| Abdomen 1 View (74018) |
$270.24 |
$563 |
2.4× |
| Abdomen 2 views (74019) |
$405.12 |
$844 |
3.0× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$306.72 |
$639 |
0.6× |
| Adrenal Cortex & Medulla Img (78075) |
$2,191.20 |
$4,565 |
1.3× |
| Angio internal mammary (75756) |
$1,639.68 |
$3,416 |
0.4× |
| Angio pulmonary bilat (75743) |
$3,626.40 |
$7,555 |
0.9× |
| Angiography extremity bilateral rs&i (75716) |
$3,626.40 |
$7,555 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,790.24 |
$5,813 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,790.24 |
$5,813 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,378.24 |
$7,038 |
0.8× |
| Ankle 2 views (73600) |
$300.48 |
$626 |
2.7× |
| Aortography thoracic serialography rs&i (75605) |
$5,627.52 |
$11,724 |
0.8× |
| Artery X-Rays Abdomen (75726) |
$5,627.52 |
$11,724 |
0.8× |
| Artery X-Rays Adrenal Gland (75731) |
$3,378.24 |
$7,038 |
0.8× |
| Artery X-Rays Pelvis (75736) |
$5,627.52 |
$11,724 |
0.8× |
| Artery X-Rays Spine (75705) |
$5,627.52 |
$11,724 |
0.8× |
| Arthrogram ankle (73615) |
$561.60 |
$1,170 |
1.3× |
| Arthrogram hip (73525) |
$434.88 |
$906 |
1.0× |
| Arthrogram Wrist (73115) |
$562.08 |
$1,171 |
1.3× |
| Bone age studies (77072) |
$120 |
$250 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$736.32 |
$1,534 |
1.4× |
| Bone Imaging Limited Area (78300) |
$374.40 |
$780 |
0.7× |
| Bone Imaging Whole Body (78306) |
$723.36 |
$1,507 |
1.4× |
| Bone marrow imaging limited area (78102) |
$448.32 |
$934 |
0.9× |
| Bone marrow imaging; multiple areas (78103) |
$599.04 |
$1,248 |
1.2× |
| Bone marrow imaging; whole body (78104) |
$683.04 |
$1,423 |
1.3× |
| Bone survey infant (77076) |
$140.16 |
$292 |
1.0× |
| Brain Image W/Flow < 4 Views (78601) |
$399.36 |
$832 |
0.8× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$620.16 |
$1,292 |
0.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$576.48 |
$1,201 |
1.3× |
| Cat Scan Follow-Up Study (76380) |
$586.56 |
$1,222 |
5.2× |
| Cerebrospinal Fluid Scan (78630) |
$392.16 |
$817 |
0.6× |
| Chest 1 view (71045) |
$263.52 |
$549 |
2.4× |
| Chest 2 views (71046) |
$418.08 |
$871 |
3.7× |
| Chest 3 views (71047) |
$439.20 |
$915 |
3.9× |
| Chest 4 or more views (71048) |
$457.92 |
$954 |
3.4× |
| Cholecystography Oral Contrast (74290) |
$274.08 |
$571 |
1.2× |
| Clavicle complete (73000) |
$258.72 |
$539 |
2.3× |
| Contrast Exam Abdominl Aorta (75625) |
$3,378.24 |
$7,038 |
0.8× |
| Contrast X-Ray Bladder (74430) |
$318.72 |
$664 |
0.7× |
| Contrast X-Ray Of Elbow (73085) |
$434.88 |
$906 |
1.0× |
| Contrast X-Ray Of Knee Joint (73580) |
$561.60 |
$1,170 |
1.3× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$502.56 |
$1,047 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,918.88 |
$6,081 |
6.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,924.32 |
$4,009 |
6.3× |
| CT abdomen w contrast (74160) |
$1,473.12 |
$3,069 |
6.5× |
| CT abdomen w wo contrast (74170) |
$1,529.76 |
$3,187 |
6.8× |
| CT abdomen w/o contrast (74150) |
$1,010.40 |
$2,105 |
7.5× |
| CT Angio Abdomen and Pelvis (74174) |
$1,810.08 |
$3,771 |
4.0× |
| CT Angio Chest (71275) |
$2,190.24 |
$4,563 |
9.7× |
| CT Angio Head (70496) |
$1,517.28 |
$3,161 |
6.7× |
| CT angio hrt w/3d image (75574) |
$471.84 |
$983 |
1.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,118.88 |
$2,331 |
5.0× |
| CT Angio Neck (70498) |
$1,503.36 |
$3,132 |
6.7× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,074.24 |
$2,238 |
4.8× |
| CT cervical spine w/ contrast (72126) |
$1,776.48 |
$3,701 |
4.0× |
| CT cervical spine w/o contrast (72125) |
$1,452.96 |
$3,027 |
10.8× |
| CT cervical spine w/wo cont (72127) |
$2,397.60 |
$4,995 |
10.6× |
| CT chest w contrast (71260) |
$1,546.08 |
$3,221 |
6.9× |
| CT chest w/wo contrast (71270) |
