| Acute gi blood loss imaging (78278) |
$3,058.50 |
$4,078 |
7.3× |
| Angio adrenal unilat select (75731) |
$6,121.79 |
$8,162.39 |
1.9× |
| Angio extremity unilateral (75710) |
$11,456.25 |
$15,275 |
3.5× |
| Angio pulmonary unilateral (75741) |
$11,990.25 |
$15,987 |
3.6× |
| Angiogram extremity bilateral (75716) |
$12,913.50 |
$17,218 |
3.9× |
| Angiogram pelvic (75736) |
$10,670.90 |
$14,227.88 |
1.8× |
| Angiography internal mammary rs&i (75756) |
$7,317 |
$9,756 |
2.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$14,640 |
$19,520 |
4.4× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$10,829.56 |
$14,439.42 |
1.9× |
| Angrph cath f-up std tcat other than thrombylsis (75898) |
$3,700.24 |
$4,933.66 |
1.1× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$4,941.19 |
$6,588.25 |
1.5× |
| Ankle 2 views (73600) |
$705.75 |
$941 |
7.8× |
| Arthrography knee lt (73580) |
$3,543.75 |
$4,725 |
9.7× |
| Arthrography wrist lt (73115) |
$2,147.25 |
$2,863 |
5.9× |
| Barium enema (74270) |
$1,602.75 |
$2,137 |
8.8× |
| Bilat selctv renal venogram (75833) |
$7,115.57 |
$9,487.43 |
2.2× |
| Bone age studies (77072) |
$678 |
$904 |
6.2× |
| Bone imaging limited area (78300) |
$2,412 |
$3,216 |
5.8× |
| Bone survey complete (77075) |
$1,161.75 |
$1,549 |
10.6× |
| Bowel imaging (78290) |
$3,152.25 |
$4,203 |
7.6× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$3,478.50 |
$4,638 |
6.1× |
| Brain image w/flow 4 + views (78606) |
$4,059.75 |
$5,413 |
7.2× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$4,702.50 |
$6,270 |
11.3× |
| Cardiac shunt detection (78428) |
$5,247 |
$6,996 |
12.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,484.25 |
$1,979 |
8.1× |
| Cisternogram (78630) |
$4,134.75 |
$5,513 |
7.3× |
| Clavicle complete (73000) |
$1,086 |
$1,448 |
11.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$6,582.75 |
$8,777 |
35.9× |
| Contrast exam abdominl aorta (75625) |
$10,997.25 |
$14,663 |
3.3× |
| Contrast exam thoracic aorta (75605) |
$10,426.50 |
$13,902 |
1.8× |
| CT - st neck w&wo contr (70492) |
$9,583.50 |
$12,778 |
52.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$9,279.75 |
$12,373 |
25.5× |
| CT abdomen and pelvis without contrast (74176) |
$10,861.50 |
$14,482 |
43.6× |
| CT abdomen w wo contrast (74170) |
$5,478 |
$7,304 |
29.9× |
| CT abdomen w/contrast (74160) |
$5,874.75 |
$7,833 |
32.1× |
| CT abdomen w/o contrast (74150) |
$4,712.25 |
$6,283 |
43.2× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$9,417.38 |
$12,556.50 |
25.8× |
| CT angio abdom w/o & w/dye (74175) |
$5,892 |
$7,856 |
32.2× |
| CT angio abdominal arteries (75635) |
$5,393.25 |
$7,191 |
29.4× |
| CT angio hrt w/3d image (75574) |
$7,284.75 |
$9,713 |
20.0× |
| CT angiograph pelv w/o&w/dye (72191) |
$7,045.88 |
$9,394.50 |
38.5× |
| CT cervical spine w/contrast (72126) |
$6,566.25 |
$8,755 |
18.0× |
| CT cervical spine w/o contrast (72125) |
$7,061.25 |
$9,415 |
64.7× |
| CT chest w/contrast (71260) |
$7,434 |
$9,912 |
40.6× |
| CT colonography w/o cntrst (74261) |
$3,095.25 |
$4,127 |
28.4× |
| CT extremity upper w & w/o contrast (73202) |
$8,145.75 |
$10,861 |
44.5× |
| CT head/brain with contrast (70460) |
$7,434 |
$9,912 |
40.6× |
| CT head/brain without and with contrast (70470) |
$8,784 |
$11,712 |
