| Abdomen 2 views (74019) |
$221.20 |
$316 |
1.9× |
| Acute gi blood loss imaging (78278) |
$983.50 |
$1,405 |
2.2× |
| Ankle 2 views (73600) |
$469 |
$670 |
4.8× |
| Arthrogram hip (73525) |
$622.30 |
$889 |
1.6× |
| Arthrogram knee (73580) |
$1,155.70 |
$1,651 |
3.0× |
| Arthrogram shoulder (73040) |
$1,012.90 |
$1,447 |
2.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$555.80 |
$794 |
1.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$926.80 |
$1,324 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$1,127.70 |
$1,611 |
2.5× |
| Bone age studies (77072) |
$471.10 |
$673 |
4.0× |
| Bone Imaging 3 Phase (78315) |
$1,197 |
$1,710 |
2.7× |
| Bone survey complete (77075) |
$1,321.60 |
$1,888 |
11.3× |
| Bone survey infant (77076) |
$1,512 |
$2,160 |
13.0× |
| Bowel imaging (78290) |
$777.70 |
$1,111 |
1.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,086.40 |
$1,552 |
1.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,390.50 |
$3,415 |
1.5× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$585.90 |
$837 |
1.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$542.50 |
$775 |
1.2× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,026.50 |
$2,895 |
2.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,026.50 |
$2,895 |
5.2× |
| Cervical spine 2 or 3 views (72040) |
$494.90 |
$707 |
5.1× |
| Chest 1 view (71045) |
$357.70 |
$511 |
3.7× |
| Chest xray 3 views (71047) |
$423.50 |
$605 |
4.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$401.80 |
$574 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$487.20 |
$696 |
2.5× |
| Clavicle complete (73000) |
$444.50 |
$635 |
4.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$136.50 |
$195 |
1.2× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$310.80 |
$444 |
3.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$177.10 |
$253 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,684.80 |
$5,264 |
9.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,532.60 |
$3,618 |
9.5× |
| CT abdomen w contrast (74160) |
$1,314.60 |
$1,878 |
6.7× |
| CT abdomen w wo contrast (74170) |
$1,603.70 |
$2,291 |
8.2× |
| CT abdomen w/o contrast (74150) |
$1,068.20 |
$1,526 |
9.2× |
| CT angio hrt w/3d image (75574) |
$731.50 |
$1,045 |
1.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,482.60 |
$2,118 |
7.6× |
| CT angiography upper extremity lt (73206) |
$1,544.20 |
$2,206 |
7.9× |
| CT c-spine w/contrast (72126) |
$1,149.40 |
$1,642 |
3.0× |
| CT c-spine w/o contrast (72125) |
$1,108.10 |
$1,583 |
9.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,377.60 |
$1,968 |
7.0× |
| CT chest w contrast (71260) |
$1,332.80 |
$1,904 |
6.8× |
| CT chest w/wo contrast (71270) |
$1,587.60 |
$2,268 |
8.1× |
| CT head/brain with contrast (70460) |
$1,275.40 |
$1,822 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,356.60 |
$1,938 |
6.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$569.10 |
$813 |
1.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$82.25 |
$117.50 |
0.8× |
| CT hrt w/3d image congen (75573) |
$971.60 |
$1,388 |
2.5× |
| CT iac w contrast (70481) |
$1,161.30 |
$1,659 |
5.9× |
| CT limited/localized follow up study (76380) |
$109.20 |
$156 |
1.1× |
| CT lower ext w/o (73700) |
$1,069.60 |
$1,528 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$1,222.20 |
$1,746 |
6.3× |
| CT lower extremity w/contrast material (73701) |
$1,145.90 |
$1,637 |
5.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,260 |
$1,800 |
6.4× |
| CT lumbar spine w/contrast (72132) |
$1,164.10 |
$1,663 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$1,141.70 |
$1,631 |
9.8× |
| CT maxillofacial w contrast (70487) |
$1,194.20 |
$1,706 |
6.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,281 |
$1,830 |
6.6× |
| CT maxillofacial wo contrast (70486) |
$746.20 |
$1,066 |
6.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,293.60 |
$1,848 |
6.6× |
| CT orbits w/o contrast (70480) |
$1,064 |
$1,520 |
9.1× |
| CT pelvis w/o contrast (72192) |
$1,106 |
$1,580 |
9.5× |
| CT pelvis w/wo contrast (72194) |
$1,552.60 |
$2,218 |
7.9× |
| CT scan of arm combo (73202) |
$1,424.50 |
$2,035 |
7.3× |
| CT soft tissue neck w contrast (70491) |
$1,253.70 |
$1,791 |
