| Abdomen 2 views (74019) |
$204 |
$340 |
1.7× |
| Acute gi blood loss imaging (78278) |
$754.20 |
$1,257 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,288.60 |
$5,481 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$1,989 |
$3,315 |
0.5× |
| Angiography internal mammary rs&i (75756) |
$1,633.20 |
$2,722 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,926.80 |
$4,878 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,553.60 |
$4,256 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,816.40 |
$4,694 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$4,520.40 |
$7,534 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,746.60 |
$7,911 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,140.60 |
$1,901 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,633.20 |
$2,722 |
0.4× |
| Ankle 2 views (73600) |
$164.40 |
$274 |
1.6× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,577 |
$4,295 |
0.4× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,503.20 |
$4,172 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$2,599.80 |
$4,333 |
0.7× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,119.60 |
$1,866 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$1,155 |
$1,925 |
0.3× |
| Arthrogram elbow (73085) |
$535.80 |
$893 |
1.3× |
| Arthrogram hip (73525) |
$535.80 |
$893 |
1.3× |
| Arthrogram shoulder (73040) |
$749.70 |
$1,249.50 |
1.8× |
| Arthrogram wrist (73115) |
$535.80 |
$893 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$743.40 |
$1,239 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$812.40 |
$1,354 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$908.40 |
$1,514 |
1.9× |
| Bone age studies (77072) |
$223.80 |
$373 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$936.60 |
$1,561 |
2.0× |
| Bone Marrow Imaging Limited Area (78102) |
$743.40 |
$1,239 |
1.6× |
| Bone survey complete (77075) |
$538.20 |
$897 |
4.4× |
| Bone survey infant (77076) |
$350.40 |
$584 |
2.8× |
| Bowel imaging (78290) |
$743.40 |
$1,239 |
1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$978.60 |
$1,631 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$754.20 |
$1,257 |
1.6× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,723.20 |
$2,872 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,533 |
$2,555 |
3.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$964.80 |
$1,608 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$249.60 |
$416 |
2.4× |
| Chest 1 view (71045) |
$204.60 |
$341 |
2.0× |
| Chest xray 3 views (71047) |
$265.80 |
$443 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$364.20 |
$607 |
1.8× |
| Clavicle complete (73000) |
$198 |
$330 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$549.60 |
$916 |
4.5× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$449.40 |
$749 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,565.60 |
$4,276 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,967.40 |
$3,279 |
7.0× |
| CT abdomen w contrast (74160) |
$1,359.60 |
$2,266 |
6.6× |
| CT abdomen w wo contrast (74170) |
$1,435.20 |
$2,392 |
6.9× |
| CT abdomen w/o contrast (74150) |
$1,183.80 |
$1,973 |
9.6× |
| CT angio hrt w/3d image (75574) |
$1,159.80 |
$1,933 |
2.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,429.80 |
$2,383 |
6.9× |
| CT angiography upper extremity lt (73206) |
$1,183.50 |
$1,972.50 |
5.7× |
| CT c-spine w/contrast (72126) |
$1,424.40 |
$2,374 |
3.5× |
| CT c-spine w/o contrast (72125) |
$1,327.20 |
$2,212 |
10.7× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,364.40 |
$2,274 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,374.60 |
$2,291 |
6.6× |
| CT chest w contrast (71260) |
$1,353 |
$2,255 |
6.5× |
| CT chest w/wo contrast (71270) |
$1,481.40 |
$2,469 |
7.1× |
| CT colonography screening (74263) |
$1,270.20 |
$2,117 |
4.5× |
| CT colonography w/dye (74262) |
$1,007.40 |
$1,679 |
4.9× |
| CT colonography w/o cntrst (74261) |
$809.40 |
$1,349 |
6.6× |
| CT head/brain with contrast (70460) |
$1,249.20 |
$2,082 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,338 |
$2,230 |
6.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$799.80 |
$1,333 |
1.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$125.40 |
$209 |
1.2× |
| CT iac w contrast (70481) |
$1,224 |
$2,040 |
5.9× |
| CT limited/localized follow up study (76380) |
$330 |
$550 |
3.2× |
| CT lower ext w/o (73700) |
$1,410.60 |
$2,351 |
11.4× |
| CT lower extremity w wo contrast (73702) |
$1,374.60 |
$2,291 |
6.6× |
| CT lower extremity w/contrast material (73701) |
$1,276.80 |
$2,128 |
6.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,352.40 |
$2,254 |
6.5× |
| CT lumbar spine w/contrast (72132) |
