| Abdomen 1 View (74018) |
$303.20 |
$379 |
3.4× |
| Abdomen 2 views (74019) |
$385.60 |
$482 |
3.6× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,590.40 |
$1,988 |
3.9× |
| Angio pulmonary bilat (75743) |
$5,461.60 |
$6,827 |
1.7× |
| Angiography extremity bilateral rs&i (75716) |
$5,520 |
$6,900 |
1.7× |
| Angiography extremity unilateral rs&i (75710) |
$4,728.80 |
$5,911 |
1.5× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$4,458.40 |
$5,573 |
1.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,179.20 |
$3,974 |
1.0× |
| Ankle 2 views (73600) |
$304 |
$380 |
3.4× |
| Aortography thoracic serialography rs&i (75605) |
$4,795.20 |
$5,994 |
0.8× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,601.60 |
$3,252 |
0.8× |
| Artery X-Rays Abdomen (75726) |
$6,733.60 |
$8,417 |
1.2× |
| Artery X-Rays Pelvis (75736) |
$5,938.40 |
$7,423 |
1.0× |
| Artery X-Rays Spine (75705) |
$6,430.40 |
$8,038 |
1.1× |
| Arthrogram hip (73525) |
$785.60 |
$982 |
2.2× |
| Arthrogram Wrist (73115) |
$927.20 |
$1,159 |
2.6× |
| Bone age studies (77072) |
$292 |
$365 |
2.7× |
| Bone Imaging 3 Phase (78315) |
$2,036 |
$2,545 |
5.0× |
| Bone Imaging Limited Area (78300) |
$1,341.60 |
$1,677 |
3.3× |
| Bone Imaging Whole Body (78306) |
$1,896 |
$2,370 |
4.6× |
| Bone survey infant (77076) |
$768 |
$960 |
7.2× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,483.20 |
$1,854 |
2.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$883.20 |
$1,104 |
1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,980 |
$7,475 |
4.1× |
| Cardiac blood pool imaging, first pass technique; multiple studies, resting and with stress (exercise and/or… (78483) |
$1,802.40 |
$2,253 |
3.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,546.40 |
$4,433 |
9.9× |
| Cat Scan Follow-Up Study (76380) |
$1,105.60 |
$1,382 |
12.4× |
| Cerebrospinal Fluid Scan (78630) |
$1,984 |
$2,480 |
3.6× |
| Chest 1 view (71045) |
$288.80 |
$361 |
3.2× |
| Chest 2 views (71046) |
$332.80 |
$416 |
3.7× |
| Chest 3 views (71047) |
$401.60 |
$502 |
4.5× |
| Chest 4 or more views (71048) |
$492 |
$615 |
4.6× |
| Clavicle complete (73000) |
$314.40 |
$393 |
3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,642.40 |
$2,053 |
15.4× |
| Contrast Exam Abdominl Aorta (75625) |
$4,728.80 |
$5,911 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$826.40 |
$1,033 |
2.3× |
| Contrast X-Ray Of Elbow (73085) |
$989.60 |
$1,237 |
2.8× |
| Contrast X-Ray Of Knee Joint (73580) |
$1,105.60 |
$1,382 |
3.1× |
| Corpora cavernosography (74445) |
$2,417.60 |
$3,022 |
22.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,808 |
$6,010 |
13.5× |
| CT abdomen and pelvis without contrast (74176) |
$4,120 |
$5,150 |
16.9× |
| CT abdomen w contrast (74160) |
$2,553.60 |
$3,192 |
14.3× |
| CT abdomen w wo contrast (74170) |
$3,160 |
$3,950 |
17.6× |
| CT abdomen w/o contrast (74150) |
$2,429.60 |
$3,037 |
22.7× |
| CT Angio Abdomen and Pelvis (74174) |
$4,349.60 |
$5,437 |
12.2× |
| CT Angio Chest (71275) |
$2,884 |
$3,605 |
16.1× |
| CT Angio Head (70496) |
$3,008 |
$3,760 |
16.8× |
| CT angio hrt w/3d image (75574) |
$2,300.80 |
$2,876 |
6.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,553.60 |
$3,192 |
14.3× |
