| Abdomen 2 views (74019) |
$320.40 |
$534 |
3.2× |
| Acute gi blood loss imaging (78278) |
$985.80 |
$1,643 |
2.6× |
| Angiography extremity bilateral rs&i (75716) |
$4,980 |
$8,300 |
1.6× |
| Angiography extremity unilateral rs&i (75710) |
$3,111.60 |
$5,186 |
1.0× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,410.80 |
$4,018 |
0.5× |
| Ankle 2 views (73600) |
$222.60 |
$371 |
2.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,111.60 |
$5,186 |
1.0× |
| Aortography abdominal serialography rs&i (75625) |
$3,111.60 |
$5,186 |
1.0× |
| Arthrogram shoulder (73040) |
$411.60 |
$686 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,097.40 |
$1,829 |
2.9× |
| Bone &/joint imaging whole body (78306) |
$1,314 |
$2,190 |
3.4× |
| Bone age studies (77072) |
$243 |
$405 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,213.80 |
$2,023 |
3.2× |
| Bone survey complete (77075) |
$1,270.20 |
$2,117 |
12.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,462.80 |
$2,438 |
2.8× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,876.80 |
$3,128 |
1.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,314 |
$2,190 |
3.4× |
| Cervical spine 2 or 3 views (72040) |
$273.60 |
$456 |
3.3× |
| Chest 1 view (71045) |
$223.80 |
$373 |
2.7× |
| Chest xray 3 views (71047) |
$340.80 |
$568 |
4.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$579.60 |
$966 |
3.4× |
| Clavicle complete (73000) |
$243 |
$405 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,919.40 |
$3,199 |
19.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,362.20 |
$8,937 |
16.0× |
| CT abdomen and pelvis without contrast (74176) |
$3,504 |
$5,840 |
15.3× |
| CT abdomen w contrast (74160) |
$2,048.40 |
$3,414 |
12.2× |
| CT abdomen w wo contrast (74170) |
$2,446.80 |
$4,078 |
14.5× |
| CT abdomen w/o contrast (74150) |
$1,663.20 |
$2,772 |
16.6× |
| CT angio hrt w/3d image (75574) |
$1,644.60 |
$2,741 |
4.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,276.40 |
$3,794 |
13.5× |
| CT angiography upper extremity lt (73206) |
$2,276.40 |
$3,794 |
13.5× |
| CT c-spine w/contrast (72126) |
$2,464.20 |
$4,107 |
7.4× |
| CT c-spine w/o contrast (72125) |
$2,133.60 |
$3,556 |
21.3× |
| CT cervical spine w&w/o contrast (72127) |
$2,918.40 |
$4,864 |
17.3× |
| CT chest w contrast (71260) |
$2,628 |
$4,380 |
15.6× |
| CT chest w/wo contrast (71270) |
$3,141 |
$5,235 |
18.7× |
| CT head/brain with contrast (70460) |
$1,710 |
$2,850 |
10.2× |
| CT head/brain without and with contrast (70470) |
$2,428.20 |
$4,047 |
14.4× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,644.60 |
$2,741 |
4.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,644.60 |
$2,741 |
19.7× |
| CT iac w contrast (70481) |
$1,999.80 |
$3,333 |
11.9× |
| CT lower ext w/o (73700) |
$1,585.80 |
$2,643 |
15.8× |
| CT lower extremity w wo contrast (73702) |
$2,276.40 |
$3,794 |
13.5× |
| CT lower extremity w/contrast material (73701) |
$1,999.80 |
$3,333 |
11.9× |
| CT lumbar spine w & w/o contrast (72133) |
$2,918.40 |
$4,864 |
17.3× |
| CT lumbar spine w/contrast (72132) |
$2,464.20 |
$4,107 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$1,789.80 |
$2,983 |
17.8× |
| CT maxillofacial w contrast (70487) |
$1,999.80 |
$3,333 |
11.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,276.40 |
$3,794 |
13.5× |
| CT maxillofacial wo contrast (70486) |
$1,585.80 |
$2,643 |
15.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,276.40 |
$3,794 |
13.5× |
| CT orbits w/o contrast (70480) |
$1,585.80 |
$2,643 |
15.8× |
| CT pelvis w/o contrast (72192) |
$1,841.40 |
$3,069 |
18.4× |
| CT pelvis w/wo contrast (72194) |
$2,918.40 |
$4,864 |
17.3× |
| CT scan of arm combo (73202) |
$2,276.40 |
$3,794 |
13.5× |
| CT soft tissue neck w contrast (70491) |
$1,999.80 |
$3,333 |
11.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,276.40 |
$3,794 |
13.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,585.80 |
$2,643 |
15.8× |
| CT thoracic spine w/contrast (72129) |
$2,464.20 |
$4,107 |
14.6× |
| CT thoracic spine w/o contrast (72128) |
$2,177.40 |
$3,629 |
21.7× |
| CT thoracic spine w/wo contrast (72130) |
$2,025 |
$3,375 |
12.0× |
| CT thorax w/o contrast (71250) |
$1,919.40 |
$3,199 |
19.1× |
| CT upper ext wo (73200) |
$1,585.80 |
$2,643 |
15.8× |
| CT upper extremity with contrast (73201) |
$1,999.80 |
$3,333 |
6.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,276.40 |
$3,794 |
13.5× |
| Cta Abdomen (74175) |
$2,276.40 |
$3,794 |
13.5× |
| CTA abdomen pelvis (74174) |
$5,247 |
$8,745 |
15.7× |
| CTA chest (71275) |
$2,918.40 |
$4,864 |
17.3× |
| Cta Head (70496) |
$2,276.40 |
$3,794 |
13.5× |
| Cta Neck (70498) |
$2,276.40 |
$3,794 |
13.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$170.40 |
$284 |
1.7× |
| Dxa bone density study axial skeleton (77085) |
$279.60 |
$466 |
2.8× |
| Esophagus (74220) |
$574.20 |
$957 |
3.4× |
| Facial bones min 3 views (70150) |
$355.20 |
$592 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$393.60 |
$656 |
1.7× |
| Foot 2 views (73620) |
$221.40 |
$369 |
2.7× |