48.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,119.75 |
$1,493 |
12.3× |
| CT limited/localized follow up study (76380) |
$1,735.50 |
$2,314 |
19.1× |
| CT lower ext w/wo contrast (73702) |
$4,954.50 |
$6,606 |
27.0× |
| CT lower extremity w contrast (73701) |
$5,050.50 |
$6,734 |
27.6× |
| CT lower extremity w/o contrast unilateral (73700) |
$4,902 |
$6,536 |
44.9× |
| CT lumbar spine w/contrast (72132) |
$6,582.75 |
$8,777 |
18.1× |
| CT lumbar spine w/o contrast (72131) |
$6,960.75 |
$9,281 |
63.8× |
| CT lumbar spine w/o then w/ con (72133) |
$7,547.25 |
$10,063 |
41.2× |
| CT maxillofacial area w/o contrast (70486) |
$6,256.12 |
$8,341.50 |
57.3× |
| CT maxillofacial w/contrast (70487) |
$5,767.50 |
$7,690 |
31.5× |
| CT maxillofacial w/o then w/ con (70488) |
$4,959.38 |
$6,612.50 |
27.1× |
| CT orbit sella ear w/o con (70480) |
$6,620.25 |
$8,827 |
60.6× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$6,296.25 |
$8,395 |
34.4× |
| CT pelvis w & w/o contrast (72194) |
$6,837.75 |
$9,117 |
37.3× |
| CT pelvis w/o contrast (72192) |
$7,061.25 |
$9,415 |
64.7× |
| CT soft tissue neck w/contrast (70491) |
$7,015.50 |
$9,354 |
38.3× |
| CT soft tissue neck w/o contrast (70490) |
$5,610.75 |
$7,481 |
51.4× |
| CT spine cervical w/wo contrast (72127) |
$6,478.50 |
$8,638 |
35.4× |
| CT thoracic spine w/contrast (72129) |
$5,214 |
$6,952 |
28.5× |
| CT thoracic spine w/o contrast (72128) |
$6,194.25 |
$8,259 |
56.7× |
| CT thoracic spine w/o then w/ con (72130) |
$6,527.25 |
$8,703 |
35.6× |
| CT thorax lung cancer scr c- (71271) |
$446.25 |
$595 |
4.1× |
| CT thorax w/o contrast (71250) |
$7,061.25 |
$9,415 |
64.7× |
| CT thorax w/o then w/ contrast (71270) |
$6,540 |
$8,720 |
35.7× |
| CT upper extremity w/dye (73201) |
$4,815.75 |
$6,421 |
13.2× |
| CT upper extremity w/o contrast rt (73200) |
$5,017.50 |
$6,690 |
46.0× |
| CTA chest w/wo contrast (71275) |
$6,385.88 |
$8,514.50 |
34.9× |
| CTA head w contrast (70496) |
$6,505.50 |
$8,674 |
35.5× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$5,833.50 |
$7,778 |
31.8× |
| Cta Neck (70498) |
$6,516.75 |
$8,689 |
35.6× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$3,274.12 |
$4,365.50 |
17.9× |
| Dilation ureters/urethra rs&i (74485) |
$10,327.50 |
$13,770 |
4.7× |
| Doppler fetal mid cerebral artery (76821) |
$1,026 |
$1,368 |
9.4× |
| Dxa bone density study axial skeleton (77085) |
$1,356 |
$1,808 |
12.4× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$982.50 |
$1,310 |
3.9× |
| Esophogram (74220) |
$1,416 |
$1,888 |
7.7× |
| Fetal biophysical profile non-stress testing (76818) |
$2,343 |
$3,124 |
21.5× |
| Fetal biophysical profile w/o nst (76819) |
$2,136 |
$2,848 |
19.6× |
| Fetal echo complete (76825) |
$1,750.50 |
$2,334 |
3.1× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$1,592.62 |
$2,123.50 |
6.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Age Under 21 (78265) |
$4,167.75 |
$5,557 |
10.0× |
| Gastric emptying study (78264) |
$3,152.25 |
$4,203 |
7.6× |
| Gastroesophageal reflux study (78262) |
$3,923.25 |
$5,231 |
9.4× |
| Gated heart planar single (78472) |
$4,280.25 |
$5,707 |
10.3× |
| Heart infarct image (78466) |
$3,426.75 |
$4,569 |
8.2× |
| Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation Other… (75889) |
$6,821.44 |
$9,095.25 |
2.1× |
| Hepatobil syst image w/drug (78227) |
