| Abdomen 2 views (74019) |
$207.60 |
$346 |
1.7× |
| Acute gi blood loss imaging (78278) |
$743.40 |
$1,239 |
1.6× |
| Angiography extremity bilateral rs&i (75716) |
$3,294 |
$5,490 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,664.60 |
$4,441 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$2,554.80 |
$4,258 |
0.7× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,937.60 |
$4,896 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,603.40 |
$4,339 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$2,872.20 |
$4,787 |
0.8× |
| Angiography Spinal Selective Rs&I (75705) |
$4,520.40 |
$7,534 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,764 |
$7,940 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,155 |
$1,925 |
0.3× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,665.60 |
$2,776 |
0.4× |
| Ankle 2 views (73600) |
$157.80 |
$263 |
1.5× |
| Aortogram thoracic (75605) |
$3,461.40 |
$5,769 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,699.60 |
$3,168 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$2,872.20 |
$4,787 |
0.8× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$1,126.20 |
$1,877 |
0.3× |
| Artery X-Rays Adrenal Gland (75731) |
$1,155 |
$1,925 |
0.3× |
| Arthrogram ankle (73615) |
$547.80 |
$913 |
1.3× |
| Arthrogram elbow (73085) |
$556.80 |
$928 |
1.4× |
| Arthrogram hip (73525) |
$556.80 |
$928 |
1.4× |
| Arthrogram knee (73580) |
$547.80 |
$913 |
1.3× |
| Arthrogram shoulder (73040) |
$781.80 |
$1,303 |
1.9× |
| Arthrogram wrist (73115) |
$547.80 |
$913 |
1.3× |
| Basic dosimetry (77300) |
$261.60 |
$436 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$743.40 |
$1,239 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$835.80 |
$1,393 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$858.60 |
$1,431 |
1.8× |
| Bone age studies (77072) |
$109.20 |
$182 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$904.20 |
$1,507 |
1.9× |
| Bone Marrow Imaging Limited Area (78102) |
$743.40 |
$1,239 |
1.6× |
| Bone survey complete (77075) |
$409.20 |
$682 |
3.3× |
| Bone survey infant (77076) |
$167.40 |
$279 |
1.4× |
| Bowel imaging (78290) |
$743.40 |
$1,239 |
1.6× |
| Brachytx isodose complex (77318) |
$517.20 |
$862 |
1.2× |
| Brain Imaging Vascular Flow Only (78610) |
$964.80 |
$1,608 |
1.5× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$964.80 |
$1,608 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$743.40 |
$1,239 |
1.6× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,723.20 |
$2,872 |
1.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,553.40 |
$2,589 |
3.8× |
| Cardiac shunt detection (78428) |
$791.40 |
$1,319 |
1.7× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$964.80 |
$1,608 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$255 |
$425 |
2.5× |
| Chest 1 view (71045) |
$205.20 |
$342 |
2.0× |
| Chest xray 3 views (71047) |
$267 |
$445 |
2.6× |
| Cholecystography, oral contrast Non-Facility (74290) |
$481.20 |
$802 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$416.40 |
$694 |
2.0× |
| Clavicle complete (73000) |
$171 |
$285 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$406.20 |
$677 |
3.3× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$462 |
$770 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,538 |
$4,230 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,009.40 |
$3,349 |
7.1× |
| CT abdomen w contrast (74160) |
$1,378.20 |
$2,297 |
6.7× |
| CT abdomen w wo contrast (74170) |
$1,686 |
$2,810 |
8.1× |
| CT abdomen w/o contrast (74150) |
$1,156.80 |
$1,928 |
9.4× |
| CT angio hrt w/3d image (75574) |
$1,123.20 |
$1,872 |
2.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,462.50 |
$2,437.50 |
7.1× |
| CT angiography upper extremity lt (73206) |
$1,258.80 |
$2,098 |
6.1× |
| CT c-spine w/contrast (72126) |
$1,383 |
$2,305 |
3.4× |
| CT c-spine w/o contrast (72125) |
$1,090.20 |
$1,817 |
8.8× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,360.80 |
$2,268 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,470.60 |
$2,451 |
7.1× |
| CT chest w contrast (71260) |
$1,393.80 |
$2,323 |
6.7× |
| CT chest w/wo contrast (71270) |
$1,509.60 |
$2,516 |
7.3× |
| CT colonography screening (74263) |
$1,360.20 |
$2,267 |
4.8× |
| CT colonography w/dye (74262) |
$1,077.60 |
$1,796 |