| CT Angio Neck (70498) |
$3,191.20 |
$3,989 |
17.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,781.60 |
$3,477 |
15.5× |
| CT bone density (77078) |
$582.40 |
$728 |
6.6× |
| CT cervical spine w/ contrast (72126) |
$2,402.40 |
$3,003 |
6.7× |
| CT cervical spine w/o contrast (72125) |
$2,199.20 |
$2,749 |
20.6× |
| CT cervical spine w/wo cont (72127) |
$2,704.80 |
$3,381 |
15.1× |
| CT chest w contrast (71260) |
$2,472 |
$3,090 |
13.8× |
| CT chest w/wo contrast (71270) |
$2,920.80 |
$3,651 |
16.3× |
| CT head/brain with contrast (70460) |
$2,151.20 |
$2,689 |
12.0× |
| CT head/brain without and with contrast (70470) |
$2,427.20 |
$3,034 |
13.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$3,020 |
$3,775 |
8.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$795.20 |
$994 |
8.9× |
| CT hrt w/3d image congen (75573) |
$3,020 |
$3,775 |
8.5× |
| CT iac w contrast (70481) |
$2,436 |
$3,045 |
13.6× |
| CT l-spine w&w/o contrast (72133) |
$2,604 |
$3,255 |
14.5× |
| CT lower ext w/o (73700) |
$2,224 |
$2,780 |
20.8× |
| CT lower extremity w/contrast material (73701) |
$2,528.80 |
$3,161 |
14.1× |
| CT lumbar spine w contrast (72132) |
$2,371.20 |
$2,964 |
6.7× |
| CT lumbar spine w/o contrast (72131) |
$2,472 |
$3,090 |
23.1× |
| CT maxillofacial w contrast (70487) |
$2,266.40 |
$2,833 |
12.6× |
| CT maxillofacial wo contrast (70486) |
$1,854.40 |
$2,318 |
17.4× |
| CT neck tissue combo (70492) |
$2,656 |
$3,320 |
14.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,709.60 |
$3,387 |
15.1× |
| CT orbits w/o contrast (70480) |
$2,235.20 |
$2,794 |
20.9× |
| CT pelvis w&w/o contrast (72194) |
$2,577.60 |
$3,222 |
14.4× |
| CT pelvis w/o contrast (72192) |
$1,896 |
$2,370 |
17.8× |
| CT scans face/jaw combo (70488) |
$2,472 |
$3,090 |
13.8× |
| CT soft tissue neck w contrast (70491) |
$2,427.20 |
$3,034 |
13.5× |
| CT soft tissue neck w/o contrast (70490) |
$2,358.40 |
$2,948 |
22.1× |
| CT thoracic spine w contrast (72129) |
$2,464.80 |
$3,081 |
13.8× |
| CT thoracic spine w/o contrast (72128) |
$2,178.40 |
$2,723 |
20.4× |
| CT thoracic spine w/wo cont (72130) |
$2,676 |
$3,345 |
14.9× |
| CT thorax w/o contrast (71250) |
$2,060 |
$2,575 |
19.3× |
| CT upper ext wo (73200) |
$1,915.20 |
$2,394 |
17.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,350.40 |
$2,938 |
13.1× |
| CT upper extremity with contrast (73201) |
$2,087.20 |
$2,609 |
5.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,191.20 |
$3,989 |
17.8× |
| Cta Abdomen (74175) |
$3,160 |
$3,950 |
17.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,008 |
$3,760 |
8.4× |
| CTA pelvis (72191) |
$2,856.80 |
$3,571 |
15.9× |
| Dilation ureters/urethra rs&i (74485) |
$961.60 |
$1,202 |
0.5× |
| Discography Cerv/Thor Spine (72285) |
$2,628 |
$3,285 |
1.3× |
| Diskography lumbar (72295) |
$3,684 |
$4,605 |
1.8× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$502.40 |
$628 |
4.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$706.40 |
$883 |
6.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$494.40 |
$618 |
4.6× |
| Dxa Bone Density Axial (77080) |
$491.20 |
$614 |
4.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$254.40 |
$318 |
2.9× |
| Echo exam of fetal heart (76825) |
$1,566.40 |