$4,280.25 |
$5,707 |
7.5× |
| Hepatobiliary system imaging (78226) |
$4,280.25 |
$5,707 |
10.3× |
| Humerus min 2 views (73060) |
$971.25 |
$1,295 |
10.7× |
| Hysterosalpingography (74740) |
$2,513.25 |
$3,351 |
10.1× |
| Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when… (77778) |
$17,652.75 |
$23,537 |
24.3× |
| Ivp (74400) |
$2,507.62 |
$3,343.50 |
13.7× |
| Ivp w tomography (74415) |
$3,196.50 |
$4,262 |
17.5× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$6,637.50 |
$8,850 |
11.7× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$3,497.25 |
$4,663 |
6.2× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$4,650.75 |
$6,201 |
8.2× |
| Kidney w vascular flow (78701) |
$3,603.75 |
$4,805 |
8.6× |
| Liver & spleen; static only (78215) |
$4,280.25 |
$5,707 |
10.3× |
| Liver & spleen; w vasc flow (78216) |
$4,963.50 |
$6,618 |
11.9× |
| Liver imaging w/vascular flow (78202) |
$2,868.75 |
$3,825 |
5.1× |
| Lung perfusion differential (78597) |
$2,946.75 |
$3,929 |
7.1× |
| Lung ventilat&perfus imaging (78582) |
$3,798 |
$5,064 |
6.7× |
| Lung ventilation imaging (78579) |
$6,637.50 |
$8,850 |
15.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$6,769.50 |
$9,026 |
18.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$7,059.75 |
$9,413 |
19.4× |
| Mammary ductogram multiple ducts (77054) |
$2,043.75 |
$2,725 |
8.2× |
| Mammary ductogram single (77053) |
$3,186.75 |
$4,249 |
12.8× |
| Mr safety determination physician/other qhp (76016) |
$360 |
$480 |
4.0× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$243 |
$324 |
3.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$99.75 |
$133 |
3.3× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$375 |
$500 |
3.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$987.75 |
$1,317 |
4.0× |
| MRA head w & w/o contrast (70546) |
$7,068.75 |
$9,425 |
19.4× |
| MRA head w/contrast (70545) |
$9,207.75 |
$12,277 |
25.3× |
| MRA head w/o contrast (70544) |
$9,189 |
$12,252 |
36.9× |
| MRA neck w/contrast (70548) |
$5,280 |
$7,040 |
14.5× |
| MRA neck w/o contrast (70547) |
$7,366.12 |
$9,821.50 |
29.6× |
| MRA neck w/wo contrast (70549) |
$9,189 |
$12,252 |
25.2× |
| MRI abdomen w/contrast (74182) |
$7,821.75 |
$10,429 |
21.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$8,415 |
$11,220 |
23.1× |
| MRI abdomen w/o contrast (74181) |
$7,531.50 |
$10,042 |
30.2× |
| MRI any jnt lwr ext with con lt (73722) |
$5,118 |
$6,824 |
6.3× |
| MRI breast without contrast bilateral (77047) |
$6,635.25 |
$8,847 |
26.6× |
| MRI breast without contrast material unilateral (77046) |
$4,965.75 |
$6,621 |
19.9× |
| MRI cervical spine w/o contrast (72141) |
$7,682.25 |
$10,243 |
30.8× |
| MRI cervical spine with contrast (72142) |
$2,301 |
$3,068 |
6.3× |
| MRI chest w & w/o contrast (71552) |
$5,788.50 |
$7,718 |
15.9× |
| MRI chest w/contrast (71551) |
$8,900.25 |
$11,867 |
10.9× |
| MRI chest w/o contrast (71550) |
$6,129 |
$8,172 |
24.6× |
| MRI fetal sngl/1st gestation (74712) |
$3,426.75 |
$4,569 |
13.8× |
| MRI joint upper ext w/contrast (73222) |
$6,680.25 |
$8,907 |
8.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$6,769.50 |
$9,026 |
18.6× |
| MRI joint upr extrem w/o dye (73221) |
$6,436.50 |
$8,582 |
25.8× |
| Mri Lower Extremity W/O Dye (73718) |
$6,769.50 |
$9,026 |
