| Acute gi blood loss imaging (78278) |
$996.40 |
$2,491 |
2.4× |
| Angio adrenal bilat select (75733) |
$4,350.40 |
$10,876 |
1.3× |
| Angio adrenal unilat select (75731) |
$4,350.40 |
$10,876 |
1.3× |
| Angio extremity unilateral (75710) |
$2,885.60 |
$7,214 |
0.9× |
| Angio pulmonary unilateral (75741) |
$2,472.40 |
$6,181 |
0.7× |
| Angiogram extremity bilateral (75716) |
$3,113.60 |
$7,784 |
0.9× |
| Angiogram pelvic (75736) |
$9,960.80 |
$24,902 |
1.7× |
| Angiography internal mammary rs&i (75756) |
$4,113.60 |
$10,284 |
1.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,200.80 |
$5,502 |
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× |
| Aortography thoracic w/o serialography rs&i (75600) |
$4,113.60 |
$10,284 |
1.2× |
| Arthrography knee lt (73580) |
$785.60 |
$1,964 |
2.2× |
| Arthrography wrist lt (73115) |
$579.20 |
$1,448 |
1.6× |
| Barium enema (74270) |
$2,038.40 |
$5,096 |
11.1× |
| Bilat selctv renal venogram (75833) |
$2,090.40 |
$5,226 |
0.6× |
| Bone age studies (77072) |
$782 |
$1,955 |
7.2× |
| Bone imaging limited area (78300) |
$777.60 |
$1,944 |
1.9× |
| Bone survey complete (77075) |
$1,651.60 |
$4,129 |
15.1× |
| Bowel imaging (78290) |
$539.60 |
$1,349 |
1.3× |
| Brain image w/flow 4 + views (78606) |
$965.20 |
$2,413 |
1.7× |
| Card MRI w/stress img & dye (75563) |
$1,841.20 |
$4,603 |
2.2× |
| Cardiac MRI w/stress img (75559) |
$1,202.80 |
$3,007 |
2.1× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$1,936 |
$4,840 |
5.3× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (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× |
| Cisternogram (78630) |
$1,190 |
$2,975 |
2.1× |
| Clavicle complete (73000) |
$883.60 |
$2,209 |
9.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,104 |
$5,260 |
11.5× |
| Contrast exam abdominl aorta (75625) |
$2,296.40 |
$5,741 |
0.7× |
| Contrast exam thoracic aorta (75605) |
$3,550 |
$8,875 |
0.6× |
| CT - st neck w&wo contr (70492) |
$1,588 |
$3,970 |
8.7× |
| 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 wo contrast (74170) |
$2,090.80 |
$5,227 |
11.4× |
| CT abdomen w/contrast (74160) |
$2,004 |
$5,010 |
10.9× |
| CT abdomen w/o contrast (74150) |
$1,412.80 |
$3,532 |
12.9× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$2,104 |
$5,260 |
5.8× |
| CT angio abdom w/o & w/dye (74175) |
$2,104 |
$5,260 |
11.5× |
| CT angio abdominal arteries (75635) |
$2,162.80 |
$5,407 |
11.8× |
| CT angio hrt w/3d image (75574) |
$806.40 |
$2,016 |
2.2× |
| CT angiograph pelv w/o&w/dye (72191) |
$3,310.80 |
$8,277 |
18.1× |
| CT cervical spine w/contrast (72126) |
$1,611.20 |
$4,028 |
4.4× |
| CT cervical spine w/o contrast (72125) |
$2,104 |
$5,260 |
19.3× |
| CT chest w/contrast (71260) |
$1,858.80 |
$4,647 |
10.1× |
| CT extremity upper w & w/o contrast (73202) |
$1,900.80 |
$4,752 |
10.4× |
| 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 limited/localized follow up study (76380) |
$578.40 |
$1,446 |
6.4× |
| CT lower ext w/wo contrast (73702) |
$1,532 |
$3,830 |
8.4× |
| CT lower extremity w contrast (73701) |
$1,539.20 |
$3,848 |
8.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,104 |
$5,260 |
19.3× |
| 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 lumbar spine w/o then w/ con (72133) |
$1,608.40 |
$4,021 |
8.8× |
| CT maxillofacial area w/o contrast (70486) |
$1,896 |
$4,740 |
17.4× |
| CT maxillofacial w/contrast (70487) |
$1,795.60 |
$4,489 |
9.8× |
| CT maxillofacial w/o then w/ con (70488) |
$2,104 |
$5,260 |
11.5× |
| CT orbit sella ear w/o con (70480) |
$2,104 |
$5,260 |
