| Abdomen 2 views (74019) |
$223 |
$446 |
2.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$727.50 |
$1,455 |
2.0× |
| Angiography extremity bilateral rs&i (75716) |
$3,243 |
$6,486 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$1,996.50 |
$3,993 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$1,376 |
$2,752 |
0.5× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,576.50 |
$7,153 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,576.50 |
$7,153 |
1.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,167.50 |
$6,335 |
1.1× |
Angiography Spinal Selective Rs&I (75705)
unusually low: confirm this is the full procedure |
$1,677.50 |
$3,355 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,844 |
$9,688 |
1.0× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,992 |
$3,984 |
0.7× |
| Ankle 2 views (73600) |
$151 |
$302 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$475.50 |
$951 |
1.5× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$1,826.50 |
$3,653 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,576.50 |
$7,153 |
1.3× |
| Aortography abdominal serialography rs&i (75625) |
$2,276.50 |
$4,553 |
0.8× |
| Arthrogram elbow (73085) |
$654 |
$1,308 |
2.1× |
| Arthrogram hip (73525) |
$510 |
$1,020 |
1.6× |
| Arthrogram shoulder (73040) |
$524 |
$1,048 |
1.7× |
| Arthrogram wrist (73115) |
$429 |
$858 |
1.4× |
| Arthrography knee lt (73580) |
$576 |
$1,152 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,068 |
$2,136 |
3.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,068 |
$2,136 |
3.0× |
| Bone &/joint imaging whole body (78306) |
$1,106.50 |
$2,213 |
3.1× |
| Bone age studies (77072) |
$200.50 |
$401 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,245 |
$2,490 |
3.4× |
| Bone survey complete (77075) |
$441.50 |
$883 |
4.7× |
| Brain image w/flow 4 + views (78606) |
$743 |
$1,486 |
1.5× |
| Brain imaging < 4 static views w vascular flow (78601) |
$618 |
$1,236 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,437 |
$4,874 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,819 |
$3,638 |
5.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$727.50 |
$1,455 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$200.50 |
$401 |
2.5× |
| Chest 1 view (71045) |
$192 |
$384 |
2.4× |
| Chest 3 views (71047) |
$246 |
$492 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$382 |
$764 |
2.4× |
| Clavicle complete (73000) |
$187.50 |
$375 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$273 |
$546 |
2.9× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$310.50 |
$621 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,874.50 |
$3,749 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,594.50 |
$3,189 |
7.4× |
| CT abdomen w contrast (74160) |
$1,488 |
$2,976 |
9.4× |
| CT abdomen w wo contrast (74170) |
$1,594.50 |
$3,189 |
10.0× |
| CT abdomen w/o contrast (74150) |
$1,227.50 |
$2,455 |
13.0× |
| CT angio hrt w/3d image (75574) |
$1,044 |
$2,088 |
3.3× |
| CT angiography upper extremity lt (73206) |
$1,499 |
$2,998 |
9.4× |
| CT c-spine w/o contrast (72125) |
$1,315 |
$2,630 |
13.9× |
| CT cervical spine w&w/o contrast (72127) |
$3,126.50 |
$6,253 |
19.7× |
| CT cervical spine with contrast (72126) |
$6,110 |
$12,220 |
19.3× |
| CT chest w/wo contrast (71270) |
$1,544 |
$3,088 |
9.7× |
| CT chest with contrast (71260) |
$1,373 |
$2,746 |
8.6× |
| CT colonography screening (74263) |
$768 |
$1,536 |
3.6× |
| CT colonography w/dye (74262) |
$909 |
$1,818 |
5.7× |
| CT colonography w/o cntrst (74261) |
$532.50 |
$1,065 |
5.6× |
| CT head/brain with contrast (70460) |
$1,217 |
$2,434 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,341.50 |
$2,683 |
8.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$437 |
$874 |
1.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$50 |
$100 |
0.6× |
| CT hrt w/3d image congen (75573) |
$1,033.50 |
$2,067 |
3.3× |
| CT iac w contrast (70481) |
$1,162 |
$2,324 |
7.3× |
| CT limited/localized follow up study (76380) |
$468.50 |
$937 |
5.9× |
| CT lower ext w/o (73700) |
$1,227.50 |
$2,455 |
13.0× |
| CT lower extremity w wo contrast (73702) |
$2,131 |
$4,262 |
13.4× |
| CT lower extremity with contrast (73701) |
$2,113 |
$4,226 |
13.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,347 |
$4,694 |
14.8× |
| CT lumbar spine w/o contrast (72131) |
$1,495 |
$2,990 |
15.8× |
| CT lumbar spine with contrast (72132) |
$5,144.50 |
$10,289 |
16.3× |
| CT maxillofacial w contrast (70487) |
$2,186 |
$4,372 |
13.8× |
| CT maxillofacial w/o contrast (70486) |
$937 |
$1,874 |
9.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,351 |
$4,702 |
14.8× |