$1,958 |
2.8× |
| Echo Guide For Artery Repair (76936) |
$750.40 |
$938 |
3.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$1,081.60 |
$1,352 |
4.4× |
| Esophagram (74220) |
$632.80 |
$791 |
3.5× |
| Fetal Biophys Profile W/Nst (76818) |
$753.60 |
$942 |
7.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$741.60 |
$927 |
6.9× |
| Fluoroscopy up to 1 hr (76000) |
$657.60 |
$822 |
2.7× |
| Follow-Up Angiography (75898) |
$1,687.20 |
$2,109 |
0.5× |
| Foot 2 views (73620) |
$233.60 |
$292 |
2.6× |
| Forearm 2 views (73090) |
$248.80 |
$311 |
2.8× |
| Gastric emptying imaging study (78264) |
$1,813.60 |
$2,267 |
4.4× |
| Gastroesophageal Reflux Exam (78262) |
$1,514.40 |
$1,893 |
3.7× |
| Gated Heart Planar Single (78472) |
$1,925.60 |
$2,407 |
4.7× |
| Hand 2 views (73120) |
$253.60 |
$317 |
2.4× |
| Heart Image (Pet) Multiple (78492) |
$6,296.80 |
$7,871 |
4.3× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$4,777.60 |
$5,972 |
1.5× |
| Hepatobil Syst Image W/Drug (78227) |
$2,068.80 |
$2,586 |
3.7× |
| Hepatobiliary System Imaging (78226) |
$1,889.60 |
$2,362 |
4.6× |
| Ht Muscle Image Spect Sing (78451) |
$3,408 |
$4,260 |
2.6× |
| Hysterosalpingogram (74740) |
$680.80 |
$851 |
2.8× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$564 |
$705 |
6.3× |
| Infant hip ultrasound, limited static exam (76886) |
$643.20 |
$804 |
7.2× |
| K Flow/Funct Image W/Drug (78708) |
$2,126.40 |
$2,658 |
3.8× |
| K Flow/Funct Image W/O Drug (78707) |
$1,843.20 |
$2,304 |
3.3× |
| Kidney Funcj Study Non-Img Radioisotopic Study (78725) |
$1,542.40 |
$1,928 |
3.8× |
| Kidney Imaging Morphol (78700) |
$936.80 |
$1,171 |
2.3× |
| Knee 3 Views (73562) |
$384.80 |
$481 |
4.3× |
| Leveen/Shunt Patency Exam (78291) |
$1,168.80 |
$1,461 |
2.9× |
| Liver & Spleen Imaging Static Only (78215) |
$1,554.40 |
$1,943 |
3.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$744 |
$930 |
1.8× |
| Lung Perf&Ventilat Diferentl (78598) |
$2,256.80 |
$2,821 |
4.1× |
| Lung perfusion differential (78597) |
$1,459.20 |
$1,824 |
3.6× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,028.80 |
$2,536 |
3.7× |
| Lung Ventilation Imaging (78579) |
$1,181.60 |
$1,477 |
2.9× |
| Lymph System Imaging (78195) |
$2,256 |
$2,820 |
4.1× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,918.40 |
$2,398 |
0.6× |
| Magnetic Image Jaw Joint (70336) |
$2,836.80 |
$3,546 |
11.6× |
| Meckels Divert Exam (78290) |
$1,508 |
$1,885 |
3.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,681.60 |
$4,602 |
10.3× |
| MRA head w/o contrast (70544) |
$2,590.40 |
$3,238 |
10.6× |
| MRA head with contrast (70545) |
$2,950.40 |
$3,688 |
8.3× |
| MRA neck w contrast (70548) |
$2,936 |
$3,670 |
8.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,592.80 |
$4,491 |
10.1× |
| MRA neck w/o contrast (70547) |
$2,516.80 |
$3,146 |
10.3× |
| MRI abdomen w/o contrast (74181) |
$2,902.40 |
$3,628 |
11.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,223.20 |
$4,029 |
4.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,904.80 |
$4,881 |
11.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,223.20 |
$4,029 |
4.0× |
| MRI bone marrow blood supply (77084) |
$2,785.60 |
$3,482 |
11.4× |
| MRI cardiac w/o contrast (75557) |
