| Abdomen 2 views (74019) |
$584.33 |
$584.33 |
5.4× |
| Acute gi blood loss imaging (78278) |
$999.97 |
$999.97 |
2.4× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$449.82 |
$449.82 |
0.3× |
| Angio Adrenal Bilat Select (75733) |
$1,397.97 |
$1,397.97 |
0.4× |
| Angiography extremity bilateral rs&i (75716) |
$9,665.62 |
$9,665.62 |
2.9× |
| Angiography extremity unilateral rs&i (75710) |
$8,059.93 |
$8,059.93 |
2.4× |
| Angiography internal mammary rs&i (75756) |
$3,262.30 |
$3,262.30 |
1.0× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$9,624.83 |
$9,624.83 |
1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$9,740.59 |
$9,740.59 |
3.0× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,665.55 |
$3,665.55 |
1.1× |
Angiography Spinal Selective Rs&I (75705)
likely a partial charge, not the full procedure |
$1,582.09 |
$1,582.09 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$15,755.83 |
$15,755.83 |
2.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$711.11 |
$711.11 |
0.2× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,397.97 |
$1,397.97 |
0.4× |
| Ankle 2 views (73600) |
$469.67 |
$469.67 |
5.2× |
| Aortogram thoracic (75605) |
$9,254.39 |
$9,254.39 |
1.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$9,214.70 |
$9,214.70 |
2.8× |
| Aortography abdominal serialography rs&i (75625) |
$9,588.44 |
$9,588.44 |
2.9× |
| Aortography Thoracic W/O Serialography Rs&I (75600) |
$9,220.21 |
$9,220.21 |
2.8× |
| Artery X-Rays Adrenal Gland (75731) |
$1,207.50 |
$1,207.50 |
0.4× |
| Arthrogram ankle (73615) |
$1,509.32 |
$1,509.32 |
4.1× |
| Arthrogram elbow (73085) |
$2,337.88 |
$2,337.88 |
6.4× |
| Arthrogram hip (73525) |
$1,508.22 |
$1,508.22 |
4.1× |
| Arthrogram knee (73580) |
$1,508.22 |
$1,508.22 |
4.1× |
| Arthrogram shoulder (73040) |
$1,394.11 |
$1,394.11 |
3.8× |
| Arthrogram wrist (73115) |
$1,691.24 |
$1,691.24 |
4.6× |
| Basic dosimetry (77300) |
$739.20 |
$739.20 |
5.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,975.68 |
$1,975.68 |
4.7× |
| Bone &/joint imaging whole body (78306) |
$2,130.03 |
$2,130.03 |
5.1× |
| Bone age studies (77072) |
$486.20 |
$486.20 |
4.5× |
| Bone Imaging 3 Phase (78315) |
$1,995.53 |
$1,995.53 |
4.8× |
| Bone Marrow Imaging Limited Area (78102) |
$1,212.75 |
$1,212.75 |
2.9× |
| Bone survey complete (77075) |
$825.77 |
$825.77 |
7.6× |
| Bone survey infant (77076) |
$450.92 |
$450.92 |
4.1× |
| Bowel imaging (78290) |
$429.98 |
$429.98 |
1.0× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,480.66 |
$1,480.66 |
2.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$6,219.20 |
$6,219.20 |
4.2× |
| Brain Imaging Vascular Flow Only (78610) |
$1,531.60 |
$1,531.60 |
2.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,087.62 |
$1,087.62 |
2.6× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$2,691.20 |
$2,691.20 |
3.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,691.20 |
$2,691.20 |
7.4× |
| Cervical spine 2 or 3 views (72040) |
$657.09 |
$657.09 |
7.2× |
| Chest 1 view (71045) |
$428.04 |
$428.04 |
4.7× |
| Chest xray 3 views (71047) |
$465.26 |
$465.26 |
5.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,139.99 |
$1,139.99 |
6.2× |
| Cisternography Positive Contrast Rs&I (70015) |
$2,767.28 |
$2,767.28 |
3.4× |
| Clavicle complete (73000) |
$791.60 |
$791.60 |
8.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,620.68 |
$1,620.68 |
14.8× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$636.30 |
$636.30 |
3.5× |
| Corpora cavernosography (74445) |
$547.94 |
$547.94 |
5.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$9,402.12 |