| CT neck soft tissue w contrast (70491) |
$2,216 |
$4,432 |
14.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,268 |
$2,536 |
8.0× |
| CT orbits w/o contrast (70480) |
$1,133 |
$2,266 |
12.0× |
| CT pelvis w & w/o contrast (72194) |
$1,602 |
$3,204 |
10.1× |
| CT pelvis w/o contrast (72192) |
$1,195.50 |
$2,391 |
12.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,465.50 |
$4,931 |
15.5× |
| CT soft tissue neck w/o contrast (70490) |
$967.50 |
$1,935 |
10.2× |
| CT thoracic spine w/contrast (72129) |
$2,577 |
$5,154 |
16.2× |
| CT thoracic spine w/o contrast (72128) |
$1,313.50 |
$2,627 |
13.9× |
| CT thoracic spine w/wo contrast (72130) |
$2,534 |
$5,068 |
16.0× |
| CT thorax w/o contrast (71250) |
$1,284 |
$2,568 |
13.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,247.50 |
$4,495 |
14.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,136 |
$2,272 |
12.0× |
| CT upper extremity with contrast (73201) |
$3,427.50 |
$6,855 |
10.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,737 |
$3,474 |
10.9× |
| Cta Abdomen (74175) |
$1,590 |
$3,180 |
10.0× |
| CTA abdomen pelvis (74174) |
$1,848.50 |
$3,697 |
5.9× |
| CTA chest (71275) |
$1,669 |
$3,338 |
10.5× |
| Cta Head (70496) |
$1,570.50 |
$3,141 |
9.9× |
| CTA lwr ext w&w/o contrast (73706) |
$2,143.50 |
$4,287 |
13.5× |
| Cta Neck (70498) |
$1,663.50 |
$3,327 |
10.5× |
| Cta Pelvis (72191) |
$1,757.50 |
$3,515 |
11.1× |
| Cystography minimum 3 views rs&i (74430) |
$483 |
$966 |
1.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$322.50 |
$645 |
3.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$306 |
$612 |
3.2× |
| Dxa bone density study axial skeleton (77085) |
$453 |
$906 |
4.8× |
| Echoencephalography real time imaging (76506) |
$368 |
$736 |
3.9× |
| Esophagus (74220) |
$300.50 |
$601 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$518 |
$1,036 |
5.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$356 |
$712 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$328 |
$656 |
1.5× |
| Foot 2 views (73620) |
$129.50 |
$259 |
1.6× |
| Forearm 2 views (73090) |
$154 |
$308 |
2.0× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$892 |
$1,784 |
1.8× |
| Gastric mucosa imaging (78261) |
$347.50 |
$695 |
1.0× |
| Gated Heart Planar Single (78472) |
$1,214 |
$2,428 |
3.4× |
| Hand 2 views (73120) |
$129 |
$258 |
1.4× |
| Hand 3 views (73130) |
$159 |
$318 |
2.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,045.50 |
$6,091 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,067 |
$2,134 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$892 |
$1,784 |
2.5× |
| Ht muscle image spect sing (78451) |
$1,655.50 |
$3,311 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$159 |
$318 |
2.0× |
| Hysterosalpingogram (74740) |
$695 |
$1,390 |
3.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$111.50 |
$223 |
1.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,249.50 |
$2,499 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,302 |
$2,604 |
2.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,375.50 |
$2,751 |
2.8× |
| Knee 3 views (73562) |
$168 |
$336 |
2.1× |
| Liver & spleen imaging static only (78215) |
$640.50 |
$1,281 |
1.8× |
| Liver imaging static only (78201) |
$2,163.50 |
$4,327 |
4.4× |
| Lung perf&ventilat diferentl (78598) |
$1,238 |
$2,476 |
2.5× |
| Lung perfusion differential (78597) |
$938 |
$1,876 |
2.6× |
| Lung Ventilation Imaging (78579) |
$771.50 |
$1,543 |
2.1× |
| Lymphoscintigraphy (78195) |
$727.50 |
$1,455 |
1.5× |
| Mammary ductogram or galactogram multiple (77054) |
$482 |
$964 |
2.2× |
| Mammary ductogram or galactogram single (77053) |
$463.50 |
$927 |
2.1× |
| Meckels Diverticulum (78290) |
$536 |
$1,072 |
1.5× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$94.50 |
$189 |
0.3× |
| Mr elastography (76391) |
$284.50 |
$569 |
1.3× |
| MRA head w & w/o contrast (70546) |
$1,292 |
$2,584 |
4.1× |
| MRA head w/o contrast (70544) |
$1,558 |
$3,116 |
7.2× |
| MRA head with contrast (70545) |
$963 |
$1,926 |
3.0× |
| MRA neck w contrast (70548) |
$1,650.50 |
$3,301 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,840 |
$3,680 |
5.8× |
| MRA neck w/o contrast (70547) |
$1,798.50 |
$3,597 |
8.3× |
| MRI abdomen w contrast (74182) |
$1,620 |
$3,240 |
5.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,168 |
$4,336 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,500 |
$3,000 |
6.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,514.50 |
$3,029 |
2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$4,306 |
$8,612 |
6.1× |
| MRI bone marrow blood supply (77084) |
$1,636.50 |
$3,273 |
7.6× |
| MRI breast w/o contrast bilateral (77047) |
