| Abdomen 2 views (74019) |
$232.50 |
$465 |
2.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$910 |
$1,820 |
2.3× |
| Acute venous thrombus image (78456) |
$1,301.52 |
$2,603.04 |
1.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,683.50 |
$5,367 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,093.50 |
$6,187 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$2,811 |
$5,622 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$2,029.50 |
$4,059 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,811 |
$5,622 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,566.50 |
$5,133 |
0.8× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,917 |
$3,834 |
0.6× |
| Angiography Spinal Selective Rs&I (75705) |
$2,811 |
$5,622 |
0.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,093.50 |
$6,187 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,045.50 |
$4,091 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,637 |
$3,274 |
0.5× |
| Ankle 2 views (73600) |
$187.75 |
$375.50 |
2.2× |
| Antegrade urography radiological supvj & interpj (74425) |
$307 |
$614 |
0.9× |
| Aortogram thoracic (75605) |
$7,027.50 |
$14,055 |
1.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,045 |
$4,090 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,932 |
$3,864 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$2,176.50 |
$4,353 |
0.7× |
| Arthrogram elbow (73085) |
$625 |
$1,250 |
1.8× |
| Arthrogram hip (73525) |
$625 |
$1,250 |
1.8× |
| Arthrogram shoulder (73040) |
$625 |
$1,250 |
1.8× |
| Arthrogram wrist (73115) |
$625 |
$1,250 |
1.8× |
| Arthrography knee lt (73580) |
$625 |
$1,250 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$431 |
$862 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$1,102 |
$2,204 |
2.8× |
| Bone age studies (77072) |
$129.50 |
$259 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,242.50 |
$2,485 |
3.2× |
| Bone Marrow Imaging Limited Area (78102) |
$823 |
$1,646 |
2.1× |
| Bone survey complete (77075) |
$335 |
$670 |
3.3× |
| Brain image w/flow 4 + views (78606) |
$1,014.50 |
$2,029 |
1.9× |
| Brain imaging < 4 static views (78600) |
$450 |
$900 |
1.2× |
| Brain imaging < 4 static views w vascular flow (78601) |
$946.50 |
$1,893 |
2.4× |
| Brain Imaging Minimum 4 Static Views (78605) |
$728 |
$1,456 |
1.4× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,525 |
$7,050 |
2.5× |
| Brain Imaging Vascular Flow Only (78610) |
$1,091.50 |
$2,183 |
2.1× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$20.50 |
$41 |
1.9× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$770 |
$1,540 |
2.0× |
| Cardiac shunt detection (78428) |
$816.50 |
$1,633 |
2.1× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,014.50 |
$2,029 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$280 |
$560 |
3.3× |
| Chest 1 view (71045) |
$196 |
$392 |
2.3× |
| Chest 3 views (71047) |
$280 |
$560 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$383 |
$766 |
2.2× |
| Cineradiography/videoradiography (76120) |
$188 |
$376 |
1.9× |
| Clavicle complete (73000) |
$196 |
$392 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$183 |
$366 |
1.8× |
| Corpora cavernosography (74445) |
$377 |
$754 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,248.50 |
$6,497 |
9.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,292.50 |
$4,585 |
9.9× |
| CT abdomen w contrast (74160) |
$1,608 |
$3,216 |
9.4× |
| CT abdomen w wo contrast (74170) |
$1,848.50 |
$3,697 |
10.8× |
| CT abdomen w/o contrast (74150) |
$1,244 |
$2,488 |
12.2× |
| CT angio hrt w/3d image (75574) |
$985.50 |
$1,971 |
2.9× |
| CT angiography upper extremity lt (73206) |
$1,499 |
$2,998 |
8.8× |
| CT c-spine w/o contrast (72125) |
$1,300 |
$2,600 |
12.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,913.50 |
$3,827 |
11.2× |
| CT cervical spine with contrast (72126) |
$1,608 |
$3,216 |
4.7× |
| CT chest w/wo contrast (71270) |
$1,752 |
$3,504 |
10.3× |
| CT chest with contrast (71260) |
$1,432.50 |
$2,865 |
8.4× |
| CT colonography screening (74263) |
$1,191.50 |
$2,383 |
5.1× |
| CT colonography w/o cntrst (74261) |
$1,178.50 |
$2,357 |
11.6× |
| CT head/brain with contrast (70460) |
$1,275.50 |
$2,551 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,464.50 |
$2,929 |
8.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$494.50 |
$989 |
1.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$125 |
$250 |
1.5× |
| CT hrt w/3d image congen (75573) |
$535 |
$1,070 |
1.6× |
| CT iac w contrast (70481) |
$1,432.50 |
$2,865 |
8.4× |
| CT limited/localized follow up study (76380) |
$495 |
$990 |
5.9× |
| CT lower ext w/o (73700) |
$1,164 |
$2,328 |
11.5× |
| CT lower extremity w wo contrast (73702) |
