| Abdomen 2 views (74019) |
$178.80 |
$298 |
1.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,117.20 |
$1,862 |
3.1× |
| Ankle 2 views (73600) |
$187.80 |
$313 |
2.4× |
| Arthrogram shoulder (73040) |
$244.50 |
$407.50 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$748.20 |
$1,247 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$1,251 |
$2,085 |
3.5× |
| Bone age studies (77072) |
$121.20 |
$202 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,720.80 |
$2,868 |
4.8× |
| Bone survey complete (77075) |
$454.80 |
$758 |
4.8× |
| Cervical spine 2 or 3 views (72040) |
$210 |
$350 |
2.7× |
| Chest 1 view (71045) |
$72.90 |
$121.50 |
0.9× |
| Chest 3 views (71047) |
$241.20 |
$402 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$208.80 |
$348 |
1.3× |
| Clavicle complete (73000) |
$159.60 |
$266 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$192.60 |
$321 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,730 |
$9,550 |
18.2× |
| CT abdomen and pelvis without contrast (74176) |
$3,650.40 |
$6,084 |
17.0× |
| CT abdomen w contrast (74160) |
$1,710 |
$2,850 |
10.8× |
| CT abdomen w wo contrast (74170) |
$1,954.20 |
$3,257 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,423.80 |
$2,373 |
15.1× |
| CT angiography upper extremity lt (73206) |
$930 |
$1,550 |
5.9× |
| CT c-spine w/o contrast (72125) |
$2,214 |
$3,690 |
23.5× |
| CT cervical spine w&w/o contrast (72127) |
$2,447.40 |
$4,079 |
15.5× |
| CT cervical spine with contrast (72126) |
$1,889.40 |
$3,149 |
6.0× |
| CT chest w/wo contrast (71270) |
$1,601.10 |
$2,668.50 |
10.1× |
| CT chest with contrast (71260) |
$1,971 |
$3,285 |
12.5× |
| CT head/brain with contrast (70460) |
$1,482.60 |
$2,471 |
9.4× |
| CT head/brain without and with contrast (70470) |
$1,775.40 |
$2,959 |
11.2× |
| CT iac w contrast (70481) |
$1,984.80 |
$3,308 |
12.6× |
| CT limited/localized follow up study (76380) |
$616.20 |
$1,027 |
7.9× |
| CT lower ext w/o (73700) |
$1,791.60 |
$2,986 |
19.0× |
| CT lower extremity w wo contrast (73702) |
$2,179.20 |
$3,632 |
13.8× |
| CT lower extremity with contrast (73701) |
$1,306.80 |
$2,178 |
8.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,002 |
$1,670 |
6.3× |
| CT lumbar spine w/o contrast (72131) |
$2,143.80 |
$3,573 |
22.8× |
| CT lumbar spine with contrast (72132) |
$2,583 |
$4,305 |
8.2× |
| CT maxillofacial w contrast (70487) |
$1,168.20 |
$1,947 |
7.4× |
| CT maxillofacial w/o contrast (70486) |
$729.60 |
$1,216 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,894.80 |
$3,158 |
12.0× |
| CT neck soft tissue w contrast (70491) |
$1,457.40 |
$2,429 |
9.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$721.80 |
$1,203 |
4.6× |
| CT orbits w/o contrast (70480) |
$563.40 |
$939 |
6.0× |
| CT pelvis w & w/o contrast (72194) |
$1,717.80 |
$2,863 |
10.9× |
| CT pelvis w/o contrast (72192) |
$1,390.20 |
$2,317 |
14.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,693.80 |
$2,823 |
10.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,411.20 |
$2,352 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$1,597.80 |
$2,663 |
10.1× |
| CT thoracic spine w/o contrast (72128) |
$2,092.20 |
$3,487 |
22.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,833.60 |
$3,056 |
11.6× |
| CT thorax w/o contrast (71250) |
$1,694.40 |
$2,824 |
18.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,182.80 |
$3,638 |
13.8× |
| CT upper extremity w/o contrast rt (73200) |
$1,791.60 |
$2,986 |
19.0× |
| CT upper extremity with contrast (73201) |
$1,561.80 |
$2,603 |
5.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,788 |
$2,980 |
11.3× |
| Cta Abdomen (74175) |
$2,297.40 |
$3,829 |
14.5× |
| CTA abdomen pelvis (74174) |
$5,985 |
$9,975 |
19.0× |
| CTA chest (71275) |
$1,915.20 |
$3,192 |
12.1× |
| Cta Head (70496) |
$1,953 |
$3,255 |
12.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,002.60 |
$1,671 |
6.3× |
| Cta Neck (70498) |
$1,562.40 |
$2,604 |
9.9× |
| Cta Pelvis (72191) |
$1,145.40 |
$1,909 |
7.2× |
| Cystography minimum 3 views rs&i (74430) |
$265.20 |
$442 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$12 |
$20 |
0.1× |
| Esophagus (74220) |
$325.20 |
$542 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$192 |
$320 |
2.0× |
| Foot 2 views (73620) |
$139.80 |
$233 |
1.8× |
| Forearm 2 views (73090) |
$174 |
$290 |
2.2× |
| Hand 2 views (73120) |
$151.20 |
$252 |
1.6× |
| Hand 3 views (73130) |
$193.20 |
$322 |
2.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$675.60 |
$1,126 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$961.20 |
$1,602 |
2.7× |
| Humerus Min 2 Views Left (73060) |
$198.60 |
$331 |
2.5× |
| Hysterosalpingogram (74740) |
$270 |
$450 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$372 |
$620 |
