| Abdomen 2 views (74019) |
$204 |
$255 |
2.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$588 |
$735 |
1.6× |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
$3,298.40 |
$4,123 |
1.1× |
| Angiography extremity bilateral rs&i (75716) |
$4,859.22 |
$6,074.02 |
1.6× |
| Angiography extremity unilateral rs&i (75710) |
$4,320 |
$5,400 |
1.5× |
| Angiography internal mammary rs&i (75756) |
$1,059.20 |
$1,324 |
0.4× |
Angiography pelvic slctv/supraslctv rs&i (75736)
unusually low: confirm this is the full procedure |
$2,019.20 |
$2,524 |
0.4× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$2,019.20 |
$2,524 |
0.7× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$3,298.40 |
$4,123 |
1.1× |
| Angiography Spinal Selective Rs&I (75705) |
$5,777.60 |
$7,222 |
1.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$4,800 |
$6,000 |
0.9× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,059.20 |
$1,324 |
0.4× |
| Angrph pulmonary nonslctv cath/ven njx rs&i (75746) |
$1,059.20 |
$1,324 |
0.4× |
| Ankle 2 views (73600) |
$107.20 |
$134 |
1.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$384.80 |
$481 |
1.2× |
| Aortogram thoracic (75605) |
$4,560 |
$5,700 |
0.9× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,640 |
$3,300 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$2,640 |
$3,300 |
0.9× |
| Aortography thoracic w/o serialography rs&i (75600) |
$2,019.20 |
$2,524 |
0.7× |
| Artery X-Rays Adrenal Gland (75731) |
$2,019.20 |
$2,524 |
0.7× |
| Bone &/joint imaging whole body (78306) |
$588 |
$735 |
1.6× |
| Bone age studies (77072) |
$160 |
$200 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$588 |
$735 |
1.6× |
| Bone Marrow Imaging Limited Area (78102) |
$460 |
$575 |
1.2× |
| Bone survey complete (77075) |
$116.80 |
$146 |
1.2× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,445.60 |
$1,807 |
4.4× |
| Cervical spine 2 or 3 views (72040) |
$107.20 |
$134 |
1.3× |
| Chest 1 view (71045) |
$729.98 |
$912.48 |
8.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$241.60 |
$302 |
1.5× |
| Clavicle complete (73000) |
$107.20 |
$134 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$150 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$604 |
$755 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$604 |
$755 |
2.7× |
| CT abdomen w contrast (74160) |
$604 |
$755 |
3.7× |
| CT abdomen w wo contrast (74170) |
$604 |
$755 |
3.7× |
| CT abdomen w/o contrast (74150) |
$604 |
$755 |
6.1× |
| CT angio hrt w/3d image (75574) |
$604 |
$755 |
1.8× |
| CT angiography upper extremity lt (73206) |
$604 |
$755 |
3.7× |
| CT c-spine w/o contrast (72125) |
$604 |
$755 |
6.1× |
| CT cervical spine w&w/o contrast (72127) |
$604 |
$755 |
3.7× |
| CT cervical spine with contrast (72126) |
$604 |
$755 |
1.8× |
| CT chest w/wo contrast (71270) |
$604 |
$755 |
3.7× |
| CT chest with contrast (71260) |
$604 |
$755 |
3.7× |
| CT head/brain with contrast (70460) |
$604 |
$755 |
3.7× |
| CT head/brain without and with contrast (70470) |
$604 |
$755 |
3.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$604 |
$755 |
1.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$60 |
$75 |
0.7× |
| CT iac w contrast (70481) |
$684.16 |
$855.20 |
4.2× |
| CT lower ext w/o (73700) |
$604 |
$755 |
6.1× |
| CT lower extremity w wo contrast (73702) |
$604 |
$755 |
3.7× |
| CT lower extremity with contrast (73701) |
$604 |
$755 |
3.7× |
| CT lumbar spine w & w/o contrast (72133) |
$604 |
$755 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$604 |
$755 |
6.1× |
| CT lumbar spine with contrast (72132) |
$604 |
$755 |
1.8× |
| CT maxillofacial w contrast (70487) |
$604 |
$755 |
3.7× |
| CT maxillofacial w/o contrast (70486) |
$604 |
$755 |
6.1× |
| CT maxillofacial w/wo contrast (70488) |
$604 |
$755 |
3.7× |
| CT neck soft tissue w contrast (70491) |
$604 |
$755 |
3.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$684.16 |
$855.20 |
4.2× |
| CT orbits w/o contrast (70480) |
$360.18 |
$450.22 |
3.7× |
| CT pelvis w & w/o contrast (72194) |
$604 |
$755 |
3.7× |
| CT pelvis w/o contrast (72192) |
$604 |
$755 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$604 |
$755 |
3.7× |
| CT soft tissue neck w/o contrast (70490) |
$604 |
$755 |
6.1× |
| CT thoracic spine w/contrast (72129) |
$604 |
$755 |
3.7× |
| CT thoracic spine w/o contrast (72128) |
$604 |
$755 |
6.1× |
| CT thoracic spine w/wo contrast (72130) |
$604 |
$755 |
3.7× |
| CT thorax w/o contrast (71250) |
$604 |
$755 |
6.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$604 |
$755 |
3.7× |
| CT upper extremity w/o contrast rt (73200) |
