| Abdomen 2 views (74019) |
$273 |
$455 |
2.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$703.80 |
$1,173 |
1.8× |
| Angiography extremity bilateral rs&i (75716) |
$3,614.40 |
$6,024 |
1.1× |
| Angiography extremity unilateral rs&i (75710) |
$3,307.20 |
$5,512 |
1.0× |
| Angiography internal mammary rs&i (75756) |
$3,307.20 |
$5,512 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$5,748 |
$9,580 |
1.0× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,745.80 |
$6,243 |
1.2× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,307.20 |
$5,512 |
1.0× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,748 |
$9,580 |
1.0× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$3,307.20 |
$5,512 |
1.0× |
| Ankle 2 views (73600) |
$330.60 |
$551 |
3.8× |
| Antegrade urography radiological supvj & interpj (74425) |
$468 |
$780 |
1.3× |
| Aortogram thoracic (75605) |
$5,748 |
$9,580 |
1.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,685.20 |
$6,142 |
1.2× |
| Aortography abdominal serialography rs&i (75625) |
$3,307.20 |
$5,512 |
1.0× |
| Arthrogram elbow (73085) |
$468 |
$780 |
1.3× |
| Arthrogram hip (73525) |
$587.40 |
$979 |
1.7× |
| Arthrogram shoulder (73040) |
$566.40 |
$944 |
1.6× |
| Arthrogram wrist (73115) |
$521.40 |
$869 |
1.5× |
| Arthrography knee lt (73580) |
$504 |
$840 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$864 |
$1,440 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,036.20 |
$1,727 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$2,868 |
$4,780 |
7.2× |
| Bone age studies (77072) |
$366.60 |
$611 |
3.5× |
| Bone Imaging 3 Phase (78315) |
$3,410.40 |
$5,684 |
8.5× |
| Bone survey complete (77075) |
$354.60 |
$591 |
3.4× |
| Brain imaging < 4 static views w vascular flow (78601) |
$625.80 |
$1,043 |
1.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$5,118 |
$8,530 |
3.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,709.80 |
$6,183 |
10.6× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$705.60 |
$1,176 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$181.20 |
$302 |
2.1× |
| Chest 1 view (71045) |
$249 |
$415 |
2.9× |
| Chest 3 views (71047) |
$360 |
$600 |
4.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$261 |
$435 |
1.5× |
| Clavicle complete (73000) |
$411.60 |
$686 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,223.60 |
$3,706 |
6.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,420.20 |
$2,367 |
5.9× |
| CT abdomen w contrast (74160) |
$1,617.60 |
$2,696 |
9.2× |
| CT abdomen w wo contrast (74170) |
$1,828.80 |
$3,048 |
10.4× |
| CT abdomen w/o contrast (74150) |
$707.40 |
$1,179 |
6.8× |
| CT angio hrt w/3d image (75574) |
$2,382 |
$3,970 |
6.8× |
| CT angiography upper extremity lt (73206) |
$1,921.20 |
$3,202 |
10.9× |
| CT c-spine w/o contrast (72125) |
$693 |
$1,155 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,270.20 |
$2,117 |
7.2× |
| CT cervical spine with contrast (72126) |
$1,093.20 |
$1,822 |
3.1× |
| CT chest w/wo contrast (71270) |
$1,059 |
$1,765 |
6.0× |
| CT chest with contrast (71260) |
$916.80 |
$1,528 |
5.2× |
| CT head/brain with contrast (70460) |
$866.40 |
$1,444 |
4.9× |
| CT head/brain without and with contrast (70470) |
$963.60 |
$1,606 |
5.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,063.80 |
$1,773 |
3.0× |
| CT hrt w/3d image congen (75573) |
$2,165.40 |
$3,609 |
6.2× |
| CT iac w contrast (70481) |
$2,291.40 |
$3,819 |
13.0× |
| CT limited/localized follow up study (76380) |
$440.40 |
$734 |
5.1× |
| CT lower ext w/o (73700) |
$1,123.20 |
$1,872 |
10.7× |
| CT lower extremity w wo contrast (73702) |
$1,854.60 |
$3,091 |
10.6× |
| CT lower extremity with contrast (73701) |
$1,190.40 |
$1,984 |
6.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,597.80 |
$2,663 |
9.1× |
| CT lumbar spine w/o contrast (72131) |
$1,288.80 |
$2,148 |
12.3× |
| CT lumbar spine with contrast (72132) |
$1,293.60 |
$2,156 |
3.7× |
| CT maxillofacial w contrast (70487) |
$861 |
$1,435 |
4.9× |
| CT maxillofacial w/o contrast (70486) |
$675 |
$1,125 |
6.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,029.60 |
$1,716 |
5.9× |
| CT neck soft tissue w contrast (70491) |
$817.20 |
