| Abdomen 2 views (74019) |
$111.60 |
$248 |
1.1× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,379.15 |
$5,287 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$3,692.92 |
$8,206.50 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$2,956.50 |
$6,570 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$1,948.05 |
$4,329 |
0.6× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,529.90 |
$5,622 |
0.5× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$4,433.85 |
$9,853 |
1.4× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,699.65 |
$3,777 |
0.5× |
| Angiography Spinal Selective Rs&I (75705) |
$5,179.05 |
$11,509 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,179.05 |
$11,509 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,840.95 |
$4,091 |
0.6× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,473.30 |
$3,274 |
0.5× |
| Ankle 2 views (73600) |
$98.32 |
$218.50 |
1.1× |
| Antegrade urography radiological supvj & interpj (74425) |
$501.30 |
$1,114 |
1.4× |
| Aortogram thoracic (75605) |
$4,484.25 |
$9,965 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,834.20 |
$4,076 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$1,834.20 |
$4,076 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$1,929.60 |
$4,288 |
0.6× |
| Arthrogram elbow (73085) |
$508.50 |
$1,130 |
1.5× |
| Arthrogram hip (73525) |
$531.45 |
$1,181 |
1.5× |
| Arthrogram shoulder (73040) |
$483.08 |
$1,073.50 |
1.4× |
| Arthrogram wrist (73115) |
$374.40 |
$832 |
1.1× |
| Arthrography knee lt (73580) |
$479.25 |
$1,065 |
1.4× |
| Bone age studies (77072) |
$234.90 |
$522 |
2.2× |
| Bone survey complete (77075) |
$688.05 |
$1,529 |
6.6× |
| Brachytx isodose complex (77318) |
$575.10 |
$1,278 |
1.5× |
| Brachytx isodose intermed (77317) |
$453.60 |
$1,008 |
1.2× |
| Brachytx isodose pln smpl w/dosimetry cal (77316) |
$428.40 |
$952 |
1.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,766.60 |
$6,148 |
7.9× |
| Cervical spine 2 or 3 views (72040) |
$121.95 |
$271 |
1.4× |
| Chest 1 view (71045) |
$103.05 |
$229 |
1.2× |
| Chest 3 views (71047) |
$306.90 |
$682 |
3.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$323.10 |
$718 |
1.8× |
| Cineradiography/videoradiography (76120) |
$179.55 |
$399 |
1.7× |
| Clavicle complete (73000) |
$128.25 |
$285 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$177.30 |
$394 |
1.7× |
| Continuing medical physics consltj pr wk (77336) |
$552.60 |
$1,228 |
4.1× |
| Corpora cavernosography (74445) |
$360 |
$800 |
3.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,813.95 |
$4,031 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,260 |
$2,800 |
5.3× |
| CT abdomen w contrast (74160) |
$888.75 |
$1,975 |
5.1× |
| CT abdomen w wo contrast (74170) |
$1,299.82 |
$2,888.50 |
7.4× |
| CT abdomen w/o contrast (74150) |
$740.25 |
$1,645 |
7.1× |
| CT angio hrt w/3d image (75574) |
$913.05 |
$2,029 |
2.6× |
| CT angiography upper extremity lt (73206) |
$1,087.42 |
$2,416.50 |
6.2× |
| CT c-spine w/o contrast (72125) |
$800.10 |
$1,778 |
7.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,107.45 |
$2,461 |
6.3× |
| CT cervical spine with contrast (72126) |
$922.95 |
$2,051 |
2.6× |
| CT chest w/wo contrast (71270) |
$1,727.10 |
$3,838 |
9.8× |
| CT chest with contrast (71260) |
$933.75 |
$2,075 |
5.3× |
| CT colonography screening (74263) |
$1,103.85 |
$2,453 |
4.6× |
| CT colonography w/o cntrst (74261) |
$1,092.15 |
$2,427 |
10.4× |
| CT head/brain with contrast (70460) |
$810 |
$1,800 |
4.6× |
| CT head/brain without and with contrast (70470) |
$1,011.60 |
$2,248 |
5.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$921.15 |
$2,047 |
2.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$125 |
$277.78 |
1.4× |
| CT hrt w/3d image congen (75573) |
$1,086.75 |
$2,415 |
3.1× |
| CT iac w contrast (70481) |
$769.05 |
$1,709 |
4.4× |
| CT limited/localized follow up study (76380) |
$386.55 |
$859 |
4.4× |
| CT lower ext w/o (73700) |
$611.10 |
$1,358 |
5.8× |
| CT lower extremity w wo contrast (73702) |
