| Abdomen 2 views (74019) |
$87.68 |
$175.36 |
0.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$460 |
$920 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$491 |
$982 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$1,979 |
$3,958 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$3,490 |
$6,980 |
1.2× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$5,815 |
$6,019.16 |
1.1× |
| Ankle 2 views (73600) |
$35.52 |
$71.03 |
0.4× |
Aortogram thoracic (75605)
likely a partial charge, not the full procedure |
$141.66 |
$283.32 |
0.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,838.66 |
$3,677.30 |
0.6× |
| Aortography abdominal serialography rs&i (75625) |
$3,490 |
$3,604.63 |
1.2× |
| Arthrogram elbow (73085) |
$452.50 |
$905 |
1.4× |
| Arthrogram hip (73525) |
$452.50 |
$905 |
1.4× |
| Arthrogram shoulder (73040) |
$288.75 |
$577.50 |
0.9× |
| Arthrogram wrist (73115) |
$452.50 |
$905 |
1.4× |
| Arthrography knee lt (73580) |
$452.50 |
$905 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$460 |
$920 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$460 |
$920 |
1.2× |
| Bone age studies (77072) |
$81.39 |
$162.78 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$460 |
$920 |
1.2× |
| Bone survey complete (77075) |
$123.90 |
$247.81 |
1.3× |
| Brain image w/flow 4 + views (78606) |
$597.50 |
$1,195 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$45.78 |
$91.55 |
0.6× |
| Chest 1 view (71045) |
$96.36 |
$192.71 |
1.2× |
| Chest 3 views (71047) |
$73.30 |
$146.60 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$181.67 |
$363.34 |
1.1× |
| Clavicle complete (73000) |
$35.83 |
$71.66 |
0.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$149.36 |
$298.72 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$732.82 |
$1,465.63 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$567.24 |
$1,134.49 |
2.6× |
| CT abdomen w contrast (74160) |
$403.36 |
$806.73 |
2.5× |
| CT abdomen w wo contrast (74170) |
$462.91 |
$925.82 |
2.8× |
| CT abdomen w/o contrast (74150) |
$309.67 |
$619.34 |
3.2× |
| CT angio hrt w/3d image (75574) |
$367.53 |
$735.06 |
1.1× |
| CT angiography upper extremity lt (73206) |
$517.94 |
$1,035.88 |
3.2× |
| CT c-spine w/o contrast (72125) |
$311.23 |
$622.46 |
3.2× |
| CT cervical spine w&w/o contrast (72127) |
$333.58 |
$667.16 |
2.1× |
| CT cervical spine with contrast (72126) |
$335.40 |
$670.80 |
1.0× |
| CT chest w/wo contrast (71270) |
$449.98 |
$899.96 |
2.8× |
| CT chest with contrast (71260) |
$372.08 |
$744.16 |
2.3× |
| CT head/brain with contrast (70460) |
$285.50 |
$570.99 |
1.8× |
| CT head/brain without and with contrast (70470) |
$378.52 |
$757.04 |
2.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$276.47 |
$552.94 |
0.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$24.75 |
$49.50 |
0.3× |
| CT iac w contrast (70481) |
$304.68 |
$609.36 |
1.9× |
| CT lower ext w/o (73700) |
$259.30 |
$518.59 |
2.7× |
| CT lower extremity w wo contrast (73702) |
$332.14 |
$664.28 |
2.0× |
| CT lower extremity with contrast (73701) |
$296.58 |
$593.16 |
1.8× |
| CT lumbar spine w & w/o contrast (72133) |
$400.70 |
$801.40 |
2.5× |
| CT lumbar spine w/o contrast (72131) |
$310.86 |
$621.72 |
3.2× |
| CT lumbar spine with contrast (72132) |
$333.08 |
$666.17 |
1.0× |
| CT maxillofacial w contrast (70487) |
$287.92 |
$575.84 |
1.8× |
| CT maxillofacial w/o contrast (70486) |
$272.98 |
$545.96 |
2.8× |
| CT maxillofacial w/wo contrast (70488) |
$326.30 |
$652.61 |
2.0× |
| CT neck soft tissue w contrast (70491) |
$312.49 |
$624.98 |
1.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$341.42 |
$682.84 |
2.1× |
| CT orbits w/o contrast (70480) |
$277.14 |
$554.26 |
2.9× |
| CT pelvis w & w/o contrast (72194) |
$449.16 |
$898.33 |
2.8× |
| CT pelvis w/o contrast (72192) |
$310.03 |
$620.06 |
3.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$415.42 |
$830.82 |
2.6× |
| CT soft tissue neck w/o contrast (70490) |
$293.54 |
$587.06 |
3.0× |
| CT thoracic spine w/contrast (72129) |
$333.37 |
$666.74 |
2.1× |
| CT thoracic spine w/o contrast (72128) |
$311.23 |
$622.46 |
3.2× |
| CT thoracic spine w/wo contrast (72130) |
$334.70 |
$669.40 |
2.1× |
| CT thorax w/o contrast (71250) |
$160.99 |
$321.98 |
1.7× |
| CT unlisted procedure (76497) |
$100 |
$200 |
1.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$350.24 |
$700.46 |
2.2× |
| CT upper extremity w/o contrast rt (73200) |
$289.06 |
$578.10 |
3.0× |
| CT upper extremity with contrast (73201) |
$347.10 |
$694.20 |
1.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$760.96 |
$1,521.92 |
4.7× |
| Cta Abdomen (74175) |
$613.78 |
$1,227.56 |
3.8× |
| CTA abdomen pelvis (74174) |
$753.48 |
$1,506.97 |
2.3× |
| CTA chest (71275) |
$562.22 |
$1,124.44 |
3.5× |
| Cta Head (70496) |
$500.80 |
$1,001.60 |
3.1× |
| CTA lwr ext w&w/o contrast (73706) |
$517.17 |
$1,034.34 |
3.2× |
| Cta Neck (70498) |
$557.06 |
$1,114.10 |
3.4× |
| Cta Pelvis (72191) |
$545.94 |
$1,091.88 |
3.4× |
| Cystography minimum 3 views rs&i (74430) |