$9,402.12 |
25.8× |
| CT abdomen and pelvis without contrast (74176) |
$7,644.74 |
$7,644.74 |
30.7× |
| CT abdomen w contrast (74160) |
$4,824.54 |
$4,824.54 |
26.3× |
| CT abdomen w wo contrast (74170) |
$4,952.98 |
$4,952.98 |
27.0× |
| CT abdomen w/o contrast (74150) |
$4,286.52 |
$4,286.52 |
39.3× |
| CT angio hrt w/3d image (75574) |
$2,234.77 |
$2,234.77 |
6.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,859.85 |
$3,859.85 |
21.1× |
| CT angiography upper extremity lt (73206) |
$3,843.32 |
$3,843.32 |
21.0× |
| CT c-spine w/contrast (72126) |
$3,905.06 |
$3,905.06 |
10.7× |
| CT c-spine w/o contrast (72125) |
$4,738.55 |
$4,738.55 |
43.4× |
| CT cervical spine w&w/o contrast (72127) |
$4,115.63 |
$4,115.63 |
22.5× |
| CT chest w contrast (71260) |
$4,425.44 |
$4,425.44 |
24.2× |
| CT chest w/wo contrast (71270) |
$4,679.01 |
$4,679.01 |
25.5× |
| CT colonography screening (74263) |
$1,380.33 |
$1,380.33 |
5.5× |
| CT colonography w/dye (74262) |
$1,652.65 |
$1,652.65 |
9.0× |
| CT colonography w/o cntrst (74261) |
$1,435.46 |
$1,435.46 |
13.1× |
| CT head/brain with contrast (70460) |
$3,708.81 |
$3,708.81 |
20.2× |
| CT head/brain without and with contrast (70470) |
$4,368.11 |
$4,368.11 |
23.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,169.72 |
$2,169.72 |
6.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$756.32 |
$756.32 |
8.3× |
| CT hrt w/3d image congen (75573) |
$2,169.72 |
$2,169.72 |
6.0× |
| CT iac w contrast (70481) |
$3,223.98 |
$3,223.98 |
17.6× |
| CT limited/localized follow up study (76380) |
$789.39 |
$789.39 |
8.7× |
| CT lower ext w/o (73700) |
$5,863.20 |
$5,863.20 |
53.7× |
| CT lower extremity w wo contrast (73702) |
$4,343.48 |
$4,343.48 |
23.7× |
| CT lower extremity w/contrast material (73701) |
$3,780.11 |
$3,780.11 |
20.6× |
| CT lumbar spine w & w/o contrast (72133) |
$4,254.55 |
$4,254.55 |
23.2× |
| CT lumbar spine w/contrast (72132) |
$4,171.86 |
$4,171.86 |
11.5× |
| CT lumbar spine w/o contrast (72131) |
$4,508.12 |
$4,508.12 |
41.3× |
| CT maxillofacial w contrast (70487) |
$3,419.40 |
$3,419.40 |
18.7× |
| CT maxillofacial w/wo contrast (70488) |
$3,502.64 |
$3,502.64 |
19.1× |
| CT maxillofacial wo contrast (70486) |
$3,384.68 |
$3,384.68 |
31.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,578.16 |
$3,578.16 |
19.5× |
| CT orbits w/o contrast (70480) |
$2,376.99 |
$2,376.99 |
21.8× |
| CT pelvis w/o contrast (72192) |
$3,326.24 |
$3,326.24 |
30.5× |
| CT pelvis w/wo contrast (72194) |
$4,518.05 |
$4,518.05 |
24.7× |
| CT scan of arm combo (73202) |
$3,433.19 |
$3,433.19 |
18.7× |
| CT soft tissue neck w contrast (70491) |
$3,305.30 |
$3,305.30 |
18.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,520.28 |
$3,520.28 |
19.2× |
| CT soft tissue neck w/o contrast (70490) |
$2,164.21 |
$2,164.21 |
19.8× |
| CT thoracic spine w/contrast (72129) |
$3,405.62 |
$3,405.62 |
18.6× |
| CT thoracic spine w/o contrast (72128) |
$3,519.18 |
$3,519.18 |
32.2× |
| CT thoracic spine w/wo contrast (72130) |
$3,433.19 |
$3,433.19 |
18.7× |
| CT thorax w/o contrast (71250) |
$3,834.50 |
$3,834.50 |
35.1× |
| CT upper ext wo (73200) |
$2,897.37 |
$2,897.37 |
26.5× |
| CT upper extremity with contrast (73201) |
$3,124.49 |
$3,124.49 |
8.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,933.72 |
$3,933.72 |
21.5× |
| Cta Abdomen (74175) |
$3,913.88 |
$3,913.88 |
21.4× |
| CTA abdomen pelvis (74174) |
$7,136.48 |
$7,136.48 |
19.6× |
| CTA chest (71275) |
$3,863.16 |
$3,863.16 |
21.1× |
| Cta Head (70496) |
$3,881.90 |
$3,881.90 |
