| Abdomen 2 views (74019) |
$756.40 |
$1,891 |
6.9× |
| Acute gi blood loss imaging (78278) |
$996.40 |
$2,491 |
2.4× |
| Angio Adrenal Bilat Select (75733) |
$4,350.40 |
$10,876 |
1.3× |
| Angiography extremity bilateral rs&i (75716) |
$3,113.60 |
$7,784 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,885.60 |
$7,214 |
0.9× |
| Angiography internal mammary rs&i (75756) |
$4,113.60 |
$10,284 |
1.2× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$9,960.80 |
$24,902 |
1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,200.80 |
$5,502 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,472.40 |
$6,181 |
0.7× |
| Angiography Spinal Selective Rs&I (75705) |
$4,113.60 |
$10,284 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$9,960.80 |
$24,902 |
1.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,185.20 |
$5,463 |
0.7× |
| Ankle 2 views (73600) |
$201.60 |
$504 |
2.2× |
| Aortogram thoracic (75605) |
$3,550 |
$8,875 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$5,823.20 |
$14,558 |
1.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,296.40 |
$5,741 |
0.7× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$4,113.60 |
$10,284 |
1.2× |
| Artery X-Rays Adrenal Gland (75731) |
$4,350.40 |
$10,876 |
1.3× |
| Arthrogram ankle (73615) |
$666.80 |
$1,667 |
1.8× |
| Arthrogram elbow (73085) |
$666.80 |
$1,667 |
1.8× |
| Arthrogram hip (73525) |
$770 |
$1,925 |
2.1× |
| Arthrogram knee (73580) |
$785.60 |
$1,964 |
2.2× |
| Arthrogram shoulder (73040) |
$1,400 |
$3,500 |
3.8× |
| Arthrogram wrist (73115) |
$579.20 |
$1,448 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$777.60 |
$1,944 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,456 |
$3,640 |
3.5× |
| Bone age studies (77072) |
$782 |
$1,955 |
7.2× |
| Bone Imaging 3 Phase (78315) |
$1,380.80 |
$3,452 |
3.3× |
| Bone survey complete (77075) |
$1,651.60 |
$4,129 |
15.1× |
| Bone survey infant (77076) |
$611.20 |
$1,528 |
5.6× |
| Bowel imaging (78290) |
$539.60 |
$1,349 |
1.3× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$965.20 |
$2,413 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,529.60 |
$3,824 |
1.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,465.60 |
$3,664 |
3.5× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,841.20 |
$4,603 |
2.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,936 |
$4,840 |
5.3× |
| Cervical spine 2 or 3 views (72040) |
$348 |
$870 |
3.8× |
| Chest 1 view (71045) |
$486.80 |
$1,217 |
5.4× |
| Chest xray 3 views (71047) |
$813.20 |
$2,033 |
8.9× |
| Cholecystography, oral contrast Non-Facility (74290) |
$761.60 |
$1,904 |
4.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,214 |
$3,035 |
6.6× |
| Clavicle complete (73000) |
$883.60 |
$2,209 |
9.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,045.60 |
$2,614 |
9.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,104 |
$5,260 |
5.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,104 |
$5,260 |
8.4× |
| CT abdomen w contrast (74160) |
$2,004 |
$5,010 |
10.9× |
| CT abdomen w wo contrast (74170) |
$2,090.80 |
$5,227 |
11.4× |
| CT abdomen w/o contrast (74150) |
$1,412.80 |
$3,532 |
12.9× |
| CT angio hrt w/3d image (75574) |
$806.40 |
$2,016 |
2.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,479.20 |
$6,198 |
13.5× |
| CT angiography upper extremity lt (73206) |
$2,104 |
$5,260 |
11.5× |
| CT c-spine w/contrast (72126) |
$1,611.20 |
$4,028 |
4.4× |
| CT c-spine w/o contrast (72125) |
$2,104 |
$5,260 |
19.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,966.40 |
$4,916 |
10.7× |
| CT chest w contrast (71260) |
$1,858.80 |
$4,647 |
10.1× |
| CT chest w/wo contrast (71270) |
$2,104 |
$5,260 |
11.5× |
| CT head/brain with contrast (70460) |
$2,104 |
$5,260 |
11.5× |
| CT head/brain without and with contrast (70470) |
$2,104 |
$5,260 |
11.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$806.40 |
$2,016 |
2.2× |
| CT iac w contrast (70481) |
$2,104 |
$5,260 |
11.5× |