$250.38 |
$500.76 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$88.14 |
$176.27 |
0.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$68.75 |
$137.50 |
0.9× |
| Dxa bone density study axial skeleton (77085) |
$98.62 |
$197.25 |
1.0× |
| Echoencephalography real time imaging (76506) |
$132.86 |
$265.71 |
1.4× |
| Esophagus (74220) |
$174.61 |
$349.21 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$150.75 |
$301.50 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$119.25 |
$238.50 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$78 |
$156 |
0.4× |
| Foot 2 views (73620) |
$33.50 |
$67 |
0.4× |
| Forearm 2 views (73090) |
$66 |
$132 |
0.8× |
| Gated Heart Planar Single (78472) |
$261.25 |
$522.50 |
0.7× |
| Hand 2 views (73120) |
$33.50 |
$67 |
0.3× |
| Hand 3 views (73130) |
$66.75 |
$133.50 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$597.50 |
$1,195 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$460 |
$920 |
1.2× |
| Ht muscle image spect sing (78451) |
$1,013.75 |
$2,027.50 |
0.8× |
| Humerus Min 2 Views Left (73060) |
$67.75 |
$135.50 |
0.8× |
| Hysterosalpingogram (74740) |
$194.92 |
$389.85 |
0.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$93.58 |
$187.16 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$597.50 |
$1,195 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$597.50 |
$1,195 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$597.50 |
$1,195 |
1.2× |
| Knee 3 views (73562) |
$97.50 |
$195 |
1.2× |
| Liver & spleen imaging static only (78215) |
$460 |
$920 |
1.2× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$460 |
$920 |
1.2× |
| Lung perf&ventilat diferentl (78598) |
$597.50 |
$1,195 |
1.2× |
| Lymphoscintigraphy (78195) |
$597.50 |
$1,195 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$280 |
$560 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$280 |
$560 |
1.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$63.57 |
$127.14 |
0.8× |
| Meckels Diverticulum (78290) |
$460 |
$920 |
1.2× |
| MRI upper ext joint w/o contrast (73221) |
$601.50 |
$1,203 |
2.7× |
| Myelogram Cervical (72240) |
$872.50 |
$1,745 |
1.2× |
| Myelogram Lumbar (72265) |
$872.50 |
$1,745 |
1.2× |
| Myelogram thoracic (72255) |
$872.50 |
$1,745 |
1.2× |
| Myelography 2 or more regions (72270) |
$872.50 |
$1,745 |
1.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,592.50 |
$3,185 |
1.3× |
| Neck soft tissue (70360) |
$62.75 |
$125.50 |
0.8× |
| Nm cisternogram (78630) |
$597.50 |
$1,195 |
1.2× |
| Nm csf leak detection (78650) |
$1,592.50 |
$3,185 |
1.3× |
| Nm gastric emptying study (78264) |
$460 |
$920 |
1.2× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$87.50 |
$175 |
0.1× |
| Nuclear Rx Oral Admin (79005) |
$605 |
$1,210 |
2.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$126.25 |
$252.50 |
1.3× |
| Osseous survey infant (77076) |
$128.70 |
$257.40 |
1.3× |
| Parathyroid imaging (78070) |
$308.75 |
$617.50 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$35.50 |
$71 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$460 |
$920 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$597.50 |
$1,195 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$590 |
$1,180 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$41 |
$82 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$132.50 |
$265 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$127.82 |
$255.64 |
1.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$102.38 |
$204.76 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$91.29 |
$182.58 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$97.50 |
$195 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$91.17 |
$182.34 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$100.78 |
$201.55 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$207.44 |
$414.86 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$198.94 |
$397.87 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$189.28 |
$378.54 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$69.26 |
$138.53 |
0.9× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$94 |
$188 |
0.3× |
| Ribs bilateral 3 views (71110) |
$53.50 |
$107 |
0.6× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$460 |
$920 |
1.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,592.50 |
$3,185 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,592.50 |
$3,185 |
3.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,592.50 |
$3,185 |
1.3× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,805 |
$3,610 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$135.28 |
$270.56 |
0.6× |
| Scanogram (77073) |
$92.23 |
$184.46 |
1.0× |
| Scapula complete (73010) |
$35.50 |
$71 |
0.4× |
| Screening digital breast tomosynthesis (77063) |
$45.14 |
$90.28 |
1.9× |
| Small bowel series (74250) |
$180.74 |
$361.49 |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$460 |
$920 |
1.2× |
| Therapeutic Enema (74283) |
$233.88 |
$467.75 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$460 |