21.2× |
| Cta Neck (70498) |
$3,881.90 |
$3,881.90 |
21.2× |
| Cta Pelvis (72191) |
$3,776.06 |
$3,776.06 |
20.6× |
| Cystography minimum 3 views rs&i (74430) |
$1,273.39 |
$1,273.39 |
3.5× |
| Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Non-Facility (70170) |
$199.55 |
$199.55 |
0.8× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$637.25 |
$637.25 |
0.3× |
| Diskogram cervical (72285) |
$934.92 |
$934.92 |
0.5× |
| Diskography lumbar (72295) |
$934.92 |
$934.92 |
0.5× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$472.97 |
$472.97 |
4.3× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$756.32 |
$756.32 |
6.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$962.48 |
$962.48 |
8.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$776.16 |
$776.16 |
7.1× |
| Dxa bone density study axial skeleton (77085) |
$868.77 |
$868.77 |
8.0× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$552.35 |
$552.35 |
2.2× |
| Esophageal motility (78258) |
$576.61 |
$576.61 |
1.4× |
| Esophagus (74220) |
$984.53 |
$984.53 |
5.4× |
| Facial bones min 3 views (70150) |
$588.74 |
$588.74 |
5.4× |
| Fetal biophysical profile non-stress testing (76818) |
$1,053.99 |
$1,053.99 |
9.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$962.48 |
$962.48 |
8.8× |
| Fetal Echo (76825) |
$1,396.87 |
$1,396.87 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$995.56 |
$995.56 |
4.0× |
| Foot 2 views (73620) |
$421.71 |
$421.71 |
4.6× |
| Forearm 2 views (73090) |
$585.15 |
$585.15 |
6.4× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$2,494.96 |
$2,494.96 |
6.0× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$3,087 |
$3,087 |
5.4× |
| Hand 2 views (73120) |
$592.04 |
$592.04 |
5.4× |
| Heart Infarct Image (78466) |
$565.58 |
$565.58 |
1.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$11,051.46 |
$11,051.46 |
3.4× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$11,051.46 |
$11,051.46 |
3.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,750.77 |
$1,750.77 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,586.50 |
$1,586.50 |
3.8× |
| Hysterosalpingogram (74740) |
$1,486.17 |
$1,486.17 |
6.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$245.86 |
$245.86 |
2.3× |
| Kidney imaging morphology (78700) |
$1,149.91 |
$1,149.91 |
2.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,218.23 |
$2,218.23 |
3.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$3,028.57 |
$3,028.57 |
5.3× |
| Knee 3 views (73562) |
$1,179.68 |
$1,179.68 |
13.0× |
| Liver & spleen imaging static only (78215) |
$1,586.50 |
$1,586.50 |
3.8× |
| Liver imaging static only (78201) |
$1,048.48 |
$1,048.48 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$3,041.80 |
$3,041.80 |
5.4× |
| Lung perfusion differential (78597) |
$1,818.02 |
$1,818.02 |
4.4× |
| Lung ventilation imaging (78579) |
$1,628.39 |
$1,628.39 |
3.9× |
| Lymphangiography Pelvic/Abdominal Bilateral Rs&I (75807) |
$3,153.15 |
$3,153.15 |
1.0× |
| Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Facility (75803) |
$3,324.04 |
$3,324.04 |
2.0× |
| Lymphoscintigraphy (78195) |
$1,007.69 |
$1,007.69 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$4,002.08 |
$4,002.08 |
4.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,770.58 |
$2,770.58 |
7.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,904.95 |
$3,904.95 |
10.7× |
| Mammary ductogram or galactogram multiple (77054) |
$1,416.71 |
$1,416.71 |
5.7× |
| Mammary ductogram or galactogram single (77053) |
$1,416.71 |
$1,416.71 |
5.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$319.20 |
