| Abdomen 2 views (74019) |
$212.25 |
$424.50 |
2.1× |
| Acute gi blood loss imaging (78278) |
$1,718 |
$3,436 |
4.5× |
| Angiography extremity bilateral rs&i (75716) |
$2,687.25 |
$5,374.50 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$3,068.50 |
$6,137 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$2,669.50 |
$5,339 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$4,687.50 |
$9,375 |
0.9× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,669.50 |
$5,339 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,669.50 |
$5,339 |
0.9× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$2,970.50 |
$5,941 |
0.6× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,669.50 |
$5,339 |
0.9× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,669.50 |
$5,339 |
0.9× |
| Ankle 2 views (73600) |
$217.50 |
$435 |
2.6× |
| Aortogram thoracic (75605) |
$4,687.50 |
$9,375 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,844 |
$5,688 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$2,647.25 |
$5,294.50 |
0.9× |
| Arthrogram elbow (73085) |
$748 |
$1,496 |
2.2× |
| Arthrogram hip (73525) |
$614 |
$1,228 |
1.8× |
| Arthrogram knee (73580) |
$778.50 |
$1,557 |
2.3× |
| Arthrogram shoulder (73040) |
$658.50 |
$1,317 |
2.0× |
| Basic dosimetry (77300) |
$59 |
$118 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$732.50 |
$1,465 |
1.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,692.75 |
$3,385.50 |
4.4× |
| Bone &/joint imaging whole body (78306) |
$1,692.75 |
$3,385.50 |
4.4× |
| Bone age studies (77072) |
$212.25 |
$424.50 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,692.75 |
$3,385.50 |
4.4× |
| Bone survey complete (77075) |
$318.50 |
$637 |
3.2× |
| Bone survey infant (77076) |
$326.50 |
$653 |
3.3× |
| Bowel imaging (78290) |
$1,718 |
$3,436 |
4.5× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,334 |
$6,668 |
2.4× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$1,706.75 |
$3,413.50 |
3.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,066.50 |
$4,133 |
5.4× |
| Cervical spine 2 or 3 views (72040) |
$212.25 |
$424.50 |
2.5× |
| Chest 1 view (71045) |
$131.50 |
$263 |
1.6× |
| Chest xray 3 views (71047) |
$132 |
$264 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$382.50 |
$765 |
2.3× |
| Clavicle complete (73000) |
$217.50 |
$435 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$240 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,958.75 |
$3,917.50 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,417 |
$2,834 |
6.2× |
| CT abdomen w contrast (74160) |
$1,217.25 |
$2,434.50 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT abdomen w/o contrast (74150) |
$710.75 |
$1,421.50 |
7.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,389.50 |
$2,779 |
8.3× |
| CT angiography upper extremity lt (73206) |
$1,436.50 |
$2,873 |
8.5× |
| CT c-spine w/contrast (72126) |
$1,217.25 |
$2,434.50 |
3.6× |
| CT c-spine w/o contrast (72125) |
$822.50 |
$1,645 |
8.2× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,446.50 |
$2,893 |
8.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT chest w contrast (71260) |
$1,258.50 |
$2,517 |
7.5× |
| CT chest w/wo contrast (71270) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT head/brain with contrast (70460) |
$1,176 |
$2,352 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$99 |
$198 |
1.2× |
| CT iac w contrast (70481) |
$1,217.25 |
$2,434.50 |
7.2× |
| CT limited/localized follow up study (76380) |
$418.50 |
$837 |
5.0× |
| CT lower ext w/o (73700) |
$685.50 |
$1,371 |
6.8× |
| CT lower extremity w wo contrast (73702) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT lower extremity w/contrast material (73701) |
$1,258.50 |
$2,517 |
7.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT lumbar spine w/contrast (72132) |
$1,217.25 |
$2,434.50 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$710.75 |
$1,421.50 |
7.1× |
| CT maxillofacial w contrast (70487) |
$1,217.25 |
$2,434.50 |
7.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,348.25 |
$2,696.50 |
8.0× |
| CT maxillofacial wo contrast (70486) |
$710.75 |
$1,421.50 |
7.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,394 |
$2,788 |
8.3× |
