| Abdomen 2 views (74019) |
$195.75 |
$261 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,152.38 |
$1,536.50 |
3.2× |
| Acute venous thrombus image (78456) |
$234.75 |
$313 |
0.2× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$1,820.25 |
$2,427 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,409.75 |
$3,213 |
0.8× |
| Angiography extremity unilateral rs&i (75710) |
$2,455.50 |
$3,274 |
0.9× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$1,820.25 |
$2,427 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,631.75 |
$3,509 |
0.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$1,609.12 |
$2,145.50 |
0.6× |
Angiography visceral slctv/supraslctv rs&i (75726)
unusually low: confirm this is the full procedure |
$1,820.25 |
$2,427 |
0.4× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$157.50 |
$210 |
0.1× |
| Ankle 2 views (73600) |
$277.50 |
$370 |
3.5× |
| Antegrade urography radiological supvj & interpj (74425) |
$192 |
$256 |
0.6× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$1,269 |
$1,692 |
0.2× |
| Aortography abdominal serialography rs&i (75625) |
$1,819.50 |
$2,426 |
0.6× |
| Artery X-Rays Adrenal Gland (75731) |
$1,820.25 |
$2,427 |
0.6× |
| Arthrogram elbow (73085) |
$866.25 |
$1,155 |
2.7× |
| Arthrogram hip (73525) |
$866.25 |
$1,155 |
2.7× |
| Arthrogram shoulder (73040) |
$866.25 |
$1,155 |
2.7× |
| Arthrogram wrist (73115) |
$651.75 |
$869 |
2.0× |
| Arthrography knee lt (73580) |
$1,083 |
$1,444 |
3.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$468 |
$624 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,048.50 |
$1,398 |
2.9× |
| Bone &/joint imaging whole body (78306) |
$1,654.50 |
$2,206 |
4.5× |
| Bone age studies (77072) |
$146.25 |
$195 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,848 |
$2,464 |
5.1× |
| Bone Marrow Imaging Limited Area (78102) |
$588.75 |
$785 |
1.6× |
| Bone survey complete (77075) |
$339 |
$452 |
3.5× |
| Brain image w/flow 4 + views (78606) |
$1,108.50 |
$1,478 |
2.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$975 |
$1,300 |
2.0× |
| Brain Imaging Vascular Flow Only (78610) |
$1,104 |
$1,472 |
2.2× |
| Cardiac shunt detection (78428) |
$650.25 |
$867 |
1.8× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$982.50 |
$1,310 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$102.75 |
$137 |
1.3× |
| Chest 1 view (71045) |
$272.25 |
$363 |
3.4× |
| Chest 3 views (71047) |
$121.88 |
$162.50 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$353.25 |
$471 |
2.2× |
| Clavicle complete (73000) |
$297 |
$396 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$138.75 |
$185 |
1.5× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$488.25 |
$651 |
3.0× |
| Corpora cavernosography (74445) |
$471 |
$628 |
4.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,645 |
$4,860 |
11.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,324.75 |
$4,433 |
15.2× |
| CT abdomen w contrast (74160) |
$2,234.25 |
$2,979 |
13.9× |
| CT abdomen w wo contrast (74170) |
$2,006.25 |
$2,675 |
12.5× |
| CT abdomen w/o contrast (74150) |
$1,872 |
$2,496 |
19.6× |
| CT angio hrt w/3d image (75574) |
$359.25 |
$479 |
1.1× |
| CT angiography upper extremity lt (73206) |
$1,362 |
$1,816 |
8.5× |
| CT c-spine w/o contrast (72125) |
$1,839 |
$2,452 |
19.2× |
| CT cervical spine w&w/o contrast (72127) |
$2,033.25 |
$2,711 |
12.7× |
| CT cervical spine with contrast (72126) |
$1,059 |
$1,412 |
3.3× |
| CT chest w/wo contrast (71270) |
$2,741.25 |
$3,655 |
17.1× |
| CT chest with contrast (71260) |
$2,199.75 |
$2,933 |
13.7× |
| CT head/brain with contrast (70460) |
$849.75 |
$1,133 |
5.3× |
| CT head/brain without and with contrast (70470) |
$2,199.75 |
$2,933 |
13.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$288 |
$384 |
0.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$127.12 |
$169.50 |
1.6× |