$1,695 |
$3,390 |
7.8× |
| MRI breast w/o contrast unilat (77046) |
$847.50 |
$1,695 |
3.9× |
| MRI c-spine with contrast (72142) |
$1,792 |
$3,584 |
5.7× |
| MRI cardiac w/o contrast (75557) |
$1,419.50 |
$2,839 |
6.6× |
| MRI cervical spine w/o contrast (72141) |
$1,006.50 |
$2,013 |
4.7× |
| MRI chest w/o & w/contrast material (71552) |
$3,397 |
$6,794 |
10.8× |
| MRI chest w/o contrast (71550) |
$1,620 |
$3,240 |
7.5× |
| MRI chest with contrast (71551) |
$2,746.50 |
$5,493 |
3.9× |
| MRI fetal sngl/1st gestation (74712) |
$366 |
$732 |
1.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,792 |
$3,584 |
5.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,792 |
$3,584 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,620 |
$3,240 |
7.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,620 |
$3,240 |
7.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,839.50 |
$5,679 |
9.0× |
| MRI orbit/face/neck w/contrast (70542) |
$2,085 |
$4,170 |
6.6× |
| MRI pelvis w contrast (72196) |
$1,896 |
$3,792 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,247 |
$4,494 |
7.1× |
| MRI pelvis w/o contrast (72195) |
$1,620 |
$3,240 |
7.5× |
| MRI scan of arm joint before and after contrast (73223) |
$2,617 |
$5,234 |
8.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,857.50 |
$3,715 |
5.9× |
| MRI spectroscopy (76390) |
$689.50 |
$1,379 |
8.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,372 |
$4,744 |
7.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,792 |
$3,584 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,330.50 |
$4,661 |
7.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,792 |
$3,584 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,168 |
$4,336 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,620 |
$3,240 |
7.5× |
| MRI tmj (70336) |
$1,620 |
$3,240 |
7.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,548.50 |
$3,097 |
7.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,168 |
$4,336 |
6.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,620 |
$3,240 |
7.5× |
| Myelogram Cervical (72240) |
$1,448.50 |
$2,897 |
2.0× |
| Myelogram Lumbar (72265) |
$1,448.50 |
$2,897 |
2.0× |
| Myelogram thoracic (72255) |
$1,213.50 |
$2,427 |
1.7× |
| Myelography 2 or more regions (72270) |
$1,601.50 |
$3,203 |
2.3× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,611 |
$11,222 |
4.8× |
| Myocardial infarct spect (78469) |
$2,046 |
$4,092 |
4.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,057.50 |
$4,115 |
1.8× |
| Neck soft tissue (70360) |
$167 |
$334 |
2.1× |
| Nm cisternogram (78630) |
$893.50 |
$1,787 |
1.8× |
| Nm csf leak detection (78650) |
$857.50 |
$1,715 |
0.7× |
| Nm gastric emptying study (78264) |
$909 |
$1,818 |
2.5× |
| Nm gastroesophageal reflux study (78262) |
$1,000.50 |
$2,001 |
2.8× |
| Nm peritoneal-venous shunt patency (78291) |
$788.50 |
$1,577 |
2.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$3,984 |
$7,968 |
3.1× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$814 |
$1,628 |
2.2× |
| Nuclear Rx Oral Admin (79005) |
$823.50 |
$1,647 |
3.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$586.50 |
$1,173 |
6.2× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$165 |
$330 |
1.7× |
| Orthopantogram (70355) |
$158.50 |
$317 |
2.0× |
| Osseous survey infant (77076) |
$185 |
$370 |
2.0× |
| Osseous survey limited (77074) |
$367.50 |
$735 |
3.9× |
| Parathyrd planar w/spect&CT (78072) |
$1,260 |
$2,520 |
2.6× |
| Parathyrd planar w/wo subtrj (78071) |
$1,066 |
$2,132 |
2.9× |
| Parathyroid imaging (78070) |
$786.50 |
$1,573 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$149.50 |
$299 |
1.6× |
| PET image w/CT, skull-thigh (78815) |
$2,456 |
$4,912 |
1.9× |
| PET imaging CT for attenuation limited area (78814) |
$2,456 |
$4,912 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$4,622 |
$9,244 |
3.6× |
| PET imaging limited area chest head/neck (78811) |
$2,683.50 |
$5,367 |
2.3× |
| PET whole body (78813) |
$3,984 |
$7,968 |
3.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,168 |
$4,336 |
6.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$536 |
$1,072 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,241.50 |
$2,483 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$709 |
$1,418 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$89 |
$178 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$151 |
$302 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$147 |
$294 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$219.50 |
$439 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$204.50 |
$409 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$314 |