$1,428.60 |
$2,381 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$1,118.10 |
$1,863.50 |
9.1× |
| CT maxillofacial w contrast (70487) |
$1,183.80 |
$1,973 |
5.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,338 |
$2,230 |
6.5× |
| CT maxillofacial wo contrast (70486) |
$1,047 |
$1,745 |
8.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,374.60 |
$2,291 |
6.6× |
| CT orbits w/o contrast (70480) |
$1,141.80 |
$1,903 |
9.2× |
| CT pelvis w/o contrast (72192) |
$1,081.20 |
$1,802 |
8.8× |
| CT pelvis w/wo contrast (72194) |
$1,335 |
$2,225 |
6.4× |
| CT scan of arm combo (73202) |
$1,396.20 |
$2,327 |
6.7× |
| CT soft tissue neck w contrast (70491) |
$1,297.20 |
$2,162 |
6.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,374.60 |
$2,291 |
6.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,253.40 |
$2,089 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,291.80 |
$2,153 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$1,279.20 |
$2,132 |
10.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,374.60 |
$2,291 |
6.6× |
| CT thorax w/o contrast (71250) |
$1,162.20 |
$1,937 |
9.4× |
| CT unlisted procedure (76497) |
$1,053.60 |
$1,756 |
10.2× |
| CT upper ext wo (73200) |
$1,467.30 |
$2,445.50 |
11.9× |
| CT upper extremity with contrast (73201) |
$1,465.20 |
$2,442 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,726.20 |
$2,877 |
8.3× |
| Cta Abdomen (74175) |
$1,732.80 |
$2,888 |
8.4× |
| CTA abdomen pelvis (74174) |
$2,261.40 |
$3,769 |
5.5× |
| CTA chest (71275) |
$1,499.40 |
$2,499 |
7.2× |
| Cta Head (70496) |
$1,861.20 |
$3,102 |
9.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,364.40 |
$2,274 |
3.3× |
| Cta Neck (70498) |
$1,864.20 |
$3,107 |
9.0× |
| Cta Pelvis (72191) |
$1,523.70 |
$2,539.50 |
7.4× |
| Cystography minimum 3 views rs&i (74430) |
$448.80 |
$748 |
1.1× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,962.60 |
$3,271 |
0.8× |
| Diskography lumbar (72295) |
$1,519.80 |
$2,533 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$522 |
$870 |
4.2× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$522 |
$870 |
4.2× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$368.40 |
$614 |
3.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$249.60 |
$416 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$146.40 |
$244 |
1.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$473.40 |
$789 |
1.7× |
| Esophagus (74220) |
$257.40 |
$429 |
1.2× |
| Facial bones min 3 views (70150) |
$372.60 |
$621 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$411.30 |
$685.50 |
3.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$333.90 |
$556.50 |
2.7× |
| Fetal Echo (76825) |
$567.60 |
$946 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$470.40 |
$784 |
1.7× |
| Foot 2 views (73620) |
$194.70 |
$324.50 |
1.9× |
| Forearm 2 views (73090) |
$253.80 |
$423 |
2.5× |
| Hand 2 views (73120) |
$225.90 |
$376.50 |
1.8× |
| Heart Infarct Image (78466) |
$743.40 |
$1,239 |
1.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,314.80 |
$3,858 |
0.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,816.40 |
$4,694 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$978.60 |
$1,631 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$754.20 |
$1,257 |
1.6× |
| Hysterosalpingogram (74740) |
$543.60 |
$906 |
1.9× |
| Kidney imaging morphology (78700) |
$743.40 |
$1,239 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$978.60 |
$1,631 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,224 |
$2,040 |
1.9× |
| Knee 3 views (73562) |
$300 |
$500 |
2.9× |
| Liver & spleen imaging static only (78215) |
$743.40 |
$1,239 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$857.40 |
$1,429 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$964.80 |
$1,608 |
1.5× |
| Lung perfusion differential (78597) |
$743.40 |
$1,239 |
1.6× |
| Lung ventilation imaging (78579) |
$743.40 |
$1,239 |
1.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,920 |
$3,200 |
0.5× |
| Lymphoscintigraphy (78195) |
$971.70 |
$1,619.50 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,857.30 |
$3,095.50 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,524.60 |
$2,541 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,095.50 |
$3,492.50 |
5.1× |
| Mammary ductogram or galactogram multiple (77054) |
$423 |
$705 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$337.80 |
$563 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$202.20 |
$337 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$56.40 |
$94 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$222.60 |
$371 |
2.0× |
| Mr safety implt pos&/immoblj (76019) |
$151.20 |
$252 |
