| Abdomen 2 views (74019) |
$146.40 |
$244 |
1.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$2,213.40 |
$3,689 |
5.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$2,300.40 |
$3,834 |
0.7× |
| Angiography extremity bilateral rs&i (75716) |
$2,131.80 |
$3,553 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,131.80 |
$3,553 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,831.60 |
$6,386 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$5,296.20 |
$8,827 |
1.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,296.20 |
$8,827 |
1.7× |
| Angiography Spinal Selective Rs&I (75705) |
$3,831.60 |
$6,386 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,831.60 |
$6,386 |
0.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$2,300.40 |
$3,834 |
0.7× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$2,300.40 |
$3,834 |
0.7× |
| Ankle 2 views (73600) |
$312 |
$520 |
3.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$402 |
$670 |
1.2× |
| Aortogram thoracic (75605) |
$3,831.60 |
$6,386 |
0.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,284.20 |
$3,807 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$2,300.40 |
$3,834 |
0.7× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,734.20 |
$4,557 |
0.9× |
| Artery X-Rays Adrenal Gland (75731) |
$2,734.20 |
$4,557 |
0.9× |
| Arthrogram elbow (73085) |
$369.60 |
$616 |
1.1× |
| Arthrogram hip (73525) |
$402 |
$670 |
1.2× |
| Arthrogram shoulder (73040) |
$444 |
$740 |
1.3× |
| Arthrogram wrist (73115) |
$492.60 |
$821 |
1.4× |
| Arthrography knee lt (73580) |
$630.60 |
$1,051 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,493.40 |
$2,489 |
3.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,039.80 |
$1,733 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$2,661 |
$4,435 |
6.8× |
| Bone age studies (77072) |
$137.40 |
$229 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$2,256.60 |
$3,761 |
5.7× |
| Bone Marrow Imaging Limited Area (78102) |
$820.20 |
$1,367 |
2.1× |
| Bone survey complete (77075) |
$659.40 |
$1,099 |
6.4× |
| Brain image w/flow 4 + views (78606) |
$945.60 |
$1,576 |
1.8× |
| Brain imaging < 4 static views (78600) |
$1,087.80 |
$1,813 |
2.8× |
| Brain imaging < 4 static views w vascular flow (78601) |
$1,630.80 |
$2,718 |
4.1× |
| Brain Imaging Minimum 4 Static Views (78605) |
$910.80 |
$1,518 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,988 |
$4,980 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$336.30 |
$560.50 |
3.9× |
| Chest 1 view (71045) |
$355.80 |
$593 |
4.2× |
| Chest 3 views (71047) |
$267.90 |
$446.50 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$329.40 |
$549 |
1.9× |
| Clavicle complete (73000) |
$288 |
$480 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$155.10 |
$258.50 |
1.5× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$190.20 |
$317 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,568.80 |
$10,948 |
19.1× |
| CT abdomen and pelvis without contrast (74176) |
$4,574.40 |
$7,624 |
19.5× |
| CT abdomen w contrast (74160) |
$3,379.80 |
$5,633 |
19.6× |
| CT abdomen w wo contrast (74170) |
$4,113.60 |
$6,856 |
23.8× |
| CT abdomen w/o contrast (74150) |
$3,136.20 |
$5,227 |
30.5× |
| CT angio hrt w/3d image (75574) |
$649.80 |
$1,083 |
1.9× |
| CT angiography upper extremity lt (73206) |
$660 |
$1,100 |
3.8× |
| CT c-spine w/o contrast (72125) |
$5,961 |
$9,935 |
57.9× |
| CT cervical spine w&w/o contrast (72127) |
$7,510.80 |
$12,518 |
43.5× |
| CT cervical spine with contrast (72126) |
$6,295.80 |
$10,493 |
18.3× |
| CT chest w/wo contrast (71270) |
$4,143.60 |
$6,906 |
24.0× |
| CT chest with contrast (71260) |
$3,336.60 |
$5,561 |
19.3× |
| CT head/brain with contrast (70460) |
$2,343.60 |