$2,902.40 |
$3,628 |
11.9× |
| MRI cervical spine w contrast (72142) |
$3,223.20 |
$4,029 |
9.0× |
| MRI cervical spine w/o cont (72141) |
$3,253.60 |
$4,067 |
13.3× |
| MRI chest w/o contrast (71550) |
$3,223.20 |
$4,029 |
13.2× |
| MRI chest wo w contrast (71552) |
$3,868 |
$4,835 |
10.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,580.80 |
$4,476 |
10.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,253.60 |
$4,067 |
13.3× |
| MRI lumbar spine w contrast (72149) |
$3,348 |
$4,185 |
9.4× |
| Mri Neck Spine W/O & W/Dye (72156) |
$4,230.40 |
$5,288 |
11.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,095.20 |
$3,869 |
12.7× |
| MRI orbit face neck w contrast (70542) |
$3,516 |
$4,395 |
9.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,159.20 |
$5,199 |
11.7× |
| MRI pelvis w/o & w contrast (72197) |
$4,295.20 |
$5,369 |
12.1× |
| MRI pelvis w/o contrast (72195) |
$3,223.20 |
$4,029 |
13.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,253.60 |
$4,067 |
13.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,579.20 |
$3,224 |
10.6× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,544.80 |
$4,431 |
9.9× |
| MRI, abdomen, combo (74183) |
$3,937.60 |
$4,922 |
11.0× |
| MRI, dorsal spine combo (72157) |
$4,230.40 |
$5,288 |
11.9× |
| MRI, dorsal spine contrast (72147) |
$3,348 |
$4,185 |
9.4× |
| MRI, joint upper extrem (73221) |
$3,253.60 |
$4,067 |
13.3× |
| MRI, joint upper extrem combo (73223) |
$3,900.80 |
$4,876 |
10.9× |
| MRI, lumbar spine combo (72158) |
$4,230.40 |
$5,288 |
11.9× |
| Myelogram cervical (72240) |
$1,972 |
$2,465 |
2.5× |
| Myelogram Lumbar (72265) |
$1,810.40 |
$2,263 |
2.3× |
| Myelography thoracic (72255) |
$1,817.60 |
$2,272 |
2.3× |
| Myelograpy 2/more regions rs&i (72270) |
$2,453.60 |
$3,067 |
3.1× |
| Myocardial Imaging Infarct Avid Planar Qual/Quan (78466) |
$1,059.20 |
$1,324 |
2.6× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,828 |
$7,285 |
4.4× |
| Myocardial Spect Multiple Studies (78452) |
$4,556 |
$5,695 |
3.4× |
| Neck soft tissue (70360) |
$316.80 |
$396 |
3.6× |
| Nm csf leak detection (78650) |
$1,678.40 |
$2,098 |
1.3× |
| Nonvascular Shunt X-Ray (75809) |
$704 |
$880 |
6.6× |
| Ob us nuchal meas 1 gest (76813) |
$491.20 |
$614 |
4.6× |
| Optic foramina (70190) |
$276 |
$345 |
3.1× |
| Parathyroid imaging w/tomographic spect & CT (78072) |
$2,256 |
$2,820 |
4.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,256 |
$2,820 |
5.5× |
| Pelvis 1 or 2 views (72170) |
$332 |
$415 |
3.1× |
| Peritoneogram Rs&I (74190) |
$1,015.20 |
$1,269 |
1.8× |
| Pet Image W/Ct Lmtd (78814) |
$6,762.40 |
$8,453 |
4.6× |
| PET image w/CT, full body (78816) |
$6,761.60 |
$8,452 |
4.6× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$7,214.40 |
$9,018 |
4.9× |
| Pet Myocardial Sngl Study (78491) |
$5,665.60 |
$7,082 |
3.9× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$1,128 |
$1,410 |
0.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,492 |
$4,365 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,438.40 |
$1,798 |
3.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$571.20 |
$714 |
5.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$830.40 |
$1,038 |