6.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,410.50 |
$2,015 |
7.2× |
| CT soft tissue neck w/o contrast (70490) |
$920.50 |
$1,315 |
7.9× |
| CT thoracic spine w/contrast (72129) |
$1,289.40 |
$1,842 |
6.6× |
| CT thoracic spine w/o contrast (72128) |
$1,188.60 |
$1,698 |
10.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,752.80 |
$2,504 |
9.0× |
| CT thorax w/o contrast (71250) |
$1,138.20 |
$1,626 |
9.8× |
| CT upper ext wo (73200) |
$1,064 |
$1,520 |
9.1× |
| CT upper extremity with contrast (73201) |
$1,145.90 |
$1,637 |
2.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,687.30 |
$3,839 |
13.7× |
| Cta Abdomen (74175) |
$2,151.10 |
$3,073 |
11.0× |
| CTA abdomen pelvis (74174) |
$4,270 |
$6,100 |
11.0× |
| CTA chest (71275) |
$1,934.10 |
$2,763 |
9.9× |
| Cta Head (70496) |
$1,833.30 |
$2,619 |
9.4× |
| Cta Neck (70498) |
$1,665.30 |
$2,379 |
8.5× |
| Cta Pelvis (72191) |
$2,118.90 |
$3,027 |
10.8× |
| Cystography minimum 3 views rs&i (74430) |
$460.60 |
$658 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,970.10 |
$4,243 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$404.60 |
$578 |
3.5× |
| Esophagus (74220) |
$413 |
$590 |
2.1× |
| Facial bones min 3 views (70150) |
$1,006.60 |
$1,438 |
8.6× |
| Fetal biophysical profile non-stress testing (76818) |
$1,088.50 |
$1,555 |
9.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$814.10 |
$1,163 |
7.0× |
| Fluoroscopy up to 1 hr (76000) |
$459.20 |
$656 |
1.7× |
| Foot 2 views (73620) |
$471.10 |
$673 |
4.9× |
| Forearm 2 views (73090) |
$440.30 |
$629 |
4.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$945 |
$1,350 |
2.1× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$980 |
$1,400 |
1.6× |
| Hand 2 views (73120) |
$347.90 |
$497 |
3.0× |
| Heart first pass single,planar (78481) |
$651 |
$930 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,083.60 |
$1,548 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$541.80 |
$774 |
1.2× |
| Hysterosalpingogram (74740) |
$371.70 |
$531 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$508.20 |
$726 |
4.4× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$440.30 |
$629 |
1.0× |
| Kidney imaging morphology (78700) |
$585.90 |
$837 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$878.50 |
$1,255 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$922.60 |
$1,318 |
1.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$968.80 |
$1,384 |
1.6× |
| Knee 3 views (73562) |
$532.70 |
$761 |
5.5× |
| Liver & spleen imaging static only (78215) |
$585.90 |
$837 |
1.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$585.90 |
$837 |
1.3× |
| Liver imaging static only (78201) |
$585.90 |
$837 |
1.0× |
| Liver imaging w/vascular flow (78202) |
$585.90 |
$837 |
1.0× |
| Lung perf&ventilat diferentl (78598) |
$1,269.80 |
$1,814 |
2.1× |
| Lung perfusion differential (78597) |
$735.70 |
$1,051 |
1.7× |
| Lung ventilation imaging (78579) |
$543.90 |
$777 |
1.2× |
| Lymphoscintigraphy (78195) |
$719.60 |
$1,028 |
1.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,790.20 |
$3,986 |
3.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,673.30 |
$3,819 |
6.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,710.40 |
$3,872 |
7.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$446.60 |
$638 |
4.6× |
| MRA head w & w/o contrast (70546) |
$3,267.60 |
$4,668 |
8.4× |
| MRA head w/o contrast (70544) |
$1,957.20 |
$2,796 |
7.4× |
| MRA head with contrast (70545) |
$2,472.40 |
$3,532 |
6.4× |
| MRA neck w contrast (70548) |
$2,608.90 |
$3,727 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,290.70 |
$4,701 |
8.5× |
| MRA neck w/o contrast (70547) |
$2,096.50 |
$2,995 |
7.9× |
| MRI abdomen w contrast (74182) |
$3,220 |
$4,600 |
8.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,022.50 |
$7,175 |
12.9× |
| MRI abdomen w/o contrast (74181) |
$2,919.70 |
$4,171 |
11.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,332.70 |
$4,761 |
3.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,755.50 |
$5,365 |
9.7× |
| MRI bone marrow blood supply (77084) |
$1,917.30 |
$2,739 |
7.2× |
| MRI c-spine with contrast (72142) |
$2,113.30 |
$3,019 |
5.4× |
| MRI cardiac w/o cont stress (75559) |