$1,869.12 |
$3,894 |
8.3× |
| CT head/brain with contrast (70460) |
$1,813.44 |
$3,778 |
8.0× |
| CT head/brain without and with contrast (70470) |
$3,411.36 |
$7,107 |
15.1× |
| CT heart contrast eval cardiac structure&morph (75572) |
$471.84 |
$983 |
1.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$539.52 |
$1,124 |
4.8× |
| CT hrt w/3d image congen (75573) |
$471.84 |
$983 |
1.1× |
| CT iac w contrast (70481) |
$1,667.04 |
$3,473 |
7.4× |
| CT l-spine w&w/o contrast (72133) |
$2,004.48 |
$4,176 |
8.9× |
| CT lower ext w/o (73700) |
$997.92 |
$2,079 |
7.4× |
| CT lower extremity w/contrast material (73701) |
$1,118.88 |
$2,331 |
5.0× |
| CT lumbar spine w contrast (72132) |
$1,785.12 |
$3,719 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,204.32 |
$2,509 |
9.0× |
| CT maxillofacial w contrast (70487) |
$2,125.92 |
$4,429 |
9.4× |
| CT maxillofacial wo contrast (70486) |
$2,024.16 |
$4,217 |
15.1× |
| CT neck tissue combo (70492) |
$2,629.92 |
$5,479 |
11.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,763.04 |
$3,673 |
7.8× |
| CT orbits w/o contrast (70480) |
$1,620.48 |
$3,376 |
12.1× |
| CT pelvis w&w/o contrast (72194) |
$1,583.04 |
$3,298 |
7.0× |
| CT pelvis w/o contrast (72192) |
$1,010.40 |
$2,105 |
7.5× |
| CT scan of leg combo (73702) |
$1,366.56 |
$2,847 |
6.1× |
| CT scans face/jaw combo (70488) |
$2,194.56 |
$4,572 |
9.7× |
| CT soft tissue neck w contrast (70491) |
$2,036.16 |
$4,242 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,771.20 |
$3,690 |
13.2× |
| CT thoracic spine w contrast (72129) |
$1,472.64 |
$3,068 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$1,139.04 |
$2,373 |
8.5× |
| CT thoracic spine w/wo cont (72130) |
$1,518.72 |
$3,164 |
6.7× |
| CT thorax w/o contrast (71250) |
$1,334.88 |
$2,781 |
9.9× |
| CT upper ext wo (73200) |
$973.44 |
$2,028 |
7.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,074.24 |
$2,238 |
4.8× |
| CT upper extremity with contrast (73201) |
$987.36 |
$2,057 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,283.04 |
$2,673 |
5.7× |
| Cta Abdomen (74175) |
$1,810.08 |
$3,771 |
8.0× |
| CTA pelvis (72191) |
$1,270.56 |
$2,647 |
5.6× |
| Diskography lumbar (72295) |
$1,772.64 |
$3,693 |
0.7× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$144.96 |
$302 |
1.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$149.76 |
$312 |
1.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$175.20 |
$365 |
1.3× |
| Echo exam of fetal heart (76825) |
$416.64 |
$868 |
0.6× |
| Echo exam uterus (76831) |
$629.28 |
$1,311 |
2.1× |
| Echo Guide For Artery Repair (76936) |
$769.44 |
$1,603 |
2.8× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$416.64 |
$868 |
1.4× |
| Echograp Trans R Pros Study (76873) |
$284.64 |
$593 |
2.1× |
| Esophagram (74220) |
$519.84 |
$1,083 |
2.3× |
| Fetal Biophys Profile W/Nst (76818) |
$550.56 |
$1,147 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$550.56 |
$1,147 |
4.1× |
| Fetal MRI w/placntl matrnl plvc img sing/1st ges (74712) |
$330.72 |
$689 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$175.20 |
$365 |
0.6× |
| Follow-Up Angiography (75898) |
$1,775.04 |
$3,698 |
0.4× |
| Foot 2 views (73620) |
$292.80 |
$610 |
2.6× |
| Forearm 2 views (73090) |
$267.36 |
$557 |
2.4× |
| Gastric emptying imaging study (78264) |
$381.12 |
$794 |
0.7× |
| Gastroesophageal Reflux Exam (78262) |
$379.20 |
$790 |
0.7× |
| Gated Heart Planar Single (78472) |
$536.16 |
$1,117 |
1.0× |
| Gated Heart, Multiple (78473) |
$725.76 |
$1,512 |
1.4× |
| Hand 2 views (73120) |
$289.44 |
$603 |
2.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$3,378.24 |
$7,038 |
0.8× |
| Hepatc Vngrph Wdg/Fr W/O Hemodyn Eval Rs&I (75891) |
$3,378.24 |
$7,038 |
0.8× |
| Hepatobil Syst Image W/Drug (78227) |
$464.16 |
$967 |
0.7× |