$3,906 |
13.6× |
| CT head/brain without and with contrast (70470) |
$2,352.60 |
$3,921 |
13.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$649.80 |
$1,083 |
7.6× |
| CT iac w contrast (70481) |
$5,022.60 |
$8,371 |
29.1× |
| CT limited/localized follow up study (76380) |
$1,462.20 |
$2,437 |
17.1× |
| CT lower ext w/o (73700) |
$2,687.40 |
$4,479 |
26.1× |
| CT lower extremity w wo contrast (73702) |
$4,922.40 |
$8,204 |
28.5× |
| CT lower extremity with contrast (73701) |
$3,018.60 |
$5,031 |
17.5× |
| CT lumbar spine w & w/o contrast (72133) |
$3,870.60 |
$6,451 |
22.4× |
| CT lumbar spine w/o contrast (72131) |
$3,139.80 |
$5,233 |
30.5× |
| CT lumbar spine with contrast (72132) |
$3,388.20 |
$5,647 |
9.9× |
| CT maxillofacial w contrast (70487) |
$2,324.40 |
$3,874 |
13.5× |
| CT maxillofacial w/o contrast (70486) |
$2,015.40 |
$3,359 |
19.6× |
| CT maxillofacial w/wo contrast (70488) |
$2,673.30 |
$4,455.50 |
15.5× |
| CT neck soft tissue w contrast (70491) |
$2,050.80 |
$3,418 |
11.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$5,726.40 |
$9,544 |
33.2× |
| CT orbits w/o contrast (70480) |
$1,796.40 |
$2,994 |
17.5× |
| CT pelvis w & w/o contrast (72194) |
$4,379.40 |
$7,299 |
25.4× |
| CT pelvis w/o contrast (72192) |
$1,163.40 |
$1,939 |
11.3× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$700.20 |
$1,167 |
8.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,438.40 |
$4,064 |
14.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,783.20 |
$2,972 |
17.3× |
| CT thoracic spine w/contrast (72129) |
$2,749.20 |
$4,582 |
15.9× |
| CT thoracic spine w/o contrast (72128) |
$2,857.20 |
$4,762 |
27.8× |
| CT thoracic spine w/wo contrast (72130) |
$3,937.20 |
$6,562 |
22.8× |
| CT thorax w/o contrast (71250) |
$3,051.60 |
$5,086 |
29.7× |
| CT unlisted procedure (76497) |
$511.80 |
$853 |
6.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,928 |
$4,880 |
17.0× |
| CT upper extremity w/o contrast rt (73200) |
$2,507.40 |
$4,179 |
24.4× |
| CT upper extremity with contrast (73201) |
$2,967 |
$4,945 |
8.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$5,983.20 |
$9,972 |
34.7× |
| Cta Abdomen (74175) |
$4,741.20 |
$7,902 |
27.5× |
| CTA abdomen pelvis (74174) |
$2,600.40 |
$4,334 |
7.6× |
| CTA chest (71275) |
$5,669.40 |
$9,449 |
32.8× |
| Cta Head (70496) |
$2,539.80 |
$4,233 |
14.7× |
| CTA lwr ext w&w/o contrast (73706) |
$4,922.40 |
$8,204 |
28.5× |
| Cta Neck (70498) |
$2,747.40 |
$4,579 |
15.9× |
| Cta Pelvis (72191) |
$4,755 |
$7,925 |
27.5× |
| Cystography minimum 3 views rs&i (74430) |
$268.80 |
$448 |
0.8× |
| Diskography lumbar (72295) |
$3,858 |
$6,430 |
2.0× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$217.80 |
$363 |
2.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$606.60 |
$1,011 |
5.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$606.60 |
$1,011 |
7.1× |
| Dxa bone density study axial skeleton (77085) |
$165.60 |
$276 |
1.6× |
| Echoencephalography real time imaging (76506) |
$378 |
$630 |
3.7× |
| Esophagus (74220) |
$308.40 |
$514 |
1.8× |
| Fetal biophysical profile non-stress testing (76818) |
$324 |
$540 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$599.40 |
$999 |
5.8× |
| Fluoroscopy up to 1 hr (76000) |
$342.60 |
$571 |
1.5× |
| Foot 2 views (73620) |
$195.60 |
$326 |
2.3× |
| Forearm 2 views (73090) |
$251.70 |
$419.50 |
2.9× |
| Hand 2 views (73120) |
$320.40 |
$534 |
3.1× |
| Hand 3 views (73130) |
$237.60 |
$396 |
2.8× |
| Heart Infarct Image (78466) |
$1,180.80 |
$1,968 |
3.0× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$2,300.40 |
$3,834 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,193 |
$3,655 |
4.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,579.20 |