$319.20 |
3.5× |
| Mr safety determination physician/other qhp (76016) |
$184.91 |
$184.91 |
2.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$51.43 |
$51.43 |
1.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$192.76 |
$192.76 |
1.9× |
| Mr safety implt pos&/immoblj (76019) |
$124.74 |
$124.74 |
2.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$510.76 |
$510.76 |
2.0× |
| MRA head w & w/o contrast (70546) |
$3,598.56 |
$3,598.56 |
9.9× |
| MRA head w/o contrast (70544) |
$2,911.70 |
$2,911.70 |
11.7× |
| MRA head with contrast (70545) |
$3,529.10 |
$3,529.10 |
9.7× |
| MRA neck w contrast (70548) |
$3,313.01 |
$3,313.01 |
9.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,556.67 |
$3,556.67 |
9.8× |
| MRA neck w/o contrast (70547) |
$3,363.73 |
$3,363.73 |
13.5× |
| MRI abdomen w contrast (74182) |
$3,307.50 |
$3,307.50 |
9.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,255.65 |
$4,255.65 |
11.7× |
| MRI abdomen w/o contrast (74181) |
$3,400.11 |
$3,400.11 |
13.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,953.57 |
$3,953.57 |
4.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,241.29 |
$5,241.29 |
14.4× |
| MRI bone marrow blood supply (77084) |
$3,195.05 |
$3,195.05 |
12.8× |
| MRI breast w/o contrast bilateral (77047) |
$1,368.20 |
$1,368.20 |
5.5× |
| MRI breast wo contrast unilateral (77046) |
$684.65 |
$684.65 |
2.7× |
| MRI c-spine with contrast (72142) |
$4,550.02 |
$4,550.02 |
12.5× |
| MRI cardiac w/o cont stress (75559) |
$2,691.20 |
$2,691.20 |
4.7× |
| MRI cardiac w/o contrast (75557) |
$3,257.89 |
$3,257.89 |
13.1× |
| MRI cervical spine w/o contrast (72141) |
$4,390.16 |
$4,390.16 |
17.6× |
| MRI chest w/o & w/contrast material (71552) |
$4,999.84 |
$4,999.84 |
13.7× |
| MRI chest w/o contrast (71550) |
$4,695.55 |
$4,695.55 |
18.8× |
| MRI chest with contrast (71551) |
$4,846.59 |
$4,846.59 |
5.9× |
| MRI fetal sngl/1st gestation (74712) |
$778.37 |
$778.37 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,485.37 |
$3,485.37 |
9.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,599.53 |
$3,599.53 |
9.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,152.94 |
$4,152.94 |
16.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,015.37 |
$2,015.37 |
8.1× |
| MRI orbit face neck w contrast (70542) |
$2,164.21 |
$2,164.21 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,467.76 |
$2,467.76 |
6.8× |
| MRI pelvis w/contrast (72196) |
$2,949.19 |
$2,949.19 |
8.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,919.02 |
$3,919.02 |
10.8× |
| MRI pelvis w/o contrast (72195) |
$2,830.12 |
$2,830.12 |
11.4× |
| MRI spectroscopy (76390) |
$748.60 |
$748.60 |
8.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,606.25 |
$4,606.25 |
12.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,774.96 |
$3,774.96 |
10.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,480.56 |
$4,480.56 |
12.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,849.93 |
$3,849.93 |
10.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,901.75 |
$3,901.75 |
10.7× |
| MRI temporomandibular joint (70336) |
$2,847.76 |
$2,847.76 |
11.4× |
| MRI thoracic spine w/o contrast (72146) |
$3,813.55 |
$3,813.55 |
15.3× |
| MRI up ext w/o contrast (73218) |
$3,165.06 |
$3,165.06 |
12.7× |
| MRI upper ext joint w/o contrast (73221) |
$4,914.95 |
$4,914.95 |
19.7× |
| MRI, joint upper extrem combo (73223) |
$3,498.24 |
$3,498.24 |
9.6× |
| Myelogram Cervical (72240) |
$4,369.21 |
$4,369.21 |
5.3× |
| Myelogram Lumbar (72265) |
$4,555.53 |
$4,555.53 |
5.6× |
