| Abdomen 2 views (74019) |
$1,090.50 |
$1,454 |
10.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$3,771.75 |
$5,029 |
9.4× |
| Acute venous thrombus image (78456) |
$2,651.25 |
$3,535 |
2.0× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$11,892 |
$15,856 |
3.7× |
| Angiography extremity bilateral rs&i (75716) |
$8,339.62 |
$11,119.50 |
2.6× |
| Angiography extremity unilateral rs&i (75710) |
$8,136 |
$10,848 |
2.6× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$7,030.88 |
$9,374.50 |
1.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$6,997.50 |
$9,330 |
2.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$10,436.25 |
$13,915 |
3.3× |
| Angiography Spinal Selective Rs&I (75705) |
$14,040 |
$18,720 |
2.5× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$19,203.38 |
$25,604.50 |
3.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$9,742.12 |
$12,989.50 |
3.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$6,414.75 |
$8,553 |
2.0× |
| Ankle 2 views (73600) |
$762 |
$1,016 |
8.7× |
| Antegrade urography radiological supvj & interpj (74425) |
$1,581.75 |
$2,109 |
4.5× |
| Aortogram thoracic (75605) |
$18,463.12 |
$24,617.50 |
3.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$9,074.25 |
$12,099 |
2.9× |
| Aortography abdominal serialography rs&i (75625) |
$7,549.12 |
$10,065.50 |
2.4× |
| Aortography thoracic w/o serialography rs&i (75600) |
$14,523.75 |
$19,365 |
4.6× |
| Artery X-Rays Adrenal Gland (75731) |
$14,040 |
$18,720 |
4.4× |
| Arthrogram elbow (73085) |
$2,327.25 |
$3,103 |
6.6× |
| Arthrogram hip (73525) |
$1,826.25 |
$2,435 |
5.2× |
| Arthrogram shoulder (73040) |
$1,929.75 |
$2,573 |
5.5× |
| Arthrogram wrist (73115) |
$1,590 |
$2,120 |
4.5× |
| Arthrography knee lt (73580) |
$2,327.25 |
$3,103 |
6.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$2,471.25 |
$3,295 |
6.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$3,276 |
$4,368 |
8.2× |
| Bone &/joint imaging whole body (78306) |
$4,371 |
$5,828 |
10.9× |
| Bone age studies (77072) |
$725.25 |
$967 |
6.9× |
| Bone Imaging 3 Phase (78315) |
$3,367.50 |
$4,490 |
8.4× |
| Bone Marrow Imaging Limited Area (78102) |
$1,223.25 |
$1,631 |
3.0× |
| Bone survey complete (77075) |
$1,524.75 |
$2,033 |
14.5× |
| Brain image w/flow 4 + views (78606) |
$3,895.50 |
$5,194 |
7.1× |
| Brain imaging < 4 static views (78600) |
$1,743.75 |
$2,325 |
4.3× |
| Brain imaging < 4 static views w vascular flow (78601) |
$1,990.50 |
$2,654 |
5.0× |
| Brain Imaging Minimum 4 Static Views (78605) |
$6,450.75 |
$8,601 |
11.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$9,940.50 |
$13,254 |
6.9× |
| Brain Imaging Vascular Flow Only (78610) |
$1,860 |
$2,480 |
3.4× |
| Breath Test,Acquire/Analyze - Nm Breath Test Acquire Analyze (78267) |
$4,485.75 |
$5,981 |
405.6× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$3,798 |
$5,064 |
9.5× |
| Cardiac shunt detection (78428) |
$1,411.50 |
$1,882 |
3.5× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$2,747.25 |
$3,663 |
5.0× |
| Cervical spine 2 or 3 views (72040) |
$1,179.38 |
$1,572.50 |
13.5× |
| Chest 1 view (71045) |
$834.75 |
$1,113 |
9.5× |
| Chest 3 views (71047) |
$950.25 |
$1,267 |
10.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,185.75 |
$1,581 |
6.7× |
| Cineradiography/videoradiography (76120) |
$579 |
$772 |
5.5× |
| Cisternography Positive Contrast Rs&I (70015) |
$3,457.50 |
$4,610 |
4.4× |
| Clavicle complete (73000) |
$880.50 |
$1,174 |
10.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$516 |
$688 |
4.9× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$531 |
$708 |
3.0× |
| Corpora cavernosography (74445) |
$1,219.50 |
$1,626 |
11.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$12,696 |
$16,928 |