5.2× |
| CT colonography w/o cntrst (74261) |
$809.40 |
$1,349 |
6.6× |
| CT head/brain with contrast (70460) |
$1,273.20 |
$2,122 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,363.80 |
$2,273 |
6.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$762 |
$1,270 |
1.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$125.40 |
$209 |
1.2× |
| CT hrt w/3d image congen (75573) |
$883.20 |
$1,472 |
2.1× |
| CT iac w contrast (70481) |
$1,240.20 |
$2,067 |
6.0× |
| CT limited/localized follow up study (76380) |
$330 |
$550 |
3.2× |
| CT lower ext w/o (73700) |
$1,165.80 |
$1,943 |
9.4× |
| CT lower extremity w wo contrast (73702) |
$1,447.20 |
$2,412 |
7.0× |
| CT lower extremity w/contrast material (73701) |
$1,328.40 |
$2,214 |
6.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,447.20 |
$2,412 |
7.0× |
| CT lumbar spine w/contrast (72132) |
$1,528.80 |
$2,548 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,210.20 |
$2,017 |
9.8× |
| CT maxillofacial w contrast (70487) |
$1,093.80 |
$1,823 |
5.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,363.80 |
$2,273 |
6.6× |
| CT maxillofacial wo contrast (70486) |
$820.80 |
$1,368 |
6.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,378.20 |
$2,297 |
6.7× |
| CT orbits w/o contrast (70480) |
$1,180.20 |
$1,967 |
9.6× |
| CT pelvis w/o contrast (72192) |
$1,308 |
$2,180 |
10.6× |
| CT pelvis w/wo contrast (72194) |
$1,447.20 |
$2,412 |
7.0× |
| CT scan of arm combo (73202) |
$1,470.60 |
$2,451 |
7.1× |
| CT soft tissue neck w contrast (70491) |
$1,394.40 |
$2,324 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,470.60 |
$2,451 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,210.20 |
$2,017 |
9.8× |
| CT thoracic spine w/contrast (72129) |
$1,603.80 |
$2,673 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,465.20 |
$2,442 |
11.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,447.20 |
$2,412 |
7.0× |
| CT thorax w/o contrast (71250) |
$1,196.10 |
$1,993.50 |
9.7× |
| CT unlisted procedure (76497) |
$1,053.60 |
$1,756 |
10.2× |
| CT upper ext wo (73200) |
$1,103.40 |
$1,839 |
8.9× |
| CT upper extremity with contrast (73201) |
$1,273.20 |
$2,122 |
3.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,563.60 |
$2,606 |
7.5× |
| Cta Abdomen (74175) |
$1,689.30 |
$2,815.50 |
8.2× |
| CTA abdomen pelvis (74174) |
$2,649 |
$4,415 |
6.4× |
| CTA chest (71275) |
$1,532.40 |
$2,554 |
7.4× |
| Cta Head (70496) |
$1,851 |
$3,085 |
8.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,360.80 |
$2,268 |
3.3× |
| Cta Neck (70498) |
$1,915.20 |
$3,192 |
9.2× |
| Cta Pelvis (72191) |
$1,630.80 |
$2,718 |
7.9× |
| Cystography minimum 3 views rs&i (74430) |
$292.50 |
$487.50 |
0.7× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$2,001 |
$3,335 |
0.8× |
| Diskogram cervical (72285) |
$1,840.20 |
$3,067 |
0.8× |
| Diskography lumbar (72295) |
$1,992.60 |
$3,321 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$249.60 |
$416 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$146.40 |
$244 |
1.4× |
| Echo exam of eye (76529) |
$88.80 |
$148 |
0.9× |
| Esophagus (74220) |
$253.80 |
$423 |
1.2× |
| Facial bones min 3 views (70150) |
$370.20 |
$617 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$284.40 |
$474 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$81.60 |
$136 |
0.7× |
| Fluoroscopy up to 1 hr (76000) |
$473.40 |
$789 |
1.7× |
| Foot 2 views (73620) |
$166.20 |
$277 |
1.6× |
| Forearm 2 views (73090) |
$223.80 |
$373 |
2.2× |
| Functional MRI brain by phys/psych (70555) |
$1,548.60 |
$2,581 |
5.5× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$743.40 |
$1,239 |
1.6× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$964.80 |
$1,608 |
1.5× |
| Hand 2 views (73120) |
$207.60 |
$346 |
1.7× |
| Heart Infarct Image (78466) |
$743.40 |
$1,239 |
1.6× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,347.80 |
$3,913 |
0.6× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,872.20 |
$4,787 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$964.80 |
$1,608 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$743.40 |
$1,239 |
1.6× |
| Hysterosalpingogram (74740) |
$543.60 |
$906 |
1.9× |
| Interstitial radiation source applic complex (77778) |
$1,581.60 |
$2,636 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$595.80 |