19.3× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$2,104 |
$5,260 |
11.5× |
| CT pelvis w & w/o contrast (72194) |
$2,104 |
$5,260 |
11.5× |
| CT pelvis w/o contrast (72192) |
$1,925.20 |
$4,813 |
17.6× |
| CT soft tissue neck w/contrast (70491) |
$1,147.20 |
$2,868 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,221.20 |
$3,053 |
11.2× |
| CT spine cervical w/wo contrast (72127) |
$1,966.40 |
$4,916 |
10.7× |
| 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/o then w/ con (72130) |
$2,084.40 |
$5,211 |
11.4× |
| CT thorax lung cancer scr c- (71271) |
$1,045.60 |
$2,614 |
9.6× |
| CT thorax w/o contrast (71250) |
$995.20 |
$2,488 |
9.1× |
| CT thorax w/o then w/ contrast (71270) |
$2,104 |
$5,260 |
11.5× |
| CT upper extremity w/dye (73201) |
$1,557.20 |
$3,893 |
4.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,557.20 |
$3,893 |
14.3× |
| CTA chest w/wo contrast (71275) |
$2,104 |
$5,260 |
11.5× |
| CTA head w contrast (70496) |
$1,812.60 |
$4,531.50 |
9.9× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$2,479.20 |
$6,198 |
13.5× |
| Cta Neck (70498) |
$2,104 |
$5,260 |
11.5× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,104 |
$5,260 |
11.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Other Diagnostic Radiology FS (70170) |
$304.80 |
$762 |
1.2× |
| Dilation ureters/urethra rs&i (74485) |
$1,049.20 |
$2,623 |
0.5× |
| Discography, cervical or thoracic, radiological supervision and interpretation Other Diagnostic Radiology FS (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 axial skeleton (77085) |
$496.40 |
$1,241 |
4.5× |
| Esophogram (74220) |
$970 |
$2,425 |
5.3× |
| Fetal biophysical profile non-stress testing (76818) |
$236 |
$590 |
2.2× |
| Fetal biophysical profile w/o nst (76819) |
$487.40 |
$1,218.50 |
4.5× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$2,310.80 |
$5,777 |
9.3× |
| Gastric emptying study (78264) |
$938 |
$2,345 |
2.2× |
| Gated heart planar single (78472) |
$1,465.60 |
$3,664 |
3.5× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$4,113.60 |
$10,284 |
1.2× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$4,113.60 |
$10,284 |
1.2× |
| Hepatobil syst image w/drug (78227) |
$2,670.40 |
$6,676 |
4.7× |
| Hepatobiliary system imaging (78226) |
$2,670.40 |
$6,676 |
6.4× |
| Humerus min 2 views (73060) |
$1,005.20 |
$2,513 |
11.1× |
| Hysterosalpingography (74740) |
$724 |
$1,810 |
2.9× |
| Ivp (74400) |
$1,688.80 |
$4,222 |
9.2× |
| Ivp w tomography (74415) |
$1,312.40 |
$3,281 |
7.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,377.60 |
$3,444 |
2.4× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$2,561.20 |
$6,403 |
4.5× |
| Kidney w vascular flow (78701) |
$1,520.80 |
$3,802 |
3.6× |
| Liver & spleen; static only (78215) |
$1,877.20 |
$4,693 |
4.5× |
| Liver & spleen; w vasc flow (78216) |
$2,348.80 |
$5,872 |
5.6× |
| Lung perfusion differential (78597) |
$745.60 |
$1,864 |
1.8× |
| Lung ventilat&perfus imaging (78582) |
$902 |
$2,255 |
1.6× |
| Lung ventilation imaging (78579) |
$600.80 |
$1,502 |
1.4× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75803) |
$1,768 |
$4,420 |
1.1× |
| Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Other Diagnostic Radiology FS (75801) |
$1,768 |
$4,420 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,325.60 |
$3,314 |
3.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,090.40 |
$2,726 |
3.0× |
| Mammary ductogram multiple ducts (77054) |
$446.40 |
$1,116 |
1.8× |
| Mammary ductogram single (77053) |
$446.40 |
$1,116 |
1.8× |