$1,685 |
$3,370 |
9.9× |
| CT lower extremity with contrast (73701) |
$1,523 |
$3,046 |
8.9× |
| CT lumbar spine w & w/o contrast (72133) |
$2,138 |
$4,276 |
12.5× |
| CT lumbar spine w/o contrast (72131) |
$1,384 |
$2,768 |
13.6× |
| CT lumbar spine with contrast (72132) |
$1,715 |
$3,430 |
5.1× |
| CT maxillofacial w contrast (70487) |
$1,094 |
$2,188 |
6.4× |
| CT maxillofacial w/o contrast (70486) |
$1,024.50 |
$2,049 |
10.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,723 |
$3,446 |
10.1× |
| CT neck soft tissue w contrast (70491) |
$1,489 |
$2,978 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,555 |
$3,110 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,268.50 |
$2,537 |
12.5× |
| CT pelvis w & w/o contrast (72194) |
$1,509.50 |
$3,019 |
8.9× |
| CT pelvis w/o contrast (72192) |
$1,162.50 |
$2,325 |
11.4× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$245.50 |
$491 |
2.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,644 |
$3,288 |
9.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,210 |
$2,420 |
11.9× |
| CT thoracic spine w/contrast (72129) |
$1,437 |
$2,874 |
8.4× |
| CT thoracic spine w/o contrast (72128) |
$1,117 |
$2,234 |
11.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,600 |
$3,200 |
9.4× |
| CT thorax w/o contrast (71250) |
$981.75 |
$1,963.50 |
9.7× |
| CT unlisted procedure (76497) |
$405.50 |
$811 |
4.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,632.50 |
$3,265 |
9.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,334.50 |
$2,669 |
13.1× |
| CT upper extremity with contrast (73201) |
$1,499 |
$2,998 |
4.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,808 |
$3,616 |
10.6× |
| Cta Abdomen (74175) |
$1,377 |
$2,754 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,665 |
$5,330 |
7.9× |
| CTA chest (71275) |
$1,731.50 |
$3,463 |
10.2× |
| Cta Head (70496) |
$1,724 |
$3,448 |
10.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,514 |
$3,028 |
8.9× |
| Cta Neck (70498) |
$1,823 |
$3,646 |
10.7× |
| Cta Pelvis (72191) |
$1,784 |
$3,568 |
10.5× |
| Cystography minimum 3 views rs&i (74430) |
$280 |
$560 |
0.8× |
| Dacryocystography (70170) |
$355.50 |
$711 |
1.5× |
| Diskogram cervical (72285) |
$1,887 |
$3,774 |
1.0× |
| Diskography lumbar (72295) |
$2,519 |
$5,038 |
1.3× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$206 |
$412 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$205 |
$410 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$210.50 |
$421 |
2.5× |
| Dxa bone density study axial skeleton (77085) |
$147.50 |
$295 |
1.5× |
| Echoencephalography real time imaging (76506) |
$290.50 |
$581 |
2.9× |
| Esophagus (74220) |
$287.50 |
$575 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$427.50 |
$855 |
4.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$357.25 |
$714.50 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$476.50 |
$953 |
2.1× |
| Foot 2 views (73620) |
$187.75 |
$375.50 |
2.2× |
| Forearm 2 views (73090) |
$161 |
$322 |
1.9× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$3,016.50 |
$6,033 |
5.7× |
| Gated Heart Planar Single (78472) |
$1,276.50 |
$2,553 |
3.3× |
| Hand 2 views (73120) |
$161 |
$322 |
1.6× |
| Hand 3 views (73130) |
$280 |
$560 |
3.3× |
| Heart Infarct Image (78466) |
$615.50 |
$1,231 |
1.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,352.50 |
$6,705 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,620 |
$3,240 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,591 |
$3,182 |
4.1× |
| Ht muscle image spect sing (78451) |
$1,906 |
$3,812 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$161 |
$322 |
1.9× |
| Hysterosalpingogram (74740) |
$596 |
$1,192 |
2.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$196 |
$392 |
1.9× |
| Kidney imaging morphology (78700) |
$612 |
$1,224 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,049.50 |
$2,099 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,172 |
$2,344 |
2.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,697 |
$3,394 |
3.2× |
| Knee 3 views (73562) |
$280 |
$560 |
3.3× |
| Liver & spleen imaging static only (78215) |
$699.50 |
$1,399 |
1.8× |
| Liver imaging w/vascular flow (78202) |
$783 |
$1,566 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$1,294 |
$2,588 |
2.5× |
| Lung perfusion differential (78597) |
$987 |
$1,974 |
2.5× |
| Lung Ventilation Imaging (78579) |
$1,112.50 |
$2,225 |
2.9× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,672 |
$3,344 |
0.5× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$603 |
$1,206 |
1.0× |
| 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) |
$1,248.50 |
$2,497 |
2.4× |
| Mammary ductogram or galactogram multiple (77054) |
$543 |