27.2× |
| MRI lumbar spine with contrast (72149) |
$2,041.50 |
$2,722 |
5.6× |
| MRI lumbar w/wo contrast (72158) |
$9,672 |
$12,896 |
26.5× |
| MRI lwr ext w/o jnts with con rt (73719) |
$4,721.25 |
$6,295 |
13.0× |
| MRI orbit/face/neck w/contrast (70542) |
$7,823.25 |
$10,431 |
21.5× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$9,189 |
$12,252 |
25.2× |
| MRI orbit/face/neck w/o contrast (70540) |
$4,942.50 |
$6,590 |
19.8× |
| MRI pelvis w/ contrast (72196) |
$7,182.75 |
$9,577 |
19.7× |
| MRI pelvis w/o contrast (72195) |
$4,723.50 |
$6,298 |
19.0× |
| MRI pelvis w/wo contrast (72197) |
$5,788.50 |
$7,718 |
15.9× |
| MRI spine cervical wo/w contrast (72156) |
$9,672 |
$12,896 |
26.5× |
| MRI spine thoracic w/contrast (72147) |
$2,403.75 |
$3,205 |
6.6× |
| MRI thoracic spine w wo contrast (72157) |
$11,565.75 |
$15,421 |
31.7× |
| MRI thoracic spine w/o contrast (72146) |
$7,734 |
$10,312 |
31.0× |
| MRI tmj (70336) |
$6,267.75 |
$8,357 |
25.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$6,436.50 |
$8,582 |
25.8× |
| Mri Upper Extremity W/Dye (73219) |
$8,998.50 |
$11,998 |
24.7× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$6,946.50 |
$9,262 |
19.1× |
| Myelography 2 or more regions (72270) |
$6,665.25 |
$8,887 |
8.1× |
| Myelography lumbosacral (72265) |
$3,972.38 |
$5,296.50 |
4.9× |
| Myocardial perfusion planar multiple studies (78454) |
$16,300.50 |
$21,734 |
12.1× |
| Myocardial spect single study at rest or stress (78451) |
$13,010.25 |
$17,347 |
9.6× |
| Nm adrenal imaging (78075) |
$3,962.25 |
$5,283 |
2.9× |
| Nm bone 3 phase (78315) |
$4,280.25 |
$5,707 |
10.3× |
| Nm bone imaging whole body (78306) |
$4,280.25 |
$5,707 |
10.3× |
| Nm heart perfusion spect stress rest (78452) |
$19,750.50 |
$26,334 |
14.6× |
| Nm kidney imaging morphology (78700) |
$3,132 |
$4,176 |
7.5× |
| Nm lymph system (78195) |
$2,536.50 |
$3,382 |
4.5× |
| Nm myocard infarct spect (78469) |
$7,439.25 |
$9,919 |
13.1× |
| Nm thyroid imaging only (78013) |
$2,156.25 |
$2,875 |
5.2× |
| Nose to rectum for fb child (76010) |
$567 |
$756 |
6.2× |
| Ob us < 14 wks single fetus (76801) |
$950.25 |
$1,267 |
8.7× |
| Oral radiopharm rx (79005) |
$1,224 |
$1,632 |
5.0× |
| Orthopantogram (70355) |
$1,077 |
$1,436 |
11.9× |
| Parathyroid imaging (78070) |
$3,831.75 |
$5,109 |
9.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,829 |
$3,772 |
6.8× |
| PET brain metabolic eval (78608) |
$8,042.25 |
$10,723 |
5.4× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$8,410.50 |
$11,214 |
5.6× |
| PET imaging CT for attenuation limited area (78814) |
$8,042.25 |
$10,723 |
5.4× |
| PET imaging for CT attenuation whole body (78816) |
$6,453.38 |
$8,604.50 |
4.3× |
| Pulmonary perfusion imaging particulate (78580) |
$4,083.75 |
$5,445 |
9.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,188.75 |
$1,585 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$510.75 |
$681 |
5.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$916.50 |
$1,222 |
8.4× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$2,219.25 |
$2,959 |
20.3× |
| Radex entir thrc lmbr crv sac spi w/skull 6/> vw (72084) |
$1,851.75 |
$2,469 |
17.0× |
| Radex hip unilateral with pelvis 1 view (73501) |
$501 |
$668 |
5.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$840 |
$1,120 |