| Hepatobiliary System Imaging (78226) |
$464.16 |
$967 |
0.9× |
| Ht Musc Image Planar Mult (78454) |
$1,157.28 |
$2,411 |
0.7× |
| Ht Muscle Image Spect Sing (78451) |
$1,117.92 |
$2,329 |
0.7× |
| Hysterosalpingogram (74740) |
$739.68 |
$1,541 |
2.4× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$463.68 |
$966 |
4.1× |
| Infant hip ultrasound, limited static exam (76886) |
$297.60 |
$620 |
2.7× |
| K Flow/Funct Image Multiple (78709) |
$759.84 |
$1,583 |
1.1× |
| K Flow/Funct Image W/Drug (78708) |
$681.60 |
$1,420 |
1.0× |
| K Flow/Funct Image W/O Drug (78707) |
$657.60 |
$1,370 |
0.9× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$632.64 |
$1,318 |
1.2× |
| Kidney Imaging Morphol (78700) |
$328.80 |
$685 |
0.6× |
| Kidney Imaging Morphoogy W/Vascular Flow (78701) |
$565.44 |
$1,178 |
1.1× |
| Knee 3 Views (73562) |
$335.04 |
$698 |
3.0× |
| Leveen/Shunt Patency Exam (78291) |
$246.24 |
$513 |
0.5× |
| Liver & Spleen Imaging Static Only (78215) |
$583.20 |
$1,215 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$632.64 |
$1,318 |
1.2× |
| Liver imaging static only (78201) |
$418.56 |
$872 |
0.6× |
| Liver imaging w/vascular flow (78202) |
$418.56 |
$872 |
0.6× |
| Lung Perf&Ventilat Diferentl (78598) |
$737.28 |
$1,536 |
1.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$737.28 |
$1,536 |
1.1× |
| Lung Ventilation Imaging (78579) |
$737.28 |
$1,536 |
1.4× |
| Lymph System Imaging (78195) |
$353.28 |
$736 |
0.5× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,378.24 |
$7,038 |
0.8× |
| Lymphangiography, pelvic/abdominal, unilateral (75805) |
$3,378.24 |
$7,038 |
0.8× |
| Magnetic Image Jaw Joint (70336) |
$1,157.28 |
$2,411 |
3.8× |
| Mammary ductogram or galactogram single (77053) |
$496.80 |
$1,035 |
1.6× |
| Meckels Divert Exam (78290) |
$322.56 |
$672 |
0.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,302.72 |
$2,714 |
2.9× |
| MRA head w/o contrast (70544) |
$697.44 |
$1,453 |
2.3× |
| MRA head with contrast (70545) |
$892.80 |
$1,860 |
2.0× |
| MRA neck w contrast (70548) |
$876.96 |
$1,827 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,302.72 |
$2,714 |
2.9× |
| MRA neck w/o contrast (70547) |
$675.84 |
$1,408 |
2.2× |
| MRI abdomen w contrast (74182) |
$934.08 |
$1,946 |
2.1× |
| MRI abdomen w/o contrast (74181) |
$906.72 |
$1,889 |
3.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,153.92 |
$2,404 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,781.76 |
$3,712 |
4.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,031.04 |
$2,148 |
1.0× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$872.16 |
$1,817 |
2.8× |
| MRI cervical spine w contrast (72142) |
$1,109.76 |
$2,312 |
2.5× |
| MRI cervical spine w/o cont (72141) |
$946.08 |
$1,971 |
3.1× |
| MRI chest w/o contrast (71550) |
$676.80 |
$1,410 |
2.2× |
| MRI chest with contrast (71551) |
$873.12 |
$1,819 |
0.9× |
| MRI chest wo w contrast (71552) |
$1,418.88 |
$2,956 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,187.04 |
$2,473 |
2.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,244.64 |
$2,593 |
2.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$939.36 |
$1,957 |
3.1× |
| MRI lumbar spine w contrast (72149) |
$1,104.96 |
$2,302 |
2.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,770.24 |
$3,688 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$726.72 |
$1,514 |
2.4× |
| MRI orbit face neck w contrast (70542) |
$774.72 |
$1,614 |
1.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,356.48 |
$2,826 |
3.0× |
| MRI pelvis w contrast (72196) |
$883.20 |
$1,840 |
2.0× |
| MRI pelvis w/o & w contrast (72197) |
$1,767.84 |
$3,683 |
3.9× |
| MRI pelvis w/o contrast (72195) |
$751.68 |
$1,566 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$994.56 |
$2,072 |