36.2× |
| CT abdomen and pelvis without contrast (74176) |
$12,135.75 |
$16,181 |
50.6× |
| CT abdomen w contrast (74160) |
$6,345.75 |
$8,461 |
36.0× |
| CT abdomen w wo contrast (74170) |
$7,002 |
$9,336 |
39.7× |
| CT abdomen w/o contrast (74150) |
$5,349.75 |
$7,133 |
50.9× |
| CT angio hrt w/3d image (75574) |
$3,742.50 |
$4,990 |
10.7× |
| CT angiography upper extremity lt (73206) |
$5,737.50 |
$7,650 |
32.6× |
| CT c-spine w/o contrast (72125) |
$7,003.50 |
$9,338 |
66.7× |
| CT cervical spine w&w/o contrast (72127) |
$7,469.25 |
$9,959 |
42.4× |
| CT cervical spine with contrast (72126) |
$5,795.25 |
$7,727 |
16.5× |
| CT chest w/wo contrast (71270) |
$5,685 |
$7,580 |
32.3× |
| CT chest with contrast (71260) |
$5,253.75 |
$7,005 |
29.8× |
| CT colonography screening (74263) |
$6,191.25 |
$8,255 |
25.8× |
| CT colonography w/dye (74262) |
$2,076.75 |
$2,769 |
11.8× |
| CT colonography w/o cntrst (74261) |
$3,120.75 |
$4,161 |
29.7× |
| CT head/brain with contrast (70460) |
$5,123.25 |
$6,831 |
29.1× |
| CT head/brain without and with contrast (70470) |
$6,505.50 |
$8,674 |
36.9× |
| CT heart contrast eval cardiac structure&morph (75572) |
$4,890.75 |
$6,521 |
14.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,106.25 |
$1,475 |
12.7× |
| CT hrt w/3d image congen (75573) |
$2,028.75 |
$2,705 |
5.8× |
| CT iac w contrast (70481) |
$5,687.25 |
$7,583 |
32.3× |
| CT limited/localized follow up study (76380) |
$2,837.25 |
$3,783 |
32.5× |
| CT lower ext w/o (73700) |
$3,361.50 |
$4,482 |
32.0× |
| CT lower extremity w wo contrast (73702) |
$4,218.75 |
$5,625 |
23.9× |
| CT lower extremity with contrast (73701) |
$3,242.25 |
$4,323 |
18.4× |
| CT lumbar spine w & w/o contrast (72133) |
$5,559.75 |
$7,413 |
31.6× |
| CT lumbar spine w/o contrast (72131) |
$5,568.75 |
$7,425 |
53.0× |
| CT lumbar spine with contrast (72132) |
$5,031.75 |
$6,709 |
14.4× |
| CT maxillofacial w contrast (70487) |
$5,758.12 |
$7,677.50 |
32.7× |
| CT maxillofacial w/o contrast (70486) |
$5,754 |
$7,672 |
54.8× |
| CT maxillofacial w/wo contrast (70488) |
$7,765.50 |
$10,354 |
44.1× |
| CT neck soft tissue w contrast (70491) |
$5,695.50 |
$7,594 |
32.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$6,994.50 |
$9,326 |
39.7× |
| CT orbits w/o contrast (70480) |
$6,057 |
$8,076 |
57.7× |
| CT pelvis w & w/o contrast (72194) |
$6,814.50 |
$9,086 |
38.7× |
| CT pelvis w/o contrast (72192) |
$5,358.75 |
$7,145 |
51.0× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$517.50 |
$690 |
5.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$6,381.75 |
$8,509 |
36.2× |
| CT soft tissue neck w/o contrast (70490) |
$4,868.25 |
$6,491 |
46.4× |
| CT thoracic spine w/contrast (72129) |
$6,445.50 |
$8,594 |
36.6× |
| CT thoracic spine w/o contrast (72128) |
$5,065.50 |
$6,754 |
48.2× |
| CT thoracic spine w/wo contrast (72130) |
$8,418.75 |
$11,225 |
47.8× |
| CT thorax w/o contrast (71250) |
$4,677.75 |
$6,237 |
44.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$5,776.50 |
$7,702 |
32.8× |
| CT upper extremity w/o contrast rt (73200) |
$4,159.50 |
$5,546 |
39.6× |
| CT upper extremity with contrast (73201) |
$4,197 |
$5,596 |
12.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$10,279.88 |
$13,706.50 |
58.3× |
| Cta Abdomen (74175) |
$6,741 |
$8,988 |
38.3× |
| CTA abdomen pelvis (74174) |
$10,206.38 |
$13,608.50 |
29.1× |
| CTA chest (71275) |
$6,678.38 |
$8,904.50 |
37.9× |
| Cta Head (70496) |
$6,930.38 |
$9,240.50 |
39.3× |
| CTA lwr ext w&w/o contrast (73706) |
$5,207.25 |
$6,943 |
29.6× |
| Cta Neck (70498) |
$6,147.38 |
$8,196.50 |
34.9× |
| Cta Pelvis (72191) |
$5,588.62 |
$7,451.50 |
31.7× |
| Cystography minimum 3 views rs&i (74430) |
$1,714.50 |
$2,286 |
4.9× |
| Dacryocystography (70170) |