| Myelogram thoracic (72255) |
$1,470.74 |
$1,470.74 |
1.8× |
| Myelography 2 or more regions (72270) |
$2,823.50 |
$2,823.50 |
3.4× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$5,734.10 |
$5,734.10 |
4.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$799.31 |
$799.31 |
0.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,138.85 |
$2,138.85 |
1.6× |
| Myocardial Spect Multiple Studies (78452) |
$5,439.74 |
$5,439.74 |
4.0× |
| Myocardial spect single study at rest or stress (78451) |
$2,299.82 |
$2,299.82 |
1.7× |
| N-invas est c ffr sw aly CTA (75580) |
$2,091.60 |
$2,091.60 |
2.3× |
| Neck soft tissue (70360) |
$429.98 |
$429.98 |
4.7× |
| Nm adrenal scan (78075) |
$303.19 |
$303.19 |
0.2× |
| Nm bone marrow wb (78104) |
$1,080.45 |
$1,080.45 |
2.6× |
| Nm cardiac blood pool multiple (78473) |
$3,975.62 |
$3,975.62 |
9.5× |
| Nm cisternogram (78630) |
$2,518.11 |
$2,518.11 |
4.4× |
| Nm csf leak detection (78650) |
$2,741.51 |
$2,741.51 |
2.0× |
| Nm gastric emptying study (78264) |
$635.04 |
$635.04 |
1.5× |
| Nm gastroesophageal reflux study (78262) |
$335.16 |
$335.16 |
0.8× |
| Nm kidney scan w/flow (78701) |
$1,205.49 |
$1,205.49 |
2.9× |
| Nm peritoneal-venous shunt patency (78291) |
$1,038.56 |
$1,038.56 |
2.5× |
| Nonvascular shunt X-ray (75809) |
$281.98 |
$281.98 |
2.6× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$449.82 |
$449.82 |
1.1× |
| Nuclear Rx Oral Admin (79005) |
$4,160.84 |
$4,160.84 |
17.1× |
| Ob us nuchal meas 1 gest (76813) |
$1,130.06 |
$1,130.06 |
10.4× |
| Orthopantogram (70355) |
$394.70 |
$394.70 |
4.3× |
| Osseous survey limited (77074) |
$786.45 |
$786.45 |
7.2× |
| Parathyrd planar w/spect&CT (78072) |
$2,091.44 |
$2,091.44 |
3.7× |
| Parathyroid Planar Imaging (78070) |
$1,049.58 |
$1,049.58 |
2.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,035.22 |
$2,035.22 |
4.9× |
| Pelvis 1 or 2 views (72170) |
$798.21 |
$798.21 |
7.3× |
| Peritoneogram after injection (74190) |
$2,686.79 |
$2,686.79 |
4.7× |
| PET image w/CT, skull-thigh (78815) |
$7,294.14 |
$7,294.14 |
4.9× |
| PET imaging CT for attenuation limited area (78814) |
$5,908.30 |
$5,908.30 |
4.0× |
| PET imaging for CT attenuation whole body (78816) |
$7,365.80 |
$7,365.80 |
4.9× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$1,397.97 |
$1,397.97 |
0.4× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$1,397.97 |
$1,397.97 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$841.21 |
$841.21 |
2.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,604.11 |
$2,604.11 |
4.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,354.97 |
$1,354.97 |
2.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$575.51 |
$575.51 |
6.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$472.97 |
$472.97 |
5.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$409.03 |
$409.03 |
4.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$174.20 |
$174.20 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$296.57 |
$296.57 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$567.79 |
$567.79 |
5.2× |
| Radex fingr minimum 2 views (73140) |
$357.21 |
$357.21 |
3.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$616.57 |
$616.57 |
6.8× |
| Radex Hand Minimum 3 Views (73130) |
$606.10 |
$606.10 |
6.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$179.71 |
$179.71 |
2.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$300.98 |
$300.98 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$299.88 |
$299.88 |
2.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$567.79 |
$567.79 |
5.2× |