| CT limited/localized follow up study (76380) |
$578.40 |
$1,446 |
6.4× |
| CT lower ext w/o (73700) |
$2,104 |
$5,260 |
19.3× |
| CT lower extremity w wo contrast (73702) |
$1,532 |
$3,830 |
8.4× |
| CT lower extremity w/contrast material (73701) |
$1,539.20 |
$3,848 |
8.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,608.40 |
$4,021 |
8.8× |
| CT lumbar spine w/contrast (72132) |
$1,318.40 |
$3,296 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,843.60 |
$4,609 |
16.9× |
| CT maxillofacial w contrast (70487) |
$1,795.60 |
$4,489 |
9.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,104 |
$5,260 |
11.5× |
| CT maxillofacial wo contrast (70486) |
$1,896 |
$4,740 |
17.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,104 |
$5,260 |
11.5× |
| CT orbits w/o contrast (70480) |
$2,104 |
$5,260 |
19.3× |
| CT pelvis w/o contrast (72192) |
$1,925.20 |
$4,813 |
17.6× |
| CT pelvis w/wo contrast (72194) |
$2,104 |
$5,260 |
11.5× |
| CT scan of arm combo (73202) |
$1,900.80 |
$4,752 |
10.4× |
| CT soft tissue neck w contrast (70491) |
$1,147.20 |
$2,868 |
6.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,588 |
$3,970 |
8.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,221.20 |
$3,053 |
11.2× |
| CT thoracic spine w/contrast (72129) |
$1,709.20 |
$4,273 |
9.3× |
| CT thoracic spine w/o contrast (72128) |
$1,530 |
$3,825 |
14.0× |
| CT thoracic spine w/wo contrast (72130) |
$2,084.40 |
$5,211 |
11.4× |
| CT thorax w/o contrast (71250) |
$995.20 |
$2,488 |
9.1× |
| CT upper ext wo (73200) |
$1,557.20 |
$3,893 |
14.3× |
| CT upper extremity with contrast (73201) |
$1,557.20 |
$3,893 |
4.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,162.80 |
$5,407 |
11.8× |
| Cta Abdomen (74175) |
$2,104 |
$5,260 |
11.5× |
| CTA abdomen pelvis (74174) |
$2,104 |
$5,260 |
5.8× |
| CTA chest (71275) |
$2,104 |
$5,260 |
11.5× |
| Cta Head (70496) |
$1,812.60 |
$4,531.50 |
9.9× |
| Cta Neck (70498) |
$2,104 |
$5,260 |
11.5× |
| Cta Pelvis (72191) |
$3,310.80 |
$8,277 |
18.1× |
| Cystography minimum 3 views rs&i (74430) |
$473.20 |
$1,183 |
1.3× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$304.80 |
$762 |
1.2× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,049.20 |
$2,623 |
0.5× |
| Diskogram cervical (72285) |
$4,440 |
$11,100 |
2.2× |
| Diskography lumbar (72295) |
$5,315.20 |
$13,288 |
2.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$368.40 |
$921 |
3.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$697.60 |
$1,744 |
6.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$260.80 |
$652 |
2.9× |
| Dxa bone density study axial skeleton (77085) |
$496.40 |
$1,241 |
4.5× |
| Esophagus (74220) |
$970 |
$2,425 |
5.3× |
| Facial bones min 3 views (70150) |
$708.80 |
$1,772 |
6.5× |
| Fetal biophysical profile non-stress testing (76818) |
$236 |
$590 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$487.40 |
$1,218.50 |
4.5× |
| Fluoroscopy up to 1 hr (76000) |
$2,310.80 |
$5,777 |
9.3× |
| Foot 2 views (73620) |
$355.20 |
$888 |
3.9× |
| Forearm 2 views (73090) |
$719.20 |
$1,798 |
7.9× |
| Hand 2 views (73120) |
$353.20 |
$883 |
3.2× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,113.60 |
$10,284 |
1.2× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,113.60 |
$10,284 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,670.40 |
$6,676 |
4.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,670.40 |
$6,676 |
6.4× |
| Hysterosalpingogram (74740) |
$724 |
$1,810 |
2.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$914.40 |
$2,286 |
8.4× |
| Kidney imaging morphology (78700) |
$1,253.20 |
$3,133 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,377.60 |
$3,444 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,561.20 |
$6,403 |
4.5× |
| Knee 3 views (73562) |
$638.40 |
$1,596 |
7.0× |
| Liver & spleen imaging static only (78215) |
$1,877.20 |
$4,693 |
4.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$2,348.80 |
$5,872 |
5.6× |