$604 |
$755 |
6.1× |
| CT upper extremity with contrast (73201) |
$604 |
$755 |
1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$604 |
$755 |
3.7× |
| Cta Abdomen (74175) |
$604 |
$755 |
3.7× |
| CTA abdomen pelvis (74174) |
$604 |
$755 |
1.8× |
| CTA chest (71275) |
$604 |
$755 |
3.7× |
| Cta Head (70496) |
$604 |
$755 |
3.7× |
| CTA lwr ext w&w/o contrast (73706) |
$604 |
$755 |
3.7× |
| Cta Neck (70498) |
$604 |
$755 |
3.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$136 |
$170 |
1.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$144 |
$180 |
1.8× |
| Dxa bone density study axial skeleton (77085) |
$128 |
$160 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$188.80 |
$236 |
0.8× |
| Foot 2 views (73620) |
$107.20 |
$134 |
1.3× |
| Forearm 2 views (73090) |
$107.20 |
$134 |
1.3× |
| Gated Heart Planar Single (78472) |
$819.80 |
$1,024.75 |
2.2× |
| Hand 2 views (73120) |
$107.20 |
$134 |
1.1× |
| Hand 3 views (73130) |
$107.20 |
$134 |
1.3× |
| Hepatc vngrph wdg/fr w/o hemodyn eval rs&i (75891) |
$3,298.40 |
$4,123 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$564 |
$705 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$564 |
$705 |
1.5× |
| Ht muscle image spect sing (78451) |
$2,164.69 |
$2,705.86 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$107.20 |
$134 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$588 |
$735 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$588 |
$735 |
1.2× |
| Knee 3 views (73562) |
$107.20 |
$134 |
1.3× |
| Liver & spleen imaging static only (78215) |
$628.75 |
$785.94 |
1.7× |
| Liver imaging static only (78201) |
$823.98 |
$1,029.98 |
1.6× |
| Lung perfusion differential (78597) |
$392 |
$490 |
1.0× |
| Meckels Diverticulum (78290) |
$433.20 |
$541.50 |
1.2× |
| MRA head w/o contrast (70544) |
$855.20 |
$1,069 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,000 |
$1,250 |
3.1× |
| MRA neck w/o contrast (70547) |
$640 |
$800 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,000 |
$1,250 |
3.1× |
| MRI abdomen w/o contrast (74181) |
$847.20 |
$1,059 |
3.8× |
| MRI cardiac w/o contrast (75557) |
$1,020 |
$1,275 |
4.5× |
| MRI cervical spine w/o contrast (72141) |
$847.20 |
$1,059 |
3.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,330.32 |
$1,662.90 |
4.1× |
| MRI chest w/o contrast (71550) |
$847.20 |
$1,059 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$847.20 |
$1,059 |
3.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$847.20 |
$1,059 |
3.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$847.20 |
$1,059 |
2.6× |
| MRI pelvis w contrast (72196) |
$847.20 |
$1,059 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$847.20 |
$1,059 |
2.6× |
| MRI pelvis w/o contrast (72195) |
$847.20 |
$1,059 |
3.8× |
| MRI scan of arm joint before and after contrast (73223) |
$847.20 |
$1,059 |
2.6× |
| MRI scan of leg joint before and after contrast (73723) |
$847.20 |
$1,059 |
2.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$847.20 |
$1,059 |
2.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$847.20 |
$1,059 |
2.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$847.20 |
$1,059 |
2.6× |
| MRI thoracic spine w/o contrast (72146) |
$847.20 |
$1,059 |
3.8× |
| MRI upper ext joint w/o contrast (73221) |
$847.20 |
$1,059 |
3.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$847.20 |
$1,059 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$847.20 |
$1,059 |
3.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,476.80 |
$1,846 |
1.2× |
| Myocrd img PET prfuj mlt std rst&strs cncrnt CT (78431) |
$4,140 |
$5,175 |
2.0× |
| Neck soft tissue (70360) |
$107.20 |
$134 |
1.3× |
| Nm bone marrow wb (78104) |
$460 |
$575 |
1.2× |
| Nm gastric emptying study (78264) |
$588 |
$735 |
1.6× |
| Nm whole blood volume (78122) |
$724.80 |
$906 |
1.4× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$981.60 |
$1,227 |
0.8× |
| Parathyroid imaging (78070) |
$628.75 |
$785.94 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$107.20 |
$134 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$847.20 |
$1,059 |
2.6× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$3,298.40 |
$4,123 |
1.1× |
| Prq transhepatc portograpy w/o hemodyn evl intrp (75887) |
$2,019.20 |
$2,524 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$424.80 |
$531 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$520 |
$650 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$407.20 |
$509 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$107.20 |
$134 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$107.20 |