1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$380 |
$475 |
4.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$306.40 |
$383 |
3.4× |
| Radex elbow complete minimum 3 views (73080) |
$380 |
$475 |
4.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$521.60 |
$652 |
4.9× |
| Radex fingr minimum 2 views (73140) |
$253.60 |
$317 |
2.9× |
| Radex foot complete minimum 3 views (73630) |
$380 |
$475 |
4.3× |
| Radex Hand Minimum 3 Views (73130) |
$252 |
$315 |
2.8× |
| Radex lower extremity infant minimum 2 views (73592) |
$212 |
$265 |
2.4× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$354.40 |
$443 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$473.60 |
$592 |
5.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$295.20 |
$369 |
3.3× |
| Radex shoulder complete minimum 2 views (73030) |
$380 |
$475 |
4.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$313.60 |
$392 |
3.5× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$1,455.20 |
$1,819 |
8.1× |
| Radex Spine 1 View Specify Level (72020) |
$344 |
$430 |
3.9× |
| Radex Sternum Minimum 2 Views (71120) |
$340 |
$425 |
3.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$452 |
$565 |
5.1× |
| Radex Toe Minimum 2 Views (73660) |
$273.60 |
$342 |
3.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$278.40 |
$348 |
2.6× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$288.80 |
$361 |
3.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$676.80 |
$846 |
6.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$478.40 |
$598 |
4.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$424.80 |
$531 |
4.0× |
| Radiologic exam colon double contrast study (74280) |
$1,186.40 |
$1,483 |
6.6× |
| Radiologic exam colon single contrast study (74270) |
$1,073.60 |
$1,342 |
6.0× |
| Radiologic exam knee complete 4/more views (73564) |
$435.20 |
$544 |
4.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$410.40 |
$513 |
3.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$798.40 |
$998 |
4.5× |
| Radiologic exam swallow function contrast study (74230) |
$642.40 |
$803 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$950.40 |
$1,188 |
5.3× |
| Radiologic examination femur 1 view (73551) |
$280.80 |
$351 |
3.2× |
| Radiologic examination femur minimum 2 views (73552) |
$255.20 |
$319 |
2.9× |
| Radiologic examination knee 1/2 views (73560) |
$313.60 |
$392 |
3.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$564.80 |
$706 |
5.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$125.60 |
$157 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$342.40 |
$428 |
3.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$143.20 |
$179 |
1.6× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$1,215.20 |
$1,519 |
2.2× |
| Renal Cyst Study (74470) |
$958.40 |
$1,198 |
1.7× |
| Ribs bilateral 3 views (71110) |
$320 |
$400 |
3.0× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$949.60 |
$1,187 |
2.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$2,108.80 |
$2,636 |
5.2× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,712 |
$4,640 |
6.7× |
| Rp Loclzj Tum Plnr Whole Body Single Day Imaging (78802) |
$2,806.40 |
$3,508 |
5.1× |
| Rp Loclzj Tum Spect 1 Area Single Day Imaging (78803) |
$2,669.60 |
$3,337 |