| CT orbits w/o contrast (70480) |
$710.75 |
$1,421.50 |
7.1× |
| CT pelvis w/o contrast (72192) |
$735 |
$1,470 |
7.3× |
| CT pelvis w/wo contrast (72194) |
$1,394 |
$2,788 |
8.3× |
| CT scan of arm combo (73202) |
$1,394 |
$2,788 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$1,217.25 |
$2,434.50 |
7.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,302.50 |
$2,605 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$710.75 |
$1,421.50 |
7.1× |
| CT thoracic spine w/contrast (72129) |
$1,217.25 |
$2,434.50 |
7.2× |
| CT thoracic spine w/o contrast (72128) |
$710.75 |
$1,421.50 |
7.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,394 |
$2,788 |
8.3× |
| CT thorax w/o contrast (71250) |
$710.75 |
$1,421.50 |
7.1× |
| CT unlisted procedure (76497) |
$1,067 |
$2,134 |
12.8× |
| CT upper ext wo (73200) |
$682 |
$1,364 |
6.8× |
| CT upper extremity with contrast (73201) |
$1,217.25 |
$2,434.50 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,072 |
$2,144 |
6.4× |
| Cta Abdomen (74175) |
$1,389.50 |
$2,779 |
8.3× |
| CTA abdomen pelvis (74174) |
$1,971.75 |
$3,943.50 |
5.9× |
| CTA chest (71275) |
$1,389.50 |
$2,779 |
8.3× |
| Cta Head (70496) |
$1,389.50 |
$2,779 |
8.3× |
| Cta Neck (70498) |
$1,389.50 |
$2,779 |
8.3× |
| Cta Pelvis (72191) |
$1,389.50 |
$2,779 |
8.3× |
| Cystography minimum 3 views rs&i (74430) |
$338.50 |
$677 |
1.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$77.50 |
$155 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$341.50 |
$683 |
3.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$162.50 |
$325 |
1.9× |
| Esophagus (74220) |
$382.50 |
$765 |
2.3× |
| Facial bones min 3 views (70150) |
$326.50 |
$653 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$162 |
$324 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$458.25 |
$916.50 |
4.6× |
| Fluoroscopy up to 1 hr (76000) |
$465 |
$930 |
2.0× |
| Foot 2 views (73620) |
$217.50 |
$435 |
2.6× |
| Forearm 2 views (73090) |
$212.25 |
$424.50 |
2.5× |
| Functional MRI brain by phys/psych (70555) |
$370.50 |
$741 |
1.6× |
| Hand 2 views (73120) |
$217.50 |
$435 |
2.2× |
| Heart Infarct Image (78466) |
$2,066.50 |
$4,133 |
5.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,964 |
$3,928 |
3.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$182.50 |
$365 |
0.5× |
| Hysterosalpingogram (74740) |
$324.50 |
$649 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,227.50 |
$4,455 |
4.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,013.50 |
$2,027 |
1.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,154.50 |
$4,309 |
4.1× |
| Knee 3 views (73562) |
$217.50 |
$435 |
2.6× |
| Liver & spleen imaging static only (78215) |
$2,101.50 |
$4,203 |
5.5× |
| Liver imaging static only (78201) |
$2,101.50 |
$4,203 |
4.0× |
| Lung perf&ventilat diferentl (78598) |
$626.75 |
$1,253.50 |
1.2× |
| Lung perfusion differential (78597) |
$828.50 |
$1,657 |
2.2× |
| Lung ventilation imaging (78579) |
$1,478 |
$2,956 |
3.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,007.50 |
$4,015 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,815.50 |
$3,631 |
5.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,249.50 |
$4,499 |
6.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$217.50 |
$435 |
2.6× |
| MRA head w & w/o contrast (70546) |
$2,531.50 |
$5,063 |
7.6× |
| MRA head w/o contrast (70544) |
$1,509.25 |
$3,018.50 |
6.6× |
| MRA head with contrast (70545) |
$2,094 |
$4,188 |
6.3× |
| MRA neck w contrast (70548) |
$2,094 |
$4,188 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,809 |
$3,618 |
5.4× |
| MRA neck w/o contrast (70547) |
$1,509.25 |
$3,018.50 |
6.6× |
| MRI abdomen w contrast (74182) |
$1,815.50 |
$3,631 |
5.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,249.50 |
$4,499 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$1,386 |
$2,772 |
6.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,906.50 |
$3,813 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,194.50 |
$4,389 |
6.6× |
| MRI c-spine with contrast (72142) |
$2,094 |
$4,188 |
6.3× |
| MRI cervical spine w/o contrast (72141) |
$1,519 |
$3,038 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,304.50 |
$4,609 |
6.9× |
| MRI chest w/o contrast (71550) |