9.2× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$1,164.75 |
$1,553 |
10.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$745.12 |
$993.50 |
6.8× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$2,405.25 |
$3,207 |
22.0× |
| Radex spine cervical 2 or 3 views (72040) |
$1,382.25 |
$1,843 |
15.2× |
| Radex spine cervical 4 or 5 views (72050) |
$1,315.50 |
$1,754 |
12.1× |
| Radex spine cervical 6 or more views (72052) |
$894 |
$1,192 |
8.2× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$562.50 |
$750 |
6.2× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$1,165.50 |
$1,554 |
10.7× |
| Radiologic exam esophagus double contrast study (74221) |
$1,088.25 |
$1,451 |
5.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$2,622 |
$3,496 |
14.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,296 |
$1,728 |
7.1× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$651 |
$868 |
7.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$945 |
$1,260 |
10.4× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$1,683.75 |
$2,245 |
15.4× |
| Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique Other Diagnostic… (70370) |
$1,174.50 |
$1,566 |
12.9× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,221 |
$1,628 |
2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$4,308.75 |
$5,745 |
10.3× |
| Rp loclzj tum plnr whole body 2+ days imaging (78804) |
$7,439.25 |
$9,919 |
13.1× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$4,493.25 |
$5,991 |
7.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$5,436.75 |
$7,249 |
9.6× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$7,593.75 |
$10,125 |
5.6× |
| Rp therapy intra-arterial particulate admn (79445) |
$919.50 |
$1,226 |
3.8× |
| Saline infused sonohysterogram (76831) |
$1,585.50 |
$2,114 |
6.4× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$373.50 |
$498 |
16.0× |
| Shoulder arthrogram (73040) |
$3,000 |
$4,000 |
8.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,188.75 |
$1,585 |
10.9× |
| Small bowel series (74250) |
$1,390.50 |
$1,854 |
7.6× |
| Testicular imaging w/flow (78761) |
$5,612.25 |
$7,483 |
13.4× |
| Therapeutic enema barium or air (74283) |
$1,583.25 |
$2,111 |
8.6× |
| Thyroid met imaging body (78018) |
$4,280.25 |
$5,707 |
7.5× |
| Thyroid uptake single/multiple quant measurement (78012) |
$3,003 |
$4,004 |
7.2× |
| Ultrasound breast limited (76642) |
$1,560 |
$2,080 |
17.2× |
| Ultrasound, abdomen limited (76705) |
$1,827.75 |
$2,437 |
16.7× |
| Umbilical-artery Doppler (OB) (76820) |
$1,214.25 |
$1,619 |
11.1× |
| Ureteral reflux study (78740) |
$2,536.50 |
$3,382 |
6.1× |
| Urethrocystography retrograde rs&i (74450) |
$2,100 |
$2,800 |
8.4× |
| Urethrocystography voiding (74455) |
$2,269.50 |
$3,026 |
9.1× |
| Urography antegrade (74425) |
$1,372.50 |
$1,830 |
3.8× |
| Urography retrograde w/wo kub (74420) |
$2,019 |
$2,692 |
5.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$937.88 |
$1,250.50 |
8.6× |
| Us breast uni real time with image complete (76641) |
$1,598.25 |
$2,131 |
14.6× |
| Us chest (76604) |
$1,104.75 |
$1,473 |
10.1× |
| Us compl joint r-t w/image documentation (76881) |
$4,552.50 |
$6,070 |
41.7× |
| Us encephalogram (76506) |
$1,710 |
$2,280 |
15.7× |
| Us guided compression repair (76936) |
$1,901.25 |
$2,535 |