$1,362 |
4.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,718.60 |
$4,531 |
15.5× |
| CT orbits w/o contrast (70480) |
$2,091.60 |
$3,486 |
20.0× |
| CT pelvis w & w/o contrast (72194) |
$1,508.40 |
$2,514 |
8.6× |
| CT pelvis w/o contrast (72192) |
$696.60 |
$1,161 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,037.40 |
$1,729 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$717.60 |
$1,196 |
6.9× |
| CT thoracic spine w/contrast (72129) |
$937.80 |
$1,563 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$916.20 |
$1,527 |
8.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,728 |
$2,880 |
9.8× |
| CT thorax w/o contrast (71250) |
$816.60 |
$1,361 |
7.8× |
| CT unlisted procedure (76497) |
$670.80 |
$1,118 |
7.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,342.20 |
$2,237 |
12.8× |
| CT upper extremity with contrast (73201) |
$1,715.40 |
$2,859 |
4.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$864 |
$1,440 |
4.9× |
| Cta Abdomen (74175) |
$2,011.80 |
$3,353 |
11.5× |
| CTA abdomen pelvis (74174) |
$2,446.20 |
$4,077 |
7.0× |
| CTA chest (71275) |
$1,165.20 |
$1,942 |
6.6× |
| Cta Head (70496) |
$1,060.20 |
$1,767 |
6.0× |
| CTA lwr ext w&w/o contrast (73706) |
$2,040 |
$3,400 |
11.6× |
| Cta Neck (70498) |
$1,141.20 |
$1,902 |
6.5× |
| Cta Pelvis (72191) |
$1,659 |
$2,765 |
9.4× |
| Cystography minimum 3 views rs&i (74430) |
$468 |
$780 |
1.3× |
| Echo exam of eye (76529) |
$115.80 |
$193 |
1.3× |
| Echoencephalography real time imaging (76506) |
$283.20 |
$472 |
2.7× |
| Esophagus (74220) |
$793.80 |
$1,323 |
4.5× |
| Fluoroscopy up to 1 hr (76000) |
$346.20 |
$577 |
1.4× |
| Foot 2 views (73620) |
$369.60 |
$616 |
4.2× |
| Forearm 2 views (73090) |
$348.60 |
$581 |
4.0× |
| Functional MRI brain by phys/psych (70555) |
$2,750.40 |
$4,584 |
11.5× |
| Functional MRI brain by tech (70554) |
$2,720.40 |
$4,534 |
11.4× |
| Hand 2 views (73120) |
$421.20 |
$702 |
4.0× |
| Hand 3 views (73130) |
$523.20 |
$872 |
6.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,555.60 |
$5,926 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,926.80 |
$4,878 |
5.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$818.40 |
$1,364 |
2.0× |
| Ht muscle image spect sing (78451) |
$1,710 |
$2,850 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$118.80 |
$198 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$247.20 |
$412 |
2.4× |
| Kidney funcj study non-img radioisotopic study (78725) |
$628.80 |
$1,048 |
1.6× |
| Kidney imaging morphology (78700) |
$862.20 |
$1,437 |
2.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,168.40 |
$3,614 |
4.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,276.40 |
$3,794 |
4.2× |
| Knee 3 views (73562) |
$447 |
$745 |
5.1× |
| Lung perf&ventilat diferentl (78598) |
$1,026 |
$1,710 |
1.9× |
| Lung perfusion differential (78597) |
$696 |
$1,160 |
1.7× |
| Lung Ventilation Imaging (78579) |
$526.80 |
$878 |
1.3× |
| Lymphangio Abd/Pelv Bilat - Ir Lymphangiogram Abdomen Pelvis Bilat (75807) |
$3,307.20 |
$5,512 |
1.0× |
| Lymphangiography Pelvic/Abdominal Unilat Rs&I (75805) |
$3,035.40 |
$5,059 |
1.0× |
| Lymphoscintigraphy (78195) |
$1,648.80 |
$2,748 |
3.0× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$115.80 |
$193 |
1.3× |
| Meckels Diverticulum (78290) |
$992.40 |
$1,654 |
2.5× |
| Medical physics dose eval radiation expos w/rprt (76145) |
$316.20 |
$527 |
0.8× |
| Mr elastography (76391) |
$2,154.60 |
$3,591 |
9.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$35.40 |
$59 |
1.2× |
| MRA head w & w/o contrast (70546) |
$1,684.80 |
$2,808 |
4.8× |
| MRA head w/o contrast (70544) |
$1,045.80 |
$1,743 |
4.4× |
| MRA head with contrast (70545) |
$1,329.60 |
$2,216 |
3.8× |
| MRA neck w contrast (70548) |
$2,514 |
$4,190 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,679.60 |
$4,466 |
7.7× |
| MRA neck w/o contrast (70547) |
$2,280.60 |
$3,801 |
9.5× |
| MRI abdomen w contrast (74182) |
$2,223 |
$3,705 |
6.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,211.60 |
$8,686 |
14.9× |
| MRI abdomen w/o contrast (74181) |
$2,167.20 |
$3,612 |
9.1× |
| MRI any jnt lwr ext with con lt (73722) |
$4,143.60 |
