| Abdomen 2 views (74019) |
$101.70 |
$339 |
1.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$709.05 |
$2,363.50 |
2.0× |
| Angiography extremity bilateral rs&i (75716) |
$2,045.70 |
$6,819 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,045.70 |
$6,819 |
0.7× |
| Ankle 2 views (73600) |
$130.95 |
$436.50 |
1.7× |
| Antegrade urography radiological supvj & interpj (74425) |
$513 |
$1,710 |
1.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,947.60 |
$16,492 |
1.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,807.80 |
$6,026 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$710.85 |
$2,369.50 |
2.0× |
| Bone age studies (77072) |
$130.95 |
$436.50 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$710.85 |
$2,369.50 |
2.0× |
| Bone survey complete (77075) |
$217.50 |
$725 |
2.3× |
| Brain imaging < 4 static views w vascular flow (78601) |
$369.30 |
$1,231 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$130.95 |
$436.50 |
1.7× |
| Chest 1 view (71045) |
$137.10 |
$457 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$271.65 |
$905.50 |
1.7× |
| Clavicle complete (73000) |
$130.95 |
$436.50 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$191.55 |
$638.50 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,796.70 |
$5,989 |
5.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,522.65 |
$5,075.50 |
7.0× |
| CT abdomen w contrast (74160) |
$1,100.25 |
$3,667.50 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,292.70 |
$4,309 |
8.1× |
| CT abdomen w/o contrast (74150) |
$762.30 |
$2,541 |
8.1× |
| CT angiography upper extremity lt (73206) |
$869.40 |
$2,898 |
5.5× |
| CT c-spine w/o contrast (72125) |
$762.30 |
$2,541 |
8.1× |
| CT cervical spine w&w/o contrast (72127) |
$783.48 |
$2,611.60 |
4.9× |
| CT cervical spine with contrast (72126) |
$734.10 |
$2,447 |
2.3× |
| CT chest w/wo contrast (71270) |
$1,292.70 |
$4,309 |
8.1× |
| CT chest with contrast (71260) |
$1,100.25 |
$3,667.50 |
6.9× |
| CT head/brain with contrast (70460) |
$734.10 |
$2,447 |
4.6× |
| CT head/brain without and with contrast (70470) |
$1,291.80 |
$4,306 |
8.1× |
| CT iac w contrast (70481) |
$734.10 |
$2,447 |
4.6× |
| CT lower ext w/o (73700) |
$744.15 |
$2,480.50 |
7.9× |
| CT lower extremity w wo contrast (73702) |
$524.62 |
$1,748.75 |
3.3× |
| CT lower extremity with contrast (73701) |
$734.10 |
$2,447 |
4.6× |
| CT lumbar spine w & w/o contrast (72133) |
$861.90 |
$2,873 |
5.4× |
| CT lumbar spine w/o contrast (72131) |
$762.30 |
$2,541 |
8.1× |
| CT lumbar spine with contrast (72132) |
$734.10 |
$2,447 |
2.3× |
| CT maxillofacial w contrast (70487) |
$734.10 |
$2,447 |
4.6× |
| CT maxillofacial w/o contrast (70486) |
$762.30 |
$2,541 |
8.1× |
| CT maxillofacial w/wo contrast (70488) |
$861.90 |
$2,873 |
5.4× |
| CT neck soft tissue w contrast (70491) |
$734.10 |
$2,447 |
4.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$861.90 |
$2,873 |
5.4× |
| CT orbits w/o contrast (70480) |
$634.95 |
$2,116.50 |
6.7× |
| CT pelvis w & w/o contrast (72194) |
$1,292.70 |
$4,309 |
8.1× |
| CT pelvis w/o contrast (72192) |
$762.30 |
$2,541 |
8.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,292.70 |
$4,309 |
8.1× |
| CT soft tissue neck w/o contrast (70490) |
$762.30 |
$2,541 |
8.1× |
| CT thoracic spine w/contrast (72129) |
$734.10 |
$2,447 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$762.30 |
$2,541 |
8.1× |
| CT thoracic spine w/wo contrast (72130) |
$861.90 |
$2,873 |
5.4× |
| CT thorax w/o contrast (71250) |
$762.30 |
$2,541 |
8.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$861.90 |
$2,873 |
5.4× |
| CT upper extremity w/o contrast rt (73200) |
$762.30 |
$2,541 |
8.1× |
| CT upper extremity with contrast (73201) |
$734.10 |
$2,447 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,304.55 |
$4,348.50 |
8.2× |
| Cta Abdomen (74175) |
$1,304.40 |
$4,348 |
8.2× |
| CTA abdomen pelvis (74174) |
$2,097 |
$6,990 |
6.6× |
| CTA chest (71275) |
$1,304.55 |
$4,348.50 |
8.2× |
| Cta Head (70496) |
$1,245.15 |
$4,150.50 |
7.8× |
| CTA lwr ext w&w/o contrast (73706) |
$869.40 |
$2,898 |
5.5× |
| Cta Neck (70498) |
$1,245.15 |
$4,150.50 |
7.8× |
| Cystography minimum 3 views rs&i (74430) |
$513 |
$1,710 |
1.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$214.20 |
