| Abdomen 2 views (74019) |
$327.60 |
$546 |
3.2× |
| Acute gi blood loss imaging (78278) |
$466.20 |
$777 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$2,265.60 |
$3,776 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,265.60 |
$3,776 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,601.80 |
$6,003 |
0.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,028.60 |
$3,381 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,180.60 |
$5,301 |
0.6× |
| Ankle 2 views (73600) |
$422.40 |
$704 |
5.0× |
Aortogram thoracic (75605)
unusually low: confirm this is the full procedure |
$2,651.40 |
$4,419 |
0.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,364 |
$3,940 |
0.8× |
| Aortography abdominal serialography rs&i (75625) |
$2,496 |
$4,160 |
0.8× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$2,265.60 |
$3,776 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$489.60 |
$816 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$1,484.40 |
$2,474 |
3.8× |
| Bone age studies (77072) |
$394.80 |
$658 |
3.9× |
| Bone Imaging 3 Phase (78315) |
$2,340 |
$3,900 |
6.0× |
| Bone Marrow Imaging Limited Area (78102) |
$1,108.80 |
$1,848 |
2.8× |
| Bone survey complete (77075) |
$1,675.20 |
$2,792 |
16.4× |
| Bone survey infant (77076) |
$405.60 |
$676 |
4.0× |
| Bowel imaging (78290) |
$624 |
$1,040 |
1.6× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,052.40 |
$1,754 |
2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,641.20 |
$4,402 |
1.9× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$307.80 |
$513 |
0.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,074.60 |
$1,791 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$803.40 |
$1,339 |
9.5× |
| Chest 1 view (71045) |
$115.20 |
$192 |
1.4× |
| Chest xray 3 views (71047) |
$279.60 |
$466 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$420.60 |
$701 |
2.5× |
| Clavicle complete (73000) |
$558 |
$930 |
6.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$265.20 |
$442 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,374 |
$7,290 |
12.8× |
| CT abdomen and pelvis without contrast (74176) |
$4,530 |
$7,550 |
19.5× |
| CT abdomen w contrast (74160) |
$2,822.40 |
$4,704 |
16.5× |
| CT abdomen w wo contrast (74170) |
$3,406.80 |
$5,678 |
19.9× |
| CT abdomen w/o contrast (74150) |
$1,533.60 |
$2,556 |
15.0× |
| CT angio hrt w/3d image (75574) |
$1,811.40 |
$3,019 |
5.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,710.60 |
$2,851 |
10.0× |
| CT c-spine w/contrast (72126) |
$3,373.80 |
$5,623 |
9.9× |
| CT c-spine w/o contrast (72125) |
$2,520 |
$4,200 |
24.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,089.80 |
$3,483 |
12.2× |
| CT chest w contrast (71260) |
$1,578.60 |
$2,631 |
9.2× |
| CT chest w/wo contrast (71270) |
$3,013.80 |
$5,023 |
17.6× |
| CT colonography screening (74263) |
$899.40 |
$1,499 |
3.9× |
| CT colonography w/o cntrst (74261) |
$1,445.40 |
$2,409 |
14.2× |
| CT head/brain with contrast (70460) |
$1,986.60 |
$3,311 |
11.6× |
| CT head/brain without and with contrast (70470) |
$2,436 |
$4,060 |
14.2× |
| CT iac w contrast (70481) |
$1,852.80 |
$3,088 |
10.8× |
| CT limited/localized follow up study (76380) |
$1,010.40 |
$1,684 |
11.9× |
| CT lower ext w/o (73700) |
$1,849.80 |
$3,083 |
18.1× |
| CT lower extremity w wo contrast (73702) |
$1,998.60 |
$3,331 |
11.7× |
| CT lower extremity w/contrast material (73701) |
$1,558.80 |
$2,598 |
9.1× |
| CT lumbar spine w/contrast (72132) |
$3,379.20 |
$5,632 |
9.9× |
| CT lumbar spine w/o contrast (72131) |
$2,187 |
$3,645 |
21.4× |
| CT maxillofacial w contrast (70487) |
$2,024.40 |
$3,374 |
11.8× |
| CT maxillofacial wo contrast (70486) |
$1,437 |
$2,395 |
14.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,104.80 |
$3,508 |
12.3× |
| CT orbits w/o contrast (70480) |
$1,834.20 |
$3,057 |
18.0× |
| CT pelvis w/o contrast (72192) |