$1,727.10 |
$3,838 |
9.8× |
| CT lower extremity with contrast (73701) |
$706.95 |
$1,571 |
4.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,107.45 |
$2,461 |
6.3× |
| CT lumbar spine w/o contrast (72131) |
$800.10 |
$1,778 |
7.6× |
| CT lumbar spine with contrast (72132) |
$959.85 |
$2,133 |
2.7× |
| CT maxillofacial w contrast (70487) |
$769.05 |
$1,709 |
4.4× |
| CT maxillofacial w/o contrast (70486) |
$792 |
$1,760 |
7.6× |
| CT maxillofacial w/wo contrast (70488) |
$959.85 |
$2,133 |
5.5× |
| CT neck soft tissue w contrast (70491) |
$959.85 |
$2,133 |
5.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$922.95 |
$2,051 |
5.3× |
| CT orbits w/o contrast (70480) |
$666.90 |
$1,482 |
6.4× |
| CT pelvis w & w/o contrast (72194) |
$1,128.38 |
$2,507.50 |
6.4× |
| CT pelvis w/o contrast (72192) |
$859.28 |
$1,909.50 |
8.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$202.95 |
$451 |
2.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,727.10 |
$3,838 |
9.8× |
| CT soft tissue neck w/o contrast (70490) |
$641.25 |
$1,425 |
6.1× |
| CT thoracic spine w/contrast (72129) |
$959.85 |
$2,133 |
5.5× |
| CT thoracic spine w/o contrast (72128) |
$800.10 |
$1,778 |
7.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,107.45 |
$2,461 |
6.3× |
| CT thorax w/o contrast (71250) |
$762.30 |
$1,694 |
7.3× |
| CT unlisted procedure (76497) |
$500.85 |
$1,113 |
5.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,726.65 |
$3,837 |
9.8× |
| CT upper extremity w/o contrast rt (73200) |
$587.25 |
$1,305 |
5.6× |
| CT upper extremity with contrast (73201) |
$704.70 |
$1,566 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$914.85 |
$2,033 |
5.2× |
| Cta Abdomen (74175) |
$1,128.15 |
$2,507 |
6.4× |
| CTA abdomen pelvis (74174) |
$1,172.70 |
$2,606 |
3.4× |
| CTA chest (71275) |
$1,231.65 |
$2,737 |
7.0× |
| Cta Head (70496) |
$799.65 |
$1,777 |
4.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,108.58 |
$2,463.50 |
6.3× |
| Cta Neck (70498) |
$831.60 |
$1,848 |
4.7× |
| Cta Pelvis (72191) |
$1,776.15 |
$3,947 |
10.1× |
| Cystography minimum 3 views rs&i (74430) |
$377.10 |
$838 |
1.1× |
| Dacryocystography (70170) |
$315.45 |
$701 |
1.3× |
| Diskogram cervical (72285) |
$1,800.90 |
$4,002 |
0.9× |
| Diskography lumbar (72295) |
$2,403.90 |
$5,342 |
1.2× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$146.70 |
$326 |
1.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$442.35 |
$983 |
4.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$149.85 |
$333 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$123.30 |
$274 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$186.75 |
$415 |
2.1× |
| Dxa bone density study axial skeleton (77085) |
$206.10 |
$458 |
2.0× |
| Echo exam of fetal heart (76825) |
$1,091.25 |
$2,425 |
2.0× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$608.85 |
$1,353 |
2.5× |
| Echoencephalography real time imaging (76506) |
$422.10 |
$938 |
4.0× |
| Esophagus (74220) |
$242.10 |
$538 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$324.90 |
$722 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$256.50 |
$570 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$295.65 |
$657 |
1.2× |
| Foot 2 views (73620) |
$88.65 |
$197 |
1.0× |
| Forearm 2 views (73090) |
$164.25 |
$365 |
1.9× |
| Functional MRI brain by phys/psych (70555) |
$787.50 |
$1,750 |
3.3× |
| Functional MRI brain by tech (70554) |
$787.50 |
$1,750 |
3.3× |
| Hand 2 views (73120) |
$89.78 |
$199.50 |
0.9× |
| Hand 3 views (73130) |
$144.45 |
$321 |
1.7× |
| Hdr rdncl ntrstl/intrcav brachytx 1 channel (77770) |
$1,099.80 |
$2,444 |
1.6× |
| Hdr rdncl ntrstl/intrcav brachytx 2-12 channel (77771) |
$1,376.10 |
$3,058 |
2.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,955.60 |
$6,568 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$103.95 |
$231 |
1.2× |
| Hysterosalpingogram (74740) |
$355.05 |
$789 |
1.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$155.02 |
$344.50 |
1.5× |
| Knee 3 views (73562) |