$1,829.25 |
$2,439 |
7.6× |
| Diskogram cervical (72285) |
$15,021 |
$20,028 |
7.7× |
| Diskography lumbar (72295) |
$13,908.75 |
$18,545 |
7.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$559.50 |
$746 |
5.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$966 |
$1,288 |
9.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$154.50 |
$206 |
1.8× |
| Dxa bone density study axial skeleton (77085) |
$936.75 |
$1,249 |
8.9× |
| Echo exam of fetal heart (76825) |
$1,195.50 |
$1,594 |
2.2× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$723.75 |
$965 |
3.0× |
| Echoencephalography real time imaging (76506) |
$1,813.50 |
$2,418 |
17.3× |
| Esophageal motility (78258) |
$1,696.50 |
$2,262 |
4.2× |
| Esophagus (74220) |
$1,555.50 |
$2,074 |
8.8× |
| Fetal biophysical profile non-stress testing (76818) |
$2,010 |
$2,680 |
19.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$1,341 |
$1,788 |
12.8× |
| Fluoroscopy up to 1 hr (76000) |
$1,120.50 |
$1,494 |
4.7× |
| Foot 2 views (73620) |
$809.25 |
$1,079 |
9.3× |
| Forearm 2 views (73090) |
$969 |
$1,292 |
11.1× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$336.75 |
$449 |
1.4× |
| Functional MRI brain by tech (70554) |
$2,376.75 |
$3,169 |
9.9× |
| Gastric mucosa imaging (78261) |
$1,883.25 |
$2,511 |
4.7× |
| Gated Heart Planar Single (78472) |
$3,893.25 |
$5,191 |
9.7× |
| Hand 2 views (73120) |
$647.25 |
$863 |
6.2× |
| Hand 3 views (73130) |
$843 |
$1,124 |
9.6× |
| Heart Infarct Image (78466) |
$6,357 |
$8,476 |
15.8× |
| Heart infarct image w ef (78468) |
$1,634.25 |
$2,179 |
3.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$14,040 |
$18,720 |
4.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$4,506 |
$6,008 |
8.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$3,386.25 |
$4,515 |
8.4× |
| Ht muscle image spect sing (78451) |
$5,907.75 |
$7,877 |
4.5× |
| Humerus Min 2 Views Left (73060) |
$880.50 |
$1,174 |
10.1× |
| Hysterosalpingogram (74740) |
$1,928.25 |
$2,571 |
8.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$961.50 |
$1,282 |
9.2× |
| Kidney funcj study non-img radioisotopic study (78725) |
$3,480.75 |
$4,641 |
8.7× |
| Kidney imaging morphology (78700) |
$3,119.25 |
$4,159 |
7.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$3,405 |
$4,540 |
6.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$3,990.75 |
$5,321 |
7.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$4,475.25 |
$5,967 |
8.2× |
| Knee 3 views (73562) |
$1,001.25 |
$1,335 |
11.5× |
| Liver & spleen imaging static only (78215) |
$3,272.25 |
$4,363 |
8.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,145.75 |
$2,861 |
5.3× |
| Liver imaging static only (78201) |
$4,806 |
$6,408 |
8.8× |
| Liver imaging w/vascular flow (78202) |
$3,216.75 |
$4,289 |
5.9× |
| Lung perf&ventilat diferentl (78598) |
$3,911.25 |
$5,215 |
7.2× |
| Lung perfusion differential (78597) |
$5,075.25 |
$6,767 |
12.6× |
| Lung Ventilation Imaging (78579) |
$3,580.50 |
$4,774 |
8.9× |
| Lymphoscintigraphy (78195) |
$2,601.75 |
$3,469 |
4.8× |
| Mammary ductogram or galactogram multiple (77054) |
$1,599.75 |
$2,133 |
6.7× |
| Mammary ductogram or galactogram single (77053) |
$1,264.50 |
$1,686 |
5.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$401.25 |
$535 |
4.6× |
| Meckels Diverticulum (78290) |
$3,512.25 |
$4,683 |
8.7× |
| Mr safety determination physician/other qhp (76016) |
$360 |
$480 |
4.1× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$243 |
$324 |
4.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$99.75 |
$133 |
3.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$375 |
$500 |
3.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$987.75 |
$1,317 |
4.1× |
| MRA head w & w/o contrast (70546) |