| MRA head w & w/o contrast (70546) |
$1,325.60 |
$3,314 |
3.6× |
| MRA head w/contrast (70545) |
$905.60 |
$2,264 |
2.5× |
| MRA head w/o contrast (70544) |
$828 |
$2,070 |
3.3× |
| MRA neck w/contrast (70548) |
$905.60 |
$2,264 |
2.5× |
| MRA neck w/o contrast (70547) |
$701.60 |
$1,754 |
2.8× |
| MRA neck w/wo contrast (70549) |
$1,325.60 |
$3,314 |
3.6× |
| 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 jnt lwr ext with con lt (73722) |
$1,156 |
$2,890 |
1.4× |
| MRI breast without contrast bilateral (77047) |
$1,722 |
$4,305 |
6.9× |
| MRI breast without contrast material unilateral (77046) |
$1,235.20 |
$3,088 |
5.0× |
| 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 cervical spine with contrast (72142) |
$878.40 |
$2,196 |
2.4× |
| MRI chest w & w/o contrast (71552) |
$1,090.40 |
$2,726 |
3.0× |
| MRI chest w/contrast (71551) |
$1,090.40 |
$2,726 |
1.3× |
| MRI chest w/o contrast (71550) |
$1,090.40 |
$2,726 |
4.4× |
| MRI joint upper ext w/contrast (73222) |
$996.40 |
$2,491 |
1.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$1,162 |
$2,905 |
3.2× |
| MRI joint upr extrem w/o dye (73221) |
$1,296.80 |
$3,242 |
5.2× |
| Mri Lower Extremity W/O Dye (73718) |
$1,090.40 |
$2,726 |
4.4× |
| MRI lumbar spine with contrast (72149) |
$1,096.80 |
$2,742 |
3.0× |
| MRI lumbar w/wo contrast (72158) |
$1,325.60 |
$3,314 |
3.6× |
| MRI lwr ext w/o jnts with con rt (73719) |
$1,156 |
$2,890 |
3.2× |
| MRI orbit/face/neck w/contrast (70542) |
$756 |
$1,890 |
2.1× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,325.60 |
$3,314 |
3.6× |
| MRI orbit/face/neck w/o contrast (70540) |
$701.60 |
$1,754 |
2.8× |
| MRI pelvis w/ contrast (72196) |
$1,526.80 |
$3,817 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,325.60 |
$3,314 |
5.3× |
| MRI pelvis w/wo contrast (72197) |
$1,325.60 |
$3,314 |
3.6× |
| MRI spectroscopy (76390) |
$973.60 |
$2,434 |
10.7× |
| MRI spine cervical wo/w contrast (72156) |
$1,274.40 |
$3,186 |
3.5× |
| MRI spine thoracic w/contrast (72147) |
$877.60 |
$2,194 |
2.4× |
| MRI thoracic spine w wo contrast (72157) |
$1,078.80 |
$2,697 |
3.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,029.20 |
$2,573 |
4.1× |
| MRI tmj (70336) |
$1,325.60 |
$3,314 |
5.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$939.60 |
$2,349 |
3.8× |
| Mri Upper Extremity W/Dye (73219) |
$996.40 |
$2,491 |
2.7× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$939.60 |
$2,349 |
2.6× |
| Myelogram Cpa (70010) |
$1,375.60 |
$3,439 |
3.8× |
| Myelogram thoracic (72255) |
$2,344.80 |
$5,862 |
2.9× |
| Myelography 2 or more regions (72270) |
$3,316 |
$8,290 |
4.1× |
| Myelography lumbosacral (72265) |
$2,203.20 |
$5,508 |
2.7× |
| Myocardial spect single study at rest or stress (78451) |
$3,898.40 |
$9,746 |
2.9× |
| Myocrd img PET metab eval single study (78459) |
$1,529.60 |
$3,824 |
1.1× |
| Nm bone 3 phase (78315) |
$1,380.80 |
$3,452 |
3.3× |
| Nm bone imaging whole body (78306) |
$1,456 |
$3,640 |
3.5× |
| Nm heart perfusion spect stress rest (78452) |
$7,710.40 |
$19,276 |
5.7× |
| Nm kidney imaging morphology (78700) |
$1,253.20 |
$3,133 |
3.0× |
| Nm lymph system (78195) |
$2,683.20 |
$6,708 |
4.7× |
| Nm thyroid imaging only (78013) |
$674 |
$1,685 |
1.6× |
| Nose to rectum for fb child (76010) |
$607.60 |
$1,519 |
6.7× |
| Nuclear rx IV admin (79101) |
$1,536 |
$3,840 |
6.3× |
| Ob us < 14 wks single fetus (76801) |
$680.40 |
$1,701 |
6.2× |
| Ob us nuchal meas 1 gest (76813) |
$890 |
$2,225 |
8.2× |
| Parathyroid imaging (78070) |
$1,456.40 |
$3,641 |
3.5× |