| Forearm 2 views (73090) |
$232.20 |
$387 |
2.8× |
| Hand 2 views (73120) |
$202.20 |
$337 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,314 |
$2,190 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$688.80 |
$1,148 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,314 |
$2,190 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,314 |
$2,190 |
2.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,444.80 |
$2,408 |
2.8× |
| Knee 3 views (73562) |
$255 |
$425 |
3.1× |
| Lymphoscintigraphy (78195) |
$792.60 |
$1,321 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,243.60 |
$5,406 |
4.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,243.60 |
$5,406 |
9.7× |
| MRA head w & w/o contrast (70546) |
$2,816.40 |
$4,694 |
8.4× |
| MRA head w/o contrast (70544) |
$2,656.20 |
$4,427 |
11.6× |
| MRA neck w/o contrast (70547) |
$2,656.20 |
$4,427 |
11.6× |
| MRI abdomen w contrast (74182) |
$2,704.80 |
$4,508 |
8.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,704.80 |
$4,508 |
8.1× |
| MRI abdomen w/o contrast (74181) |
$2,552.40 |
$4,254 |
11.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,243.60 |
$5,406 |
9.7× |
| MRI c-spine with contrast (72142) |
$3,242.40 |
$5,404 |
9.7× |
| MRI cervical spine w/o contrast (72141) |
$3,060.60 |
$5,101 |
13.4× |
| MRI chest w/o contrast (71550) |
$3,243.60 |
$5,406 |
14.2× |
| MRI chest with contrast (71551) |
$3,243.60 |
$5,406 |
4.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,243.60 |
$5,406 |
9.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,243.60 |
$5,406 |
9.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,060.60 |
$5,101 |
13.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,060.60 |
$5,101 |
13.4× |
| MRI orbit face neck w contrast (70542) |
$3,243.60 |
$5,406 |
9.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,181.60 |
$8,636 |
15.5× |
| MRI pelvis w/contrast (72196) |
$3,243.60 |
$5,406 |
9.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,243.60 |
$5,406 |
9.7× |
| MRI pelvis w/o contrast (72195) |
$3,060.60 |
$5,101 |
13.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,926.60 |
$8,211 |
14.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,384.60 |
$5,641 |
10.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,051.80 |
$6,753 |
12.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,242.40 |
$5,404 |
9.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,926.60 |
$8,211 |
14.7× |
| MRI thoracic spine w/o contrast (72146) |
$3,243.60 |
$5,406 |
14.2× |
| MRI up ext w/o contrast (73218) |
$2,338.80 |
$3,898 |
10.2× |
| MRI upper ext joint w/o contrast (73221) |
$3,243.60 |
$5,406 |
14.2× |
| MRI, joint upper extrem combo (73223) |
$3,183 |
$5,305 |
9.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,185.60 |
$1,976 |
1.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,878 |
$3,130 |
1.5× |
| Neck soft tissue (70360) |
$222.60 |
$371 |
2.7× |
| Nm gastric emptying study (78264) |
$1,340.40 |
$2,234 |
3.5× |
| Nonvascular shunt X-ray (75809) |
$60 |
$100 |
0.6× |
| Parathyroid Planar Imaging (78070) |
$791.40 |
$1,319 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$243 |
$405 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$5,751 |
$9,585 |
4.2× |
| PET imaging CT for attenuation limited area (78814) |
$4,471.20 |
$7,452 |
3.3× |
| PET imaging for CT attenuation whole body (78816) |
$5,751 |
$9,585 |
4.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$684.60 |
$1,141 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,460.40 |
$2,434 |
2.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$265.80 |
$443 |
3.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$232.20 |
$387 |
2.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$273.60 |
$456 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$487.80 |
$813 |
4.9× |
| Radex fingr minimum 2 views (73140) |
$197.40 |
$329 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$250.80 |
$418 |
3.0× |
| Radex Hand Minimum 3 Views (73130) |
$243.60 |
$406 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$235.20 |
$392 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$250.20 |
$417 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$470.70 |
$784.50 |
4.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$34.80 |
$58 |
0.3× |
| Radex Humerus Minimum 2 Views (73060) |
$243 |
$405 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$229.20 |
$382 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$300 |
$500 |
3.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$393.60 |
$656 |
3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$243 |
$405 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$320.40 |
$534 |
3.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$243 |
$405 |
2.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$243 |
$405 |
2.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$382.20 |
$637 |
3.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$393.60 |
$656 |
4.7× |
| Radex Toe Minimum 2 Views (73660) |
$183 |
$305 |