$6,906 |
5.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,898.20 |
$6,497 |
5.0× |
| MRI bone marrow blood supply (77084) |
$358.80 |
$598 |
1.5× |
| MRI c-spine with contrast (72142) |
$3,720.60 |
$6,201 |
10.6× |
| MRI cardiac w/o cont stress (75559) |
$2,944.80 |
$4,908 |
5.4× |
| MRI cardiac w/o contrast (75557) |
$2,804.40 |
$4,674 |
11.7× |
| MRI cervical spine w/o contrast (72141) |
$3,543.60 |
$5,906 |
14.8× |
| MRI chest w/o & w/contrast material (71552) |
$4,158.60 |
$6,931 |
11.9× |
| MRI chest w/o contrast (71550) |
$3,730.80 |
$6,218 |
15.6× |
| MRI fetal sngl/1st gestation (74712) |
$1,338 |
$2,230 |
5.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,003.60 |
$5,006 |
8.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$5,900.40 |
$9,834 |
16.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$5,042.70 |
$8,404.50 |
21.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,821 |
$3,035 |
7.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,200 |
$7,000 |
12.0× |
| MRI orbit/face/neck w/contrast (70542) |
$2,151 |
$3,585 |
6.2× |
| MRI pelvis w contrast (72196) |
$6,004.80 |
$10,008 |
17.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,915.80 |
$8,193 |
14.1× |
| MRI pelvis w/o contrast (72195) |
$3,422.40 |
$5,704 |
14.3× |
| MRI scan of arm joint before and after contrast (73223) |
$4,093.20 |
$6,822 |
11.7× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$3,810.60 |
$6,351 |
4.9× |
| MRI scan of leg joint before and after contrast (73723) |
$4,602.60 |
$7,671 |
13.2× |
| MRI spectroscopy (76390) |
$1,312.80 |
$2,188 |
15.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,679.40 |
$7,799 |
13.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,650.40 |
$6,084 |
10.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,690.80 |
$7,818 |
13.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,617.40 |
$6,029 |
10.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,683 |
$7,805 |
13.4× |
| MRI thoracic spine w/o contrast (72146) |
$3,445.20 |
$5,742 |
14.4× |
| MRI tmj (70336) |
$3,916.80 |
$6,528 |
16.4× |
| MRI upper ext joint w/o contrast (73221) |
$3,712.80 |
$6,188 |
15.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,095.60 |
$6,826 |
11.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,172.80 |
$5,288 |
13.3× |
| Myocardial Spect Multiple Studies (78452) |
$2,377.80 |
$3,963 |
1.8× |
| Neck soft tissue (70360) |
$115.80 |
$193 |
1.3× |
| Nm gastric emptying study (78264) |
$2,472.60 |
$4,121 |
6.2× |
| Nm gastroesophageal reflux study (78262) |
$874.80 |
$1,458 |
2.2× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$3,160.20 |
$5,267 |
2.2× |
| Nuclear medicine study of digestive tracts (78299) |
$401.40 |
$669 |
1.0× |
| Orthopantogram (70355) |
$116.40 |
$194 |
1.3× |
| Osseous survey infant (77076) |
$178.80 |
$298 |
1.7× |
| Osseous survey limited (77074) |
$263.40 |
$439 |
2.5× |
| Parathyrd planar w/spect&CT (78072) |
$939.60 |
$1,566 |
1.7× |
| Parathyrd planar w/wo subtrj (78071) |
$767.40 |
$1,279 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$421.80 |
$703 |
4.0× |
| Perineogram (74775) |
$511.20 |
$852 |
2.1× |
| PET image w/CT, skull-thigh (78815) |
$3,396.60 |
$5,661 |
2.4× |
| PET imaging CT for attenuation limited area (78814) |
$2,674.80 |
$4,458 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$4,395.60 |
$7,326 |
3.1× |
| PET imaging limited area chest head/neck (78811) |
$1,875 |
$3,125 |
1.4× |
| PET whole body (78813) |
$3,475.20 |
$5,792 |
2.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,420.80 |
$7,368 |
12.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$4,075.20 |
$6,792 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$683.40 |
$1,139 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,987.20 |
$3,312 |
3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$689.40 |
$1,149 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$193.20 |
$322 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$241.20 |
$402 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$220.20 |
$367 |
2.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$255 |
$425 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$387.60 |