$1,086 |
2.3× |
| Mammary ductogram or galactogram single (77053) |
$338.50 |
$677 |
1.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$129.50 |
$259 |
1.5× |
| Meckels Diverticulum (78290) |
$699.50 |
$1,399 |
1.8× |
| Myelogram Cervical (72240) |
$788 |
$1,576 |
1.0× |
| Myelogram Lumbar (72265) |
$1,003.25 |
$2,006.50 |
1.3× |
| Myelogram thoracic (72255) |
$2,598.50 |
$5,197 |
3.4× |
| Myelography 2 or more regions (72270) |
$1,124 |
$2,248 |
1.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$2,825 |
$5,650 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,165 |
$6,330 |
2.5× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$1,896.50 |
$3,793 |
1.4× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$2,925.50 |
$5,851 |
1.4× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$2,608 |
$5,216 |
3.1× |
| Neck soft tissue (70360) |
$196 |
$392 |
2.3× |
| Nfs/Instlj Radioelmnt Sln 3 Mo Follow-Up Care (77750) |
$266.30 |
$532.60 |
0.7× |
| Nm bone marrow multiple (78103) |
$823 |
$1,646 |
2.1× |
| Nm cisternogram (78630) |
$1,014.50 |
$2,029 |
1.9× |
| Nm csf leak detection (78650) |
$1,301.52 |
$2,603.04 |
1.0× |
| Nm gastric emptying study (78264) |
$1,321.50 |
$2,643 |
3.4× |
| Nm gastroesophageal reflux study (78262) |
$483.50 |
$967 |
1.2× |
| Nm peritoneal-venous shunt patency (78291) |
$629.50 |
$1,259 |
1.6× |
| Nm whole blood volume (78122) |
$1,102 |
$2,204 |
2.1× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$2,478 |
$4,956 |
1.8× |
| Nuclear medicine of heart pumping function (78473) |
$770 |
$1,540 |
2.0× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$2,478 |
$4,956 |
1.8× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,453 |
$2,906 |
3.7× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$787.50 |
$1,575 |
2.0× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$928 |
$1,856 |
2.4× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$450 |
$900 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$764.50 |
$1,529 |
3.4× |
| Nuclr Rx Interstit Colloid (79300) |
$463.50 |
$927 |
2.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$256 |
$512 |
2.5× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$283.50 |
$567 |
2.8× |
| Orthopantogram (70355) |
$256.50 |
$513 |
3.0× |
| Osseous survey infant (77076) |
$232.50 |
$465 |
2.3× |
| Osseous survey limited (77074) |
$181 |
$362 |
1.8× |
| Parathyrd planar w/spect&CT (78072) |
$2,773.50 |
$5,547 |
5.3× |
| Parathyrd planar w/wo subtrj (78071) |
$1,012 |
$2,024 |
2.6× |
| Parathyroid imaging (78070) |
$804.50 |
$1,609 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$232.50 |
$465 |
2.3× |
| Peritoneogram rs&i (74190) |
$315 |
$630 |
0.6× |
| PET image w/CT, skull-thigh (78815) |
$5,135.25 |
$10,270.50 |
3.7× |
| PET imaging CT for attenuation limited area (78814) |
$3,525 |
$7,050 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,135.25 |
$10,270.50 |
3.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,177 |
$4,354 |
0.7× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,045.50 |
$4,091 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$629.50 |
$1,259 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,276.50 |
$2,553 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$366 |
$732 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$174 |
$348 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$195 |
$390 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$232.50 |
$465 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$280 |
$560 |
2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$295 |
$590 |
2.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$297.50 |
$595 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$196 |
$392 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$280 |
$560 |
2.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$232.50 |
$465 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$614.50 |
$1,229 |
3.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$287.50 |
$575 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$350 |
$700 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$324.50 |
$649 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$232.50 |
$465 |
2.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$57.50 |
$115 |
0.7× |
| Radiological examination surgical specimen (76098) |
$451.50 |
$903 |
0.9× |
| Radiopharm Dacryocystography (78660) |
$378.04 |
$756.07 |
1.0× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$571.50 |
$1,143 |
2.5× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,566 |
$5,132 |
0.8× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,393 |
$4,786 |
0.8× |
| Ribs bilateral 3 views (71110) |
$280 |
