (76706) |
$313 |
$626 |
3.0× |
| Us breast unilateral complete (76641) |
$337.25 |
$674.50 |
3.2× |
| Us breast unilateral limited (76642) |
$332.75 |
$665.50 |
3.8× |
| Us chest (76604) |
$269 |
$538 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$397 |
$794 |
3.8× |
| Us elastography parenchyma (76981) |
$241.50 |
$483 |
2.3× |
| Us guided compression repair (76936) |
$902 |
$1,804 |
4.2× |
| Us infant hips dynamic (76885) |
$291 |
$582 |
3.3× |
| Us kidney transplant (76776) |
$437.50 |
$875 |
4.2× |
| Us ob detailed single fetus (76811) |
$589 |
$1,178 |
2.5× |
| Us ob transvaginal (76817) |
$407 |
$814 |
3.9× |
| Us pelvic non ob complete (76856) |
$679 |
$1,358 |
6.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$254.50 |
$509 |
2.4× |
| Us pregnancy ltd (76815) |
$327 |
$654 |
3.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$415.50 |
$831 |
4.0× |
| Us retroperitoneal complete (76770) |
$592.50 |
$1,185 |
5.7× |
| Us retroperitoneal limited (76775) |
$363.50 |
$727 |
3.5× |
| Us scrotum and contents (76870) |
$543.50 |
$1,087 |
5.2× |
| Us soft tissue head/neck (76536) |
$481 |
$962 |
4.6× |
| Us spinal canal and contents (76800) |
$418 |
$836 |
4.0× |
| Us xtr non-vasc lmtd (76882) |
$179.50 |
$359 |
1.7× |
| Venogram extremity bilateral (75822) |
$1,008.50 |
$2,017 |
0.6× |
| Venography caval inferior serialography rs&i (75825) |
$2,084.50 |
$4,169 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,364 |
$2,728 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$941.50 |
$1,883 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$2,648 |
$5,296 |
0.8× |
| Wrist 2 views (73100) |
$217 |
$434 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$352 |
$704 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$275.50 |
$551 |
3.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$275.50 |
$551 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$641.50 |
$1,283 |
3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$210 |
$420 |
2.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$275.50 |
$551 |
3.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$267 |
$534 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$193 |
$386 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$245.50 |
$491 |
2.8× |
| X-ray exam hip uni 4/> views (73503) |
$293 |
$586 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$293 |
$586 |
2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$316.50 |
$633 |
3.0× |
| X-ray exam of femur 1 (73551) |
$193 |
$386 |
2.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$634.50 |
$1,269 |
3.6× |
| X-ray eye for foreign body (70030) |
$193 |
$386 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$275.50 |
$551 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$233.50 |
$467 |
2.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$275.50 |
$551 |
3.2× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,267 |
$2,534 |
0.6× |
| X-ray head for orthodontia (70350) |
$135.50 |
$271 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$229 |
$458 |
2.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$390.50 |
$781 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$293 |
$586 |
3.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$293 |
$586 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$293 |
$586 |
3.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$229 |
$458 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$275.50 |
$551 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$383 |
$766 |
3.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$293 |
$586 |
2.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$275.50 |
$551 |
3.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$193 |
$386 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$339 |
$678 |
3.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$275.50 |
$551 |
2.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$503 |
$1,006 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$219.50 |
$439 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$271.50 |
$543 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$275.50 |
$551 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$275.50 |
$551 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$229 |
$458 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$229 |
$458 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$275.50 |
$551 |
3.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$233.50 |
$467 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$339 |
$678 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$275.50 |
$551 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$193 |
$386 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$275.50 |
$551 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$229 |
$458 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$229 |
$458 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$297.50 |
$595 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$193 |
$386 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$275.50 |
$551 |
3.2× |
| Xr arthrogram ankle (73615) |
$529.50 |
$1,059 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$366 |
$732 |
3.5× |
| Xr chest 4+ views (71048) |
$297.50 |
$595 |
2.8× |
| Xr Cholecystography Oral Contrast (74290) |
$219 |
$438 |
1.2× |
| Xr finger(s) 2+ views (73140) |
$193 |
$386 |
2.2× |
| Xr internal auditory meati complete (70134) |
$336.50 |
$673 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$229 |
$458 |
2.2× |
| Xr optic foramina (70190) |
$120.50 |
$241 |
1.4× |
| Xr shoulder 1 view (73020) |
$193 |
$386 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$339 |
$678 |
3.2× |
| Xr tibia/fibula 2 views (73590) |
$209.75 |
$419.50 |
2.4× |
| Xr tmj bilateral (70330) |
$258.50 |
$517 |
3.0× |
| Xray knee 1 or 2 views rt (73560) |
$229 |
$458 |
2.6× |