$1,352 |
$2,704 |
5.9× |
| MRI chest with contrast (71551) |
$1,815.50 |
$3,631 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,815.50 |
$3,631 |
5.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,249.50 |
$4,499 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,386 |
$2,772 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,531 |
$3,062 |
6.7× |
| MRI orbit face neck w contrast (70542) |
$1,957 |
$3,914 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,424.75 |
$4,849.50 |
7.2× |
| MRI pelvis w/contrast (72196) |
$1,815.50 |
$3,631 |
5.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,249.50 |
$4,499 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,386 |
$2,772 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,365.50 |
$4,731 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,879.25 |
$3,758.50 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,227 |
$4,454 |
6.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,943 |
$3,886 |
5.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,271.50 |
$4,543 |
6.8× |
| MRI temporomandibular joint (70336) |
$1,352 |
$2,704 |
5.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,510.75 |
$3,021.50 |
6.6× |
| MRI up ext w/o contrast (73218) |
$1,420 |
$2,840 |
6.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,420 |
$2,840 |
6.2× |
| MRI, joint upper extrem combo (73223) |
$2,194.50 |
$4,389 |
6.6× |
| Myelogram Cervical (72240) |
$1,668.50 |
$3,337 |
2.2× |
| Myelogram Lumbar (72265) |
$1,663 |
$3,326 |
2.2× |
| Myelogram thoracic (72255) |
$1,264.50 |
$2,529 |
1.7× |
| Myelography 2 or more regions (72270) |
$2,139.50 |
$4,279 |
2.8× |
| Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including… (78433) |
$5,451.50 |
$10,903 |
2.6× |
| Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall… (78429) |
$3,496.50 |
$6,993 |
2.5× |
| Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or… (78431) |
$5,451.50 |
$10,903 |
2.6× |
| Myocardial Spect Multiple Studies (78452) |
$4,396.75 |
$8,793.50 |
3.5× |
| Myocardial spect single study at rest or stress (78451) |
$4,545.50 |
$9,091 |
3.7× |
| Myocrd img PET prfuj 1std rest/stress cncrnt CT (78430) |
$3,496.50 |
$6,993 |
2.5× |
| N-invas est c ffr sw aly CTA (75580) |
$3,066.50 |
$6,133 |
3.7× |
| Neck soft tissue (70360) |
$212.25 |
$424.50 |
2.5× |
| Nm cisternogram (78630) |
$3,066 |
$6,132 |
5.9× |
| Nm gastric emptying study (78264) |
$1,661.75 |
$3,323.50 |
4.3× |
| Nm kidney scan w/flow (78701) |
$2,227.50 |
$4,455 |
5.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$2,141 |
$4,282 |
5.6× |
| Nuclear Rx Oral Admin (79005) |
$1,584 |
$3,168 |
7.1× |
| Ob us nuchal meas 1 gest (76813) |
$199 |
$398 |
2.0× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$160 |
$320 |
1.6× |
| Osseous survey limited (77074) |
$334.50 |
$669 |
3.3× |
| Parathyrd planar w/spect&CT (78072) |
$1,090 |
$2,180 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$1,508 |
$3,016 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$207 |
$414 |
2.1× |
| Perineogram (74775) |
$403.50 |
$807 |
1.8× |
| Peritoneogram after injection (74190) |
$765 |
$1,530 |
1.5× |
| PET image w/CT, skull-thigh (78815) |
$3,243.50 |
$6,487 |
2.4× |
| PET imaging CT for attenuation limited area (78814) |
$3,334 |
$6,668 |
2.4× |
| PET imaging for CT attenuation whole body (78816) |
$3,254.50 |
$6,509 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,478 |
$2,956 |
3.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,103 |
$4,206 |
4.0× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,069.50 |
$2,139 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$242.50 |
$485 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$217.50 |
$435 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$212.25 |
$424.50 |
2.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$217.50 |
$435 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$212.25 |
$424.50 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$212.25 |
$424.50 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$189.75 |
$379.50 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$212 |
$424 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$315.75 |
$631.50 |