$6,726.75 |
$8,969 |
19.2× |
| MRA head w/o contrast (70544) |
$7,981.50 |
$10,642 |
33.3× |
| MRA neck w contrast (70548) |
$5,676 |
$7,568 |
16.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$12,640.50 |
$16,854 |
36.1× |
| MRA neck w/o contrast (70547) |
$7,981.50 |
$10,642 |
33.3× |
| MRI abdomen w contrast (74182) |
$7,290 |
$9,720 |
20.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$7,409.25 |
$9,879 |
21.1× |
| MRI abdomen w/o contrast (74181) |
$5,583.75 |
$7,445 |
23.3× |
| MRI any jnt lwr ext with con lt (73722) |
$5,901.75 |
$7,869 |
7.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$5,358.75 |
$7,145 |
6.8× |
| MRI bone marrow blood supply (77084) |
$4,285.50 |
$5,714 |
17.9× |
| MRI breast w/o contrast bilateral (77047) |
$6,714.75 |
$8,953 |
28.0× |
| MRI breast w/o contrast unilat (77046) |
$6,460.50 |
$8,614 |
27.0× |
| MRI c-spine with contrast (72142) |
$10,769.25 |
$14,359 |
30.7× |
| MRI cervical spine w/o contrast (72141) |
$8,568.75 |
$11,425 |
35.7× |
| MRI chest w/o & w/contrast material (71552) |
$5,185.50 |
$6,914 |
14.8× |
| MRI chest w/o contrast (71550) |
$3,746.25 |
$4,995 |
15.6× |
| MRI chest with contrast (71551) |
$4,568.25 |
$6,091 |
5.8× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$6,828 |
$9,104 |
19.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$6,469.50 |
$8,626 |
18.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$5,629.50 |
$7,506 |
23.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$5,800.50 |
$7,734 |
24.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$7,942.50 |
$10,590 |
22.7× |
| MRI orbit/face/neck w/contrast (70542) |
$6,596.25 |
$8,795 |
18.8× |
| MRI pelvis w contrast (72196) |
$6,461.25 |
$8,615 |
18.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$6,609.75 |
$8,813 |
18.9× |
| MRI pelvis w/o contrast (72195) |
$4,754.25 |
$6,339 |
19.8× |
| MRI scan of arm joint before and after contrast (73223) |
$7,243.50 |
$9,658 |
20.7× |
| MRI scan of leg joint before and after contrast (73723) |
$7,613.25 |
$10,151 |
21.7× |
| MRI spectroscopy (76390) |
$2,978.25 |
$3,971 |
34.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$13,680.75 |
$18,241 |
39.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$7,130.25 |
$9,507 |
20.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$7,619.25 |
$10,159 |
21.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$7,773.75 |
$10,365 |
22.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$8,520 |
$11,360 |
24.3× |
| MRI thoracic spine w/o contrast (72146) |
$5,676.75 |
$7,569 |
23.7× |
| MRI tmj (70336) |
$5,059.50 |
$6,746 |
21.1× |
| MRI upper ext joint w/o contrast (73221) |
$5,506.50 |
$7,342 |
23.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$5,820.75 |
$7,761 |
16.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$4,809 |
$6,412 |
20.1× |
| Myelogram Cervical (72240) |
$3,808.50 |
$5,078 |
4.8× |
| Myelogram Lumbar (72265) |
$3,516.75 |
$4,689 |
4.5× |
| Myelogram thoracic (72255) |
$4,210.50 |
$5,614 |
5.3× |
| Myelography 2 or more regions (72270) |
$5,680.50 |
$7,574 |
7.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$8,148 |
$10,864 |
6.3× |
| Myocardial infarct spect (78469) |
$4,614 |
$6,152 |
8.5× |
| Myocardial Spect Multiple Studies (78452) |
$9,756 |
$13,008 |
7.5× |
| Neck soft tissue (70360) |
$930 |
$1,240 |
10.6× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$812.25 |
$1,083 |
2.0× |
| Nm adrenal scan (78075) |
$3,421.50 |
$4,562 |
2.6× |
| Nm bone marrow multiple (78103) |
$1,626.75 |
$2,169 |
4.1× |
| Nm bone marrow wb (78104) |
$2,905.50 |
$3,874 |
7.2× |
| Nm cisternogram (78630) |
$2,800.50 |
$3,734 |
5.1× |
| Nm csf leak detection (78650) |
$2,596.50 |
$3,462 |
2.0× |
| Nm gastric emptying study (78264) |