3.2× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$1,031.04 |
$2,148 |
2.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$845.76 |
$1,762 |
2.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,111.20 |
$2,315 |
2.5× |
| MRI, abdomen, combo (74183) |
$1,543.20 |
$3,215 |
3.4× |
| MRI, dorsal spine combo (72157) |
$1,816.80 |
$3,785 |
4.0× |
| MRI, dorsal spine contrast (72147) |
$1,006.08 |
$2,096 |
2.2× |
| MRI, joint upper extrem (73221) |
$790.08 |
$1,646 |
2.6× |
| MRI, joint upper extrem combo (73223) |
$1,111.20 |
$2,315 |
2.5× |
| MRI, lumbar spine combo (72158) |
$1,684.80 |
$3,510 |
3.8× |
| Myelogram cervical (72240) |
$844.32 |
$1,759 |
0.8× |
| Myelogram Lumbar (72265) |
$577.92 |
$1,204 |
0.6× |
| Myelograpy 2/more regions rs&i (72270) |
$660.48 |
$1,376 |
0.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,494.72 |
$3,114 |
0.9× |
| N-invas est c ffr sw aly CTA (75580) |
$1,567.68 |
$3,266 |
1.4× |
| Neck soft tissue (70360) |
$259.20 |
$540 |
2.3× |
| Nm csf leak detection (78650) |
$1,117.92 |
$2,329 |
0.7× |
| Nonvascular Shunt X-Ray (75809) |
$324.48 |
$676 |
2.4× |
| Ob us nuchal meas 1 gest (76813) |
$216.96 |
$452 |
1.6× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$1,783.20 |
$3,715 |
2.6× |
| Parathyroid Planar Imaging (78070) |
$322.56 |
$672 |
0.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,783.20 |
$3,715 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$304.80 |
$635 |
2.3× |
| Peritoneogram Rs&I (74190) |
$739.68 |
$1,541 |
1.1× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$2,069.76 |
$4,312 |
1.1× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,378.24 |
$7,038 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$670.56 |
$1,397 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$448.80 |
$935 |
3.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$384.48 |
$801 |
0.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$310.08 |
$646 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$274.56 |
$572 |
2.5× |
| Radex elbow complete minimum 3 views (73080) |
$325.44 |
$678 |
2.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$444 |
$925 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$248.16 |
$517 |
2.2× |
| Radex foot complete minimum 3 views (73630) |
$300.48 |
$626 |
2.7× |
| Radex Hand Minimum 3 Views (73130) |
$295.68 |
$616 |
2.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$412.80 |
$860 |
3.7× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$179.52 |
$374 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$289.44 |
$603 |
2.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$309.60 |
$645 |
2.8× |
| Radex shoulder complete minimum 2 views (73030) |
$289.44 |
$603 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$222.72 |
$464 |
2.0× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$657.60 |
$1,370 |
2.9× |
| Radex Spine 1 View Specify Level (72020) |
$124.80 |
$260 |
1.1× |
| Radex Sternum Minimum 2 Views (71120) |
$266.88 |
$556 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$256.32 |
$534 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$237.60 |
$495 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$274.56 |
$572 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$314.88 |
$656 |
2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$685.92 |
$1,429 |
5.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$352.32 |
$734 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$448.80 |
$935 |
3.3× |
| Radiologic exam colon double contrast study (74280) |
$825.12 |
$1,719 |
3.7× |
| Radiologic exam colon single contrast study (74270) |
$766.08 |
$1,596 |
3.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$519.84 |
$1,083 |
2.3× |
| Radiologic exam knee complete 4/more views (73564) |
$352.32 |
$734 |