3.8× |
| Radex Hand Minimum 3 Views (73130) |
$217.50 |
$435 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$212.25 |
$424.50 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$212.25 |
$424.50 |
2.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$164 |
$328 |
1.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$326.50 |
$653 |
3.3× |
| Radex Humerus Minimum 2 Views (73060) |
$217.50 |
$435 |
2.6× |
| Radex Kne 1/2 Views (73560) |
$217.50 |
$435 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$334.50 |
$669 |
3.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$326.50 |
$653 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$212.25 |
$424.50 |
2.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$199.50 |
$399 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$217.50 |
$435 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$212.25 |
$424.50 |
2.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$334.50 |
$669 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$212.25 |
$424.50 |
2.5× |
| Radex Toe Minimum 2 Views (73660) |
$217.50 |
$435 |
2.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$212.25 |
$424.50 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$217.50 |
$435 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$164 |
$328 |
1.6× |
| Radiation Delivery Stereotactic Cranial Linear (77372) |
$4,919.50 |
$9,839 |
0.7× |
| Radiation treatment delivery level 3 (77412) |
$635 |
$1,270 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$212.25 |
$424.50 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$217.50 |
$435 |
2.2× |
| Radiologic exam chest 2 views (71046) |
$217.50 |
$435 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$553.50 |
$1,107 |
3.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$356.75 |
$713.50 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$309 |
$618 |
1.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$312.75 |
$625.50 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$132 |
$264 |
1.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$212.25 |
$424.50 |
2.5× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$334.50 |
$669 |
0.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$212.25 |
$424.50 |
2.1× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$334.50 |
$669 |
3.3× |
| Radiological examination surgical specimen (76098) |
$197.50 |
$395 |
0.4× |
| Ribs bilateral 3 views (71110) |
$326.50 |
$653 |
3.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$886 |
$1,772 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$886 |
$1,772 |
2.3× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,977.75 |
$5,955.50 |
5.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,219.50 |
$6,439 |
6.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$3,078.50 |
$6,157 |
5.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$3,078.50 |
$6,157 |
2.5× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,563.50 |
$7,127 |
2.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,038.25 |
$6,076.50 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$201 |
$402 |
2.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$552.50 |
$1,105 |
2.4× |
| Scapula (73010) |
$207 |
$414 |
2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$58.50 |
$117 |
2.5× |
| Sella turcica (70240) |
$217.50 |
$435 |
2.6× |
| Shoulder 1 view (73020) |
$212.25 |
$424.50 |
2.5× |
| Sialogram (70390) |
$454.50 |
$909 |
2.0× |
| Small bowel series (74250) |
$386 |
$772 |
2.3× |
| Special treatment procedure (77470) |
$1,645.50 |
$3,291 |
3.1× |
| Spine thoracic 3 views (72072) |
$326.50 |
$653 |
3.3× |
| Testicular Imaging With Vascular Flow (78761) |
$2,227.50 |
$4,455 |
5.8× |
| Ther rad simulaj-aided field setting complex (77290) |
$1,163 |
$2,326 |
3.2× |
| Thoracolumbar 2 views (72080) |
$181 |
$362 |
2.2× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,007 |
$4,014 |
3.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,457 |
$2,914 |
3.8× |
| Tomogram (76100) |
$334.50 |
$669 |
3.3× |
| Treatment device complex (77334) |
$805.50 |
$1,611 |
2.2× |
| Ultrasound breast complete (76641) |
$291 |
$582 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$305 |