$2,632 |
4.0× |
| Ht muscle image spect sing (78451) |
$3,274.20 |
$5,457 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$310.20 |
$517 |
3.6× |
| Hysterosalpingogram (74740) |
$465.60 |
$776 |
2.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$149.40 |
$249 |
1.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,942.80 |
$3,238 |
3.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,942.80 |
$3,238 |
3.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,725 |
$2,875 |
3.2× |
| Knee 3 views (73562) |
$145.20 |
$242 |
1.7× |
| Liver & spleen imaging static only (78215) |
$1,542 |
$2,570 |
3.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,397.40 |
$2,329 |
3.6× |
| Liver imaging static only (78201) |
$1,010.40 |
$1,684 |
1.9× |
| Liver imaging w/vascular flow (78202) |
$1,038.60 |
$1,731 |
1.9× |
| Lung perf&ventilat diferentl (78598) |
$1,287.60 |
$2,146 |
2.4× |
| Lung perfusion differential (78597) |
$795 |
$1,325 |
2.0× |
| Lung Ventilation Imaging (78579) |
$742.80 |
$1,238 |
1.9× |
| Lymphoscintigraphy (78195) |
$1,733.40 |
$2,889 |
3.2× |
| Mammary ductogram or galactogram multiple (77054) |
$790.80 |
$1,318 |
3.4× |
| Mammary ductogram or galactogram single (77053) |
$592.80 |
$988 |
2.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$127.80 |
$213 |
1.5× |
| Meckels Diverticulum (78290) |
$1,510.80 |
$2,518 |
3.8× |
| MRA head w & w/o contrast (70546) |
$6,415.80 |
$10,693 |
18.7× |
| MRA head w/o contrast (70544) |
$3,139.50 |
$5,232.50 |
13.4× |
| MRA head with contrast (70545) |
$3,246.30 |
$5,410.50 |
9.5× |
| MRA neck w contrast (70548) |
$2,944.20 |
$4,907 |
8.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,268.50 |
$5,447.50 |
9.5× |
| MRA neck w/o contrast (70547) |
$2,712.60 |
$4,521 |
11.6× |
| MRI abdomen w contrast (74182) |
$6,700.80 |
$11,168 |
19.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$7,439.10 |
$12,398.50 |
21.7× |
| MRI abdomen w/o contrast (74181) |
$5,673.30 |
$9,455.50 |
24.2× |
| MRI any jnt lwr ext with con lt (73722) |
$6,276.90 |
$10,461.50 |
8.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$5,488.80 |
$9,148 |
7.1× |
| MRI c-spine with contrast (72142) |
$3,395.40 |
$5,659 |
9.9× |
| MRI cervical spine w/o contrast (72141) |
$2,984.70 |
$4,974.50 |
12.7× |
| MRI chest w/o & w/contrast material (71552) |
$7,845.30 |
$13,075.50 |
22.9× |
| MRI chest w/o contrast (71550) |
$3,730.80 |
$6,218 |
15.9× |
| MRI chest with contrast (71551) |
$3,953.40 |
$6,589 |
5.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$5,579.40 |
$9,299 |
16.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,433.10 |
$7,388.50 |
12.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,193.40 |
$6,989 |
17.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,171.60 |
$5,286 |
13.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,428.90 |
$7,381.50 |
12.9× |
| MRI orbit/face/neck w/contrast (70542) |
$3,697.80 |
$6,163 |
10.8× |
| MRI pelvis w contrast (72196) |
$5,317.80 |
$8,863 |
15.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$6,619.80 |
$11,033 |
19.3× |
| MRI pelvis w/o contrast (72195) |
$5,131.50 |
$8,552.50 |
21.9× |
| MRI scan of arm joint before and after contrast (73223) |
$5,017.50 |
$8,362.50 |
14.6× |
| MRI scan of leg joint before and after contrast (73723) |
$6,276.90 |
$10,461.50 |
18.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,825.30 |
$6,375.50 |
11.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$5,746.20 |
$9,577 |
16.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,370 |
$8,950 |
15.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$5,787 |
$9,645 |
16.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,370 |
$8,950 |
15.6× |