$920 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$460 |
$920 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$103 |
$206 |
1.1× |
| Upper Extremity Infant (73092) |
$132.50 |
$265 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$184.78 |
$369.57 |
0.8× |
| Urethrocystography voiding (74455) |
$199.82 |
$399.65 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$194.92 |
$389.82 |
1.2× |
| Us abdl aorta screen aaa (76706) |
$127.85 |
$255.70 |
1.3× |
| Us breast unilateral complete (76641) |
$140.50 |
$281 |
1.5× |
| Us breast unilateral limited (76642) |
$125.50 |
$251 |
1.6× |
| Us chest (76604) |
$102.56 |
$205.13 |
1.1× |
| Us compl joint r-t w/image documentation (76881) |
$147 |
$294 |
1.5× |
| Us fetal nuchal translucency 1st gestation (76813) |
$132.50 |
$265 |
1.4× |
| Us infant hips dynamic (76885) |
$134.50 |
$269 |
1.7× |
| Us ob detailed single fetus (76811) |
$244.50 |
$489 |
1.1× |
| Us ob transvaginal (76817) |
$127.75 |
$255.50 |
1.3× |
| Us pelvic non ob complete (76856) |
$127.75 |
$255.50 |
1.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$132.50 |
$265 |
1.4× |
| Us pregnancy ltd (76815) |
$132.50 |
$265 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$130.50 |
$261 |
1.3× |
| Us retroperitoneal complete (76770) |
$136.36 |
$272.72 |
1.4× |
| Us retroperitoneal limited (76775) |
$101.09 |
$202.18 |
1.0× |
| Us scrotum and contents (76870) |
$136.98 |
$273.97 |
1.4× |
| Us soft tissue head/neck (76536) |
$151 |
$301.99 |
1.6× |
| Venogram extremity bilateral (75822) |
$1,715 |
$3,430 |
1.2× |
| Venography caval inferior serialography rs&i (75825) |
$1,949.75 |
$819 |
0.7× |
| Venography caval superior serialography rs&i (75827) |
$409.50 |
$819 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$1,715 |
$3,430 |
1.2× |
| Venography venous sinus/jugular cath rs&i (75860) |
$3,490 |
$6,980 |
1.2× |
| Vertebral fracture assessment via dxa (77086) |
$67.74 |
$135.48 |
0.8× |
| Wrist 2 views (73100) |
$65.50 |
$131 |
0.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$95.23 |
$190.46 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$71.50 |
$143 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$66.75 |
$133.50 |
0.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$252.30 |
$504.60 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$65.50 |
$131 |
0.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$38 |
$76 |
0.5× |
| X-ray exam hip uni 1 view (73501) |
$97.50 |
$195 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$97.50 |
$195 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$93.38 |
$186.75 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$66.75 |
$133.50 |
0.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$97.50 |
$195 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$43 |
$86 |
0.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$66 |
$132 |
0.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$97.50 |
$195 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$47 |
$94 |
0.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$101.88 |
$203.76 |
1.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$89.70 |
$179.39 |
0.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$97.50 |
$195 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$94 |
$188.01 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$45.50 |
$91 |
0.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$271.02 |
$542.03 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$70.14 |
$140.28 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$90.80 |
$181.60 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$94.41 |
$188.82 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$86.75 |
$173.50 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$67.75 |
$135.50 |
0.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$39.91 |
$79.82 |
0.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$70.52 |
$141.04 |
0.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$86.96 |
$173.90 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$97.50 |
$195 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$47.65 |
$95.29 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$68.21 |
$136.42 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$44 |
$88 |
0.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$97.50 |
$195 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$69.75 |
$139.50 |
0.9× |
| Xr arthrogram ankle (73615) |
$452.50 |
$905 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$102.06 |
$204.13 |
1.1× |
| Xr chest 4+ views (71048) |
$93.18 |
$186.34 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$97.50 |
$195 |
1.2× |
| Xr shoulder 1 view (73020) |
$68 |
$136 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$97.50 |
$195 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$66.50 |
$133 |
0.8× |
| Xr tmj bilateral (70330) |
$79.17 |
$158.34 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$66.75 |
$133.50 |
0.8× |