$646 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$285 |
$475 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$257.40 |
$429 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$304.80 |
$508 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$340.80 |
$568 |
3.9× |
| Radiologic exam colon single contrast study (74270) |
$372 |
$620 |
2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$879.60 |
$1,466 |
5.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$660 |
$1,100 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$567.60 |
$946 |
3.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$148.80 |
$248 |
1.7× |
| Review by radiologist of liver vein image with assessment of blood flow (75889) |
$3,734.40 |
$6,224 |
1.2× |
| Ribs bilateral 3 views (71110) |
$321.60 |
$536 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,849.20 |
$3,082 |
4.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$3,031.20 |
$5,052 |
5.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,989 |
$3,315 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,254.20 |
$3,757 |
1.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$5,579.40 |
$9,299 |
3.9× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$3,936.60 |
$6,561 |
3.0× |
| Rp Therapy Intravenous Administration (79101) |
$651 |
$1,085 |
2.8× |
| Sacroiliac Joints < 3 Views (72200) |
$348.60 |
$581 |
3.3× |
| Scanogram (77073) |
$402 |
$670 |
3.8× |
| Scapula complete (73010) |
$354.60 |
$591 |
3.4× |
| Small bowel series (74250) |
$334.20 |
$557 |
1.9× |
| Speech evaluation complex (70371) |
$440.40 |
$734 |
1.8× |
| Spine thoracic 3 views (72072) |
$303.60 |
$506 |
2.9× |
| Spleen imaging only (78185) |
$526.80 |
$878 |
1.3× |
| Splenoportograpy rs&i (75810) |
$3,307.20 |
$5,512 |
1.0× |
| Therapeutic Enema (74283) |
$619.80 |
$1,033 |
3.5× |
| Thoracolumbar 2 views (72080) |
$190.80 |
$318 |
2.2× |
| Ultrasound elastography first target lesion (76982) |
$639 |
$1,065 |
6.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$359.40 |
$599 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$285 |
$475 |
2.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$177 |
$295 |
2.0× |
| Unlisted magnetic resonance procedure (76498) |
$1,740 |
$2,900 |
20.0× |
| Unlisted nervous system procedure, diagnostic nuclear medicine UNSCHEDULED (78699) |
$557.40 |
$929 |
1.4× |
| Unlisted Ultrasound Procedure (76999) |
$145.80 |
$243 |
1.7× |
| Upper Extremity Infant (73092) |
$280.20 |
$467 |
2.7× |
| Urethrocystography retrograde rs&i (74450) |
$446.40 |
$744 |
1.9× |
| Urethrocystography voiding (74455) |
$997.80 |
$1,663 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$240.60 |
$401 |
2.3× |
| Us breast unilateral complete (76641) |
$429 |
$715 |
4.1× |
| Us breast unilateral limited (76642) |
$334.80 |
$558 |
3.8× |
| Us chest (76604) |
$214.80 |
$358 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$324.60 |
$541 |
3.1× |
| Us elastography parenchyma (76981) |
$999 |
$1,665 |
9.5× |
| Us guided compression repair (76936) |
$742.80 |
$1,238 |
3.4× |
| Us infant hips dynamic (76885) |
$580.80 |
$968 |
6.7× |
| Us infant hips limited static (76886) |
$553.20 |
$922 |
6.3× |
| Us kidney transplant (76776) |
$358.80 |
$598 |
3.4× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$388.80 |
$648 |
3.7× |
| Us ob transvaginal (76817) |
$262.80 |
$438 |
2.5× |
| Us pelvic non ob complete (76856) |
$309 |
$515 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$282 |
$470 |
2.7× |
| Us pregnancy ltd (76815) |
$258 |
$430 |
2.5× |
| Us retroperitoneal complete (76770) |
$1,189.80 |
$1,983 |
11.4× |
| Us retroperitoneal limited (76775) |
$254.40 |
$424 |
2.4× |
| Us scrotum and contents (76870) |
$460.80 |
$768 |
4.4× |
| Us soft tissue head/neck (76536) |
$1,118.40 |
$1,864 |
10.7× |
| Us spinal canal and contents (76800) |
$700.20 |
$1,167 |
6.7× |
| Us xtr non-vasc lmtd (76882) |
$270.60 |
$451 |
2.6× |
| Us, eye b-scan (76512) |
$241.20 |
$402 |
2.3× |
| Venogram extremity bilateral (75822) |
$1,660.20 |
$2,767 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$3,307.20 |
$5,512 |
1.0× |
| Venography caval superior serialography rs&i (75827) |