| MRI thoracic spine w/o contrast (72146) |
$5,510.70 |
$9,184.50 |
23.5× |
| MRI tmj (70336) |
$3,659.40 |
$6,099 |
15.6× |
| MRI upper ext joint w/o contrast (73221) |
$5,017.50 |
$8,362.50 |
21.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$6,184.20 |
$10,307 |
18.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$5,579.40 |
$9,299 |
23.8× |
| Myelogram Cervical (72240) |
$1,704 |
$2,840 |
2.2× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,077.40 |
$5,129 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$4,887.60 |
$8,146 |
3.8× |
| Neck soft tissue (70360) |
$128.70 |
$214.50 |
1.5× |
| Nm gastric emptying study (78264) |
$2,594.40 |
$4,324 |
6.6× |
| Nm red cell sequestration (78140) |
$1,401.60 |
$2,336 |
3.6× |
| Nuclear medicine of heart pumping function (78473) |
$1,614 |
$2,690 |
4.1× |
| Nuclear medicine of heart pumping function by first pass technique (78483) |
$1,248 |
$2,080 |
2.3× |
| Nuclear medicine study from skull base to mid-thigh (78812) |
$4,299.60 |
$7,166 |
3.1× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$1,182.60 |
$1,971 |
3.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$423.60 |
$706 |
4.1× |
| Osseous survey infant (77076) |
$256.80 |
$428 |
2.5× |
| Osseous survey limited (77074) |
$465 |
$775 |
4.5× |
| Parathyrd planar w/spect&CT (78072) |
$1,713 |
$2,855 |
3.2× |
| Parathyrd planar w/wo subtrj (78071) |
$1,659.60 |
$2,766 |
4.2× |
| Parathyroid imaging (78070) |
$1,786.20 |
$2,977 |
4.5× |
| Pelvis 1 or 2 views (72170) |
$300 |
$500 |
2.9× |
| PET image w/CT, skull-thigh (78815) |
$5,115.30 |
$8,525.50 |
3.6× |
| PET imaging CT for attenuation limited area (78814) |
$4,799.70 |
$7,999.50 |
3.4× |
| PET imaging for CT attenuation whole body (78816) |
$4,787.40 |
$7,979 |
3.4× |
| PET imaging limited area chest head/neck (78811) |
$3,641.40 |
$6,069 |
2.9× |
| PET whole body (78813) |
$2,853.90 |
$4,756.50 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,193.40 |
$6,989 |
12.2× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,300.40 |
$3,834 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,708.20 |
$2,847 |
4.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,331.40 |
$2,219 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$388.80 |
$648 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$267 |
$445 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$186 |
$310 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$107.40 |
$179 |
1.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$176.40 |
$294 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$333 |
$555 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$199.20 |
$332 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$355.80 |
$593 |
4.2× |
| Radiologic exam colon single contrast study (74270) |
$512.40 |
$854 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$499.80 |
$833 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$414 |
$690 |
2.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$141.60 |
$236 |
1.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$87 |
$145 |
1.0× |
| Review by radiologist of adrenal gland vein image (75840) |
$2,300.40 |
$3,834 |
0.7× |
| Ribs bilateral 3 views (71110) |
$362.40 |
$604 |
3.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,801.50 |
$3,002.50 |
3.4× |
| Sacroiliac Joints < 3 Views (72200) |
$338.40 |
$564 |
3.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$645 |
$1,075 |
2.7× |
| Scanogram (77073) |
$193.20 |
$322 |
1.9× |
| Scapula complete (73010) |
$259.50 |
$432.50 |
2.5× |
| Sella turcica (70240) |
$178.20 |
$297 |
2.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$243 |
$405 |
2.4× |
| Sialogram (70390) |
$345 |
$575 |
1.5× |
| Small bowel series (74250) |