$2,218.80 |
$3,698 |
21.8× |
| CT soft tissue neck w contrast (70491) |
$2,440.20 |
$4,067 |
14.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,773 |
$2,955 |
17.4× |
| CT thoracic spine w/contrast (72129) |
$3,346.80 |
$5,578 |
19.6× |
| CT thoracic spine w/o contrast (72128) |
$1,530 |
$2,550 |
15.0× |
| CT thorax w/o contrast (71250) |
$1,256.40 |
$2,094 |
12.3× |
| CT upper ext wo (73200) |
$1,998 |
$3,330 |
19.6× |
| CT upper extremity with contrast (73201) |
$2,314.80 |
$3,858 |
6.8× |
| Cta Abdomen (74175) |
$2,967.60 |
$4,946 |
17.3× |
| CTA abdomen pelvis (74174) |
$4,444.80 |
$7,408 |
13.1× |
| CTA chest (71275) |
$1,789.80 |
$2,983 |
10.5× |
| Cta Head (70496) |
$1,808.40 |
$3,014 |
10.6× |
| Cta Neck (70498) |
$1,931.40 |
$3,219 |
11.3× |
| Cta Pelvis (72191) |
$2,958.60 |
$4,931 |
17.3× |
| Cystography minimum 3 views rs&i (74430) |
$839.40 |
$1,399 |
2.5× |
| Diskography lumbar (72295) |
$2,508 |
$4,180 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$649.20 |
$1,082 |
6.4× |
| Esophagus (74220) |
$820.20 |
$1,367 |
4.8× |
| Facial bones min 3 views (70150) |
$527.40 |
$879 |
5.2× |
| Fetal biophysical profile non-stress testing (76818) |
$223.20 |
$372 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$223.20 |
$372 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$529.20 |
$882 |
2.3× |
| Foot 2 views (73620) |
$384.60 |
$641 |
4.5× |
| Forearm 2 views (73090) |
$355.80 |
$593 |
4.2× |
| Hand 2 views (73120) |
$414.60 |
$691 |
4.1× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$2,739 |
$4,565 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,406.60 |
$4,011 |
4.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$886.80 |
$1,478 |
2.3× |
| Hysterosalpingogram (74740) |
$1,053 |
$1,755 |
4.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,178.60 |
$3,631 |
4.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,929 |
$3,215 |
3.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$848.40 |
$1,414 |
1.6× |
| Knee 3 views (73562) |
$467.40 |
$779 |
5.5× |
| Liver & spleen imaging static only (78215) |
$640.80 |
$1,068 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$568.20 |
$947 |
1.5× |
| Lung perfusion differential (78597) |
$450.60 |
$751 |
1.2× |
| Lymphoscintigraphy (78195) |
$783 |
$1,305 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$4,015.80 |
$6,693 |
5.3× |
| Mr safety determination physician/other qhp (76016) |
$166.20 |
$277 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$46.20 |
$77 |
1.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$173.40 |
$289 |
1.9× |
| Mr safety implt pos&/immoblj (76019) |
$112.20 |
$187 |
1.9× |
| Mr safety med physics xm customization plng&mntr (76017) |
$456.60 |
$761 |
2.0× |
| MRA head w & w/o contrast (70546) |
$4,847.40 |
$8,079 |
14.2× |
| MRA head w/o contrast (70544) |
$3,268.80 |
$5,448 |
14.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,398 |
$7,330 |
12.9× |
| MRA neck w/o contrast (70547) |
$1,870.20 |
$3,117 |
8.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$6,756.60 |
$11,261 |
19.8× |
| MRI abdomen w/o contrast (74181) |
$4,209 |
$7,015 |
18.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,853.20 |
$6,422 |
5.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,818 |
$8,030 |
14.2× |
| MRI cervical spine w/o contrast (72141) |
$1,858.80 |
$3,098 |
8.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,723.20 |
$7,872 |
13.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,046.40 |
$6,744 |
17.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,117.40 |
$3,529 |
9.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,941.20 |
$9,902 |
17.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,946.20 |
$6,577 |
11.6× |
| MRI pelvis w/o contrast (72195) |
$3,367.20 |
$5,612 |
14.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$8,206.20 |
$13,677 |