$993 |
4.8× |
| Kidney imaging morphology (78700) |
$743.40 |
$1,239 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$964.80 |
$1,608 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,148.40 |
$1,914 |
1.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,210.80 |
$2,018 |
1.9× |
| Knee 3 views (73562) |
$266.10 |
$443.50 |
2.6× |
| Liver & spleen imaging static only (78215) |
$743.40 |
$1,239 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$857.40 |
$1,429 |
1.8× |
| Liver imaging static only (78201) |
$1,098.60 |
$1,831 |
1.7× |
| Lung perf&ventilat diferentl (78598) |
$964.80 |
$1,608 |
1.5× |
| Lung perfusion differential (78597) |
$743.40 |
$1,239 |
1.6× |
| Lung ventilation imaging (78579) |
$743.40 |
$1,239 |
1.6× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$1,920 |
$3,200 |
0.5× |
| Lymphoscintigraphy (78195) |
$964.80 |
$1,608 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,749.60 |
$2,916 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,323.60 |
$2,206 |
3.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,543.80 |
$2,573 |
3.7× |
| Mammary ductogram or galactogram multiple (77054) |
$436.20 |
$727 |
1.5× |
| Mammary ductogram or galactogram single (77053) |
$347.40 |
$579 |
1.2× |
| Mr safety determination physician/other qhp (76016) |
$202.20 |
$337 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$56.40 |
$94 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$222.60 |
$371 |
2.0× |
| Mr safety implt pos&/immoblj (76019) |
$151.20 |
$252 |
2.2× |
| Mr safety med physics xm customization plng&mntr (76017) |
$555 |
$925 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,122.20 |
$3,537 |
5.1× |
| MRA head w/o contrast (70544) |
$1,308 |
$2,180 |
4.6× |
| MRA head with contrast (70545) |
$1,734.60 |
$2,891 |
4.2× |
| MRA neck w contrast (70548) |
$1,624.50 |
$2,707.50 |
3.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,856.10 |
$3,093.50 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,492.20 |
$2,487 |
5.3× |
| MRI abdomen w contrast (74182) |
$1,520.40 |
$2,534 |
3.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,924.80 |
$3,208 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$1,716 |
$2,860 |
6.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,686 |
$2,810 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,899 |
$3,165 |
4.6× |
| MRI bone marrow blood supply (77084) |
$1,371.60 |
$2,286 |
4.9× |
| MRI breast w/o contrast bilateral (77047) |
$2,031.60 |
$3,386 |
7.2× |
| MRI breast wo contrast unilateral (77046) |
$1,410 |
$2,350 |
5.0× |
| MRI c-spine with contrast (72142) |
$1,436.40 |
$2,394 |
3.5× |
| MRI cardiac w/o cont stress (75559) |
$1,303.80 |
$2,173 |
2.0× |
| MRI cardiac w/o contrast (75557) |
$1,441.20 |
$2,402 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,392.90 |
$2,321.50 |
4.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,765.80 |
$2,943 |
4.3× |
| MRI chest w/o contrast (71550) |
$1,452.90 |
$2,421.50 |
5.2× |
| MRI chest with contrast (71551) |
$1,686 |
$2,810 |
1.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,436.40 |
$2,394 |
3.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,752 |
$2,920 |
4.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,654.20 |
$2,757 |
5.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,464.60 |
$2,441 |
5.2× |
| MRI orbit face neck w contrast (70542) |
$1,517.40 |
$2,529 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,952.40 |
$3,254 |
4.7× |
| MRI pelvis w/contrast (72196) |
$1,524.30 |
$2,540.50 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,802.70 |
$3,004.50 |
4.4× |
| MRI pelvis w/o contrast (72195) |
$1,594.80 |
$2,658 |
5.7× |
| MRI spectroscopy (76390) |
$1,374 |
$2,290 |
13.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,746 |
$2,910 |
4.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,635.60 |
$2,726 |
4.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,037.60 |
$3,396 |
4.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,638.60 |
$2,731 |
4.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,774.80 |
$2,958 |
4.3× |
| MRI temporomandibular joint (70336) |
$1,324.80 |
$2,208 |
4.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,512.60 |
$2,521 |
5.4× |
| MRI up ext w/o contrast (73218) |