0.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$463.80 |
$773 |
0.9× |
| Knee 3 views (73562) |
$199.20 |
$332 |
2.5× |
| Liver & spleen imaging static only (78215) |
$783.60 |
$1,306 |
2.2× |
| Mammary ductogram or galactogram multiple (77054) |
$274.80 |
$458 |
1.3× |
| Mammary ductogram or galactogram single (77053) |
$154.80 |
$258 |
0.7× |
| Meckels Diverticulum (78290) |
$354.60 |
$591 |
1.0× |
| MRA head w/o contrast (70544) |
$1,903.80 |
$3,173 |
8.9× |
| MRA neck w/o contrast (70547) |
$1,178.40 |
$1,964 |
5.5× |
| MRI abdomen w contrast (74182) |
$899.40 |
$1,499 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,077 |
$1,795 |
3.4× |
| MRI abdomen w/o contrast (74181) |
$1,132.20 |
$1,887 |
5.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,581.60 |
$2,636 |
2.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,245.80 |
$3,743 |
3.2× |
| MRI c-spine with contrast (72142) |
$1,893.60 |
$3,156 |
6.0× |
| MRI cervical spine w/o contrast (72141) |
$1,962 |
$3,270 |
9.1× |
| MRI chest w/o & w/contrast material (71552) |
$949.80 |
$1,583 |
3.0× |
| MRI chest w/o contrast (71550) |
$598.80 |
$998 |
2.8× |
| MRI chest with contrast (71551) |
$1,588.20 |
$2,647 |
2.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,162.80 |
$1,938 |
3.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,372.20 |
$2,287 |
4.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,231.10 |
$3,718.50 |
10.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,540.20 |
$2,567 |
7.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,332.80 |
$3,888 |
7.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,182.60 |
$1,971 |
3.8× |
| MRI pelvis w contrast (72196) |
$2,646 |
$4,410 |
8.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,395.80 |
$3,993 |
7.6× |
| MRI pelvis w/o contrast (72195) |
$2,125.20 |
$3,542 |
9.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,641.20 |
$4,402 |
8.4× |
| MRI scan of leg joint before and after contrast (73723) |
$2,186.40 |
$3,644 |
7.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,256.20 |
$5,427 |
10.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,705.20 |
$2,842 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,931.60 |
$4,886 |
9.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,399.80 |
$2,333 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,691 |
$4,485 |
8.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,622.40 |
$2,704 |
7.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,001.60 |
$3,336 |
9.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,001.60 |
$3,336 |
6.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,400.60 |
$4,001 |
11.2× |
| Myocardial Spect Multiple Studies (78452) |
$3,390.30 |
$5,650.50 |
2.9× |
| Neck soft tissue (70360) |
$151.20 |
$252 |
1.9× |
| Nm gastric emptying study (78264) |
$1,209 |
$2,015 |
3.4× |
| Osseous survey infant (77076) |
$253.80 |
$423 |
2.7× |
| Osseous survey limited (77074) |
$285 |
$475 |
3.0× |
| Parathyroid imaging (78070) |
$1,047 |
$1,745 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$168 |
$280 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,186.40 |
$3,644 |
7.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$211.80 |
$353 |
0.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$255.60 |
$426 |
0.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$246.30 |
$410.50 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$254.40 |
$424 |
3.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$94.80 |
$158 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$319.20 |
$532 |
3.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$67.20 |
$112 |
0.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$263.40 |
$439 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$142.80 |
$238 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$238.20 |
$397 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$181.80 |
$303 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$206.40 |
$344 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$370.80 |
$618 |
2.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$276.90 |
$461.50 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$198 |
$330 |
2.5× |
| Radiological examination surgical specimen (76098) |
$236.40 |
$394 |
0.5× |
| Ribs bilateral 3 views (71110) |
$452.40 |
$754 |
4.8× |
| Scapula complete (73010) |
$228 |
$380 |
2.4× |
| Screening digital breast tomosynthesis (77063) |
$82.20 |
$137 |
3.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$330.60 |
$551 |
3.5× |
| Small bowel series (74250) |
$323.40 |
$539 |
2.0× |
| Spine thoracic 3 views (72072) |
$104.40 |
$174 |
1.1× |
| Thoracolumbar 2 views (72080) |
$211.80 |
$353 |
2.7× |
| Thyroid Imaging With Vascular Flow (78013) |