$1,660.20 |
$2,767 |
1.1× |
| Venography extremity unilateral rs&i (75820) |
$1,363.20 |
$2,272 |
0.9× |
| Venography renal unilateral selective rs&i (75831) |
$4,204.80 |
$7,008 |
1.3× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,307.20 |
$5,512 |
1.0× |
| Wrist 2 views (73100) |
$319.80 |
$533 |
3.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$260.40 |
$434 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$291.30 |
$485.50 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$367.20 |
$612 |
4.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$504 |
$840 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$313.80 |
$523 |
3.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$403.20 |
$672 |
4.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$312 |
$520 |
3.0× |
| X-ray exam hip uni 1 view (73501) |
$117.60 |
$196 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$179.40 |
$299 |
2.1× |
| X-ray exam hip uni 4/> views (73503) |
$400.80 |
$668 |
3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$392.40 |
$654 |
3.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$462 |
$770 |
4.4× |
| X-ray exam of femur 1 (73551) |
$116.40 |
$194 |
1.3× |
| X-ray eye for foreign body (70030) |
$123 |
$205 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$273 |
$455 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$209.40 |
$349 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$382.80 |
$638 |
4.4× |
| X-ray head for orthodontia (70350) |
$115.80 |
$193 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$391.20 |
$652 |
4.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$205.80 |
$343 |
2.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$512.40 |
$854 |
4.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$290.40 |
$484 |
3.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$143.40 |
$239 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$426.60 |
$711 |
4.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$544.80 |
$908 |
5.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$343.80 |
$573 |
3.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$459.60 |
$766 |
5.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$136.20 |
$227 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$468 |
$780 |
4.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$451.80 |
$753 |
4.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$468 |
$780 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$226.80 |
$378 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$223.80 |
$373 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$392.40 |
$654 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$439.80 |
$733 |
4.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$418.50 |
$697.50 |
4.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$432.60 |
$721 |
5.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$348 |
$580 |
4.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$166.80 |
$278 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$670.80 |
$1,118 |
6.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$146.40 |
$244 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$157.80 |
$263 |
1.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$264.60 |
$441 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$233.70 |
$389.50 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$187.80 |
$313 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$349.20 |
$582 |
3.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$429 |
$715 |
4.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$407.40 |
$679 |
4.7× |
| Xr arthrogram ankle (73615) |
$468 |
$780 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$807 |
$1,345 |
7.7× |
| Xr chest 4+ views (71048) |
$385.20 |
$642 |
3.7× |
| Xr finger(s) 2+ views (73140) |
$326.40 |
$544 |
3.7× |
| Xr shoulder 1 view (73020) |
$150 |
$250 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$694.20 |
$1,157 |
6.6× |
| Xr tibia/fibula 2 views (73590) |
$365.40 |
$609 |
4.2× |
| Xr tmj bilateral (70330) |
$314.40 |
$524 |
3.6× |
| Xray knee 1 or 2 views rt (73560) |
$348.60 |
$581 |
4.0× |