$1,395 |
$2,325 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,787.40 |
$2,979 |
6.3× |
| MRI, joint upper extrem combo (73223) |
$2,099.40 |
$3,499 |
5.1× |
| Myocardial infarct spect (78469) |
$1,959 |
$3,265 |
3.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,785.80 |
$4,643 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,575.80 |
$4,293 |
1.7× |
| N-invas est c ffr sw aly CTA (75580) |
$1,431 |
$2,385 |
1.4× |
| Neck soft tissue (70360) |
$233.40 |
$389 |
2.3× |
| Njx Rp Loclzj Non-Img Probe Study Intravenous (78808) |
$386.40 |
$644 |
0.8× |
| Nm bone marrow multi (78103) |
$835.20 |
$1,392 |
1.8× |
| Nm cardiac blood pool multiple (78473) |
$876.60 |
$1,461 |
1.9× |
| Nm cisternogram (78630) |
$964.80 |
$1,608 |
1.5× |
| Nm csf leak detection (78650) |
$2,575.80 |
$4,293 |
1.7× |
| Nm gastric emptying study (78264) |
$743.40 |
$1,239 |
1.6× |
| Nm gastroesophageal reflux study (78262) |
$743.40 |
$1,239 |
1.6× |
| Nm kidney scan w/flow (78701) |
$743.40 |
$1,239 |
1.6× |
| Nm peritoneal-venous shunt patency (78291) |
$743.40 |
$1,239 |
1.6× |
| Noncardiac Vascular Flow Imaging (78445) |
$743.40 |
$1,239 |
1.6× |
| Nonvascular shunt X-ray (75809) |
$497.40 |
$829 |
4.0× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$1,696.80 |
$2,828 |
3.6× |
| Nuclear Rx Oral Admin (79005) |
$478.20 |
$797 |
1.7× |
| Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Non-Facility (76519) |
$64.20 |
$107 |
0.5× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$72.60 |
$121 |
0.6× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$6 |
$10 |
0.2× |
| Osseous survey limited (77074) |
$256.20 |
$427 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$743.40 |
$1,239 |
1.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$743.40 |
$1,239 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$162.60 |
$271 |
1.3× |
| Perineogram (74775) |
$528.60 |
$881 |
1.9× |
| Peritoneogram after injection (74190) |
$547.20 |
$912 |
0.8× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,872.20 |
$4,787 |
0.8× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,889.40 |
$3,149 |
0.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$743.40 |
$1,239 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$964.80 |
$1,608 |
1.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$530.40 |
$884 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$234 |
$390 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$137.70 |
$229.50 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$246.90 |
$411.50 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$128.40 |
$214 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$222.90 |
$371.50 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$242.10 |
$403.50 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$142.20 |
$237 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$221.40 |
$369 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$248.40 |
$414 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$121.80 |
$203 |
1.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$198.60 |
$331 |
1.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$184.50 |
$307.50 |
1.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$341.10 |
$568.50 |
2.8× |
| Radex Humerus Minimum 2 Views (73060) |
$157.80 |
$263 |
1.5× |
| Radex Kne 1/2 Views (73560) |
$194.70 |
$324.50 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$300 |
$500 |
2.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$340.80 |
$568 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$227.40 |
$379 |
2.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$277.20 |
$462 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$222.90 |
$371.50 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$160.80 |
$268 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$211.80 |
$353 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$482.40 |
$804 |
4.7× |
| Radex Toe Minimum 2 Views (73660) |
$127.20 |
$212 |
1.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$208.80 |
$348 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$237 |
$395 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$325.80 |
$543 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$192 |
$320 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$222 |