$628 |
3.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$223.50 |
$447 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$494 |
$988 |
3.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$299.50 |
$599 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$468 |
$936 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$570 |
$1,140 |
3.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$181.50 |
$363 |
2.3× |
| Radiological examination surgical specimen (76098) |
$640 |
$1,280 |
1.3× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,868 |
$7,736 |
1.4× |
| Ribs bilateral 3 views (71110) |
$233.50 |
$467 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,068 |
$2,136 |
3.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,593 |
$3,186 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,797 |
$3,594 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,068 |
$2,136 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,068 |
$2,136 |
0.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,027 |
$2,054 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$107 |
$214 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$395 |
$790 |
1.8× |
| Scanogram (77073) |
$146 |
$292 |
1.5× |
| Scapula complete (73010) |
$168 |
$336 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$39.50 |
$79 |
1.7× |
| Sella turcica (70240) |
$31.50 |
$63 |
0.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$168 |
$336 |
1.8× |
| Sialogram (70390) |
$466 |
$932 |
2.2× |
| Small bowel series (74250) |
$390 |
$780 |
2.5× |
| Spine thoracic 3 views (72072) |
$207.50 |
$415 |
2.2× |
| Therapeutic Enema (74283) |
$375.50 |
$751 |
2.4× |
| Thoracolumbar 2 views (72080) |
$242.50 |
$485 |
3.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$727.50 |
$1,455 |
1.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$483.50 |
$967 |
1.3× |
| Thyroid uptake measurement (78012) |
$483.50 |
$967 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$643.50 |
$1,287 |
1.8× |
| Tmj unilateral (70328) |
$72.50 |
$145 |
0.9× |
| Tomogram (76100) |
$436.50 |
$873 |
4.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,160.50 |
$4,321 |
4.4× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,027 |
$2,054 |
2.8× |
| Ultrasound elastography first target lesion (76982) |
$143 |
$286 |
1.5× |
| Ultrasound scan of cornea to determine thickness (76514) |
$62 |
$124 |
2.4× |
| Ultrasound scan to determine eye length and lens power (76519) |
$221.50 |
$443 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$417.50 |
$835 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$273 |
$546 |
2.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$162.50 |
$325 |
2.1× |
| Unlisted magnetic resonance procedure (76498) |
$620 |
$1,240 |
7.9× |
| Upper Extremity Infant (73092) |
$200.50 |
$401 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$520 |
$1,040 |
2.4× |
| Urethrocystography voiding (74455) |
$475.50 |
$951 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$502.50 |
$1,005 |
3.2× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$724.50 |
$1,449 |
4.6× |
| Us abdl aorta screen aaa (76706) |
$197.50 |
$395 |
2.1× |
| Us breast unilateral complete (76641) |
$220 |
$440 |
2.3× |
| Us breast unilateral limited (76642) |
$220 |
$440 |
2.8× |
| Us chest (76604) |
$437 |
$874 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$336 |
$672 |
3.5× |
| Us elastography parenchyma (76981) |
$148.50 |
$297 |
1.6× |
| Us guided compression repair (76936) |
$344.50 |
$689 |
1.8× |
| Us infant hips dynamic (76885) |
$127.50 |
$255 |
1.6× |
| Us kidney transplant (76776) |
$462 |
$924 |
4.9× |
| Us ob detailed single fetus (76811) |
$532 |
$1,064 |
2.5× |
| Us ob transvaginal (76817) |
$357 |
$714 |
3.8× |
| Us pelvic non ob complete (76856) |
$488 |
$976 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$285.50 |
$571 |
3.0× |
| Us pregnancy ltd (76815) |
$209 |
$418 |
2.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$387 |
$774 |
4.1× |
| Us retroperitoneal complete (76770) |
$488 |
$976 |
5.2× |
| Us retroperitoneal limited (76775) |
$434 |
$868 |
4.6× |
| Us scrotum and contents (76870) |
$446 |
$892 |
4.7× |
| Us soft tissue head/neck (76536) |
$439.50 |
$879 |
4.6× |
| Us spinal canal and contents (76800) |
$294 |
$588 |
3.1× |
| Us transrectal (76872) |
$418.50 |
$837 |
4.4× |
| Us transrectal prostate volume (76873) |
$422 |
$844 |
4.5× |
| Us xtr non-vasc lmtd (76882) |
$190 |
$380 |
2.0× |
| Us, eye b-scan (76512) |
$345 |
$690 |
3.6× |
| Vascular flow imaging (78445) |
$505.50 |
$1,011 |
1.4× |
| Venogram extremity bilateral (75822) |
$1,268 |