$3,225 |
$4,300 |
8.0× |
| Nm gastroesophageal reflux study (78262) |
$5,770.50 |
$7,694 |
14.4× |
| Nm peritoneal-venous shunt patency (78291) |
$1,815.75 |
$2,421 |
4.5× |
| Nm red cell sequestration (78140) |
$1,109.25 |
$1,479 |
2.8× |
| Nuclear medicine of blood flow in heart muscle at rest and with stress (78492) |
$8,148 |
$10,864 |
5.7× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$8,224.50 |
$10,966 |
6.3× |
| Nuclear medicine of heart pumping function (78473) |
$5,177.25 |
$6,903 |
12.9× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$8,648.25 |
$11,531 |
15.9× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$9,000 |
$12,000 |
6.3× |
| Nuclear medicine study of blood flow in heart muscle at rest with stress (78491) |
$8,148 |
$10,864 |
5.7× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$2,148.75 |
$2,865 |
1.7× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,929.75 |
$2,573 |
4.8× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$3,507 |
$4,676 |
8.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$5,314.50 |
$7,086 |
13.2× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$4,365 |
$5,820 |
8.0× |
| Nuclear Rx Oral Admin (79005) |
$3,733.50 |
$4,978 |
15.9× |
| Nuclr Rx Interstit Colloid (79300) |
$600 |
$800 |
2.6× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$1,003.50 |
$1,338 |
9.6× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$435 |
$580 |
4.1× |
| Orthopantogram (70355) |
$1,436.25 |
$1,915 |
16.4× |
| Osseous survey infant (77076) |
$1,662 |
$2,216 |
15.8× |
| Osseous survey limited (77074) |
$938.25 |
$1,251 |
8.9× |
| Parathyrd planar w/spect&CT (78072) |
$2,428.50 |
$3,238 |
4.5× |
| Parathyrd planar w/wo subtrj (78071) |
$2,382.75 |
$3,177 |
5.9× |
| Pelvis 1 or 2 views (72170) |
$844.88 |
$1,126.50 |
8.0× |
| Perineogram (74775) |
$1,293.75 |
$1,725 |
5.4× |
| PET image w/CT, skull-thigh (78815) |
$10,113 |
$13,484 |
7.0× |
| PET imaging CT for attenuation limited area (78814) |
$9,940.50 |
$13,254 |
6.9× |
| PET imaging for CT attenuation whole body (78816) |
$10,802.25 |
$14,403 |
7.5× |
| PET imaging limited area chest head/neck (78811) |
$7,666.50 |
$10,222 |
5.9× |
| PET whole body (78813) |
$7,666.50 |
$10,222 |
5.3× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$8,123.25 |
$10,831 |
6.2× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$8,123.25 |
$10,831 |
6.2× |
| Pr csf ventriculography (78635) |
$2,486.25 |
$3,315 |
4.6× |
| Pr gi endoscopic ultrasound (76975) |
$1,061.25 |
$1,415 |
4.4× |
| Pr heart first pass single,planar (78481) |
$4,233 |
$5,644 |
7.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$6,981.75 |
$9,309 |
19.9× |
| Pr red cell survival study (78130) |
$1,109.25 |
$1,479 |
2.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$14,040 |
$18,720 |
4.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,978.50 |
$6,638 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$2,298 |
$3,064 |
5.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$4,140 |
$5,520 |
7.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,895.25 |
$2,527 |
3.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$1,084.50 |
$1,446 |
12.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$618.75 |
$825 |
5.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$910.50 |
$1,214 |
8.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$911.25 |
$1,215 |
8.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$886.50 |
$1,182 |
8.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$720 |
$960 |
8.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$1,034.25 |
$1,379 |
9.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$1,283.25 |
$1,711 |
14.7× |
| Radiologic exam colon single contrast study (74270) |