| CT hrt w/3d image congen (75573) |
$345.75 |
$461 |
1.1× |
| CT iac w contrast (70481) |
$849.75 |
$1,133 |
5.3× |
| CT limited/localized follow up study (76380) |
$955.50 |
$1,274 |
12.0× |
| CT lower ext w/o (73700) |
$1,545.75 |
$2,061 |
16.2× |
| CT lower extremity w wo contrast (73702) |
$1,710.75 |
$2,281 |
10.7× |
| CT lower extremity with contrast (73701) |
$1,362.75 |
$1,817 |
8.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,033.25 |
$2,711 |
12.7× |
| CT lumbar spine w/o contrast (72131) |
$1,839 |
$2,452 |
19.2× |
| CT lumbar spine with contrast (72132) |
$2,199.75 |
$2,933 |
6.9× |
| CT maxillofacial w contrast (70487) |
$1,305.75 |
$1,741 |
8.1× |
| CT maxillofacial w/o contrast (70486) |
$1,473.75 |
$1,965 |
15.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,628.25 |
$2,171 |
10.1× |
| CT neck soft tissue w contrast (70491) |
$1,760.25 |
$2,347 |
11.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,628.25 |
$2,171 |
10.1× |
| CT orbits w/o contrast (70480) |
$711.75 |
$949 |
7.4× |
| CT pelvis w & w/o contrast (72194) |
$1,270.50 |
$1,694 |
7.9× |
| CT pelvis w/o contrast (72192) |
$1,788 |
$2,384 |
18.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,628.25 |
$2,171 |
10.1× |
| CT soft tissue neck w/o contrast (70490) |
$711.75 |
$949 |
7.4× |
| CT thoracic spine w/contrast (72129) |
$1,628.25 |
$2,171 |
10.1× |
| CT thoracic spine w/o contrast (72128) |
$886.50 |
$1,182 |
9.3× |
| CT thoracic spine w/wo contrast (72130) |
$2,033.25 |
$2,711 |
12.7× |
| CT thorax w/o contrast (71250) |
$886.50 |
$1,182 |
9.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,710.75 |
$2,281 |
10.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,545.75 |
$2,061 |
16.2× |
| CT upper extremity with contrast (73201) |
$1,362 |
$1,816 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$667.50 |
$890 |
4.2× |
| Cta Abdomen (74175) |
$636 |
$848 |
4.0× |
| CTA abdomen pelvis (74174) |
$1,250.25 |
$1,667 |
3.9× |
| CTA chest (71275) |
$651.75 |
$869 |
4.1× |
| Cta Head (70496) |
$541.50 |
$722 |
3.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,362 |
$1,816 |
8.5× |
| Cta Neck (70498) |
$552 |
$736 |
3.4× |
| Cta Pelvis (72191) |
$617.25 |
$823 |
3.8× |
| Cystography minimum 3 views rs&i (74430) |
$591 |
$788 |
1.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$171.75 |
$229 |
1.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$91.12 |
$121.50 |
1.1× |
| Dxa bone density study axial skeleton (77085) |
$128.25 |
$171 |
1.3× |
| Echoencephalography real time imaging (76506) |
$599.25 |
$799 |
6.3× |
| Esophagus (74220) |
$657.75 |
$877 |
4.1× |
| Fetal biophysical profile non-stress testing (76818) |
$194.25 |
$259 |
2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$120 |
$160 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$261 |
$348 |
1.2× |
| Foot 2 views (73620) |
$280.50 |
$374 |
3.5× |
| Forearm 2 views (73090) |
$297 |
$396 |
3.7× |
| Gastric mucosa imaging (78261) |
$1,177.50 |
$1,570 |
3.2× |
| Gated Heart Planar Single (78472) |
$1,581 |
$2,108 |
4.3× |
| Hand 2 views (73120) |
$137.25 |
$183 |
1.4× |
| Hand 3 views (73130) |
$296.62 |
$395.50 |
3.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,482 |
$1,976 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,414.50 |
$1,886 |
3.9× |
| Ht muscle image spect sing (78451) |
$1,375.50 |
$1,834 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$322.50 |
$430 |
4.1× |
| Hysterosalpingogram (74740) |
$132 |
$176 |
0.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$64.50 |
$86 |
0.7× |
| Kidney imaging morphology (78700) |
$873 |
$1,164 |
2.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$836.25 |
$1,115 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,730.25 |
$2,307 |
3.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,283.25 |
$1,711 |
2.6× |
| Knee 3 views (73562) |