$1,325.80 |
$1,894 |
2.2× |
| MRI cardiac w/o contrast (75557) |
$1,325.80 |
$1,894 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$2,021.60 |
$2,888 |
7.6× |
| MRI chest w/o & w/contrast material (71552) |
$3,374.70 |
$4,821 |
8.7× |
| MRI chest w/o contrast (71550) |
$2,177.70 |
$3,111 |
8.2× |
| MRI chest with contrast (71551) |
$2,249.10 |
$3,213 |
2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,257.80 |
$4,654 |
8.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,795.40 |
$5,422 |
9.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,371.60 |
$3,388 |
8.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,582.70 |
$2,261 |
6.0× |
| MRI orbit face neck w contrast (70542) |
$2,479.40 |
$3,542 |
6.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,028.90 |
$4,327 |
7.8× |
| MRI pelvis w/contrast (72196) |
$3,332.70 |
$4,761 |
8.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,721.90 |
$5,317 |
9.6× |
| MRI pelvis w/o contrast (72195) |
$2,222.50 |
$3,175 |
8.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,492 |
$3,560 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,736.30 |
$3,909 |
7.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,309.25 |
$4,727.50 |
8.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,110.80 |
$4,444 |
8.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,965.90 |
$4,237 |
7.6× |
| MRI temporomandibular joint (70336) |
$1,636.60 |
$2,338 |
6.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,487.80 |
$3,554 |
9.4× |
| MRI up ext w/o contrast (73218) |
$2,288.30 |
$3,269 |
8.6× |
| MRI upper ext joint w/o contrast (73221) |
$2,468.90 |
$3,527 |
9.3× |
| MRI, joint upper extrem combo (73223) |
$3,174.50 |
$4,535 |
8.2× |
| Myelogram Lumbar (72265) |
$1,227.10 |
$1,753 |
1.4× |
| Myocardial infarct spect (78469) |
$788.90 |
$1,127 |
1.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,094.10 |
$1,563 |
0.8× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$1,270.50 |
$1,815 |
0.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,847.30 |
$2,639 |
1.3× |
| Myocardial spect single study at rest or stress (78451) |
$822.50 |
$1,175 |
0.6× |
| Neck soft tissue (70360) |
$172.20 |
$246 |
1.8× |
| Nm adrenal scan (78075) |
$1,951.60 |
$2,788 |
1.4× |
| Nm bone marrow multi (78103) |
$589.40 |
$842 |
1.3× |
| Nm gastric emptying study (78264) |
$945 |
$1,350 |
2.1× |
| Nm gastroesophageal reflux study (78262) |
$585.90 |
$837 |
1.3× |
| Nm kidney scan w/flow (78701) |
$614.60 |
$878 |
1.4× |
| Nonvascular shunt X-ray (75809) |
$378 |
$540 |
3.2× |
| Ob us nuchal meas 1 gest (76813) |
$980.70 |
$1,401 |
8.4× |
| Osseous survey limited (77074) |
$1,211 |
$1,730 |
10.4× |
| Parathyrd planar w/spect&CT (78072) |
$1,047.90 |
$1,497 |
1.7× |
| Parathyroid Planar Imaging (78070) |
$603.40 |
$862 |
1.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$603.40 |
$862 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$418.60 |
$598 |
3.6× |
| PET image w/CT, skull-thigh (78815) |
$4,894.40 |
$6,992 |
3.1× |
| PET imaging CT for attenuation limited area (78814) |
$2,261.70 |
$3,231 |
1.4× |
| PET imaging for CT attenuation whole body (78816) |
$5,395.60 |
$7,708 |
3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$585.90 |
$837 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,087.80 |
$1,554 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$438.20 |
$626 |
0.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$492.80 |
$704 |
5.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$424.20 |
$606 |
4.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$505.40 |
$722 |
5.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$584.50 |
$835 |
6.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$868.70 |
$1,241 |
7.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$1,003.80 |
$1,434 |
8.6× |
| Radex fingr minimum 2 views (73140) |
$323.40 |
$462 |
3.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$513.80 |
$734 |
5.3× |
| Radex Hand Minimum 3 Views (73130) |
$600.60 |
$858 |
6.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$359.80 |
$514 |
3.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$504 |
$720 |