$1,899.75 |
$2,533 |
10.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,555.50 |
$2,074 |
8.8× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$1,568.25 |
$2,091 |
6.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$2,277.75 |
$3,037 |
12.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,797.75 |
$2,397 |
10.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$1,021.50 |
$1,362 |
11.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$310.50 |
$414 |
3.6× |
| Radiological examination surgical specimen (76098) |
$3,035.25 |
$4,047 |
5.5× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$1,002 |
$1,336 |
4.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$1,109.25 |
$1,479 |
2.8× |
| Review by radiologist of adrenal gland vein image (75840) |
$14,040 |
$18,720 |
4.4× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$14,040 |
$18,720 |
4.4× |
| Ribs bilateral 3 views (71110) |
$1,554 |
$2,072 |
14.8× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$4,281.75 |
$5,709 |
10.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,396 |
$4,528 |
6.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$4,613.25 |
$6,151 |
8.5× |
| Rp Ther Radiolbld Monoclonal Antibody IV Infus (79403) |
$1,002 |
$1,336 |
4.3× |
| Rp therapy intra-arterial particulate admn (79445) |
$966 |
$1,288 |
4.1× |
| Rp Therapy Intravenous Administration (79101) |
$2,901 |
$3,868 |
12.4× |
| Sacroiliac Joints < 3 Views (72200) |
$503.25 |
$671 |
4.8× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,332 |
$1,776 |
5.6× |
| Salivary gland function study (78232) |
$928.50 |
$1,238 |
2.3× |
| Salivary gland imaging (78230) |
$4,652.25 |
$6,203 |
11.6× |
| Salivary gland imaging serial images (78231) |
$2,861.25 |
$3,815 |
7.1× |
| Scanogram (77073) |
$631.12 |
$841.50 |
6.0× |
| Scapula complete (73010) |
$728.25 |
$971 |
6.9× |
| Screening digital breast tomosynthesis (77063) |
$69.75 |
$93 |
3.0× |
| Sella turcica (70240) |
$310.50 |
$414 |
3.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$923.25 |
$1,231 |
8.8× |
| Sialogram (70390) |
$2,064 |
$2,752 |
8.6× |
| Small bowel series (74250) |
$1,537.50 |
$2,050 |
8.7× |
| Speech evaluation complex (70371) |
$579 |
$772 |
2.4× |
| Spine thoracic 3 views (72072) |
$1,423.50 |
$1,898 |
13.6× |
| Spleen imaging only (78185) |
$1,555.50 |
$2,074 |
3.9× |
| Splenoportograpy rs&i (75810) |
$14,040 |
$18,720 |
4.4× |
| Superior sagittal sinus venogram (75870) |
$4,978.50 |
$6,638 |
1.6× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$2,074.50 |
$2,766 |
8.7× |
| Testicular Imaging With Vascular Flow (78761) |
$1,270.50 |
$1,694 |
3.2× |
| Therapeutic Enema (74283) |
$942.75 |
$1,257 |
5.4× |
| Thoracolumbar 2 views (72080) |
$1,181.25 |
$1,575 |
13.5× |
| Thyroid carcinoma metastases img addl study (78016) |
$2,422.50 |
$3,230 |
6.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$4,171.50 |
$5,562 |
7.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,283.25 |
$1,711 |
3.2× |
| Thyroid uptake measurement (78012) |
$1,181.25 |
$1,575 |
2.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,778.25 |
$2,371 |
4.4× |
| Tmj unilateral (70328) |
$669.75 |
$893 |
7.7× |
| Tomogram (76100) |
$1,982.25 |
$2,643 |
18.9× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$6,504.75 |
$8,673 |
11.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$2,607.75 |
$3,477 |
6.5× |
| Ultrasound, abdomen limited (76705) |
$1,949.25 |
$2,599 |
18.6× |
| Umbilical-artery Doppler (OB) (76820) |
$577.50 |
$770 |
5.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$808.50 |
$1,078 |
9.2× |
| Unlisted Ultrasound Procedure (76999) |
$543 |
$724 |
6.2× |
| Upper Extremity Infant (73092) |
$499.50 |
$666 |
4.8× |