2.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$304.80 |
$635 |
2.3× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$481.44 |
$1,003 |
2.1× |
| Radiologic exam swallow function contrast study (74230) |
$534.72 |
$1,114 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$582.72 |
$1,214 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$315.36 |
$657 |
2.8× |
| Radiologic examination femur minimum 2 views (73552) |
$331.68 |
$691 |
3.0× |
| Radiologic examination knee 1/2 views (73560) |
$232.80 |
$485 |
2.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$249.12 |
$519 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$305.76 |
$637 |
2.7× |
| Ribs bilateral 3 views (71110) |
$253.92 |
$529 |
1.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$481.92 |
$1,004 |
0.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$481.92 |
$1,004 |
0.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,721.28 |
$3,586 |
2.5× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$1,714.08 |
$3,571 |
2.5× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$1,721.28 |
$3,586 |
2.5× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,721.28 |
$3,586 |
1.0× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$2,223.36 |
$4,632 |
1.2× |
| Rp loclzj tum spect w/CT 1 area/acquisj 1day img (78830) |
$1,721.28 |
$3,586 |
1.0× |
| Scapula (73010) |
$258.72 |
$539 |
1.9× |
| Shoulder 1 view (73020) |
$274.56 |
$572 |
2.5× |
| Shoulder Arthrography (73040) |
$434.88 |
$906 |
1.0× |
| Skull less than 4 views (70250) |
$300.48 |
$626 |
2.2× |
| Sternoclavicular joints (71130) |
$154.08 |
$321 |
1.4× |
| Superior sagittal sinus venogram (75870) |
$2,240.64 |
$4,668 |
0.6× |
| Testicular Imaging W/Flow (78761) |
$306.24 |
$638 |
0.6× |
| Thoracic spine 2 views (72070) |
$386.88 |
$806 |
2.9× |
| Thoracic spine 3 views (72072) |
$412.80 |
$860 |
3.1× |
| Thoracolumbar 2 views (72080) |
$232.80 |
$485 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$322.56 |
$672 |
0.6× |
| Thyroid Met Imaging Body (78018) |
$500.16 |
$1,042 |
0.7× |
| Thyroid Uptake Measurement (78012) |
$253.44 |
$528 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$490.08 |
$1,021 |
1.0× |
| Ultrasound Breast Limited (76642) |
$349.44 |
$728 |
3.1× |
| Ultrasound Exam Aaa Screen (76706) |
$259.68 |
$541 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$870.72 |
$1,814 |
6.5× |
| Umbilical-artery Doppler (OB) (76820) |
$112.32 |
$234 |
0.8× |
| Unlisted Dx Radiographic Procedure (76499) |
$156 |
$325 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$1,000.32 |
$2,084 |
8.9× |
| Unlisted magnetic resonance procedure (76498) |
$136.32 |
$284 |
1.2× |
| Unlisted us procedure (76999) |
$165.60 |
$345 |
1.5× |
| Upper gi w/o kub (74240) |
$576.96 |
$1,202 |
2.6× |
| Urethrocystogram voiding (74455) |
$630.72 |
$1,314 |
2.1× |
| Urethrocystography retrograde (74450) |
$643.68 |
$1,341 |
2.1× |
| Us breast unilateral complete (76641) |
$349.44 |
$728 |
2.6× |
| Us chest (76604) |
$380.64 |
$793 |
2.8× |
| Us complete joint (76881) |
$450.72 |
$939 |
3.4× |
| Us exam, pelvic, limited (76857) |
$476.16 |
$992 |
3.5× |
| Us head (76506) |
$620.64 |
$1,293 |
4.6× |
| Us kidney transplant (76776) |
$455.52 |
$949 |
3.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$140.16 |
$292 |
1.0× |
| Us ob detailed single fetus (76811) |
$308.16 |
$642 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$550.56 |
$1,147 |
4.1× |
| Us ob transvaginal (76817) |
$666.24 |
$1,388 |
5.0× |
| Us pelvic non ob complete (76856) |
$587.04 |
$1,223 |
4.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$920.16 |
$1,917 |
6.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$505.44 |
$1,053 |
3.8× |
| Us retroperitoneal complete (76770) |
$881.28 |
$1,836 |
6.6× |