$194.85 |
$433 |
2.2× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$1,595.25 |
$3,545 |
0.5× |
| Lymphangio extrem unilat - ir lymphangiogram extremity (75801) |
$575.10 |
$1,278 |
0.9× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$727.20 |
$1,616 |
0.5× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$1,473.30 |
$3,274 |
0.5× |
| Mammary ductogram or galactogram multiple (77054) |
$518.40 |
$1,152 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$652.95 |
$1,451 |
2.7× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$114.75 |
$255 |
1.3× |
| Mr elastography (76391) |
$264.60 |
$588 |
1.1× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$121.50 |
$270 |
2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$50.40 |
$112 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$187.65 |
$417 |
2.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$495 |
$1,100 |
2.1× |
| MRA head w & w/o contrast (70546) |
$1,739.25 |
$3,865 |
5.0× |
| MRA head w/o contrast (70544) |
$798.30 |
$1,774 |
3.3× |
| MRA head with contrast (70545) |
$1,963.80 |
$4,364 |
5.6× |
| MRA neck w contrast (70548) |
$1,895.40 |
$4,212 |
5.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,409.40 |
$3,132 |
4.0× |
| MRA neck w/o contrast (70547) |
$810 |
$1,800 |
3.4× |
| MRI abdomen w contrast (74182) |
$2,252.70 |
$5,006 |
6.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,777.50 |
$3,950 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,287.45 |
$2,861 |
5.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,641.38 |
$3,647.50 |
2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,252.70 |
$5,006 |
2.9× |
| MRI bone marrow blood supply (77084) |
$252.90 |
$562 |
1.1× |
| MRI breast w/o contrast bilateral (77047) |
$964.35 |
$2,143 |
4.0× |
| MRI breast w/o contrast unilat (77046) |
$963.90 |
$2,142 |
4.0× |
| MRI c-spine with contrast (72142) |
$1,690.65 |
$3,757 |
4.8× |
| MRI cardiac w/o cont stress (75559) |
$1,231.20 |
$2,736 |
2.2× |
| MRI cardiac w/o contrast (75557) |
$655.20 |
$1,456 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$1,515.38 |
$3,367.50 |
6.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,424.25 |
$3,165 |
4.1× |
| MRI chest w/o contrast (71550) |
$1,406.70 |
$3,126 |
5.9× |
| MRI chest with contrast (71551) |
$1,543.05 |
$3,429 |
2.0× |
| MRI fetal sngl/1st gestation (74712) |
$350.55 |
$779 |
1.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,836.90 |
$4,082 |
5.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,660.50 |
$3,690 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,041.30 |
$2,314 |
4.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$884.92 |
$1,966.50 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,617.30 |
$3,594 |
4.6× |
| MRI orbit/face/neck w/contrast (70542) |
$1,687.95 |
$3,751 |
4.8× |
| MRI pelvis w contrast (72196) |
$2,251.35 |
$5,003 |
6.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,193.85 |
$2,653 |
3.4× |
| MRI pelvis w/o contrast (72195) |
$1,048.50 |
$2,330 |
4.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,598.40 |
$3,552 |
4.6× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,918.35 |
$4,263 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,577.25 |
$3,505 |
4.5× |
| MRI spectroscopy (76390) |
$547.20 |
$1,216 |
6.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,995.30 |
$4,434 |
5.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,804.95 |
$4,011 |
5.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,029.72 |
$4,510.50 |
5.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,534.18 |
$5,631.50 |
7.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,029.72 |
$4,510.50 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,515.38 |
$3,367.50 |
6.3× |
| MRI tmj (70336) |
$1,263.60 |
$2,808 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,065.38 |
$2,367.50 |
4.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,597.95 |
$3,551 |
4.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,044.22 |
$2,320.50 |