$239.25 |
$319 |
3.0× |
| Liver & spleen imaging static only (78215) |
$840.75 |
$1,121 |
2.3× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$999.75 |
$1,333 |
2.7× |
| Liver imaging static only (78201) |
$681 |
$908 |
1.4× |
| Liver imaging w/vascular flow (78202) |
$826.50 |
$1,102 |
1.7× |
| Lung perf&ventilat diferentl (78598) |
$1,317 |
$1,756 |
2.7× |
| Lung Ventilation Imaging (78579) |
$1,131.75 |
$1,509 |
3.1× |
| Lymphoscintigraphy (78195) |
$420 |
$560 |
0.8× |
| Mammary ductogram or galactogram single (77053) |
$84.75 |
$113 |
0.4× |
| Meckels Diverticulum (78290) |
$873 |
$1,164 |
2.4× |
| Mr elastography (76391) |
$720 |
$960 |
3.3× |
| Mr safety determination physician/other qhp (76016) |
$114.75 |
$153 |
1.4× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$77.25 |
$103 |
1.4× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$32.25 |
$43 |
1.2× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$119.25 |
$159 |
1.4× |
| Mr safety med physics xm customization plng&mntr (76017) |
$314.25 |
$419 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,831.50 |
$2,442 |
5.7× |
| MRA head w/o contrast (70544) |
$2,203.50 |
$2,938 |
10.1× |
| MRA neck w contrast (70548) |
$1,831.50 |
$2,442 |
5.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,306 |
$4,408 |
10.4× |
| MRA neck w/o contrast (70547) |
$2,203.50 |
$2,938 |
10.1× |
| MRI abdomen w contrast (74182) |
$3,160.50 |
$4,214 |
9.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,306 |
$4,408 |
10.4× |
| MRI abdomen w/o contrast (74181) |
$2,203.50 |
$2,938 |
10.1× |
| MRI any jnt lwr ext with con lt (73722) |
$2,707.50 |
$3,610 |
3.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,306 |
$4,408 |
4.6× |
| MRI breast w/o contrast bilateral (77047) |
$702 |
$936 |
3.2× |
| MRI breast w/o contrast unilat (77046) |
$702 |
$936 |
3.2× |
| MRI c-spine with contrast (72142) |
$2,109 |
$2,812 |
6.6× |
| MRI cervical spine w/o contrast (72141) |
$2,203.50 |
$2,938 |
10.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,106 |
$2,808 |
6.6× |
| MRI chest w/o contrast (71550) |
$2,203.50 |
$2,938 |
10.1× |
| MRI chest with contrast (71551) |
$3,022.50 |
$4,030 |
4.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,831.50 |
$2,442 |
5.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,109 |
$2,812 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,475.75 |
$3,301 |
11.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,682 |
$3,576 |
12.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,306 |
$4,408 |
10.4× |
| MRI orbit/face/neck w/contrast (70542) |
$2,109 |
$2,812 |
6.6× |
| MRI pelvis w contrast (72196) |
$2,109 |
$2,812 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,208.38 |
$2,944.50 |
6.9× |
| MRI pelvis w/o contrast (72195) |
$2,203.50 |
$2,938 |
10.1× |
| MRI scan of arm joint before and after contrast (73223) |
$3,306 |
$4,408 |
10.4× |
| MRI scan of leg joint before and after contrast (73723) |
$3,306 |
$4,408 |
10.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,306 |
$4,408 |
10.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,022.50 |
$4,030 |
9.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,306 |
$4,408 |
10.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,831.50 |
$2,442 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,306 |
$4,408 |
10.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,203.50 |
$2,938 |
10.1× |
| MRI tmj (70336) |
$1,831.50 |
$2,442 |
8.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,475.75 |
$3,301 |
11.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,306 |
$4,408 |
10.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,613 |
$3,484 |
12.0× |
| Myelogram Cervical (72240) |
$451.50 |
$602 |
0.6× |
| Myelogram Lumbar (72265) |
$799.50 |
$1,066 |
1.1× |
| Myelogram thoracic (72255) |
$631.50 |
$842 |
0.9× |