| Peritoneogram rs&i (74190) |
$1,136.80 |
$2,842 |
2.0× |
| PET brain metabolic eval (78608) |
$1,529.60 |
$3,824 |
1.0× |
| PET imaging CT attenuation skull base mid-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 w/o hemodyn evl intrp (75887) |
$4,113.60 |
$10,284 |
1.2× |
| Pulmonary perfusion imaging particulate (78580) |
$676.40 |
$1,691 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$347.20 |
$868 |
0.6× |
| 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 entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$950 |
$2,375 |
8.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$300.40 |
$751 |
3.3× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$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 spine cervical 2 or 3 views (72040) |
$348 |
$870 |
3.8× |
| Radex spine cervical 4 or 5 views (72050) |
$1,906.40 |
$4,766 |
17.5× |
| Radex spine cervical 6 or more views (72052) |
$1,450.40 |
$3,626 |
13.3× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$580 |
$1,450 |
6.4× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$875.60 |
$2,189 |
8.0× |
| 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 - Xr Femur 1 Vw Right (73551) |
$300.40 |
$751 |
3.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$300.40 |
$751 |
3.3× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,092.80 |
$2,732 |
10.0× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$94 |
$235 |
0.9× |
| Radiologic examination, salivary gland for calculus Other Diagnostic Radiology FS (70380) |
$724 |
$1,810 |
8.0× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$418 |
$1,045 |
3.8× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$693.60 |
$1,734 |
6.4× |
| Renal cyst study (74470) |
$526 |
$1,315 |
0.9× |
| 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× |
| Saline infused sonohysterogram (76831) |
$879.20 |
$2,198 |
3.5× |
| Salivary gland imaging (78230) |
$912.40 |
$2,281 |
2.2× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$68.40 |
$171 |
2.9× |
| Selective spinal angiogram (75705) |
$4,113.60 |
$10,284 |
0.7× |
| Shoulder arthrogram (73040) |
$1,400 |
$3,500 |
3.8× |
| Small bowel series (74250) |
$2,006.40 |
$5,016 |
11.0× |
| Speech evaluation complex (70371) |
$437.60 |
$1,094 |
1.8× |
| Splenoportography (75810) |
$4,113.60 |
$10,284 |
1.2× |
| Superior sagittal sinus venogram (75870) |
$4,113.60 |
$10,284 |
1.2× |
| Tbs technical calculation only (77091) |
$183.20 |
$458 |
2.0× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Other Diagnostic Radiology FS (70332) |
$666.80 |
$1,667 |
2.7× |
| Therapeutic enema barium or air (74283) |
$3,126.80 |
$7,817 |
17.1× |
| Thyroid met imaging body (78018) |
$1,123.60 |
$2,809 |
2.0× |
| Thyroid uptake single/multiple quant measurement (78012) |
$552.80 |
$1,382 |
1.3× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$927.20 |
$2,318 |
2.2× |
| Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical preparation and transmission… (77090) |
$183.20 |
$458 |
2.0× |
| Ultrasound breast limited (76642) |
$622 |
$1,555 |
6.8× |
| Ultrasound, abdomen limited (76705) |
$2,155.20 |
$5,388 |
19.7× |
| Ultrasound, elastography; first target lesion (76982) |
$623.20 |
$1,558 |
5.7× |
| 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× |
| Urethrocystography retrograde rs&i (74450) |
$607.60 |
$1,519 |
2.4× |
| Urethrocystography voiding (74455) |
$619.60 |
$1,549 |
2.5× |
| Urography antegrade (74425) |
$372.40 |
$931 |
1.0× |
| Urography retrograde w/wo kub (74420) |
$708.80 |
$1,772 |
1.9× |