$357.60 |
$596 |
2.1× |
| Speech evaluation complex (70371) |
$290.40 |
$484 |
1.2× |
| Spine thoracic 3 views (72072) |
$310.50 |
$517.50 |
3.0× |
| Spleen imaging only (78185) |
$964.20 |
$1,607 |
2.5× |
| Therapeutic Enema (74283) |
$694.80 |
$1,158 |
4.0× |
| Thoracolumbar 2 views (72080) |
$206.40 |
$344 |
2.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,035 |
$1,725 |
2.6× |
| Thyroid uptake measurement (78012) |
$881.40 |
$1,469 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,285.80 |
$2,143 |
3.3× |
| Tmj unilateral (70328) |
$146.40 |
$244 |
1.7× |
| Tomogram (76100) |
$268.20 |
$447 |
2.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$3,156.60 |
$5,261 |
5.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$670.80 |
$1,118 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$938.40 |
$1,564 |
9.1× |
| Umbilical-artery Doppler (OB) (76820) |
$223.80 |
$373 |
2.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$753 |
$1,255 |
8.8× |
| Unlisted magnetic resonance procedure (76498) |
$3,141.90 |
$5,236.50 |
36.7× |
| Unlisted Ultrasound Procedure (76999) |
$273 |
$455 |
3.2× |
| Upper Extremity Infant (73092) |
$141.60 |
$236 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$325.80 |
$543 |
1.4× |
| Urethrocystography voiding (74455) |
$439.80 |
$733 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$640.20 |
$1,067 |
3.7× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$291.30 |
$485.50 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$369 |
$615 |
3.6× |
| Us breast unilateral complete (76641) |
$370.80 |
$618 |
3.6× |
| Us breast unilateral limited (76642) |
$740.40 |
$1,234 |
8.6× |
| Us chest (76604) |
$424.20 |
$707 |
4.1× |
| Us compl joint r-t w/image documentation (76881) |
$776.40 |
$1,294 |
7.5× |
| Us guided compression repair (76936) |
$591 |
$985 |
2.8× |
| Us infant hips dynamic (76885) |
$467.40 |
$779 |
5.5× |
| Us infant hips limited static (76886) |
$365.40 |
$609 |
4.3× |
| Us ob detailed single fetus (76811) |
$592.80 |
$988 |
2.5× |
| Us ob transvaginal (76817) |
$666.60 |
$1,111 |
6.5× |
| Us pelvic non ob complete (76856) |
$960.60 |
$1,601 |
9.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$677.40 |
$1,129 |
6.6× |
| Us pregnancy ltd (76815) |
$572.40 |
$954 |
5.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$790.80 |
$1,318 |
7.7× |
| Us retroperitoneal complete (76770) |
$885.60 |
$1,476 |
8.6× |
| Us retroperitoneal limited (76775) |
$878.40 |
$1,464 |
8.5× |
| Us scrotum and contents (76870) |
$892.20 |
$1,487 |
8.7× |
| Us soft tissue head/neck (76536) |
$969.60 |
$1,616 |
9.4× |
| Us spinal canal and contents (76800) |
$373.80 |
$623 |
3.6× |
| Us transrectal (76872) |
$775.80 |
$1,293 |
7.5× |
| Us xtr non-vasc lmtd (76882) |
$947.40 |
$1,579 |
9.2× |
| Vascular flow imaging (78445) |
$952.20 |
$1,587 |
2.4× |
| Vasogram (74440) |
$243 |
$405 |
1.0× |
| Venogram extremity bilateral (75822) |
$2,636.40 |
$4,394 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,073.60 |
$3,456 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$1,558.20 |
$2,597 |
1.0× |
| Venography extremity unilateral rs&i (75820) |
$1,130.40 |
$1,884 |
0.7× |
| Venography Renal Bilateral (75833) |
$2,300.40 |
$3,834 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,300.40 |
$3,834 |
0.7× |
| Venous sampling thru cath w/wo angiography rs& (75893) |
$3,831.60 |
$6,386 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$209.40 |
$349 |
2.4× |
| Wrist 2 views (73100) |
$201.90 |
$336.50 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$199.20 |
$332 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$238.80 |
$398 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$361.20 |
$602 |