24.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,103.40 |
$6,839 |
12.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,152.20 |
$8,587 |
15.1× |
| MRI temporomandibular joint (70336) |
$4,613.40 |
$7,689 |
19.8× |
| MRI thoracic spine w/o contrast (72146) |
$3,602.40 |
$6,004 |
15.5× |
| MRI up ext w/o contrast (73218) |
$3,509.40 |
$5,849 |
15.1× |
| MRI upper ext joint w/o contrast (73221) |
$5,052.60 |
$8,421 |
21.7× |
| MRI, joint upper extrem combo (73223) |
$4,874.40 |
$8,124 |
14.3× |
| Myocardial Spect Multiple Studies (78452) |
$3,801.60 |
$6,336 |
3.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,374 |
$2,290 |
1.1× |
| Neck soft tissue (70360) |
$440.40 |
$734 |
5.2× |
| Nm bone marrow wb (78104) |
$369.60 |
$616 |
0.9× |
| Nm gastric emptying study (78264) |
$1,840.80 |
$3,068 |
4.7× |
| Nm peritoneal-venous shunt patency (78291) |
$496.80 |
$828 |
1.3× |
| Parathyrd planar w/spect&CT (78072) |
$817.20 |
$1,362 |
1.5× |
| Parathyroid Planar Imaging (78070) |
$1,390.80 |
$2,318 |
3.6× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$817.20 |
$1,362 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$462.60 |
$771 |
4.5× |
| PET image w/CT, skull-thigh (78815) |
$7,663.20 |
$12,772 |
5.5× |
| PET imaging CT for attenuation limited area (78814) |
$9,122.40 |
$15,204 |
6.5× |
| PET imaging for CT attenuation whole body (78816) |
$9,579 |
$15,965 |
6.9× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,761.80 |
$4,603 |
0.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,360.20 |
$2,267 |
3.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,306.80 |
$2,178 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$815.40 |
$1,359 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$520.80 |
$868 |
6.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$480 |
$800 |
5.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$422.40 |
$704 |
5.0× |
| Radex fingr minimum 2 views (73140) |
$287.40 |
$479 |
3.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$492 |
$820 |
5.8× |
| Radex Hand Minimum 3 Views (73130) |
$480.60 |
$801 |
5.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$343.80 |
$573 |
4.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$615.60 |
$1,026 |
6.0× |
| Radex Humerus Minimum 2 Views (73060) |
$348.60 |
$581 |
4.1× |
| Radex Kne 1/2 Views (73560) |
$461.40 |
$769 |
5.4× |
| Radex Kne Compl 4/More Views (73564) |
$504.60 |
$841 |
4.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$553.20 |
$922 |
5.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$369.60 |
$616 |
4.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$349.80 |
$583 |
4.1× |
| Radex Toe Minimum 2 Views (73660) |
$389.40 |
$649 |
4.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$246 |
$410 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$447.60 |
$746 |
5.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$388.20 |
$647 |
4.6× |
| Radiologic exam chest 2 views (71046) |
$211.80 |
$353 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$871.20 |
$1,452 |
5.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,009.80 |
$1,683 |
5.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$918 |
$1,530 |
5.4× |
| Radiologic examination femur 1 view (73551) |
$343.20 |
$572 |
4.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$441 |
$735 |
5.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,344 |
$2,240 |
3.4× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$233.40 |
$389 |
0.6× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,398.60 |
$2,331 |
2.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$699.60 |
$1,166 |
1.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,242.80 |
$3,738 |
4.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,172.40 |
$1,954 |
0.9× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$3,481.80 |
$5,803 |