4.4× |
| Myelogram Cervical (72240) |
$751.50 |
$1,670 |
1.0× |
| Myelogram Lumbar (72265) |
$896.40 |
$1,992 |
1.1× |
| Myelogram thoracic (72255) |
$1,419.98 |
$3,155.50 |
1.8× |
| Myelography 2 or more regions (72270) |
$996.75 |
$2,215 |
1.3× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$2,394 |
$5,320 |
2.8× |
| Neck soft tissue (70360) |
$73.35 |
$163 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$226.12 |
$502.50 |
2.2× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$206.55 |
$459 |
2.0× |
| Orthopantogram (70355) |
$256.50 |
$570 |
2.9× |
| Osseous survey infant (77076) |
$70.20 |
$156 |
0.7× |
| Osseous survey limited (77074) |
$435.15 |
$967 |
4.2× |
| Pelvis 1 or 2 views (72170) |
$100.35 |
$223 |
1.0× |
| Perineogram (74775) |
$409.95 |
$911 |
1.7× |
| Peritoneogram rs&i (74190) |
$301.05 |
$669 |
0.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,442.70 |
$3,206 |
4.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,955.60 |
$6,568 |
0.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,840.95 |
$4,091 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$718.65 |
$1,597 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$305.55 |
$679 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$237.60 |
$528 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$131.85 |
$293 |
1.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$247.95 |
$551 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$240.30 |
$534 |
2.3× |
| Radiation treatment delivery 1 mev >= complex (77412) |
$736.65 |
$1,637 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$154.80 |
$344 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$100.35 |
$223 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$302.85 |
$673 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$650.48 |
$1,445.50 |
7.5× |
| Radiologic exam colon single contrast study (74270) |
$490.50 |
$1,090 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$316.80 |
$704 |
1.8× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$158.85 |
$353 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$477 |
$1,060 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$500.40 |
$1,112 |
2.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$128.70 |
$286 |
1.5× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$62.10 |
$138 |
0.7× |
| Radiological examination surgical specimen (76098) |
$436.05 |
$969 |
0.8× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,448.90 |
$5,442 |
0.8× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$2,283.75 |
$5,075 |
0.7× |
| Ribs bilateral 3 views (71110) |
$166.95 |
$371 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$133.42 |
$296.50 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$378.90 |
$842 |
1.6× |
| Scanogram (77073) |
$335.70 |
$746 |
3.2× |
| Scapula complete (73010) |
$252.45 |
$561 |
2.4× |
| Screening digital breast tomosynthesis (77063) |
$23.40 |
$52 |
1.0× |
| Sella turcica (70240) |
$116.55 |
$259 |
1.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$98.55 |
$219 |
0.9× |
| Sialogram (70390) |
$354.38 |
$787.50 |
1.5× |
| Small bowel series (74250) |
$469.80 |
$1,044 |
2.7× |
| Spec medical radj physics consltj (77370) |
$542.70 |
$1,206 |
4.0× |
| Spec telethx port pln parts hemibdy tot bdy (77321) |
$591.75 |
$1,315 |
1.6× |
| Special dosimetry (77331) |
$351.45 |
$781 |
2.6× |
| Special treatment procedure (77470) |
$962.55 |
$2,139 |
1.7× |
| Spine thoracic 3 views (72072) |
$135.45 |
$301 |
1.3× |
| Splenoportograpy rs&i (75810) |
$2,449.35 |
$5,443 |
0.8× |
| Superior sagittal sinus venogram (75870) |
$1,840.95 |
$4,091 |
0.6× |
| Telethx isodose pln cplx w/basic dosimetry (77307) |
$926.10 |
$2,058 |
2.5× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$597.60 |
$1,328 |
2.5× |
| Ther rad simulaj-aided field setting simple (77280) |
$733.95 |
$1,631 |
5.5× |
| Therapeutic Enema (74283) |
$145.80 |
$324 |
0.8× |
| Thoracolumbar 2 views (72080) |
$70.20 |
$156 |
0.8× |
| Tmj unilateral (70328) |