4.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$707.70 |
$1,011 |
6.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$779.10 |
$1,113 |
6.7× |
| Radex Humerus Minimum 2 Views (73060) |
$428.40 |
$612 |
4.4× |
| Radex Kne 1/2 Views (73560) |
$399 |
$570 |
4.1× |
| Radex Kne Compl 4/More Views (73564) |
$559.30 |
$799 |
4.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$697.90 |
$997 |
6.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$508.20 |
$726 |
5.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$497.70 |
$711 |
4.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$511.70 |
$731 |
5.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$418.60 |
$598 |
4.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$450.10 |
$643 |
3.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$719.60 |
$1,028 |
7.4× |
| Radex Toe Minimum 2 Views (73660) |
$357.70 |
$511 |
3.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$652.40 |
$932 |
5.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$625.80 |
$894 |
6.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,141 |
$1,630 |
9.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$176.40 |
$252 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$291.20 |
$416 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$402.50 |
$575 |
4.2× |
| Radiologic exam colon single contrast study (74270) |
$578.90 |
$827 |
3.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$434 |
$620 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$529.20 |
$756 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$265.30 |
$379 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$763.70 |
$1,091 |
7.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$281.40 |
$402 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$418.60 |
$598 |
4.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$1,052.80 |
$1,504 |
9.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$541.80 |
$774 |
4.7× |
| Radiological examination surgical specimen (76098) |
$1,518.30 |
$2,169 |
2.5× |
| Ribs bilateral 3 views (71110) |
$625.80 |
$894 |
5.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$783.30 |
$1,119 |
1.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$822.50 |
$1,175 |
1.8× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,951.60 |
$2,788 |
3.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$863.10 |
$1,233 |
1.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,283.10 |
$1,833 |
2.1× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,107 |
$3,010 |
1.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,390.50 |
$3,415 |
1.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,107 |
$3,010 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$546 |
$780 |
4.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,315.30 |
$1,879 |
4.9× |
| Scapula (73010) |
$470.40 |
$672 |
4.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$71.40 |
$102 |
3.1× |
| Shoulder 1 view (73020) |
$388.50 |
$555 |
4.0× |
| Sialogram (70390) |
$340.20 |
$486 |
1.3× |
| Small bowel series (74250) |
$487.90 |
$697 |
2.5× |
| Speech evaluation complex (70371) |
$698.60 |
$998 |
2.6× |
| Spine thoracic 3 views (72072) |
$581.70 |
$831 |
5.0× |
| Spleen imaging only (78185) |
$585.90 |
$837 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$585.90 |
$837 |
1.3× |
| Thoracolumbar 2 views (72080) |
$795.20 |
$1,136 |
8.2× |
| Thyroid imaging w/blood flow (78013) |
$353.50 |
$505 |
0.8× |
| Thyroid uptake measurement (78012) |
$730.10 |
$1,043 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$623.70 |
$891 |
1.4× |
| Tmj unilateral (70328) |
$208.60 |
$298 |
2.2× |
| Ultrasound breast complete (76641) |
$301 |
$430 |
2.6× |
| Ultrasound elastography first target lesion (76982) |
$952 |
$1,360 |
8.2× |
| Ultrasound Exam Aaa Screen (76706) |
$392.70 |
$561 |
3.4× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$641.90 |
$917 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$690.90 |
$987 |
5.9× |
| Umbilical-artery Doppler (OB) (76820) |
$246.40 |
$352 |
2.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$876.40 |
$1,252 |
9.0× |
| Unlisted ultrasound procedure (76999) |
$241.50 |
$345 |
2.5× |