$2,536 |
0.9× |
| Venography caval inferior serialography rs&i (75825) |
$3,576.50 |
$7,153 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$1,240 |
$2,480 |
0.9× |
| Venography extremity unilateral rs&i (75820) |
$960.50 |
$1,921 |
0.7× |
| Venography Renal Bilateral (75833) |
$1,989.50 |
$3,979 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,567.50 |
$3,135 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,240 |
$2,480 |
0.4× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,576.50 |
$7,153 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$109 |
$218 |
1.4× |
| Wrist 2 views (73100) |
$146.50 |
$293 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$314 |
$628 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$119.50 |
$239 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$164.50 |
$329 |
2.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$512 |
$1,024 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$161.50 |
$323 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$201.50 |
$403 |
2.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$271 |
$542 |
2.9× |
| X-ray exam hip uni 1 view (73501) |
$115.50 |
$231 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$149 |
$298 |
1.9× |
| X-ray exam hip uni 4/> views (73503) |
$149 |
$298 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$243 |
$486 |
2.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$282 |
$564 |
3.0× |
| X-ray exam of femur 1 (73551) |
$89 |
$178 |
1.1× |
| X-ray eye for foreign body (70030) |
$176.50 |
$353 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$209.50 |
$419 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$150.50 |
$301 |
1.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$155 |
$310 |
2.0× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$2,974.50 |
$5,949 |
1.6× |
| X-ray head for orthodontia (70350) |
$131 |
$262 |
1.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$137 |
$274 |
1.7× |
| X-ray IV pyelogram+drip infusn (74410) |
$617 |
$1,234 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$143.50 |
$287 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$199.50 |
$399 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$141.50 |
$283 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$199 |
$398 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$229 |
$458 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$334.50 |
$669 |
3.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$289.50 |
$579 |
3.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$159 |
$318 |
2.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$233.50 |
$467 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$205.50 |
$411 |
2.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$223 |
$446 |
2.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$475.50 |
$951 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$178 |
$356 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$286.50 |
$573 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$358 |
$716 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$195 |
$390 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$159 |
$318 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$223.50 |
$447 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$219.50 |
$439 |
2.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$186.50 |
$373 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$262.50 |
$525 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$159 |
$318 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$143.50 |
$287 |
1.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$87 |
$174 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$171.50 |
$343 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$191 |
$382 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$261 |
$522 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$137 |
$274 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$155 |
$310 |
2.0× |
| Xr arthrogram ankle (73615) |
$543.50 |
$1,087 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$365 |
$730 |
3.9× |
| Xr chest 4+ views (71048) |
$255.50 |
$511 |
2.7× |
| Xr finger(s) 2+ views (73140) |
$130.50 |
$261 |
1.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$120.50 |
$241 |
1.3× |
| Xr optic foramina (70190) |
$87 |
$174 |
1.1× |
| Xr shoulder 1 view (73020) |
$172.50 |
$345 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$280 |
$560 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$159 |
$318 |
2.0× |
| Xr tmj bilateral (70330) |
$195 |
$390 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$149.50 |
$299 |
1.9× |