2.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$555 |
$925 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,258.40 |
$3,764 |
5.5× |
| MRA head w/o contrast (70544) |
$1,407.60 |
$2,346 |
5.0× |
| MRA head with contrast (70545) |
$1,760.40 |
$2,934 |
4.3× |
| MRA neck w contrast (70548) |
$1,648.20 |
$2,747 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,702.80 |
$2,838 |
4.1× |
| MRA neck w/o contrast (70547) |
$1,619.40 |
$2,699 |
5.7× |
| MRI abdomen w contrast (74182) |
$1,640.40 |
$2,734 |
4.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,185.80 |
$3,643 |
5.3× |
| MRI abdomen w/o contrast (74181) |
$1,518 |
$2,530 |
5.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,772.10 |
$2,953.50 |
1.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,950 |
$3,250 |
4.7× |
| MRI breast w/o contrast bilateral (77047) |
$2,031.60 |
$3,386 |
7.2× |
| MRI breast wo contrast unilateral (77046) |
$1,410 |
$2,350 |
5.0× |
| MRI c-spine with contrast (72142) |
$1,414.20 |
$2,357 |
3.4× |
| MRI cardiac w/o cont stress (75559) |
$1,242 |
$2,070 |
1.9× |
| MRI cardiac w/o contrast (75557) |
$1,395 |
$2,325 |
4.9× |
| MRI cervical spine w/o contrast (72141) |
$1,423.20 |
$2,372 |
5.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,753.80 |
$2,923 |
4.3× |
| MRI chest w/o contrast (71550) |
$1,441.80 |
$2,403 |
5.1× |
| MRI chest with contrast (71551) |
$1,686 |
$2,810 |
1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,622.10 |
$2,703.50 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,864.20 |
$3,107 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,669.20 |
$2,782 |
5.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,395 |
$2,325 |
4.9× |
| MRI orbit face neck w contrast (70542) |
$1,323.60 |
$2,206 |
3.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,638 |
$2,730 |
4.0× |
| MRI pelvis w/contrast (72196) |
$1,333.20 |
$2,222 |
3.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,923.60 |
$3,206 |
4.7× |
| MRI pelvis w/o contrast (72195) |
$1,695 |
$2,825 |
6.0× |
| MRI spectroscopy (76390) |
$1,196.40 |
$1,994 |
11.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,919.40 |
$3,199 |
4.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,568.40 |
$2,614 |
3.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,939.80 |
$3,233 |
4.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,555.80 |
$2,593 |
3.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,783.20 |
$2,972 |
4.3× |
| MRI temporomandibular joint (70336) |
$1,242 |
$2,070 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,493.40 |
$2,489 |
5.3× |
| MRI up ext w/o contrast (73218) |
$1,829.40 |
$3,049 |
6.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,753.50 |
$2,922.50 |
6.2× |
| MRI, joint upper extrem combo (73223) |
$1,950.60 |
$3,251 |
4.7× |
| Myocardial infarct spect (78469) |
$1,902 |
$3,170 |
3.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,774.40 |
$4,624 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,575.80 |
$4,293 |
1.7× |
| N-invas est c ffr sw aly CTA (75580) |
$1,431 |
$2,385 |
1.4× |
| Neck soft tissue (70360) |
$213 |
$355 |
2.1× |
| Nm bone marrow multi (78103) |
$810.60 |
$1,351 |
1.7× |
| Nm cardiac blood pool multiple (78473) |
$876.60 |
$1,461 |
1.9× |
| Nm cisternogram (78630) |
$964.80 |
$1,608 |
1.5× |
| Nm csf leak detection (78650) |
$2,575.80 |
$4,293 |
1.7× |
| Nm gastric emptying study (78264) |
$754.20 |
$1,257 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$743.40 |
$1,239 |
1.6× |
| Nm red cell sequestration (78140) |
$743.40 |
$1,239 |
1.6× |
| Nonvascular shunt X-ray (75809) |
$483 |
$805 |
3.9× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,648.80 |
$2,748 |
3.5× |
| Nuclear Rx Oral Admin (79005) |
$478.20 |
$797 |
1.7× |
| Ob us nuchal meas 1 gest (76813) |
$153.60 |
$256 |
1.2× |
| Parathyrd planar w/spect&CT (78072) |
$978.60 |
$1,631 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$743.40 |
$1,239 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$743.40 |
$1,239 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$178.80 |
$298 |
1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,816.40 |
$4,694 |
0.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,301.40 |
$2,169 |
0.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$743.40 |
$1,239 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$978.60 |
$1,631 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$511.80 |
$853 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$258.60 |
$431 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$156.60 |
$261 |
1.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$271.20 |