$560 |
2.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$768.50 |
$1,537 |
2.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,407 |
$2,814 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,301.52 |
$2,603.04 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,231.17 |
$2,462.33 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,356.45 |
$2,712.89 |
1.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,231.17 |
$2,462.33 |
1.0× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$831 |
$1,662 |
3.7× |
| Rp Therapy Intravenous Administration (79101) |
$764.50 |
$1,529 |
3.4× |
| Sacroiliac Joints < 3 Views (72200) |
$280 |
$560 |
2.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$401 |
$802 |
1.7× |
| Salivary gland imaging (78230) |
$408.69 |
$817.38 |
1.1× |
| Salivary gland imaging serial images (78231) |
$423.50 |
$847 |
1.1× |
| Scanogram (77073) |
$188 |
$376 |
1.9× |
| Scapula complete (73010) |
$280 |
$560 |
2.8× |
| Screening digital breast tomosynthesis (77063) |
$86.50 |
$173 |
3.7× |
| Sella turcica (70240) |
$131.50 |
$263 |
1.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$188 |
$376 |
1.9× |
| Sialogram (70390) |
$291 |
$582 |
1.3× |
| Small bowel series (74250) |
$350 |
$700 |
2.1× |
| Spine thoracic 3 views (72072) |
$280 |
$560 |
2.8× |
| Spleen imaging only (78185) |
$746 |
$1,492 |
1.9× |
| Splenoportograpy rs&i (75810) |
$2,566.50 |
$5,133 |
0.8× |
| Superior sagittal sinus venogram (75870) |
$2,045.50 |
$4,091 |
0.7× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$626.25 |
$1,252.50 |
2.7× |
| Testicular Imaging With Vascular Flow (78761) |
$837 |
$1,674 |
2.2× |
| Therapeutic Enema (74283) |
$614.50 |
$1,229 |
3.6× |
| Thoracolumbar 2 views (72080) |
$232.50 |
$465 |
2.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,364 |
$2,728 |
2.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$595.50 |
$1,191 |
1.5× |
| Thyroid uptake measurement (78012) |
$420 |
$840 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$643 |
$1,286 |
1.7× |
| Tmj unilateral (70328) |
$196 |
$392 |
2.3× |
| Tomogram (76100) |
$219.50 |
$439 |
2.2× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$1,767 |
$3,534 |
3.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$768.50 |
$1,537 |
2.0× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$679.50 |
$1,359 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$479.50 |
$959 |
4.7× |
| Umbilical-artery Doppler (OB) (76820) |
$206 |
$412 |
2.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$785.50 |
$1,571 |
9.3× |
| Unlisted Ultrasound Procedure (76999) |
$150.50 |
$301 |
1.8× |
| Upper Extremity Infant (73092) |
$232.50 |
$465 |
2.3× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$837 |
$1,674 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$371 |
$742 |
1.6× |
| Urethrocystography voiding (74455) |
$573 |
$1,146 |
2.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$364 |
$728 |
2.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$445 |
$890 |
2.6× |
| Us abdl aorta screen aaa (76706) |
$298 |
$596 |
2.9× |
| Us breast unilateral complete (76641) |
$316.50 |
$633 |
3.1× |
| Us breast unilateral limited (76642) |
$316.50 |
$633 |
3.7× |
| Us chest (76604) |
$256 |
$512 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$378 |
$756 |
3.7× |
| Us guided compression repair (76936) |
$360.50 |
$721 |
1.7× |
| Us infant hips dynamic (76885) |
$277 |
$554 |
3.3× |
| Us kidney transplant (76776) |
$416.50 |
$833 |
4.1× |
| Us ob detailed single fetus (76811) |
$561 |
$1,122 |
2.4× |
| Us ob transvaginal (76817) |
$388 |
$776 |
3.8× |
| Us pelvic non ob complete (76856) |
$647 |
$1,294 |
6.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$242 |
$484 |
2.4× |
| Us pregnancy ltd (76815) |
$311.50 |
$623 |
3.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$395.50 |
$791 |
3.9× |
| Us retroperitoneal complete (76770) |
$564 |
$1,128 |
5.6× |
| Us retroperitoneal limited (76775) |
$346.50 |
$693 |
3.4× |
| Us scrotum and contents (76870) |
$517.50 |
$1,035 |
5.1× |
| Us soft tissue head/neck (76536) |
$458 |
$916 |
4.5× |
| Us spinal canal and contents (76800) |
$398.50 |
$797 |
3.9× |
| Us transrectal (76872) |
$574 |
$1,148 |
5.7× |
| Us xtr non-vasc lmtd (76882) |
$179.50 |
$359 |
1.8× |
| Venogram extremity bilateral (75822) |
$1,024 |
$2,048 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,116.50 |
$4,233 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,364 |
$2,728 |
0.9× |
| Venography epidural rs&i (75872) |
$966.50 |
$1,933 |
1.6× |
| Venography extremity unilateral rs&i (75820) |
$941.50 |
$1,883 |
0.6× |
| Venography Renal Bilateral (75833) |
$3,078.50 |
$6,157 |
1.0× |