4.8× |
| Scapula (73010) |
$286.40 |
$358 |
2.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$87.20 |
$109 |
3.7× |
| Sella turcica (70240) |
$144 |
$180 |
1.6× |
| Shoulder 1 view (73020) |
$207.20 |
$259 |
2.3× |
| Shoulder Arthrography (73040) |
$1,063.20 |
$1,329 |
3.0× |
| Sialogram (70390) |
$623.20 |
$779 |
2.6× |
| Skull less than 4 views (70250) |
$483.20 |
$604 |
4.5× |
| Spleen Imaging (78185) |
$1,690.40 |
$2,113 |
4.1× |
| Sternoclavicular joints (71130) |
$324 |
$405 |
3.6× |
| Superior sagittal sinus venogram (75870) |
$2,863.20 |
$3,579 |
0.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$984.80 |
$1,231 |
4.0× |
| Testicular Imaging W/Flow (78761) |
$1,096 |
$1,370 |
2.7× |
| Thoracic spine 2 views (72070) |
$400.80 |
$501 |
3.8× |
| Thoracic spine 3 views (72072) |
$493.60 |
$617 |
4.6× |
| Thoracolumbar 2 views (72080) |
$367.20 |
$459 |
4.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,032 |
$1,290 |
2.5× |
| Thyroid Met Imaging Body (78018) |
$2,220.80 |
$2,776 |
4.0× |
| Thyroid Uptake Measurement (78012) |
$860 |
$1,075 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,378.40 |
$1,723 |
3.4× |
| Ultrasound Breast Limited (76642) |
$574.40 |
$718 |
6.5× |
| Ultrasound Exam Aaa Screen (76706) |
$462.40 |
$578 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$741.60 |
$927 |
6.9× |
| Umbilical-artery Doppler (OB) (76820) |
$464 |
$580 |
4.3× |
Unlisted Dx Radiographic Procedure (76499)
range across 2 matching MRF lines |
$721.60–$960 |
$902–$1,200 |
varies |
| Unlisted magnetic resonance procedure (76498) |
$2,656.80 |
$3,321 |
29.9× |
| Unlisted us procedure (76999) |
$464 |
$580 |
5.2× |
| Upper gi w/o kub (74240) |
$955.20 |
$1,194 |
5.3× |
| Ureteral Reflux Study (78740) |
$1,182.40 |
$1,478 |
2.9× |
| Urethrocystogram voiding (74455) |
$908 |
$1,135 |
3.7× |
| Urethrocystography retrograde (74450) |
$848.80 |
$1,061 |
3.5× |
| Us breast unilateral complete (76641) |
$569.60 |
$712 |
5.3× |
| Us chest (76604) |
$560 |
$700 |
5.2× |
| Us complete joint (76881) |
$783.20 |
$979 |
7.3× |
| Us exam, pelvic, limited (76857) |
$641.60 |
$802 |
6.0× |
| Us head (76506) |
$651.20 |
$814 |
6.1× |
| Us kidney transplant (76776) |
$848 |
$1,060 |
7.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$449.60 |
$562 |
4.2× |
| Us ob detailed single fetus (76811) |
$1,072 |
$1,340 |
4.4× |
| Us ob limited 1 or more fetuses (76815) |
$542.40 |
$678 |
5.1× |
| Us ob transvaginal (76817) |
$615.20 |
$769 |
5.8× |
| Us pelvic non ob complete (76856) |
$820.80 |
$1,026 |
7.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$741.60 |
$927 |
6.9× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$537.60 |
$672 |
5.0× |
| Us retroperitoneal complete (76770) |
$854.40 |
$1,068 |
8.0× |
| Us retroperitoneal limited (76775) |
$627.20 |
$784 |
5.9× |
| Us scrotum and contents (76870) |
$726.40 |
$908 |
6.8× |
| Us spinal canal and contents (76800) |
$620 |
$775 |
5.8× |
| Us thyroid (76536) |
$741.60 |
$927 |
6.9× |
| Us transrectal (76872) |
$692 |
$865 |
6.5× |
| Vein X-Ray Chest (75827) |
$2,840.80 |
$3,551 |
1.8× |
| Vein X-Ray Liver W/O Hemodyn (75887) |
$3,120.80 |
$3,901 |
1.0× |
| Venogram Sinus/Jugular (75860) |
$2,495.20 |
$3,119 |