| Lung perfusion differential (78597) |
$745.60 |
$1,864 |
1.8× |
| Lung ventilation imaging (78579) |
$600.80 |
$1,502 |
1.4× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$1,768 |
$4,420 |
1.1× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Facility (75801) |
$1,768 |
$4,420 |
2.7× |
| Lymphoscintigraphy (78195) |
$2,683.20 |
$6,708 |
4.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$996.40 |
$2,491 |
1.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$996.40 |
$2,491 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$939.60 |
$2,349 |
2.6× |
| Mammary ductogram or galactogram multiple (77054) |
$446.40 |
$1,116 |
1.8× |
| Mammary ductogram or galactogram single (77053) |
$446.40 |
$1,116 |
1.8× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$211.60 |
$529 |
2.3× |
| MRA head w & w/o contrast (70546) |
$1,325.60 |
$3,314 |
3.6× |
| MRA head w/o contrast (70544) |
$828 |
$2,070 |
3.3× |
| MRA head with contrast (70545) |
$905.60 |
$2,264 |
2.5× |
| MRA neck w contrast (70548) |
$905.60 |
$2,264 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,325.60 |
$3,314 |
3.6× |
| MRA neck w/o contrast (70547) |
$701.60 |
$1,754 |
2.8× |
| MRI abdomen w contrast (74182) |
$1,328 |
$3,320 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,325.60 |
$3,314 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$1,325.60 |
$3,314 |
5.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,156 |
$2,890 |
1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,325.60 |
$3,314 |
3.6× |
| MRI breast w/o contrast bilateral (77047) |
$1,722 |
$4,305 |
6.9× |
| MRI breast wo contrast unilateral (77046) |
$1,235.20 |
$3,088 |
5.0× |
| MRI c-spine with contrast (72142) |
$878.40 |
$2,196 |
2.4× |
| MRI cardiac w/o cont stress (75559) |
$1,202.80 |
$3,007 |
2.1× |
| MRI cardiac w/o contrast (75557) |
$1,374 |
$3,435 |
5.5× |
| MRI cervical spine w/o contrast (72141) |
$1,204.80 |
$3,012 |
4.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,090.40 |
$2,726 |
3.0× |
| MRI chest w/o contrast (71550) |
$1,090.40 |
$2,726 |
4.4× |
| MRI chest with contrast (71551) |
$1,090.40 |
$2,726 |
1.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,156 |
$2,890 |
3.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,090.40 |
$2,726 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,090.40 |
$2,726 |
4.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$701.60 |
$1,754 |
2.8× |
| MRI orbit face neck w contrast (70542) |
$756 |
$1,890 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,325.60 |
$3,314 |
3.6× |
| MRI pelvis w/contrast (72196) |
$1,526.80 |
$3,817 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,325.60 |
$3,314 |
3.6× |
| MRI pelvis w/o contrast (72195) |
$1,325.60 |
$3,314 |
5.3× |
| MRI spectroscopy (76390) |
$973.60 |
$2,434 |
10.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,274.40 |
$3,186 |
3.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,096.80 |
$2,742 |
3.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,325.60 |
$3,314 |
3.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$877.60 |
$2,194 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,078.80 |
$2,697 |
3.0× |
| MRI temporomandibular joint (70336) |
$1,325.60 |
$3,314 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,029.20 |
$2,573 |
4.1× |
| MRI up ext w/o contrast (73218) |
$939.60 |
$2,349 |
3.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,296.80 |
$3,242 |
5.2× |
| MRI, joint upper extrem combo (73223) |
$1,162 |
$2,905 |
3.2× |
| Myelogram Cervical (72240) |
$2,564 |
$6,410 |
3.1× |
| Myelogram Lumbar (72265) |
$2,203.20 |
$5,508 |
2.7× |
| Myelogram thoracic (72255) |
$2,344.80 |
$5,862 |
2.9× |
| Myelography 2 or more regions (72270) |
$3,316 |
$8,290 |
4.1× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$1,529.60 |
$3,824 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$7,710.40 |
$19,276 |
5.7× |
| Myocardial spect single study at rest or stress (78451) |