| Venography renal unilateral selective rs&i (75831) |
$2,688.50 |
$5,377 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,672 |
$3,344 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,285 |
$6,570 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$167.50 |
$335 |
2.0× |
| Wrist 2 views (73100) |
$161 |
$322 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$324.50 |
$649 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$280 |
$560 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$280 |
$560 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$614.50 |
$1,229 |
3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$161 |
$322 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$280 |
$560 |
3.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$215 |
$430 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$196 |
$392 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$249 |
$498 |
2.9× |
| X-ray exam hip uni 4/> views (73503) |
$297.50 |
$595 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$297.50 |
$595 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$321.50 |
$643 |
3.2× |
| X-ray exam of femur 1 (73551) |
$196 |
$392 |
2.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$321.50 |
$643 |
1.9× |
| X-ray eye for foreign body (70030) |
$196 |
$392 |
2.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$280 |
$560 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$232.50 |
$465 |
2.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$280 |
$560 |
3.3× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,286.50 |
$2,573 |
0.6× |
| X-ray head for orthodontia (70350) |
$138 |
$276 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$232.50 |
$465 |
2.7× |
| X-ray IV pyelogram+drip infusn (74410) |
$396 |
$792 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$297.50 |
$595 |
3.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$297.50 |
$595 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$297.50 |
$595 |
3.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$232.50 |
$465 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$280 |
$560 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$389 |
$778 |
3.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$297.50 |
$595 |
2.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$280 |
$560 |
3.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$196 |
$392 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$297.50 |
$595 |
2.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$280 |
$560 |
2.8× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$651 |
$1,302 |
1.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$444 |
$888 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$196 |
$392 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$232.50 |
$465 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$280 |
$560 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$280 |
$560 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$232.50 |
$465 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$232.50 |
$465 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$280 |
$560 |
3.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$158 |
$316 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$297.50 |
$595 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$280 |
$560 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$196 |
$392 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$280 |
$560 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$232.50 |
$465 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$232.50 |
$465 |
2.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$297.50 |
$595 |
2.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$196 |
$392 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$280 |
$560 |
3.3× |
| Xr arthrogram ankle (73615) |
$537.50 |
$1,075 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$372 |
$744 |
3.7× |
| Xr chest 4+ views (71048) |
$297.50 |
$595 |
2.9× |
| Xr Cholecystography Oral Contrast (74290) |
$222 |
$444 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$196 |
$392 |
2.3× |
| Xr internal auditory meati complete (70134) |
$341.50 |
$683 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$232.50 |
$465 |
2.3× |
| Xr myelogram posterior fossa (70010) |
$637.50 |
$1,275 |
1.9× |
| Xr optic foramina (70190) |
$122.50 |
$245 |
1.4× |
| Xr shoulder 1 view (73020) |
$196 |
$392 |
2.3× |
| Xr spine cervical 4 or 5 views (72050) |
$297.50 |
$595 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$161 |
$322 |
1.9× |
| Xr tmj bilateral (70330) |
$215.50 |
$431 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$201.50 |
$403 |
2.4× |