8.4× |
| Us inft hips r-t img dynamic req phys/qhp manj (76885) |
$1,941 |
$2,588 |
21.4× |
| Us inft hips r-t img lmtd static phys/qhp manj (76886) |
$1,941 |
$2,588 |
21.4× |
| Us kidney transplanted (76776) |
$1,542.75 |
$2,057 |
14.1× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$3,026.25 |
$4,035 |
27.7× |
| Us ob detailed single fetus (76811) |
$597.75 |
$797 |
2.4× |
| Us ob followup per fetus (76816) |
$1,266 |
$1,688 |
11.6× |
| Us ob limited 1 or more fetuses (76815) |
$780.38 |
$1,040.50 |
7.1× |
| Us obstetric transvaginal (76817) |
$2,496.75 |
$3,329 |
22.9× |
| Us pelvic limited or f/u non-ob (76857) |
$2,673.75 |
$3,565 |
24.5× |
| Us pelvis complete (76856) |
$2,607.75 |
$3,477 |
23.9× |
| Us retroperitoneal complete (76770) |
$2,347.50 |
$3,130 |
21.5× |
| Us retroperitoneal limited (76775) |
$1,488.75 |
$1,985 |
13.6× |
| Us scrotum (76870) |
$1,855.50 |
$2,474 |
17.0× |
| Us soft tissue head/neck (76536) |
$2,147.25 |
$2,863 |
19.7× |
| Us spinal canal (76800) |
$1,986 |
$2,648 |
18.2× |
| Us unlstd proc (76999) |
$8,520.75 |
$11,361 |
93.8× |
| Vein X-ray liver w/hemodynam (75885) |
$10,102.12 |
$13,469.50 |
3.1× |
| Venogram extremity bilateral (75822) |
$6,451.50 |
$8,602 |
3.9× |
| Venogram ivc w serialography (75825) |
$6,445.21 |
$8,593.62 |
2.0× |
| Venogram svc w serialography (75827) |
$5,788.50 |
$7,718 |
3.5× |
| Venography ext unilateral (75820) |
$4,611 |
$6,148 |
2.8× |
| Venography renal unilateral selective rs&i (75831) |
$5,955.52 |
$7,940.69 |
1.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$5,013.15 |
$6,684.20 |
1.5× |
| Venous sampling by catheter (75893) |
$9,164.77 |
$12,219.69 |
1.6× |
| Venous thrombosis imaging - nm extremity veins thrombosis right (78457) |
$4,632.75 |
$6,177 |
8.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$1,053.38 |
$1,404.50 |
11.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$1,241.25 |
$1,655 |
13.7× |
| X-ray aorta leg arteries (75630) |
$10,011.75 |
$13,349 |
3.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$2,837.25 |
$3,783 |
15.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$1,224.75 |
$1,633 |
13.5× |
| X-ray exam hips bi 3-4 views (73522) |
$929.25 |
$1,239 |
8.5× |
| X-ray exam of finger(s) (73140) |
$968.25 |
$1,291 |
10.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$1,059.75 |
$1,413 |
11.7× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$666.75 |
$889 |
7.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$1,235.25 |
$1,647 |
13.6× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$710.25 |
$947 |
6.5× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$1,077 |
$1,436 |
11.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$799.50 |
$1,066 |
8.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$873 |
$1,164 |
9.6× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$1,108.50 |
$1,478 |
12.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$1,379.25 |
$1,839 |
12.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$1,664.25 |
$2,219 |
15.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$960 |
$1,280 |
8.8× |
| X-ray perineogram (74775) |
$892.50 |
$1,190 |
3.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$1,264.50 |
$1,686 |
13.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$1,455.38 |
$1,940.50 |