| Radex Humerus Minimum 2 Views (73060) |
$608.03 |
$608.03 |
6.7× |
| Radex Kne 1/2 Views (73560) |
$630.63 |
$630.63 |
6.9× |
| Radex Kne Compl 4/More Views (73564) |
$1,004.38 |
$1,004.38 |
9.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$642.76 |
$642.76 |
5.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$429.98 |
$429.98 |
4.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$813.65 |
$813.65 |
7.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$622.91 |
$622.91 |
6.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$280.04 |
$280.04 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$741.98 |
$741.98 |
6.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$685.76 |
$685.76 |
7.5× |
| Radex Toe Minimum 2 Views (73660) |
$275.96 |
$275.96 |
3.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$517.07 |
$517.07 |
4.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$601.41 |
$601.41 |
6.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$546.84 |
$546.84 |
5.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$463.79 |
$463.79 |
5.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$877.59 |
$877.59 |
8.0× |
| Radiologic exam chest 2 views (71046) |
$575.69 |
$575.69 |
6.3× |
| Radiologic exam colon single contrast study (74270) |
$1,306.46 |
$1,306.46 |
7.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$983.43 |
$983.43 |
5.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,120.14 |
$1,120.14 |
6.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,567.76 |
$1,567.76 |
8.6× |
| Radiologic examination femur 1 view (73551) |
$180.81 |
$180.81 |
2.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$198.45 |
$198.45 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$735 |
$735 |
8.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$493.92 |
$493.92 |
4.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$560.70 |
$560.70 |
5.1× |
| Radiological examination surgical specimen (76098) |
$189.63 |
$189.63 |
0.3× |
| Renal Cyst Study (74470) |
$547.94 |
$547.94 |
1.0× |
| Ribs bilateral 3 views (71110) |
$517.07 |
$517.07 |
4.7× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$839 |
$839 |
2.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$4,247.57 |
$4,247.57 |
7.5× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,860.65 |
$1,860.65 |
3.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,072.39 |
$2,072.39 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$4,642.63 |
$4,642.63 |
3.4× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$4,642.63 |
$4,642.63 |
3.1× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$4,092.48 |
$4,092.48 |
3.0× |
| Rp therapy intra-arterial particulate admn (79445) |
$3,846.62 |
$3,846.62 |
15.8× |
| Rp Therapy Intravenous Administration (79101) |
$931.61 |
$931.61 |
3.8× |
| Sacroiliac Joints < 3 Views (72200) |
$506.67 |
$506.67 |
4.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$1,194.01 |
$1,194.01 |
4.8× |
| Salivary gland function study (78232) |
$1,074.94 |
$1,074.94 |
2.6× |
| Salivary gland imaging (78230) |
$1,132.27 |
$1,132.27 |
2.7× |
| Salivary gland imaging; with serial images Non-Facility (78231) |
$1,132.27 |
$1,132.27 |
2.7× |
| Scapula (73010) |
$505.50 |
$505.50 |
4.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$442.10 |
$442.10 |
18.9× |
| Sella turcica (70240) |
$302.09 |
$302.09 |
3.3× |
| Shoulder 1 view (73020) |
$398 |
$398 |
4.4× |
| Sialogram (70390) |
$1,357.18 |
$1,357.18 |
5.4× |
| Small bowel series (74250) |
$1,132.27 |
$1,132.27 |
6.2× |
| Spine thoracic 3 views (72072) |
$495.02 |
$495.02 |