$714 |
2.3× |
| Esophagus (74220) |
$271.65 |
$905.50 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$268.80 |
$896 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$320.85 |
$1,069.50 |
3.4× |
| Fluoroscopy up to 1 hr (76000) |
$249.15 |
$830.50 |
1.2× |
| Foot 2 views (73620) |
$130.95 |
$436.50 |
1.7× |
| Forearm 2 views (73090) |
$130.95 |
$436.50 |
1.7× |
| Hand 2 views (73120) |
$130.95 |
$436.50 |
1.4× |
| Hand 3 views (73130) |
$130.95 |
$436.50 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$795.30 |
$2,651 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$795.30 |
$2,651 |
2.2× |
| Ht muscle image spect sing (78451) |
$1,055.25 |
$3,517.50 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$130.95 |
$436.50 |
1.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,390.95 |
$4,636.50 |
2.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$516.30 |
$1,721 |
1.1× |
| Knee 3 views (73562) |
$221.85 |
$739.50 |
2.8× |
| Lung Ventilation Imaging (78579) |
$704.70 |
$2,349 |
1.9× |
| Meckels Diverticulum (78290) |
$709.05 |
$2,363.50 |
2.0× |
| MRA head w & w/o contrast (70546) |
$1,594.65 |
$5,315.50 |
5.0× |
| MRA head w/o contrast (70544) |
$1,163.10 |
$3,877 |
5.4× |
| MRA head with contrast (70545) |
$5,581.28 |
$18,604.25 |
17.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,594.65 |
$5,315.50 |
5.0× |
| MRA neck w/o contrast (70547) |
$1,163.10 |
$3,877 |
5.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,366.80 |
$4,556 |
4.3× |
| MRI abdomen w/o contrast (74181) |
$1,163.10 |
$3,877 |
5.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,382.85 |
$4,609.50 |
1.9× |
| MRI c-spine with contrast (72142) |
$1,278.30 |
$4,261 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$1,279.95 |
$4,266.50 |
5.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,455.45 |
$4,851.50 |
4.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$854.70 |
$2,849 |
2.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,011.68 |
$3,372.25 |
4.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,554 |
$5,180 |
7.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,782 |
$5,940 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,242.30 |
$4,141 |
3.9× |
| MRI pelvis w/o contrast (72195) |
$1,058.55 |
$3,528.50 |
4.9× |
| MRI scan of arm joint before and after contrast (73223) |
$1,242.30 |
$4,141 |
3.9× |
| MRI scan of leg joint before and after contrast (73723) |
$1,497.90 |
$4,993 |
4.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,710.90 |
$5,703 |
5.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,242.49 |
$4,141.66 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,753.50 |
$5,845 |
5.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,366.80 |
$4,556 |
4.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,594.65 |
$5,315.50 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,163.10 |
$3,877 |
5.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,206.90 |
$4,023 |
5.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,366.80 |
$4,556 |
4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$854.70 |
$2,849 |
4.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,110.50 |
$7,035 |
1.8× |
| Neck soft tissue (70360) |
$137.10 |
$457 |
1.7× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$277.65 |
$925.50 |
0.8× |
| Osseous survey infant (77076) |
$130.95 |
$436.50 |
1.4× |
| Osseous survey limited (77074) |
$248.10 |
$827 |
2.6× |
| Parathyroid imaging (78070) |
$646.50 |
$2,155 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$130.95 |
$436.50 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,210.20 |
$4,034 |
3.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$584.48 |
$1,948.25 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$763.35 |
$2,544.50 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$458.10 |
$1,527 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$130.95 |
$436.50 |
1.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$188.55 |
$628.50 |
2.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$130.95 |
$436.50 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$130.95 |
$436.50 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$137.10 |
$457 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$137.10 |