| Us abdominal aorta real time screen study aaa (76706) |
$562 |
$1,405 |
5.1× |
| Us breast uni real time with image complete (76641) |
$373.20 |
$933 |
3.4× |
| Us chest (76604) |
$611.80 |
$1,529.50 |
5.6× |
| 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 guided compression repair (76936) |
$4,052.40 |
$10,131 |
18.0× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,142.40 |
$2,856 |
12.6× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$879.20 |
$2,198 |
9.7× |
| Us kidney transplanted (76776) |
$858 |
$2,145 |
7.9× |
| Us lmtd jt/fcl eval 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 followup per fetus (76816) |
$359.20 |
$898 |
3.3× |
| Us ob limited 1 or more fetuses (76815) |
$548 |
$1,370 |
5.0× |
| Us obstetric transvaginal (76817) |
$379.60 |
$949 |
3.5× |
| Us pelvic limited or f/u non-ob (76857) |
$725.20 |
$1,813 |
6.6× |
| Us pelvis complete (76856) |
$2,188 |
$5,470 |
20.0× |
| Us retroperitoneal complete (76770) |
$608 |
$1,520 |
5.6× |
| Us retroperitoneal limited (76775) |
$874 |
$2,185 |
8.0× |
| Us scrotum (76870) |
$1,106 |
$2,765 |
10.1× |
| Us soft tissue head/neck (76536) |
$940 |
$2,350 |
8.6× |
| Us spinal canal (76800) |
$1,034 |
$2,585 |
9.5× |
| Us transrectal (76872) |
$935.20 |
$2,338 |
8.6× |
| Us trgt dyn mbubb 1st les (76978) |
$421.20 |
$1,053 |
1.2× |
| Us unlstd proc (76999) |
$449.20 |
$1,123 |
4.9× |
| Vein X-ray liver w/hemodynam (75885) |
$4,113.60 |
$10,284 |
1.2× |
| Venogram epidural (75872) |
$4,113.60 |
$10,284 |
6.3× |
| Venogram extremity bilateral (75822) |
$2,030.20 |
$5,075.50 |
1.2× |
| Venogram ivc w serialography (75825) |
$4,217.20 |
$10,543 |
1.3× |
| Venogram svc w serialography (75827) |
$3,882.80 |
$9,707 |
2.4× |
| Venography ext unilateral (75820) |
$2,747.20 |
$6,868 |
1.7× |
| Venography renal unilateral selective rs&i (75831) |
$1,674.40 |
$4,186 |
0.5× |
| Venous sampling by catheter (75893) |
$4,113.60 |
$10,284 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$310.40 |
$776 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$553.60 |
$1,384 |
6.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$597.60 |
$1,494 |
6.6× |
| X-ray aorta leg arteries (75630) |
$5,823.20 |
$14,558 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$3,283.20 |
$8,208 |
17.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$890.80 |
$2,227 |
9.8× |
| X-ray exam hips bi 3-4 views (73522) |
$497.60 |
$1,244 |
4.6× |
| X-ray exam of finger(s) (73140) |
$719.20 |
$1,798 |
7.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$3,489.20 |
$8,723 |
19.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$592 |
$1,480 |
6.5× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$355.20 |
$888 |
3.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$559.20 |
$1,398 |
6.2× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$353.20 |
$883 |
3.2× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$563.20 |
$1,408 |
6.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$876.80 |
$2,192 |
9.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$281.60 |
$704 |
3.1× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$638.40 |
$1,596 |
7.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$1,156.80 |
$2,892 |
10.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$545.20 |
$1,363 |
6.0× |
| 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 Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$736.80 |
$1,842 |
6.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$216 |
$540 |
2.4× |