2.5× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$746.40 |
$1,244 |
0.6× |
| Scapula (73010) |
$519.60 |
$866 |
5.1× |
| Shoulder 1 view (73020) |
$388.20 |
$647 |
4.6× |
| Small bowel series (74250) |
$944.40 |
$1,574 |
5.5× |
| Spine thoracic 3 views (72072) |
$768 |
$1,280 |
7.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,536 |
$2,560 |
2.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,300.20 |
$2,167 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$829.20 |
$1,382 |
8.1× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$487.80 |
$813 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$620.40 |
$1,034 |
6.1× |
| Unlisted fluoroscopic procedure (76496) |
$181.20 |
$302 |
2.1× |
| Urethrocystography retrograde rs&i (74450) |
$886.80 |
$1,478 |
3.8× |
| Us chest (76604) |
$554.40 |
$924 |
5.4× |
| Us elastography parenchyma (76981) |
$455.40 |
$759 |
4.5× |
| Us encephalogram (76506) |
$736.20 |
$1,227 |
7.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$426 |
$710 |
4.2× |
| Us ob limited (76815) |
$541.20 |
$902 |
5.3× |
| Us ob transvaginal (76817) |
$624 |
$1,040 |
6.1× |
| Us pelvic non ob complete (76856) |
$934.20 |
$1,557 |
9.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$334.80 |
$558 |
3.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$399.60 |
$666 |
3.9× |
| Us retroperitoneal complete (76770) |
$637.80 |
$1,063 |
6.3× |
| Us retroperitoneal limited (76775) |
$332.40 |
$554 |
3.3× |
| Us scrotum and contents (76870) |
$743.40 |
$1,239 |
7.3× |
| Us soft tissue head/neck (76536) |
$722.40 |
$1,204 |
7.1× |
| Us spinal canal and contents (76800) |
$361.80 |
$603 |
3.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$280.80 |
$468 |
2.8× |
| Venogram extremity bilateral (75822) |
$1,413.60 |
$2,356 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$1,032.60 |
$1,721 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,439.60 |
$4,066 |
0.8× |
| Venography caval superior serialography rs&i (75827) |
$1,916.40 |
$3,194 |
1.2× |
| Venography renal unilateral selective rs&i (75831) |
$1,646.40 |
$2,744 |
0.5× |
| Wrist 2 views (73100) |
$407.40 |
$679 |
4.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$708.60 |
$1,181 |
6.9× |
| X-ray b.e. reductn intuss (74283) |
$708.60 |
$1,181 |
4.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,045.80 |
$1,743 |
6.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$411 |
$685 |
4.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$281.40 |
$469 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$615.60 |
$1,026 |
6.0× |
| X-ray exam of femur 2/> (73552) |
$519 |
$865 |
6.1× |
| X-ray eye for foreign body (70030) |
$454.80 |
$758 |
5.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$401.40 |
$669 |
4.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$848.40 |
$1,414 |
8.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,333.80 |
$2,223 |
13.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$517.80 |
$863 |
5.1× |
| X-ray retrograde pyelogram (74420) |
$685.20 |
$1,142 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$329.40 |
$549 |
3.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$411 |
$685 |
4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$577.20 |
$962 |
5.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$412.20 |
$687 |
4.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$793.80 |
$1,323 |
7.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$405.60 |
$676 |
4.0× |
| X-Ray Small Bowel Enteroclysis (74251) |
$908.40 |
$1,514 |
5.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$408 |
$680 |
4.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$625.20 |
$1,042 |
6.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$511.20 |
$852 |
5.0× |
| Xr c-spine 4 or 5 views (72050) |
$1,170 |
$1,950 |
11.5× |
| Xr c-spine 6 or more views (72052) |
$1,330.20 |
$2,217 |
13.0× |