| Urea breath test, C-14 (isotopic); analysis (78268) |
$950.25 |
$1,267 |
10.1× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,638 |
$2,184 |
4.1× |
| Urethrocystography retrograde rs&i (74450) |
$1,356.75 |
$1,809 |
5.7× |
| Urethrocystography voiding (74455) |
$2,043 |
$2,724 |
8.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,938 |
$2,584 |
11.0× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$3,432.75 |
$4,577 |
19.5× |
| Us abdl aorta screen aaa (76706) |
$1,137 |
$1,516 |
10.8× |
| Us breast unilateral complete (76641) |
$1,026 |
$1,368 |
9.8× |
| Us breast unilateral limited (76642) |
$1,293.75 |
$1,725 |
14.8× |
| Us chest (76604) |
$1,464 |
$1,952 |
13.9× |
| Us compl joint r-t w/image documentation (76881) |
$1,083 |
$1,444 |
10.3× |
| Us fetal nuchal translucency 1st gestation (76813) |
$2,382.75 |
$3,177 |
22.7× |
| Us guided compression repair (76936) |
$1,164 |
$1,552 |
5.4× |
| Us infant hips dynamic (76885) |
$1,259.25 |
$1,679 |
14.4× |
| Us infant hips limited static (76886) |
$907.50 |
$1,210 |
10.4× |
| Us kidney transplant (76776) |
$996.75 |
$1,329 |
9.5× |
| Us ob detailed single fetus (76811) |
$2,370.75 |
$3,161 |
9.9× |
| Us ob transvaginal (76817) |
$1,798.50 |
$2,398 |
17.1× |
| Us pelvic non ob complete (76856) |
$2,554.50 |
$3,406 |
24.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$952.50 |
$1,270 |
9.1× |
| Us pregnancy ltd (76815) |
$1,551.75 |
$2,069 |
14.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$1,668.75 |
$2,225 |
15.9× |
| Us retroperitoneal complete (76770) |
$1,674.75 |
$2,233 |
15.9× |
| Us retroperitoneal limited (76775) |
$1,828.50 |
$2,438 |
17.4× |
| Us scrotum and contents (76870) |
$1,956 |
$2,608 |
18.6× |
| Us soft tissue head/neck (76536) |
$1,818 |
$2,424 |
17.3× |
| Us spinal canal and contents (76800) |
$863.25 |
$1,151 |
8.2× |
| Us transrectal (76872) |
$2,063.25 |
$2,751 |
19.6× |
| Us transrectal prostate volume (76873) |
$906 |
$1,208 |
8.6× |
| Us xtr non-vasc lmtd (76882) |
$735.75 |
$981 |
7.0× |
| Us, eye b-scan (76512) |
$368.25 |
$491 |
3.5× |
| Vascular flow imaging (78445) |
$1,538.25 |
$2,051 |
3.8× |
| Vasogram (74440) |
$1,219.50 |
$1,626 |
5.1× |
| Venogram extremity bilateral (75822) |
$3,197.25 |
$4,263 |
2.0× |
| Venogram orbital (75880) |
$4,978.50 |
$6,638 |
7.9× |
| Venography caval inferior serialography rs&i (75825) |
$5,886 |
$7,848 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$7,627.88 |
$10,170.50 |
4.8× |
| Venography epidural rs&i (75872) |
$4,978.50 |
$6,638 |
7.9× |
| Venography extremity unilateral rs&i (75820) |
$3,370.50 |
$4,494 |
2.1× |
| Venography Renal Bilateral (75833) |
$14,040 |
$18,720 |
4.4× |
| Venography renal unilateral selective rs&i (75831) |
$10,475.25 |
$13,967 |
3.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$4,800 |
$6,400 |
1.5× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$14,040 |
$18,720 |
2.5× |
| Vertebral fracture assessment via dxa (77086) |
$403.50 |
$538 |
4.6× |
| Wrist 2 views (73100) |
$889.50 |
$1,186 |
10.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$1,185.75 |
$1,581 |
11.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$726.75 |
$969 |
8.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$977.25 |
$1,303 |
11.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,220 |
$2,960 |
12.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$855.75 |
$1,141 |
9.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$806.25 |
$1,075 |
9.2× |
| X-ray exam hip uni 1 view (73501) |
$705.38 |
$940.50 |
8.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$691.50 |
$922 |
7.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$1,177.50 |
$1,570 |
11.2× |
| X-ray exam of femur 1 (73551) |
$529.50 |
$706 |