| Us retroperitoneal limited (76775) |
$836.16 |
$1,742 |
6.2× |
| Us scrotum and contents (76870) |
$958.08 |
$1,996 |
7.1× |
| Us spinal canal and contents (76800) |
$301.44 |
$628 |
2.2× |
| Us thyroid (76536) |
$864.48 |
$1,801 |
6.4× |
| Us transrectal (76872) |
$362.88 |
$756 |
2.7× |
| Vascular Flow Imaging (78445) |
$219.84 |
$458 |
0.4× |
| Vein X-Ray Chest (75827) |
$2,790.24 |
$5,813 |
1.4× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$3,378.24 |
$7,038 |
0.8× |
| Vein X-Ray Spleen/Liver (75810) |
$3,378.24 |
$7,038 |
0.8× |
| Venogram Sinus/Jugular (75860) |
$3,378.24 |
$7,038 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$2,790.24 |
$5,813 |
0.7× |
| Venography extremity bilateral rs&i (75822) |
$1,659.36 |
$3,457 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,659.36 |
$3,457 |
0.8× |
| Venography Renal Bilateral (75833) |
$3,626.40 |
$7,555 |
0.9× |
| Venography Renal Unilateral (75831) |
$2,790.24 |
$5,813 |
0.7× |
| Venous sampling by catheter (75893) |
$5,627.52 |
$11,724 |
0.8× |
| Wrist 2 views (73100) |
$314.88 |
$656 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$218.88 |
$456 |
2.0× |
| X-Ray Aorta Leg Arteries (75630) |
$3,378.24 |
$7,038 |
0.8× |
| X-Ray Bend Only L-S Spine (72120) |
$248.16 |
$517 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$289.44 |
$603 |
2.6× |
| X-Ray Exam Breast Specimen (76098) |
$408.48 |
$851 |
0.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$192 |
$400 |
1.7× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$384.96 |
$802 |
2.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$228.96 |
$477 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$460.80 |
$960 |
4.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$514.56 |
$1,072 |
3.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$527.04 |
$1,098 |
3.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$651.84 |
$1,358 |
4.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$758.88 |
$1,581 |
5.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$479.52 |
$999 |
3.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$345.12 |
$719 |
3.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$400.80 |
$835 |
3.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$500.64 |
$1,043 |
3.7× |
| X-ray eye for foreign body (70030) |
$158.40 |
$330 |
1.4× |
| X-ray humerus (73060) |
$280.80 |
$585 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$636.48 |
$1,326 |
2.8× |
| X-ray IV pyelogram+tomography (74415) |
$774.24 |
$1,613 |
3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$227.52 |
$474 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$185.76 |
$387 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$391.68 |
$816 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$259.20 |
$540 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$500.64 |
$1,043 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$197.28 |
$411 |
1.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$145.92 |
$304 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$340.80 |
$710 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$279.36 |
$582 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$454.08 |
$946 |
3.4× |
| X-ray thoracic spine 4 vw (72074) |
$1,571.52 |
$3,274 |
11.7× |
| X-Ray Tmj Unilat (70328) |
$144.48 |
$301 |
1.3× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$776.16 |
$1,617 |
1.7× |
| X-Rays Bone Length Studies (77073) |
$230.40 |
$480 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$300.96 |
$627 |
2.2× |
| Xr c-spine 4 or 5 views (72050) |
$391.68 |
$816 |
2.9× |
| Xr facial bones less than 3 views (70140) |
$258.72 |
$539 |
2.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$145.44 |
$303 |
1.1× |
| Xr orbits complete 4 views (70200) |
$422.40 |
$880 |
3.1× |