| Myelography 2 or more regions (72270) |
$576 |
$768 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$450 |
$600 |
0.4× |
| Neck soft tissue (70360) |
$137.62 |
$183.50 |
1.7× |
| Nm adrenal scan (78075) |
$3,104.25 |
$4,139 |
2.6× |
| Nm bone marrow multiple (78103) |
$910.50 |
$1,214 |
2.5× |
| Nm bone marrow wb (78104) |
$1,167.75 |
$1,557 |
3.2× |
| Nm cisternogram (78630) |
$1,446 |
$1,928 |
2.9× |
| Nm csf leak detection (78650) |
$1,329 |
$1,772 |
1.1× |
| Nm gastric emptying study (78264) |
$770.25 |
$1,027 |
2.1× |
| Nm gastroesophageal reflux study (78262) |
$1,218.75 |
$1,625 |
3.3× |
| Nm peritoneal-venous shunt patency (78291) |
$879 |
$1,172 |
2.4× |
| Nuclear medicine of heart pumping function (78473) |
$2,359.50 |
$3,146 |
6.5× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,020 |
$1,360 |
2.8× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$738.75 |
$985 |
2.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$385.12 |
$513.50 |
4.0× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$445.50 |
$594 |
3.7× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$255.75 |
$341 |
2.7× |
| Osseous survey infant (77076) |
$309 |
$412 |
3.2× |
| Osseous survey limited (77074) |
$389.25 |
$519 |
4.1× |
| Parathyroid imaging (78070) |
$342 |
$456 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$165 |
$220 |
1.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,306 |
$4,408 |
10.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,131.75 |
$1,509 |
3.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,023.75 |
$1,365 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$285.75 |
$381 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$81 |
$108 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$134.25 |
$179 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$149.25 |
$199 |
1.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$215.25 |
$287 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$256.50 |
$342 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$348.75 |
$465 |
3.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$146.25 |
$195 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$46.30 |
$61.73 |
0.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$483 |
$644 |
6.1× |
| Radiologic exam colon single contrast study (74270) |
$949.50 |
$1,266 |
5.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$919.50 |
$1,226 |
5.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$832.50 |
$1,110 |
5.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$107.62 |
$143.50 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$277.50 |
$370 |
3.5× |
| Radiological examination surgical specimen (76098) |
$145.88 |
$194.50 |
0.3× |
| Ribs bilateral 3 views (71110) |
$243.75 |
$325 |
2.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,212.75 |
$1,617 |
3.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,584 |
$2,112 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,734.38 |
$2,312.50 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$90.38 |
$120.50 |
0.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$144 |
$192 |
0.7× |
| Scanogram (77073) |
$328.50 |
$438 |
3.4× |
| Scapula complete (73010) |
$146.25 |
$195 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$74.25 |
$99 |
3.2× |
| Sella turcica (70240) |
$179.25 |
$239 |
2.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$427.13 |
$569.50 |
4.5× |
| Sialogram (70390) |
$737.25 |
$983 |
3.4× |
| Small bowel series (74250) |
$729 |
$972 |
4.5× |
| Speech evaluation complex (70371) |
$59.25 |
$79 |
0.3× |
| Spine thoracic 3 views (72072) |
$414.75 |
$553 |
4.3× |
| Spleen imaging only (78185) |
$681 |
$908 |
1.9× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$866.25 |
$1,155 |
4.0× |
| Testicular Imaging With Vascular Flow (78761) |
$916.50 |
$1,222 |
2.5× |
| Therapeutic Enema (74283) |