6.1× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$2,770.50 |
$3,694 |
15.7× |
| X-ray eye for foreign body (70030) |
$968.25 |
$1,291 |
11.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$1,052.25 |
$1,403 |
10.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$936.75 |
$1,249 |
10.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$1,110 |
$1,480 |
12.7× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$8,384.25 |
$11,179 |
4.0× |
| X-ray head for orthodontia (70350) |
$310.50 |
$414 |
3.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$817.50 |
$1,090 |
9.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$2,043 |
$2,724 |
11.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$801.75 |
$1,069 |
9.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$880.50 |
$1,174 |
8.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$699 |
$932 |
8.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$459.75 |
$613 |
5.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,104.75 |
$1,473 |
10.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,914.75 |
$2,553 |
18.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$806.25 |
$1,075 |
7.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$1,185.75 |
$1,581 |
13.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$1,002.75 |
$1,337 |
11.5× |
| X-ray of voice box or throat (70370) |
$579 |
$772 |
6.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$961.50 |
$1,282 |
9.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$1,702.50 |
$2,270 |
16.2× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$1,592.25 |
$2,123 |
2.9× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,751.25 |
$2,335 |
5.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$1,017 |
$1,356 |
11.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$1,342.50 |
$1,790 |
12.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,287 |
$1,716 |
12.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$717 |
$956 |
6.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$1,146 |
$1,528 |
13.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$843 |
$1,124 |
9.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,527 |
$2,036 |
17.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$817.50 |
$1,090 |
9.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,293.75 |
$1,725 |
12.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$879 |
$1,172 |
8.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$600.75 |
$801 |
6.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$679.50 |
$906 |
7.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$705 |
$940 |
8.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$1,527 |
$2,036 |
14.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$915 |
$1,220 |
8.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$941.25 |
$1,255 |
10.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$1,068.75 |
$1,425 |
12.2× |
| Xr arthrogram ankle (73615) |
$2,099.25 |
$2,799 |
6.0× |
| Xr c-spine 6 or more views (72052) |
$1,509.75 |
$2,013 |
14.4× |
| Xr chest 4+ views (71048) |
$1,610.25 |
$2,147 |
15.3× |
| Xr Cholecystography Oral Contrast (74290) |
$456 |
$608 |
2.6× |
| Xr finger(s) 2+ views (73140) |
$824.25 |
$1,099 |
9.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$289.50 |
$386 |
2.8× |
| Xr myelogram posterior fossa (70010) |
$3,457.50 |
$4,610 |
9.9× |
| Xr optic foramina (70190) |
$310.50 |
$414 |
3.6× |
| Xr shoulder 1 view (73020) |
$585 |
$780 |
6.7× |
| Xr spine cervical 4 or 5 views (72050) |
$1,687.50 |
$2,250 |
16.1× |
| Xr tibia/fibula 2 views (73590) |
$979.50 |
$1,306 |
11.2× |
| Xr tmj bilateral (70330) |
$1,273.50 |
$1,698 |
14.6× |
| Xray knee 1 or 2 views rt (73560) |
$1,010.25 |
$1,347 |
11.6× |