$152.55 |
$339 |
1.8× |
| Tomogram (76100) |
$194.85 |
$433 |
1.9× |
| Treatment device intermediate (77333) |
$400.95 |
$891 |
3.0× |
| Treatment devices simple (77332) |
$292.05 |
$649 |
2.2× |
| Tx devices design & construction complex (77334) |
$790.88 |
$1,757.50 |
2.1× |
| Ultrasound elastography first target lesion (76982) |
$144.45 |
$321 |
1.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$495 |
$1,100 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$453.15 |
$1,007 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$149.85 |
$333 |
1.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$696.60 |
$1,548 |
8.0× |
| Unlisted magnetic resonance procedure (76498) |
$571.50 |
$1,270 |
6.6× |
| Unlisted Ultrasound Procedure (76999) |
$109.35 |
$243 |
1.3× |
| Upper Extremity Infant (73092) |
$261 |
$580 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$398.70 |
$886 |
1.7× |
| Urethrocystography voiding (74455) |
$469.80 |
$1,044 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$371.25 |
$825 |
2.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$397.80 |
$884 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$85.50 |
$190 |
0.8× |
| Us breast unilateral complete (76641) |
$252.22 |
$560.50 |
2.4× |
| Us breast unilateral limited (76642) |
$213.30 |
$474 |
2.4× |
| Us chest (76604) |
$170.55 |
$379 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$390.60 |
$868 |
3.7× |
| Us elastography parenchyma (76981) |
$130.95 |
$291 |
1.3× |
| Us fetal nuchal translucency 1st gestation (76813) |
$186.75 |
$415 |
1.8× |
| Us guided compression repair (76936) |
$173.25 |
$385 |
0.8× |
| Us infant hips dynamic (76885) |
$546.30 |
$1,214 |
6.3× |
| Us infant hips limited static (76886) |
$373.05 |
$829 |
4.3× |
| Us kidney transplant (76776) |
$373.05 |
$829 |
3.6× |
| Us ob detailed single fetus (76811) |
$324.90 |
$722 |
1.4× |
| Us ob transvaginal (76817) |
$128.70 |
$286 |
1.2× |
| Us pelvic non ob complete (76856) |
$244.35 |
$543 |
2.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$361.80 |
$804 |
3.5× |
| Us pregnancy ltd (76815) |
$195.30 |
$434 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$195.30 |
$434 |
1.9× |
| Us retroperitoneal complete (76770) |
$219.60 |
$488 |
2.1× |
| Us retroperitoneal limited (76775) |
$169.20 |
$376 |
1.6× |
| Us scrotum and contents (76870) |
$156.15 |
$347 |
1.5× |
| Us soft tissue head/neck (76536) |
$150.75 |
$335 |
1.4× |
| Us spinal canal and contents (76800) |
$446.85 |
$993 |
4.3× |
| Us transrectal (76872) |
$1,347.75 |
$2,995 |
12.9× |
| Us transrectal prostate volume (76873) |
$725.85 |
$1,613 |
6.9× |
| Us xtr non-vasc lmtd (76882) |
$111.60 |
$248 |
1.1× |
| Venogram extremity bilateral (75822) |
$904.95 |
$2,011 |
0.6× |
| Venogram orbital (75880) |
$1,099.80 |
$2,444 |
1.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,956.50 |
$6,570 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$1,227.60 |
$2,728 |
0.8× |
| Venography epidural rs&i (75872) |
$922.95 |
$2,051 |
1.5× |
| Venography extremity unilateral rs&i (75820) |
$847.35 |
$1,883 |
0.5× |
| Venography Renal Bilateral (75833) |
$4,432.95 |
$9,851 |
1.4× |
| Venography renal unilateral selective rs&i (75831) |
$2,955.60 |
$6,568 |
0.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,504.80 |
$3,344 |
0.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$2,956.50 |
$6,570 |
0.5× |
| Vertebral fracture assessment via dxa (77086) |
$67.50 |
$150 |
0.8× |
| Wrist 2 views (73100) |
$83.25 |
$185 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$147.60 |
$328 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$191.25 |
$425 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$144.45 |
$321 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$594.45 |
$1,321 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$68.18 |
$151.50 |
0.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$144.45 |
$321 |
1.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$240.30 |
$534 |
2.3× |