$551.40 |
$919 |
1.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$622.20 |
$1,037 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$361.80 |
$603 |
3.8× |
| Unlisted Ultrasound Procedure (76999) |
$255 |
$425 |
3.3× |
| Upper Extremity Infant (73092) |
$63 |
$105 |
0.7× |
| Urethrocystography voiding (74455) |
$192 |
$320 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$438 |
$730 |
2.8× |
| Us abdl aorta screen aaa (76706) |
$327.60 |
$546 |
3.5× |
| Us breast unilateral complete (76641) |
$111 |
$185 |
1.2× |
| Us breast unilateral limited (76642) |
$190.80 |
$318 |
2.4× |
| Us chest (76604) |
$330 |
$550 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$457.80 |
$763 |
4.9× |
| Us infant hips dynamic (76885) |
$273.60 |
$456 |
3.5× |
| Us ob transvaginal (76817) |
$148.80 |
$248 |
1.6× |
| Us pelvic non ob complete (76856) |
$449.40 |
$749 |
4.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$377.40 |
$629 |
4.0× |
| Us pregnancy ltd (76815) |
$168.60 |
$281 |
1.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$88.20 |
$147 |
0.9× |
| Us retroperitoneal complete (76770) |
$396 |
$660 |
4.2× |
| Us retroperitoneal limited (76775) |
$456 |
$760 |
4.8× |
| Us scrotum and contents (76870) |
$451.20 |
$752 |
4.8× |
| Us soft tissue head/neck (76536) |
$328.20 |
$547 |
3.5× |
| Us spinal canal and contents (76800) |
$294.60 |
$491 |
3.1× |
| Us xtr non-vasc lmtd (76882) |
$345 |
$575 |
3.7× |
| Wrist 2 views (73100) |
$196.20 |
$327 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$331.80 |
$553 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$177 |
$295 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$228 |
$380 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$375 |
$625 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$165.60 |
$276 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$228.60 |
$381 |
2.9× |
| X-ray exam hip uni 1 view (73501) |
$201 |
$335 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$220.20 |
$367 |
2.8× |
| X-ray exam of femur 1 (73551) |
$198.60 |
$331 |
2.5× |
| X-ray eye for foreign body (70030) |
$110.40 |
$184 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$255 |
$425 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$116.40 |
$194 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$215.40 |
$359 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$139.80 |
$233 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$454.20 |
$757 |
4.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$154.80 |
$258 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$83.40 |
$139 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$300 |
$500 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$435.60 |
$726 |
4.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$226.80 |
$378 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$221.40 |
$369 |
2.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$218.40 |
$364 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$248.40 |
$414 |
2.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$13.20 |
$22 |
0.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$329.40 |
$549 |
4.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$370.20 |
$617 |
3.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$365.40 |
$609 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$135 |
$225 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$180 |
$300 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$193.80 |
$323 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$241.80 |
$403 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$286.20 |
$477 |
3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$331.20 |
$552 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$211.80 |
$353 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$97.50 |
$162.50 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$123 |
$205 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$249.60 |
$416 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$199.80 |
$333 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$385.20 |
$642 |
4.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$132.60 |
$221 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$213 |
$355 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$681.60 |
$1,136 |
7.2× |
| Xr chest 4+ views (71048) |
$301.20 |
$502 |
3.2× |
| Xr finger(s) 2+ views (73140) |
$132.60 |
$221 |
1.7× |
| Xr optic foramina (70190) |
$426.60 |
$711 |
5.4× |
| Xr shoulder 1 view (73020) |
$171.60 |
$286 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$196.80 |
$328 |
2.5× |
| Xr tmj bilateral (70330) |
$121.80 |
$203 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$193.80 |
$323 |
2.5× |