| Ureteral reflux study (78740) |
$585.90 |
$837 |
1.3× |
| Urethrocystogram voiding (74455) |
$352.10 |
$503 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$506.10 |
$723 |
1.9× |
| Us breast unilateral limited (76642) |
$281.40 |
$402 |
2.9× |
| Us chest (76604) |
$632.10 |
$903 |
5.4× |
| Us compl joint r-t w/image documentation (76881) |
$366.10 |
$523 |
3.1× |
| Us elastography parenchyma (76981) |
$952 |
$1,360 |
8.2× |
| Us encephalogram (76506) |
$1,491.70 |
$2,131 |
12.8× |
| Us hips infant static (76886) |
$323.40 |
$462 |
3.3× |
| Us infant hips w manipulation (76885) |
$323.40 |
$462 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$220.50 |
$315 |
1.9× |
| Us ob detailed single fetus (76811) |
$1,185.80 |
$1,694 |
4.5× |
| Us ob limited (76815) |
$711.90 |
$1,017 |
6.1× |
| Us ob transvaginal (76817) |
$1,050.70 |
$1,501 |
9.0× |
| Us pelvic non ob complete (76856) |
$942.20 |
$1,346 |
8.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$690.90 |
$987 |
5.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,131.20 |
$1,616 |
9.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$728.70 |
$1,041 |
6.3× |
| Us retroperitoneal complete (76770) |
$1,104.60 |
$1,578 |
9.5× |
| Us retroperitoneal limited (76775) |
$876.75 |
$1,252.50 |
7.5× |
| Us scrotum and contents (76870) |
$871.50 |
$1,245 |
7.5× |
| Us soft tissue head/neck (76536) |
$648.55 |
$926.50 |
5.6× |
| Us spinal canal and contents (76800) |
$520.10 |
$743 |
4.5× |
| Us transrectal (76872) |
$871.50 |
$1,245 |
7.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$889.70 |
$1,271 |
7.6× |
| Wrist 2 views (73100) |
$423.50 |
$605 |
4.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$319.20 |
$456 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$532.70 |
$761 |
5.5× |
| X-ray b.e. reductn intuss (74283) |
$412.30 |
$589 |
2.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$764.40 |
$1,092 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$436.80 |
$624 |
4.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$479.50 |
$685 |
4.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$740.60 |
$1,058 |
6.4× |
| X-ray exam of femur 2/> (73552) |
$801.50 |
$1,145 |
8.3× |
| X-ray eye for foreign body (70030) |
$167.30 |
$239 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$548.80 |
$784 |
5.7× |
| X-ray IV pyelogram (ivp) (74400) |
$768.60 |
$1,098 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$424.20 |
$606 |
4.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$462.70 |
$661 |
4.8× |
| X-ray leg, infant (73592) |
$815.50 |
$1,165 |
8.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$553 |
$790 |
4.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$911.40 |
$1,302 |
7.8× |
| X-ray nose-rectum child f.b. (76010) |
$296.10 |
$423 |
3.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$501.20 |
$716 |
4.3× |
| X-ray retrograde pyelogram (74420) |
$665.70 |
$951 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$565.60 |
$808 |
5.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$588 |
$840 |
5.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$789.60 |
$1,128 |
6.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$574 |
$820 |
4.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$524.30 |
$749 |
5.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$674.10 |
$963 |
7.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$928.20 |
$1,326 |
8.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$641.90 |
$917 |
5.5× |
| X-Ray Small Bowel Enteroclysis (74251) |
$512.40 |
$732 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$404.60 |
$578 |
4.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$492.10 |
$703 |
5.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$504 |
$720 |
5.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$525.70 |
$751 |
4.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$611.10 |
$873 |
5.2× |
| Xr bone length studies (77073) |
$761.60 |
$1,088 |
6.5× |
| Xr c-spine 4 or 5 views (72050) |
$789.60 |
$1,128 |
6.8× |
| Xr c-spine 6 or more views (72052) |
$980 |
$1,400 |
8.4× |
| Xr chest 4+ views (71048) |
$444.50 |
$635 |
3.8× |
| Xr urogram antegrade (74425) |
$619.50 |
$885 |
1.6× |