4.5× |
| Spleen imaging only (78185) |
$363.83 |
$363.83 |
0.9× |
| Splenoportograpy rs&i (75810) |
$11,083.43 |
$11,083.43 |
3.4× |
| Superior sagittal sinus venogram (75870) |
$1,397.97 |
$1,397.97 |
0.4× |
| Temporomandibular joint arthrography, radiological supervision and interpretation Non-Facility (70332) |
$1,048.95 |
$1,048.95 |
4.2× |
| Testicular Imaging With Vascular Flow (78761) |
$352.80 |
$352.80 |
0.8× |
| Thoracolumbar 2 views (72080) |
$868.88 |
$868.88 |
9.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$1,556.18 |
$1,556.18 |
2.7× |
| Thyroid imaging w/blood flow (78013) |
$2,021.99 |
$2,021.99 |
4.8× |
| Thyroid uptake measurement (78012) |
$987.84 |
$987.84 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$3,005.42 |
$3,005.42 |
7.2× |
| Tmj unilateral (70328) |
$346.50 |
$346.50 |
3.8× |
| Tomogram (76100) |
$776.16 |
$776.16 |
7.1× |
| Ultrasound breast complete (76641) |
$1,287.72 |
$1,287.72 |
11.8× |
| Ultrasound elastography first target lesion (76982) |
$1,216.06 |
$1,216.06 |
11.1× |
| Ultrasound Exam Aaa Screen (76706) |
$1,238.11 |
$1,238.11 |
11.3× |
| Ultrasound, abdomen limited (76705) |
$1,840.07 |
$1,840.07 |
16.9× |
| Umbilical-artery Doppler (OB) (76820) |
$674.73 |
$674.73 |
6.2× |
| Unlisted fluoroscopic procedure (76496) |
$636.30 |
$636.30 |
7.0× |
| Unlisted magnetic resonance procedure (76498) |
$2,980.79 |
$2,980.79 |
32.8× |
| Unlisted ultrasound procedure (76999) |
$781.65 |
$781.65 |
8.6× |
| Ureteral reflux study (78740) |
$2,132.24 |
$2,132.24 |
5.1× |
| Urethrocystogram voiding (74455) |
$1,456.40 |
$1,456.40 |
5.8× |
| Urethrocystography retrograde rs&i (74450) |
$1,205.03 |
$1,205.03 |
4.8× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,986.71 |
$1,986.71 |
10.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$2,005.45 |
$2,005.45 |
10.9× |
| Us breast unilateral limited (76642) |
$869.87 |
$869.87 |
9.6× |
| Us chest (76604) |
$962.48 |
$962.48 |
8.8× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$813.65 |
$813.65 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$847.82 |
$847.82 |
7.8× |
| Us elastography parenchyma (76981) |
$710.01 |
$710.01 |
6.5× |
| Us encephalogram (76506) |
$638.40 |
$638.40 |
5.8× |
| Us hips infant static (76886) |
$807.03 |
$807.03 |
8.9× |
| Us infant hips w manipulation (76885) |
$847.82 |
$847.82 |
9.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$616.85 |
$616.85 |
5.7× |
| Us ob detailed single fetus (76811) |
$989.49 |
$989.49 |
4.0× |
| Us ob limited (76815) |
$602.70 |
$602.70 |
5.5× |
| Us ob transvaginal (76817) |
$952.56 |
$952.56 |
8.7× |
| Us pelvic non ob complete (76856) |
$937.13 |
$937.13 |
8.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$955.87 |
$955.87 |
8.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$905.15 |
$905.15 |
8.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$256.88 |
$256.88 |
2.4× |
| Us retroperitoneal complete (76770) |
$1,244.72 |
$1,244.72 |
11.4× |
| Us retroperitoneal limited (76775) |
$1,192.36 |
$1,192.36 |
10.9× |
| Us scrotum and contents (76870) |
$792.70 |
$792.70 |
7.3× |
| Us soft tissue head/neck (76536) |
$884.21 |
$884.21 |
8.1× |
| Us spinal canal and contents (76800) |
$457.54 |
$457.54 |
4.2× |
| Us transrectal (76872) |
$1,216.06 |
$1,216.06 |
11.1× |
| Us transrectal prostate volume (76873) |
$1,237.95 |
$1,237.95 |
11.3× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,198.42 |
$1,198.42 |
11.0× |
| Vasogram (74440) |
$636.30 |
$636.30 |
2.6× |
| Venogram adrenal unilat (75840) |
$895.23 |
$895.23 |
0.3× |