$452 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$201 |
$335 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$360.60 |
$601 |
2.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$376.20 |
$627 |
3.0× |
| Radex fingr minimum 2 views (73140) |
$142.20 |
$237 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$233.40 |
$389 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$271.20 |
$452 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$212.40 |
$354 |
2.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$310.20 |
$517 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$325.20 |
$542 |
2.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$531 |
$885 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$225.60 |
$376 |
2.2× |
| Radex Kne 1/2 Views (73560) |
$232.80 |
$388 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$250.80 |
$418 |
2.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$400.80 |
$668 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$213.60 |
$356 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$295.80 |
$493 |
2.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$221.40 |
$369 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$180 |
$300 |
1.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$206.40 |
$344 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$444 |
$740 |
4.3× |
| Radex Toe Minimum 2 Views (73660) |
$145.20 |
$242 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$208.20 |
$347 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$207.60 |
$346 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$497.40 |
$829 |
4.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$192 |
$320 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$220.80 |
$368 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$237 |
$395 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$509.10 |
$848.50 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$297 |
$495 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$297 |
$495 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$221.40 |
$369 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$192 |
$320 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$202.80 |
$338 |
2.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$291.60 |
$486 |
2.4× |
| Radiological examination surgical specimen (76098) |
$469.20 |
$782 |
0.7× |
| Ribs bilateral 3 views (71110) |
$351 |
$585 |
2.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$754.20 |
$1,257 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$904.20 |
$1,507 |
1.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,285.40 |
$3,809 |
3.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,970.40 |
$3,284 |
3.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,633.20 |
$2,722 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,785.80 |
$4,643 |
1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,544 |
$4,240 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,685 |
$4,475 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$498.60 |
$831 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$186 |
$310 |
1.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$516 |
$860 |
1.8× |
| Salivary gland imaging (78230) |
$743.40 |
$1,239 |
1.6× |
| Scapula (73010) |
$223.80 |
$373 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$58.50 |
$97.50 |
2.5× |
| Sella turcica (70240) |
$367.20 |
$612 |
3.6× |
| Shoulder 1 view (73020) |
$171.60 |
$286 |
1.7× |
| Small bowel series (74250) |
$483 |
$805 |
2.3× |
| Spine thoracic 3 views (72072) |
$328.20 |
$547 |
2.7× |
| Spleen imaging only (78185) |
$743.40 |
$1,239 |
1.6× |
| Superior sagittal sinus venogram (75870) |
$1,301.40 |
$2,169 |
0.3× |
| Testicular Imaging With Vascular Flow (78761) |
$743.40 |
$1,239 |
1.6× |
| Thoracolumbar 2 views (72080) |
$215.40 |
$359 |
2.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$978.60 |
$1,631 |
1.5× |
| Thyroid imaging w/blood flow (78013) |
$823.80 |
$1,373 |
1.7× |
| Thyroid uptake measurement (78012) |
$743.40 |
$1,239 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,015.80 |
$1,693 |
2.2× |
| Tmj unilateral (70328) |
$257.40 |
$429 |
2.5× |
| Tomogram (76100) |
$354.60 |
$591 |
2.9× |
| Ultrasound breast complete (76641) |
$326.40 |
$544 |
2.6× |
| Ultrasound elastography first target lesion (76982) |
$273.60 |
$456 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$159.60 |
$266 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$330 |
$550 |
2.7× |
| Umbilical-artery Doppler (OB) (76820) |
$378 |
$630 |
3.1× |
| Unlisted fluoroscopic procedure (76496) |
$312 |
$520 |
3.0× |
| Unlisted magnetic resonance procedure (76498) |
$1,174.20 |