$134 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$107.20 |
$134 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$107.20 |
$134 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$241.60 |
$302 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$241.60 |
$302 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$107.20 |
$134 |
1.3× |
| Ribs bilateral 3 views (71110) |
$116.80 |
$146 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,010 |
$1,262.50 |
2.0× |
| Sacroiliac Joints < 3 Views (72200) |
$167.60 |
$209.50 |
1.7× |
| Scapula complete (73010) |
$107.20 |
$134 |
1.1× |
| Small bowel series (74250) |
$241.60 |
$302 |
1.5× |
| Speech evaluation complex (70371) |
$188.80 |
$236 |
0.8× |
| Thoracolumbar 2 views (72080) |
$138.53 |
$173.16 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$288.80 |
$361 |
2.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$144 |
$180 |
1.8× |
| Unlisted magnetic resonance procedure (76498) |
$1,200 |
$1,500 |
14.7× |
| Us breast unilateral limited (76642) |
$138.53 |
$173.16 |
1.7× |
| Us chest (76604) |
$160 |
$200 |
1.6× |
| Us elastography parenchyma (76981) |
$200 |
$250 |
2.0× |
| Us ob transvaginal (76817) |
$200 |
$250 |
2.0× |
| Us pelvic non ob complete (76856) |
$241.60 |
$302 |
2.5× |
| Us pregnancy ltd (76815) |
$172.80 |
$216 |
1.8× |
| Us retroperitoneal complete (76770) |
$241.60 |
$302 |
2.5× |
| Us scrotum and contents (76870) |
$241.60 |
$302 |
2.5× |
| Us soft tissue head/neck (76536) |
$158.40 |
$198 |
1.6× |
| Us xtr non-vasc lmtd (76882) |
$89.20 |
$111.50 |
0.9× |
| Venogram extremity bilateral (75822) |
$2,441.49 |
$3,051.86 |
1.7× |
| Venography caval inferior serialography rs&i (75825) |
$4,859.22 |
$6,074.02 |
1.6× |
| Venography caval superior serialography rs&i (75827) |
$849.60 |
$1,062 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$2,441.49 |
$3,051.86 |
1.7× |
| Venography Renal Bilateral (75833) |
$3,298.40 |
$4,123 |
1.1× |
| Venography renal unilateral selective rs&i (75831) |
$3,298.40 |
$4,123 |
1.1× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,059.20 |
$1,324 |
0.4× |
| Wrist 2 views (73100) |
$107.20 |
$134 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$186.40 |
$233 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$107.20 |
$134 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$107.20 |
$134 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$107.20 |
$134 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$107.20 |
$134 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$107.20 |
$134 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$107.20 |
$134 |
1.3× |
| X-ray eye for foreign body (70030) |
$138.53 |
$173.16 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$107.20 |
$134 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$107.20 |
$134 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$107.20 |
$134 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$107.20 |
$134 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$107.20 |
$134 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$107.20 |
$134 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$107.20 |
$134 |
1.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$107.20 |
$134 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$107.20 |
$134 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$107.20 |
$134 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$107.20 |
$134 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$186.40 |
$233 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$107.20 |
$134 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$107.20 |
$134 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$107.20 |
$134 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$107.20 |
$134 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$107.20 |
$134 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$107.20 |
$134 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$107.20 |
$134 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$107.20 |
$134 |
1.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$107.20 |
$134 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$107.20 |
$134 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$107.20 |
$134 |
1.3× |
| Xr shoulder 1 view (73020) |
$107.20 |
$134 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$167.60 |
$209.50 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$107.20 |
$134 |
1.3× |
| Xr tmj bilateral (70330) |
$107.20 |
$134 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$107.20 |
$134 |
1.3× |