| 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 Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$146 |
$365 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$502.40 |
$1,256 |
5.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$1,118.80 |
$2,797 |
12.3× |
| 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 Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$286 |
$715 |
3.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$648.80 |
$1,622 |
7.1× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$425.60 |
$1,064 |
4.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$676.80 |
$1,692 |
7.4× |
| Xr abdomen 1 view (74018) |
$713.60 |
$1,784 |
7.9× |
| Xr abdomen 2 views (74019) |
$756.40 |
$1,891 |
6.9× |
| Xr abdomen 3 views (74021) |
$801.60 |
$2,004 |
7.3× |
| Xr arthrogram ankle (73615) |
$666.80 |
$1,667 |
1.8× |
| Xr arthrogram elbow (73085) |
$666.80 |
$1,667 |
1.8× |
| Xr arthrogram hip (73525) |
$770 |
$1,925 |
2.1× |
| Xr bone density appendicular (77081) |
$260.80 |
$652 |
2.9× |
| Xr bone density axial (77080) |
$697.60 |
$1,744 |
6.4× |
| Xr bone length study (77073) |
$951.20 |
$2,378 |
8.7× |
| Xr bone survey infant (77076) |
$611.20 |
$1,528 |
5.6× |
| Xr bone survey limited (77074) |
$431.20 |
$1,078 |
3.9× |
| Xr chest 1 view (71045) |
$486.80 |
$1,217 |
5.4× |
| Xr chest 2 views (71046) |
$560 |
$1,400 |
6.2× |
| Xr chest 3 views (71047) |
$813.20 |
$2,033 |
8.9× |
| Xr cystogram 3+ views (74430) |
$473.20 |
$1,183 |
1.3× |
| Xr eye foreign body (70030) |
$643.20 |
$1,608 |
7.1× |
| Xr facial bones 3 views (70150) |
$708.80 |
$1,772 |
6.5× |
| Xr joint survey 1 view (77077) |
$914.40 |
$2,286 |
8.4× |
| Xr lower extremity 2 views infant (73592) |
$237.60 |
$594 |
2.6× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$397.60 |
$994 |
3.6× |
| Xr mandible 4 views (70110) |
$652.40 |
$1,631 |
6.0× |
| Xr myelogram c-spine (72240) |
$2,564 |
$6,410 |
3.1× |
| Xr nasal bones (70160) |
$740.80 |
$1,852 |
8.2× |
| Xr pelvis 3 views (72190) |
$1,705.60 |
$4,264 |
15.6× |
| Xr sella turcica (70240) |
$527.20 |
$1,318 |
5.8× |
| Xr sialogram (70390) |
$794 |
$1,985 |
3.2× |
| Xr spine 1 view (72020) |
$1,048.80 |
$2,622 |
11.5× |
| Xr sternum 2 views (71120) |
$448 |
$1,120 |
4.9× |
| Xr stress view joint (77071) |
$211.60 |
$529 |
2.3× |
| Xr surgical specimen (76098) |
$263.60 |
$659 |
0.5× |
| Xr upper extremity 2 views infant (73092) |
$237.60 |
$594 |
2.2× |
| Xray elbow 2 views (73070) |
$607.20 |
$1,518 |
6.7× |
| Xray forearm 2 views (73090) |
$719.20 |
$1,798 |
7.9× |
| Xray internal auditory meati compl (70134) |
$724.80 |
$1,812 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$692 |
$1,730 |
7.6× |
| Xray neck soft tissue (70360) |
$1,077.20 |
$2,693 |
11.9× |
| Xray optic foramina (70190) |
$474.40 |
$1,186 |
5.2× |
| Xray orbits complete min 4 views (70200) |
$494 |
$1,235 |
4.5× |
| Xray pelvis 1 or 2 views (72170) |
$833.20 |
$2,083 |
7.6× |
| Xray ribs bilateral 3 views (71110) |
$238.40 |
$596 |
2.2× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$553.60 |
$1,384 |
5.1× |
| Xray scapula complete (73010) |
$816.80 |
$2,042 |
7.5× |
| Xray shoulder 1 view (73020) |
$388.40 |
$971 |
4.3× |
| Xray sinuses paranasal <3 views (70210) |
$464 |
$1,160 |
5.1× |
| Xray spine thoracic 2 views (72070) |
$452.80 |
$1,132 |
4.1× |
| Xray spine thoracic 3 views (72072) |
$152 |
$380 |
1.4× |
| Xray tibia-fibula 2 views bil (73590) |
$506 |
$1,265 |
5.6× |
| Xray tmj open - closed unilat (70328) |
$214 |
$535 |
2.4× |
| Xray tmj's bilateral open-clsc (70330) |
$566.40 |
$1,416 |
6.2× |