| Venogram extremity bilateral (75822) |
$4,220.37 |
$4,220.37 |
2.6× |
| Venogram Extremity Unilateral (75820) |
$2,422.35 |
$2,422.35 |
1.5× |
| Venography caval inferior serialography rs&i (75825) |
$10,991.93 |
$10,991.93 |
3.3× |
| Venography caval superior serialography rs&i (75827) |
$3,120.08 |
$3,120.08 |
1.9× |
| Venography Orbital Rs&I (75880) |
$1,397.97 |
$1,397.97 |
2.1× |
| Venography Renal Bilateral (75833) |
$11,570.74 |
$11,570.74 |
3.5× |
| Venography renal unilateral selective rs&i (75831) |
$5,943.58 |
$5,943.58 |
1.8× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,928.21 |
$3,928.21 |
1.2× |
| Venography, epidural, radiological supervision and interpretation Non-Facility (75872) |
$3,777.17 |
$3,777.17 |
5.8× |
Venous sampling by catheter (75893)
likely a partial charge, not the full procedure |
$1,397.97 |
$1,397.97 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$181.91 |
$181.91 |
2.0× |
| Wrist 2 views (73100) |
$653.78 |
$653.78 |
7.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$657.09 |
$657.09 |
6.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$362.72 |
$362.72 |
4.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,267.88 |
$1,267.88 |
6.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$717.73 |
$717.73 |
7.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$680.40 |
$680.40 |
7.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$298.78 |
$298.78 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$177.50 |
$177.50 |
2.0× |
| X-ray eye for foreign body (70030) |
$176.10 |
$176.10 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$554.56 |
$554.56 |
6.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$554.56 |
$554.56 |
6.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$351.70 |
$351.70 |
3.9× |
| X-ray leg, infant (73592) |
$323.03 |
$323.03 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$820.26 |
$820.26 |
7.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,610.75 |
$1,610.75 |
14.8× |
| X-ray nose-rectum child f.b. (76010) |
$195.14 |
$195.14 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$1,310.87 |
$1,310.87 |
12.0× |
| X-ray retrograde pyelogram (74420) |
$1,205.03 |
$1,205.03 |
3.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$461.40 |
$461.40 |
5.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$708.36 |
$708.36 |
6.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$766.24 |
$766.24 |
7.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$509.36 |
$509.36 |
4.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$551.25 |
$551.25 |
6.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$1,071.63 |
$1,071.63 |
11.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$928.31 |
$928.31 |
8.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$502.74 |
$502.74 |
4.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$636.30 |
$636.30 |
3.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$620.71 |
$620.71 |
6.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$272.32 |
$272.32 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$732.06 |
$732.06 |
8.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$847.82 |
$847.82 |
7.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$787.50 |
$787.50 |
7.2× |
| Xr bone length studies (77073) |
$233.73 |
$233.73 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$999.97 |
$999.97 |
9.2× |
| Xr c-spine 6 or more views (72052) |
$1,004.38 |
$1,004.38 |
9.2× |
| Xr chest 4+ views (71048) |
$396.90 |
$396.90 |
3.6× |
| Xr urogram antegrade (74425) |
$1,158.73 |
$1,158.73 |
3.2× |