$370 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$238.20 |
$397 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$515.40 |
$859 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$250.20 |
$417 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$250.20 |
$417 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$217.80 |
$363 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$114 |
$190 |
1.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$402.60 |
$671 |
3.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$180 |
$300 |
1.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$297 |
$495 |
2.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$169.20 |
$282 |
1.4× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Non-Facility (70370) |
$504.60 |
$841 |
4.9× |
| Radiological examination surgical specimen (76098) |
$497.40 |
$829 |
0.8× |
| Renal Cyst Study (74470) |
$425.40 |
$709 |
0.7× |
| Ribs bilateral 3 views (71110) |
$200.40 |
$334 |
1.6× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$743.40 |
$1,239 |
1.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$904.20 |
$1,507 |
1.9× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,352 |
$3,920 |
3.7× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,001 |
$3,335 |
3.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,932.60 |
$3,221 |
3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,785.80 |
$4,643 |
1.8× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,001.80 |
$5,003 |
1.8× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,647.80 |
$4,413 |
1.7× |
| Rp therapy intra-arterial particulate admn (79445) |
$498.60 |
$831 |
1.8× |
| Rp Therapy Intravenous Administration (79101) |
$498.60 |
$831 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$186 |
$310 |
1.5× |
| Salivary gland imaging (78230) |
$743.40 |
$1,239 |
1.6× |
| Scapula (73010) |
$223.80 |
$373 |
1.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$58.50 |
$97.50 |
2.5× |
| Sella turcica (70240) |
$360.60 |
$601 |
3.5× |
| Shoulder 1 view (73020) |
$195.60 |
$326 |
1.9× |
| Sialogram (70390) |
$451.80 |
$753 |
1.6× |
| Small bowel series (74250) |
$489 |
$815 |
2.4× |
| Special treatment procedure (77470) |
$1,096.20 |
$1,827 |
1.7× |
| Spine thoracic 3 views (72072) |
$313.20 |
$522 |
2.5× |
| Spleen imaging only (78185) |
$743.40 |
$1,239 |
1.6× |
| Superior sagittal sinus venogram (75870) |
$1,328.40 |
$2,214 |
0.4× |
| Testicular Imaging With Vascular Flow (78761) |
$743.40 |
$1,239 |
1.6× |
| Thoracolumbar 2 views (72080) |
$219 |
$365 |
2.1× |
| Thyroid carcinoma metastases img whole body (78018) |
$964.80 |
$1,608 |
1.5× |
| Thyroid imaging w/blood flow (78013) |
$835.80 |
$1,393 |
1.8× |
| Thyroid uptake measurement (78012) |
$743.40 |
$1,239 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$919.80 |
$1,533 |
1.9× |
| Tmj unilateral (70328) |
$240.60 |
$401 |
2.3× |
| Tomogram (76100) |
$355.20 |
$592 |
2.9× |
| Ultrasound breast complete (76641) |
$326.40 |
$544 |
2.6× |
| Ultrasound elastography first target lesion (76982) |
$273.60 |
$456 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$187.80 |
$313 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$271.20 |
$452 |
2.2× |
| Unlisted magnetic resonance procedure (76498) |
$4,709.40 |
$7,849 |
45.8× |
| Unlisted ultrasound procedure (76999) |
$309.90 |
$516.50 |
3.0× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$223.20 |
$372 |
20.2× |
| Ureteral reflux study (78740) |
$743.40 |
$1,239 |
1.6× |
| Urethrocystogram voiding (74455) |
$549 |
$915 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$804 |
$1,340 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$703.20 |
$1,172 |
3.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$595.20 |
$992 |
2.9× |
| Us breast unilateral limited (76642) |
$273.60 |
$456 |
2.7× |
| Us chest (76604) |
$220.80 |
$368 |
1.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$339.60 |
$566 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$297.60 |
$496 |
2.4× |
| Us elastography parenchyma (76981) |
$226.80 |
$378 |
1.8× |
| Us hips infant static (76886) |
$412.80 |
$688 |
4.0× |
| Us infant hips w manipulation (76885) |
$445.20 |
$742 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$198.60 |