4.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$518.40 |
$864 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$194.10 |
$323.50 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$264 |
$440 |
3.1× |
| X-ray exam hip uni 1 view (73501) |
$413.40 |
$689 |
4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$367.20 |
$612 |
4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$508.80 |
$848 |
4.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$949.80 |
$1,583 |
5.5× |
| X-ray eye for foreign body (70030) |
$158.40 |
$264 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$295.20 |
$492 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$222 |
$370 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$247.50 |
$412.50 |
2.9× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,439.40 |
$2,399 |
0.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$256.20 |
$427 |
3.0× |
| X-ray IV pyelogram+drip infusn (74410) |
$342 |
$570 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$153 |
$255 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$257.40 |
$429 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$162.60 |
$271 |
1.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$144 |
$240 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$366.30 |
$610.50 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$427.50 |
$712.50 |
4.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$357.60 |
$596 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$293.70 |
$489.50 |
3.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$118.80 |
$198 |
1.4× |
| X-ray of voice box or throat (70370) |
$188.40 |
$314 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$510 |
$850 |
5.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$287.40 |
$479 |
2.8× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$429 |
$715 |
0.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$457.20 |
$762 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$271.50 |
$452.50 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$460.20 |
$767 |
4.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$393.60 |
$656 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$320.40 |
$534 |
3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$290.10 |
$483.50 |
3.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$251.10 |
$418.50 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$370.80 |
$618 |
4.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$268.20 |
$447 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$333 |
$555 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$227.10 |
$378.50 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$116.10 |
$193.50 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$115.20 |
$192 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$294.60 |
$491 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$302.70 |
$504.50 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$249.30 |
$415.50 |
2.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$306.60 |
$511 |
3.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$258 |
$430 |
3.0× |
| Xr arthrogram ankle (73615) |
$492.60 |
$821 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$386.40 |
$644 |
3.8× |
| Xr chest 4+ views (71048) |
$433.20 |
$722 |
4.2× |
| Xr finger(s) 2+ views (73140) |
$204.90 |
$341.50 |
2.4× |
| Xr optic foramina (70190) |
$104.70 |
$174.50 |
1.2× |
| Xr shoulder 1 view (73020) |
$300 |
$500 |
3.5× |
| Xr spine cervical 4 or 5 views (72050) |
$384.90 |
$641.50 |
3.7× |
| Xr tibia/fibula 2 views (73590) |
$232.80 |
$388 |
2.7× |
| Xr tmj bilateral (70330) |
$452.40 |
$754 |
5.3× |
| Xray knee 1 or 2 views rt (73560) |
$203.70 |
$339.50 |
2.4× |