$3,898.40 |
$9,746 |
2.9× |
| Neck soft tissue (70360) |
$1,077.20 |
$2,693 |
11.9× |
| Nm cisternogram (78630) |
$1,190 |
$2,975 |
2.1× |
| Nm gastric emptying study (78264) |
$938 |
$2,345 |
2.2× |
| Nm kidney scan w/flow (78701) |
$1,520.80 |
$3,802 |
3.6× |
| Ob us nuchal meas 1 gest (76813) |
$890 |
$2,225 |
8.2× |
| Osseous survey limited (77074) |
$431.20 |
$1,078 |
3.9× |
| Parathyroid Planar Imaging (78070) |
$1,456.40 |
$3,641 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$833.20 |
$2,083 |
7.6× |
| Peritoneogram after injection (74190) |
$1,136.80 |
$2,842 |
2.0× |
| PET image w/CT, skull-thigh (78815) |
$2,025.20 |
$5,063 |
1.4× |
| PET imaging CT for attenuation limited area (78814) |
$1,529.60 |
$3,824 |
1.0× |
| PET imaging for CT attenuation whole body (78816) |
$2,025.20 |
$5,063 |
1.4× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,113.60 |
$10,284 |
1.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$4,113.60 |
$10,284 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$676.40 |
$1,691 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$902 |
$2,255 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$347.20 |
$868 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$597.60 |
$1,494 |
6.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$876.80 |
$2,192 |
9.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$890.80 |
$2,227 |
9.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$300.80 |
$752 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$497.60 |
$1,244 |
4.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$950 |
$2,375 |
8.7× |
| Radex fingr minimum 2 views (73140) |
$719.20 |
$1,798 |
7.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$559.20 |
$1,398 |
6.2× |
| Radex Hand Minimum 3 Views (73130) |
$563.20 |
$1,408 |
6.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$300.40 |
$751 |
3.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$497.60 |
$1,244 |
4.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$497.60 |
$1,244 |
4.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$950 |
$2,375 |
8.7× |
| Radex Humerus Minimum 2 Views (73060) |
$1,005.20 |
$2,513 |
11.1× |
| Radex Kne 1/2 Views (73560) |
$692 |
$1,730 |
7.6× |
| Radex Kne Compl 4/More Views (73564) |
$1,156.80 |
$2,892 |
10.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$652.40 |
$1,631 |
6.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$740.80 |
$1,852 |
8.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$1,705.60 |
$4,264 |
15.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$1,118.80 |
$2,797 |
12.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$464 |
$1,160 |
5.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$397.60 |
$994 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$566.40 |
$1,416 |
6.2× |
| Radex Toe Minimum 2 Views (73660) |
$648.80 |
$1,622 |
7.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$237.60 |
$594 |
2.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$676.80 |
$1,692 |
7.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$950 |
$2,375 |
8.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$713.60 |
$1,784 |
7.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$801.60 |
$2,004 |
7.3× |
| Radiologic exam chest 2 views (71046) |
$560 |
$1,400 |
6.2× |
| Radiologic exam colon single contrast study (74270) |
$2,038.40 |
$5,096 |
11.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$809.20 |
$2,023 |
4.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$594.40 |
$1,486 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$594.40 |
$1,486 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$300.40 |
$751 |
3.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$724 |
$1,810 |
8.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$506 |
$1,265 |
5.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$724.80 |
$1,812 |
1.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$736.80 |
$1,842 |