$331 |
1.6× |
| Us ob detailed single fetus (76811) |
$562.80 |
$938 |
2.0× |
| Us ob limited (76815) |
$243.60 |
$406 |
2.0× |
| Us ob transvaginal (76817) |
$248.70 |
$414.50 |
2.0× |
| Us pelvic non ob complete (76856) |
$295.80 |
$493 |
2.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$197.40 |
$329 |
1.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$445.20 |
$742 |
3.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$403.80 |
$673 |
3.3× |
| Us retroperitoneal complete (76770) |
$447.60 |
$746 |
3.6× |
| Us retroperitoneal limited (76775) |
$433.20 |
$722 |
3.5× |
| Us scrotum and contents (76870) |
$250.80 |
$418 |
2.0× |
| Us soft tissue head/neck (76536) |
$280.50 |
$467.50 |
2.3× |
| Us spinal canal and contents (76800) |
$361.80 |
$603 |
2.9× |
| Us transrectal (76872) |
$271.20 |
$452 |
2.2× |
| Us, eye b-scan (76512) |
$28.80 |
$48 |
0.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$340.20 |
$567 |
2.8× |
| Vasogram (74440) |
$457.20 |
$762 |
1.6× |
| Venogram adrenal unilat (75840) |
$2,872.20 |
$4,787 |
0.8× |
| Venogram extremity bilateral (75822) |
$831.60 |
$1,386 |
0.4× |
| Venogram Extremity Unilateral (75820) |
$726 |
$1,210 |
0.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,784 |
$4,640 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$831 |
$1,385 |
0.4× |
| Venography Orbital Rs&I (75880) |
$831 |
$1,385 |
1.1× |
| Venography Renal Bilateral (75833) |
$2,872.20 |
$4,787 |
0.8× |
| Venography renal unilateral selective rs&i (75831) |
$2,872.20 |
$4,787 |
0.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,979.40 |
$3,299 |
0.5× |
| Venous sampling by catheter (75893) |
$4,769.40 |
$7,949 |
0.7× |
| Wrist 2 views (73100) |
$171.60 |
$286 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$249 |
$415 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$298.20 |
$497 |
2.9× |
| X-ray b.e. reductn intuss (74283) |
$654 |
$1,090 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$515.40 |
$859 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168 |
$280 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$175.50 |
$292.50 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$283.80 |
$473 |
2.3× |
| X-ray exam of femur 2/> (73552) |
$227.40 |
$379 |
2.2× |
| X-ray eye for foreign body (70030) |
$149.40 |
$249 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$255.60 |
$426 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$564 |
$940 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$239.40 |
$399 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$229.80 |
$383 |
2.2× |
| X-ray leg, infant (73592) |
$211.20 |
$352 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$259.80 |
$433 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$377.40 |
$629 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$183.60 |
$306 |
1.8× |
| X-ray optic foramen (70190) |
$349.20 |
$582 |
3.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$255.60 |
$426 |
2.1× |
| X-ray retrograde pyelogram (74420) |
$484.80 |
$808 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$225.60 |
$376 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$245.40 |
$409 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$428.40 |
$714 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$211.20 |
$352 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$189.90 |
$316.50 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$301.80 |
$503 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$327.60 |
$546 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$270.60 |
$451 |
2.2× |
| X-Ray Small Bowel Enteroclysis (74251) |
$649.20 |
$1,082 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$260.40 |
$434 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$234.60 |
$391 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$235.80 |
$393 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$236.40 |
$394 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$421.20 |
$702 |
3.4× |
| Xr bone length studies (77073) |
$247.80 |
$413 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$294.60 |
$491 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$306 |
$510 |
2.5× |
| Xr chest 4+ views (71048) |
$311.40 |
$519 |
2.5× |
| Xr urogram antegrade (74425) |
$369.60 |
$616 |
0.9× |