$1,057.50 |
$1,410 |
6.6× |
| Thoracolumbar 2 views (72080) |
$159 |
$212 |
2.0× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,554.75 |
$2,073 |
3.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$708 |
$944 |
1.9× |
| Thyroid uptake measurement (78012) |
$201 |
$268 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$997.50 |
$1,330 |
2.7× |
| Tmj unilateral (70328) |
$138.75 |
$185 |
1.7× |
| Tomogram (76100) |
$765.75 |
$1,021 |
8.0× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$613.50 |
$818 |
1.2× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$975 |
$1,300 |
2.7× |
| Ultrasound elastography first target lesion (76982) |
$396.75 |
$529 |
4.1× |
| Ultrasound scan of cornea to determine thickness (76514) |
$92.25 |
$123 |
3.5× |
| Ultrasound scan to determine eye length and lens power (76519) |
$144 |
$192 |
1.5× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$267 |
$356 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$89.25 |
$119 |
0.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$127.50 |
$170 |
1.6× |
| Unlisted genitourinary procedure, diagnostic nuclear medicine UNSCHEDULED (78799) |
$849.75 |
$1,133 |
2.3× |
| Unlisted Ultrasound Procedure (76999) |
$333 |
$444 |
4.2× |
| Upper Extremity Infant (73092) |
$124.50 |
$166 |
1.3× |
| Urethrocystography retrograde rs&i (74450) |
$601.50 |
$802 |
2.8× |
| Urethrocystography voiding (74455) |
$424.50 |
$566 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$180 |
$240 |
1.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$1,177.50 |
$1,570 |
7.3× |
| Us breast unilateral complete (76641) |
$123.75 |
$165 |
1.3× |
| Us breast unilateral limited (76642) |
$123.75 |
$165 |
1.6× |
| Us chest (76604) |
$632.62 |
$843.50 |
6.6× |
| Us compl joint r-t w/image documentation (76881) |
$123.75 |
$165 |
1.3× |
| Us elastography parenchyma (76981) |
$396.75 |
$529 |
4.1× |
| Us kidney transplant (76776) |
$828.75 |
$1,105 |
8.7× |
| Us ob detailed single fetus (76811) |
$192.75 |
$257 |
0.9× |
| Us ob transvaginal (76817) |
$274.12 |
$365.50 |
2.9× |
| Us pelvic non ob complete (76856) |
$495.38 |
$660.50 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$324 |
$432 |
3.4× |
| Us pregnancy ltd (76815) |
$448.12 |
$597.50 |
4.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$291.75 |
$389 |
3.1× |
| Us retroperitoneal complete (76770) |
$779.25 |
$1,039 |
8.1× |
| Us retroperitoneal limited (76775) |
$422.25 |
$563 |
4.4× |
| Us scrotum and contents (76870) |
$839.25 |
$1,119 |
8.8× |
| Us soft tissue head/neck (76536) |
$124.50 |
$166 |
1.3× |
| Us spinal canal and contents (76800) |
$246 |
$328 |
2.6× |
| Us transrectal (76872) |
$839.25 |
$1,119 |
8.8× |
| Us xtr non-vasc lmtd (76882) |
$779.25 |
$1,039 |
8.1× |
| Us, eye b-scan (76512) |
$190.50 |
$254 |
2.0× |
| Vascular flow imaging (78445) |
$532.50 |
$710 |
1.5× |
| Venogram extremity bilateral (75822) |
$220.12 |
$293.50 |
0.2× |
| Venography caval inferior serialography rs&i (75825) |
$1,185 |
$1,580 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$1,818.75 |
$2,425 |
1.3× |
| Venography extremity unilateral rs&i (75820) |
$141.75 |
$189 |
0.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,817.25 |
$2,423 |
0.6× |
Venous sampling thru cath w/wo angiography rs& (75893)
unusually low: confirm this is the full procedure |
$1,820.25 |
$2,427 |
0.4× |
| Vertebral fracture assessment via dxa (77086) |
$80.25 |
$107 |
1.0× |
| Wrist 2 views (73100) |
$275.62 |
$367.50 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$234.38 |
$312.50 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$210.38 |
$280.50 |
2.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$300.75 |
$401 |
3.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,242 |
$1,656 |
7.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$146.25 |