$457 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$271.65 |
$905.50 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$271.65 |
$905.50 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$271.65 |
$905.50 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$124.80 |
$416 |
1.6× |
| Radiological examination surgical specimen (76098) |
$986.94 |
$3,289.80 |
2.0× |
| Ribs bilateral 3 views (71110) |
$130.95 |
$436.50 |
1.4× |
| Scapula complete (73010) |
$185.70 |
$619 |
2.0× |
| Screening digital breast tomosynthesis (77063) |
$35.25 |
$117.50 |
1.5× |
| Small bowel series (74250) |
$317.85 |
$1,059.50 |
2.0× |
| Spine thoracic 3 views (72072) |
$130.95 |
$436.50 |
1.4× |
| Thoracolumbar 2 views (72080) |
$130.95 |
$436.50 |
1.7× |
| Thyroid carcinoma metastases img whole body (78018) |
$903 |
$3,010 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$325.20 |
$1,084 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$386.55 |
$1,288.50 |
4.1× |
| Upper Extremity Infant (73092) |
$128.78 |
$429.25 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$438.78 |
$1,462.62 |
2.0× |
| Urethrocystography voiding (74455) |
$513 |
$1,710 |
2.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$513 |
$1,710 |
3.2× |
| Us abdl aorta screen aaa (76706) |
$386.55 |
$1,288.50 |
4.1× |
| Us breast unilateral complete (76641) |
$244.05 |
$813.50 |
2.6× |
| Us breast unilateral limited (76642) |
$243.15 |
$810.50 |
3.1× |
| Us chest (76604) |
$104.70 |
$349 |
1.1× |
| Us pelvic non ob complete (76856) |
$426.60 |
$1,422 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$330 |
$1,100 |
3.5× |
| Us pregnancy ltd (76815) |
$267.45 |
$891.50 |
2.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$448.80 |
$1,496 |
4.7× |
| Us retroperitoneal complete (76770) |
$441.60 |
$1,472 |
4.7× |
| Us scrotum and contents (76870) |
$361.80 |
$1,206 |
3.8× |
| Us soft tissue head/neck (76536) |
$388.50 |
$1,295 |
4.1× |
| Us xtr non-vasc lmtd (76882) |
$297.60 |
$992 |
3.1× |
| Venogram extremity bilateral (75822) |
$454.80 |
$1,516 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$1,075.80 |
$3,586 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$2,894.85 |
$9,649.50 |
2.0× |
| Wrist 2 views (73100) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$437.40 |
$1,458 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$130.95 |
$436.50 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$45.45 |
$151.50 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$124.80 |
$416 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$196.05 |
$653.50 |
2.1× |
| X-ray eye for foreign body (70030) |
$137.10 |
$457 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$130.95 |
$436.50 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$194.10 |
$647 |
2.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$130.95 |
$436.50 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$126.60 |
$422 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$130.95 |
$436.50 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$341.55 |
$1,138.50 |
3.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$217.50 |
$725 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$130.95 |
$436.50 |
1.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$205.80 |
$686 |
2.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$513 |
$1,710 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$130.95 |
$436.50 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$217.50 |
$725 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$130.95 |
$436.50 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$195.60 |
$652 |
2.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$130.95 |
$436.50 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$130.95 |
$436.50 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$302.10 |
$1,007 |
3.2× |
| Xr finger(s) 2+ views (73140) |
$130.95 |
$436.50 |
1.7× |
| Xr shoulder 1 view (73020) |
$130.95 |
$436.50 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$217.50 |
$725 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$130.95 |
$436.50 |
1.7× |
| Xr tmj bilateral (70330) |
$193.80 |
$646 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$130.95 |
$436.50 |
1.7× |