$610 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$446.50 |
$893 |
4.5× |
| Umbilical-artery Doppler (OB) (76820) |
$77.50 |
$155 |
0.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$303.50 |
$607 |
3.6× |
| Unlisted fluoroscopic procedure (76496) |
$445 |
$890 |
5.3× |
| Unlisted magnetic resonance procedure (76498) |
$1,352 |
$2,704 |
16.2× |
| Unlisted ultrasound procedure (76999) |
$536 |
$1,072 |
6.4× |
| Urethrocystogram voiding (74455) |
$396.50 |
$793 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$410.50 |
$821 |
1.8× |
| Us breast unilateral limited (76642) |
$347 |
$694 |
4.2× |
| Us chest (76604) |
$306 |
$612 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$300.50 |
$601 |
3.0× |
| Us elastography parenchyma (76981) |
$162.75 |
$325.50 |
1.6× |
| Us encephalogram (76506) |
$194.50 |
$389 |
1.9× |
| Us hips infant static (76886) |
$210.25 |
$420.50 |
2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$310 |
$620 |
3.1× |
| Us ob limited (76815) |
$290.75 |
$581.50 |
2.9× |
| Us ob transvaginal (76817) |
$306 |
$612 |
3.1× |
| Us pelvic non ob complete (76856) |
$458.25 |
$916.50 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$254.75 |
$509.50 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$458.25 |
$916.50 |
4.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$298.50 |
$597 |
3.0× |
| Us retroperitoneal complete (76770) |
$456.75 |
$913.50 |
4.6× |
| Us retroperitoneal limited (76775) |
$458.25 |
$916.50 |
4.6× |
| Us scrotum and contents (76870) |
$458.25 |
$916.50 |
4.6× |
| Us soft tissue head/neck (76536) |
$469.50 |
$939 |
4.7× |
| Us spinal canal and contents (76800) |
$124.50 |
$249 |
1.2× |
| Us transrectal (76872) |
$507.50 |
$1,015 |
5.1× |
| Us, eye b-scan (76512) |
$164 |
$328 |
1.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$476.50 |
$953 |
4.8× |
| Venogram extremity bilateral (75822) |
$858 |
$1,716 |
0.6× |
| Venogram Extremity Unilateral (75820) |
$1,024 |
$2,048 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,803 |
$5,606 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$2,905 |
$5,810 |
1.9× |
| Venography venous sinus/jugular cath rs&i (75860) |
$2,803 |
$5,606 |
0.9× |
| Wrist 2 views (73100) |
$217.50 |
$435 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$326.50 |
$653 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$581.50 |
$1,163 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$326.50 |
$653 |
3.3× |
| X-ray exam of femur 2/> (73552) |
$326.50 |
$653 |
3.9× |
| X-ray eye for foreign body (70030) |
$217.50 |
$435 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$217.50 |
$435 |
2.6× |
| X-ray IV pyelogram (ivp) (74400) |
$990.50 |
$1,981 |
5.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$207 |
$414 |
2.5× |
| X-ray leg, infant (73592) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$212.25 |
$424.50 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$326.50 |
$653 |
3.3× |
| X-ray nose-rectum child f.b. (76010) |
$217.50 |
$435 |
2.6× |
| X-ray optic foramen (70190) |
$217.50 |
$435 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$326.50 |
$653 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$966.75 |
$1,933.50 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$334.50 |
$669 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$326.50 |
$653 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$212.25 |
$424.50 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$326.50 |
$653 |
3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$326.50 |
$653 |
3.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$212.25 |
$424.50 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$217.50 |
$435 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$212.25 |
$424.50 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$212.25 |
$424.50 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$166.50 |
$333 |
1.7× |
| Xr bone length studies (77073) |
$188 |
$376 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$326.50 |
$653 |
3.3× |
| Xr c-spine 6 or more views (72052) |
$326.50 |
$653 |
3.3× |
| Xr chest 4+ views (71048) |
$157.50 |
$315 |
1.6× |
| Xr urogram antegrade (74425) |
$329.25 |
$658.50 |
1.0× |