6.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$94 |
$235 |
0.9× |
| Radiological examination surgical specimen (76098) |
$263.60 |
$659 |
0.5× |
| Renal Cyst Study (74470) |
$526 |
$1,315 |
0.9× |
| Ribs bilateral 3 views (71110) |
$238.40 |
$596 |
2.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$2,804.80 |
$7,012 |
6.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,968.40 |
$4,921 |
3.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,422.80 |
$3,557 |
2.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$699.20 |
$1,748 |
1.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,438.40 |
$11,096 |
3.3× |
| Rp Therapy Intravenous Administration (79101) |
$1,536 |
$3,840 |
6.3× |
| Sacroiliac Joints < 3 Views (72200) |
$146 |
$365 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$879.20 |
$2,198 |
3.5× |
| Salivary gland imaging (78230) |
$912.40 |
$2,281 |
2.2× |
| Scapula (73010) |
$816.80 |
$2,042 |
7.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$68.40 |
$171 |
2.9× |
| Sella turcica (70240) |
$527.20 |
$1,318 |
5.8× |
| Shoulder 1 view (73020) |
$388.40 |
$971 |
4.3× |
| Sialogram (70390) |
$794 |
$1,985 |
3.2× |
| Small bowel series (74250) |
$2,006.40 |
$5,016 |
11.0× |
| Speech evaluation complex (70371) |
$437.60 |
$1,094 |
1.8× |
| Spine thoracic 3 views (72072) |
$152 |
$380 |
1.4× |
| Splenoportograpy rs&i (75810) |
$4,113.60 |
$10,284 |
1.2× |
| Superior sagittal sinus venogram (75870) |
$4,113.60 |
$10,284 |
1.2× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$183.20 |
$458 |
2.0× |
| Tbs technical calculation only (77091) |
$183.20 |
$458 |
2.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$666.80 |
$1,667 |
2.7× |
| Thoracolumbar 2 views (72080) |
$580 |
$1,450 |
6.4× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,123.60 |
$2,809 |
2.0× |
| Thyroid imaging w/blood flow (78013) |
$674 |
$1,685 |
1.6× |
| Thyroid uptake measurement (78012) |
$552.80 |
$1,382 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$927.20 |
$2,318 |
2.2× |
| Tmj unilateral (70328) |
$214 |
$535 |
2.4× |
| Tomogram (76100) |
$418 |
$1,045 |
3.8× |
| Ultrasound breast complete (76641) |
$373.20 |
$933 |
3.4× |
| Ultrasound elastography first target lesion (76982) |
$623.20 |
$1,558 |
5.7× |
| Ultrasound Exam Aaa Screen (76706) |
$562 |
$1,405 |
5.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$421.20 |
$1,053 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$2,155.20 |
$5,388 |
19.7× |
| Umbilical-artery Doppler (OB) (76820) |
$593.20 |
$1,483 |
5.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$607.60 |
$1,519 |
6.7× |
| Unlisted fluoroscopic procedure (76496) |
$522.40 |
$1,306 |
5.7× |
| Unlisted ultrasound procedure (76999) |
$449.20 |
$1,123 |
4.9× |
| Urethrocystogram voiding (74455) |
$619.60 |
$1,549 |
2.5× |
| Urethrocystography retrograde rs&i (74450) |
$607.60 |
$1,519 |
2.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,312.40 |
$3,281 |
7.2× |
| Us breast unilateral limited (76642) |
$622 |
$1,555 |
6.8× |
| Us chest (76604) |
$611.80 |
$1,529.50 |
5.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$4,052.40 |
$10,131 |
18.0× |
| Us compl joint r-t w/image documentation (76881) |
$1,194 |
$2,985 |
10.9× |
| Us elastography parenchyma (76981) |
$546 |
$1,365 |
5.0× |
| Us encephalogram (76506) |
$1,034 |
$2,585 |
9.5× |
| Us hips infant static (76886) |
$879.20 |
$2,198 |
9.7× |
| Us infant hips w manipulation (76885) |
$1,142.40 |
$2,856 |
12.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$886 |
$2,215 |
8.1× |
| Us ob detailed single fetus (76811) |
$1,339.20 |
$3,348 |
5.4× |
| Us ob limited (76815) |
$548 |
$1,370 |
5.0× |
| Us ob transvaginal (76817) |
$379.60 |
$949 |
3.5× |
| Us pelvic non ob complete (76856) |
$2,188 |
$5,470 |
20.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$725.20 |
$1,813 |
6.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$680.40 |
$1,701 |