$195 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$322.50 |
$430 |
4.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$256.50 |
$342 |
2.7× |
| X-ray exam hip uni 1 view (73501) |
$81 |
$108 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$81 |
$108 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$134.25 |
$179 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$149.25 |
$199 |
1.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$300 |
$400 |
3.1× |
| X-ray exam of femur 1 (73551) |
$81 |
$108 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$540.75 |
$721 |
3.4× |
| X-ray eye for foreign body (70030) |
$118.50 |
$158 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$246 |
$328 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$119.25 |
$159 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$300.75 |
$401 |
3.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$270 |
$360 |
3.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$603.75 |
$805 |
3.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$220.50 |
$294 |
2.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$348.75 |
$465 |
3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$88.50 |
$118 |
1.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$208.50 |
$278 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$377.25 |
$503 |
3.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$319.50 |
$426 |
3.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$374.62 |
$499.50 |
3.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$168.38 |
$224.50 |
2.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$297 |
$396 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$215.25 |
$287 |
2.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$101.25 |
$135 |
1.1× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$186 |
$248 |
0.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,462.50 |
$1,950 |
4.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$280.88 |
$374.50 |
3.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$327.38 |
$436.50 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$286.12 |
$381.50 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$93.75 |
$125 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$178.12 |
$237.50 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$322.50 |
$430 |
4.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$243.38 |
$324.50 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$148.12 |
$197.50 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$120.75 |
$161 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$106.50 |
$142 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$241.50 |
$322 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$190.50 |
$254 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$202.12 |
$269.50 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$108.38 |
$144.50 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$231 |
$308 |
2.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$137.62 |
$183.50 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$300.75 |
$401 |
3.8× |
| Xr arthrogram ankle (73615) |
$866.25 |
$1,155 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$308.25 |
$411 |
3.2× |
| Xr chest 4+ views (71048) |
$201.75 |
$269 |
2.1× |
| Xr Cholecystography Oral Contrast (74290) |
$216.75 |
$289 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$139.50 |
$186 |
1.8× |
| Xr internal auditory meati complete (70134) |
$309 |
$412 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$53.25 |
$71 |
0.6× |
| Xr shoulder 1 view (73020) |
$270 |
$360 |
3.4× |
| Xr spine cervical 4 or 5 views (72050) |
$504 |
$672 |
5.3× |
| Xr tibia/fibula 2 views (73590) |
$297 |
$396 |
3.7× |
| Xr tmj bilateral (70330) |
$348 |
$464 |
4.4× |
| Xray knee 1 or 2 views rt (73560) |
$291.75 |
$389 |
3.7× |