$1,957 |
11.4× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$220.20 |
$367 |
19.9× |
| Ureteral reflux study (78740) |
$743.40 |
$1,239 |
1.6× |
| Urethrocystogram voiding (74455) |
$549 |
$915 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$615 |
$1,025 |
2.2× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$688.80 |
$1,148 |
3.3× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$583.20 |
$972 |
2.8× |
| Us breast unilateral limited (76642) |
$273.60 |
$456 |
2.7× |
| Us chest (76604) |
$327.60 |
$546 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$333 |
$555 |
2.7× |
| Us elastography parenchyma (76981) |
$253.80 |
$423 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$247.50 |
$412.50 |
2.0× |
| Us ob detailed single fetus (76811) |
$562.80 |
$938 |
2.0× |
| Us ob limited (76815) |
$334.50 |
$557.50 |
2.7× |
| Us ob transvaginal (76817) |
$312 |
$520 |
2.5× |
| Us pelvic non ob complete (76856) |
$468 |
$780 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$273.90 |
$456.50 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$445.20 |
$742 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$403.80 |
$673 |
3.3× |
| Us retroperitoneal complete (76770) |
$448.20 |
$747 |
3.6× |
| Us retroperitoneal limited (76775) |
$340.20 |
$567 |
2.8× |
| Us scrotum and contents (76870) |
$327 |
$545 |
2.6× |
| Us soft tissue head/neck (76536) |
$381 |
$635 |
3.1× |
| Us transrectal (76872) |
$261.60 |
$436 |
2.1× |
| Us, eye b-scan (76512) |
$179.40 |
$299 |
1.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$341.40 |
$569 |
2.8× |
| Venogram adrenal unilat (75840) |
$2,816.40 |
$4,694 |
0.8× |
| Venogram extremity bilateral (75822) |
$829.80 |
$1,383 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$722.40 |
$1,204 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,336.40 |
$3,894 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$805.80 |
$1,343 |
0.4× |
| Venography Orbital Rs&I (75880) |
$815.40 |
$1,359 |
1.1× |
| Venography Renal Bilateral (75833) |
$2,509.80 |
$4,183 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,816.40 |
$4,694 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,973.40 |
$3,289 |
0.5× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$815.40 |
$1,359 |
1.1× |
| Venous sampling by catheter (75893) |
$4,675.80 |
$7,793 |
0.7× |
| Wrist 2 views (73100) |
$148.20 |
$247 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$435.60 |
$726 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$343.80 |
$573 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$513.60 |
$856 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$184.80 |
$308 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$291 |
$485 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$505.20 |
$842 |
4.1× |
| X-ray exam of femur 2/> (73552) |
$223.20 |
$372 |
2.2× |
| X-ray eye for foreign body (70030) |
$165 |
$275 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$231.60 |
$386 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$237.60 |
$396 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$217.20 |
$362 |
2.1× |
| X-ray leg, infant (73592) |
$208.20 |
$347 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$249.60 |
$416 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$389.40 |
$649 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$208.20 |
$347 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$250.20 |
$417 |
2.0× |
| X-ray retrograde pyelogram (74420) |
$762 |
$1,270 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$220.80 |
$368 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$249.60 |
$416 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$421.20 |
$702 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$207 |
$345 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$210 |
$350 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$291 |
$485 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$321.60 |
$536 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$273.60 |
$456 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$198 |
$330 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$165.60 |
$276 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$253.80 |
$423 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$235.80 |
$393 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$395.40 |
$659 |
3.2× |
| Xr bone length studies (77073) |
$241.80 |
$403 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$291 |
$485 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$311.40 |
$519 |
2.5× |
| Xr chest 4+ views (71048) |
$306.60 |
$511 |
2.5× |
| Xr urogram antegrade (74425) |
$547.20 |
$912 |
1.3× |