2.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$269.40 |
$449 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$243 |
$405 |
2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$332.40 |
$554 |
3.3× |
| Radiologic exam chest 2 views (71046) |
$265.80 |
$443 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$877.80 |
$1,463 |
5.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,225.20 |
$2,042 |
7.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,149 |
$1,915 |
6.8× |
| Radiologic examination femur 1 view (73551) |
$120.60 |
$201 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$250.80 |
$418 |
3.0× |
| Radiological examination surgical specimen (76098) |
$702 |
$1,170 |
1.3× |
| Ribs bilateral 3 views (71110) |
$477.60 |
$796 |
4.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,213.80 |
$2,023 |
3.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,663.20 |
$2,772 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$161.40 |
$269 |
1.6× |
| Scapula (73010) |
$243 |
$405 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$43.20 |
$72 |
1.8× |
| Shoulder 1 view (73020) |
$209.40 |
$349 |
2.5× |
| Small bowel series (74250) |
$466.20 |
$777 |
2.8× |
| Spine thoracic 3 views (72072) |
$370.80 |
$618 |
3.7× |
| Thoracolumbar 2 views (72080) |
$108 |
$180 |
1.3× |
| Thyroid uptake measurement (78012) |
$330.60 |
$551 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$900 |
$1,500 |
2.3× |
| Tmj unilateral (70328) |
$223.80 |
$373 |
2.7× |
| Ultrasound breast complete (76641) |
$392.40 |
$654 |
3.9× |
| Ultrasound Exam Aaa Screen (76706) |
$440.40 |
$734 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$565.20 |
$942 |
5.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$113.40 |
$189 |
1.4× |
| Unlisted fluoroscopic procedure (76496) |
$331.20 |
$552 |
4.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$753.60 |
$1,256 |
4.5× |
| Us breast unilateral limited (76642) |
$197.40 |
$329 |
2.4× |
| Us chest (76604) |
$933 |
$1,555 |
9.3× |
| Us compl joint r-t w/image documentation (76881) |
$250.20 |
$417 |
2.5× |
| Us elastography parenchyma (76981) |
$127.20 |
$212 |
1.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$163.20 |
$272 |
1.6× |
| Us ob limited (76815) |
$702 |
$1,170 |
7.0× |
| Us ob transvaginal (76817) |
$883.80 |
$1,473 |
8.8× |
| Us pelvic non ob complete (76856) |
$778.80 |
$1,298 |
7.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$194.40 |
$324 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$883.80 |
$1,473 |
8.8× |
| Us retroperitoneal limited (76775) |
$440.40 |
$734 |
4.4× |
| Us scrotum and contents (76870) |
$883.80 |
$1,473 |
8.8× |
| Us soft tissue head/neck (76536) |
$102.60 |
$171 |
1.0× |
| Us transrectal prostate volume (76873) |
$192 |
$320 |
1.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$289.20 |
$482 |
2.9× |
| Venogram extremity bilateral (75822) |
$3,990 |
$6,650 |
2.6× |
| Venogram Extremity Unilateral (75820) |
$1,575.60 |
$2,626 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$4,980 |
$8,300 |
1.6× |
| Venography venous sinus/jugular cath rs&i (75860) |
$112.80 |
$188 |
0.0× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$24 |
$40 |
0.0× |
| Wrist 2 views (73100) |
$221.40 |
$369 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$556.20 |
$927 |
5.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$954 |
$1,590 |
5.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$208.80 |
$348 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$239.40 |
$399 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$469.80 |
$783 |
4.7× |
| X-ray exam of femur 2/> (73552) |
$243 |
$405 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$243 |
$405 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$124.20 |
$207 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$418.20 |
$697 |
5.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$280.20 |
$467 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$679.80 |
$1,133 |
6.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$404.40 |
$674 |
4.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$477.60 |
$796 |
5.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$379.80 |
$633 |
3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$542.40 |
$904 |
5.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$351.60 |
$586 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$273.60 |
$456 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$393 |
$655 |
4.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$393.60 |
$656 |
3.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$243 |
$405 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$243 |
$405 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$243 |
$405 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$328.80 |
$548 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$464.40 |
$774 |
4.6× |
| Xr bone length studies (77073) |
$327.60 |
$546 |
3.3× |
| Xr c-spine 4 or 5 views (72050) |
$355.80 |
$593 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$477.60 |
$796 |
4.8× |