| X-ray exam hip uni 1 view (73501) |
$69.75 |
$155 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$157.05 |
$349 |
1.8× |
| X-ray exam hip uni 4/> views (73503) |
$234 |
$520 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$263.70 |
$586 |
2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$172.80 |
$384 |
1.7× |
| X-ray exam of femur 1 (73551) |
$122.40 |
$272 |
1.4× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$571.05 |
$1,269 |
3.3× |
| X-ray eye for foreign body (70030) |
$77.40 |
$172 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$101.25 |
$225 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$59.40 |
$132 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$124.65 |
$277 |
1.4× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,622.92 |
$3,606.50 |
0.8× |
| X-ray head for orthodontia (70350) |
$121.95 |
$271 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$119.25 |
$265 |
1.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$351.45 |
$781 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$74.25 |
$165 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$160.65 |
$357 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$72.90 |
$162 |
0.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$243.90 |
$542 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$166.50 |
$370 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$120.15 |
$267 |
1.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$88.20 |
$196 |
0.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$77.85 |
$173 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$70.65 |
$157 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$80.55 |
$179 |
0.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$106.65 |
$237 |
1.0× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$621 |
$1,380 |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$562.05 |
$1,249 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$120.60 |
$268 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$166.50 |
$370 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$194.85 |
$433 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$105.30 |
$234 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$126.45 |
$281 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$120.60 |
$268 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$122.40 |
$272 |
1.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$65.25 |
$145 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$154.80 |
$344 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$93.60 |
$208 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$114.98 |
$255.50 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$208.35 |
$463 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$117.45 |
$261 |
1.3× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$42.30 |
$94 |
0.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$113.85 |
$253 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$212.40 |
$472 |
2.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$173.70 |
$386 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$144.45 |
$321 |
1.7× |
| Xr arthrogram ankle (73615) |
$357.30 |
$794 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$147.60 |
$328 |
1.4× |
| Xr chest 4+ views (71048) |
$324 |
$720 |
3.1× |
| Xr Cholecystography Oral Contrast (74290) |
$197.10 |
$438 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$173.70 |
$386 |
2.0× |
| Xr internal auditory meati complete (70134) |
$302.85 |
$673 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$206.10 |
$458 |
2.0× |
| Xr myelogram posterior fossa (70010) |
$608.40 |
$1,352 |
1.7× |
| Xr optic foramina (70190) |
$108.45 |
$241 |
1.2× |
| Xr shoulder 1 view (73020) |
$80.55 |
$179 |
0.9× |
| Xr spine cervical 4 or 5 views (72050) |
$141.75 |
$315 |
1.4× |
| Xr tibia/fibula 2 views (73590) |
$107.78 |
$239.50 |
1.2× |
| Xr tmj bilateral (70330) |
$295.65 |
$657 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$153.45 |
$341 |
1.8× |