0.8× |
| Venography caval inferior serialography rs&i (75825) |
$5,008.80 |
$6,261 |
1.6× |
| Venography extremity bilateral rs&i (75822) |
$2,602.40 |
$3,253 |
1.6× |
| Venography extremity unilateral rs&i (75820) |
$2,213.60 |
$2,767 |
1.4× |
| Venography Renal Bilateral (75833) |
$3,151.20 |
$3,939 |
1.0× |
| Venography Renal Unilateral (75831) |
$3,856 |
$4,820 |
1.2× |
| Venous sampling by catheter (75893) |
$4,510.40 |
$5,638 |
0.8× |
| Venous Thrombosis Imaging Venogram Bilateral (78458) |
$1,549.60 |
$1,937 |
3.8× |
| Wrist 2 views (73100) |
$276.80 |
$346 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$351.20 |
$439 |
4.0× |
| X-ray antegrade pyelogram tube (74425) |
$931.20 |
$1,164 |
2.6× |
| X-Ray Aorta Leg Arteries (75630) |
$4,833.60 |
$6,042 |
1.5× |
| X-Ray Bend Only L-S Spine (72120) |
$240 |
$300 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$255.20 |
$319 |
2.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$390.40 |
$488 |
4.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$442.40 |
$553 |
4.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$281.60 |
$352 |
3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$339.20 |
$424 |
3.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$459.20 |
$574 |
4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$494.40 |
$618 |
4.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$651.20 |
$814 |
6.1× |
| X-Ray Exam L-S Spine Bending (72114) |
$564 |
$705 |
5.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$432 |
$540 |
4.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$673.60 |
$842 |
6.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$426.40 |
$533 |
4.0× |
| X-ray eye for foreign body (70030) |
$286.40 |
$358 |
3.2× |
| X-ray humerus (73060) |
$268 |
$335 |
3.0× |
| X-ray IV pyelogram (ivp) (74400) |
$714.40 |
$893 |
4.0× |
| X-ray IV pyelogram+tomography (74415) |
$728.80 |
$911 |
4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$340 |
$425 |
3.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$308 |
$385 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$439.20 |
$549 |
4.1× |
| X-ray nose-rectum child f.b. (76010) |
$305.60 |
$382 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$603.20 |
$754 |
5.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$408 |
$510 |
3.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$316 |
$395 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$345.60 |
$432 |
3.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$460.80 |
$576 |
5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$528 |
$660 |
4.9× |
| X-ray thoracic spine 4 vw (72074) |
$509.60 |
$637 |
4.8× |
| X-Ray Tmj Unilat (70328) |
$300 |
$375 |
3.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$1,065.60 |
$1,332 |
3.0× |
X-Rays Bone Length Studies (77073)
range across 2 matching MRF lines |
$332–$521.60 |
$415–$652 |
varies |
| X-Rays Bone Survey Complete (77075) |
$812 |
$1,015 |
7.6× |
| Xr c-spine 4 or 5 views (72050) |
$514.40 |
$643 |
4.8× |
| Xr facial bones less than 3 views (70140) |
$160 |
$200 |
1.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$174.40 |
$218 |
1.6× |
| Xr orbits complete 4 views (70200) |
$375.20 |
$469 |
3.5× |