6.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$359.20 |
$898 |
3.3× |
| Us retroperitoneal complete (76770) |
$608 |
$1,520 |
5.6× |
| Us retroperitoneal limited (76775) |
$874 |
$2,185 |
8.0× |
| Us scrotum and contents (76870) |
$1,106 |
$2,765 |
10.1× |
| Us soft tissue head/neck (76536) |
$940 |
$2,350 |
8.6× |
| Us spinal canal and contents (76800) |
$1,034 |
$2,585 |
9.5× |
| Us transrectal (76872) |
$935.20 |
$2,338 |
8.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$858 |
$2,145 |
7.9× |
| Venogram extremity bilateral (75822) |
$2,030.20 |
$5,075.50 |
1.2× |
| Venogram Extremity Unilateral (75820) |
$2,747.20 |
$6,868 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$4,217.20 |
$10,543 |
1.3× |
| Venography caval superior serialography rs&i (75827) |
$3,882.80 |
$9,707 |
2.4× |
| Venography Renal Bilateral (75833) |
$2,090.40 |
$5,226 |
0.6× |
| Venography renal unilateral selective rs&i (75831) |
$1,674.40 |
$4,186 |
0.5× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$4,113.60 |
$10,284 |
6.3× |
| Venous sampling by catheter (75893) |
$4,113.60 |
$10,284 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$310.40 |
$776 |
3.4× |
| Wrist 2 views (73100) |
$425.60 |
$1,064 |
4.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$1,092.80 |
$2,732 |
10.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$553.60 |
$1,384 |
6.1× |
| X-ray b.e. reductn intuss (74283) |
$3,126.80 |
$7,817 |
17.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$3,283.20 |
$8,208 |
17.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$607.20 |
$1,518 |
6.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$300.40 |
$751 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$497.60 |
$1,244 |
4.6× |
| X-ray exam of femur 2/> (73552) |
$300.40 |
$751 |
3.3× |
| X-ray eye for foreign body (70030) |
$643.20 |
$1,608 |
7.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$592 |
$1,480 |
6.5× |
| X-ray IV pyelogram (ivp) (74400) |
$1,688.80 |
$4,222 |
9.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$281.60 |
$704 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$545.20 |
$1,363 |
6.0× |
| X-ray leg, infant (73592) |
$237.60 |
$594 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$538 |
$1,345 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$981.20 |
$2,453 |
9.0× |
| X-ray nose-rectum child f.b. (76010) |
$607.60 |
$1,519 |
6.7× |
| X-ray optic foramen (70190) |
$474.40 |
$1,186 |
5.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$494 |
$1,235 |
4.5× |
| X-ray retrograde pyelogram (74420) |
$708.80 |
$1,772 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$216 |
$540 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$553.60 |
$1,384 |
5.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$813.60 |
$2,034 |
7.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$473.20 |
$1,183 |
4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$502.40 |
$1,256 |
5.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$849.20 |
$2,123 |
9.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$950.40 |
$2,376 |
8.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$510.40 |
$1,276 |
4.7× |
| X-Ray Small Bowel Enteroclysis (74251) |
$3,489.20 |
$8,723 |
19.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$1,048.80 |
$2,622 |
11.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$286 |
$715 |
3.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$448 |
$1,120 |
4.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$452.80 |
$1,132 |
4.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$693.60 |
$1,734 |
6.4× |
| Xr bone length studies (77073) |
$951.20 |
$2,378 |
8.7× |
| Xr c-spine 4 or 5 views (72050) |
$1,906.40 |
$4,766 |
17.5× |
| Xr c-spine 6 or more views (72052) |
$1,450.40 |
$3,626 |
13.3× |
| Xr chest 4+ views (71048) |
$875.60 |
$2,189 |
8.0× |
| Xr myelogram posterior fossa (70010) |
$1,375.60 |
$3,439 |
3.8× |
| Xr urogram antegrade (74425) |
$372.40 |
$931 |
1.0× |