13.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$1,392.75 |
$1,857 |
12.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$1,007.62 |
$1,343.50 |
11.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$1,020.75 |
$1,361 |
11.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$903 |
$1,204 |
9.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$1,243.50 |
$1,658 |
11.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$909 |
$1,212 |
8.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$719.25 |
$959 |
7.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$712.50 |
$950 |
7.8× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$960 |
$1,280 |
10.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$1,290.75 |
$1,721 |
14.2× |
| Xr abdomen 1 view (74018) |
$1,017.75 |
$1,357 |
11.2× |
| Xr abdomen 2 views (74019) |
$1,250.25 |
$1,667 |
11.5× |
| Xr abdomen 3 views (74021) |
$1,432.50 |
$1,910 |
13.1× |
| Xr arthrogram ankle (73615) |
$4,288.50 |
$5,718 |
11.8× |
| Xr arthrogram hip (73525) |
$2,678.25 |
$3,571 |
7.4× |
| Xr bone density axial (77080) |
$1,441.88 |
$1,922.50 |
13.2× |
| Xr bone length study (77073) |
$894 |
$1,192 |
8.2× |
| Xr bone survey infant (77076) |
$1,172.25 |
$1,563 |
10.7× |
| Xr bone survey limited (77074) |
$1,989 |
$2,652 |
18.2× |
| Xr chest 1 view (71045) |
$762 |
$1,016 |
8.4× |
| Xr chest 2 views (71046) |
$1,164 |
$1,552 |
12.8× |
| Xr chest 3 views (71047) |
$1,261.50 |
$1,682 |
13.9× |
| Xr cystogram 3+ views (74430) |
$2,313.75 |
$3,085 |
6.4× |
| Xr facial bones 3 views (70150) |
$1,379.25 |
$1,839 |
12.6× |
| Xr lower extremity 2 views infant (73592) |
$695.25 |
$927 |
7.7× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$1,374 |
$1,832 |
12.6× |
| Xr mandible 4 views (70110) |
$1,038.75 |
$1,385 |
9.5× |
| Xr myelogram c-spine (72240) |
$5,258.25 |
$7,011 |
6.4× |
| Xr nasal bones (70160) |
$1,217.25 |
$1,623 |
13.4× |
| Xr pelvis 3 views (72190) |
$902.25 |
$1,203 |
8.3× |
| Xr sialogram (70390) |
$2,495.25 |
$3,327 |
10.0× |
| Xr spine 1 view (72020) |
$621.75 |
$829 |
6.8× |
| Xr sternum 2 views (71120) |
$1,179.75 |
$1,573 |
13.0× |
| Xr surgical specimen (76098) |
$825.75 |
$1,101 |
1.4× |
| Xr upper extremity 2 views infant (73092) |
$746.25 |
$995 |
6.8× |
| Xray elbow 2 views (73070) |
$666.75 |
$889 |
7.3× |
| Xray forearm 2 views (73090) |
$1,144.50 |
$1,526 |
12.6× |
| Xray knee 1 or 2 views rt (73560) |
$755.25 |
$1,007 |
8.3× |
| Xray neck soft tissue (70360) |
$1,137 |
$1,516 |
12.5× |
| Xray orbits complete min 4 views (70200) |
$936.75 |
$1,249 |
8.6× |
| Xray pelvis 1 or 2 views (72170) |
$887.25 |
$1,183 |
8.1× |
| Xray ribs bilateral 3 views (71110) |
$1,251 |
$1,668 |
11.5× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$1,406.25 |
$1,875 |
12.9× |
| Xray scapula complete (73010) |
$1,007.25 |
$1,343 |
9.2× |
| Xray shoulder 1 view (73020) |
$741 |
$988 |
8.2× |
| Xray sinuses paranasal <3 views (70210) |
$394.50 |
$526 |
4.3× |
| Xray spine thoracic 2 views (72070) |
$1,464.75 |
$1,953 |
13.4× |
| Xray spine thoracic 3 views (72072) |
$1,518 |
$2,024 |
13.9× |
| Xray tibia-fibula 2 views bil (73590) |
$1,242 |
$1,656 |
13.7× |
| Xray tmj open - closed unilat (70328) |
$763.50 |
$1,018 |
8.4× |
| Xray tmj's bilateral open-clsc (70330) |
$1,610.25 |
$2,147 |
17.7× |