| Abdomen 2 views (74019) |
$138.60 |
$308 |
1.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$417.15 |
$927 |
1.2× |
| Ankle 2 views (73600) |
$97.42 |
$216.50 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$517.95 |
$1,151 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$652.50 |
$1,450 |
1.9× |
| Bone age studies (77072) |
$264.15 |
$587 |
2.9× |
| Bone Imaging 3 Phase (78315) |
$574.20 |
$1,276 |
1.7× |
| Bone survey complete (77075) |
$270.45 |
$601 |
3.0× |
| Cervical spine 2 or 3 views (72040) |
$236.70 |
$526 |
3.2× |
| Chest 1 view (71045) |
$106.20 |
$236 |
1.4× |
| Chest 3 views (71047) |
$213.30 |
$474 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$264.15 |
$587 |
1.7× |
| Clavicle complete (73000) |
$94.50 |
$210 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$57.60 |
$128 |
0.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,391.85 |
$3,093 |
4.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,012.50 |
$2,250 |
4.9× |
| CT abdomen w contrast (74160) |
$947.70 |
$2,106 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,124.55 |
$2,499 |
7.4× |
| CT abdomen w/o contrast (74150) |
$829.35 |
$1,843 |
9.2× |
| CT angio hrt w/3d image (75574) |
$1,184.40 |
$2,632 |
3.9× |
| CT angiography upper extremity lt (73206) |
$1,816.65 |
$4,037 |
12.0× |
| CT c-spine w/o contrast (72125) |
$829.35 |
$1,843 |
9.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,302.75 |
$2,895 |
8.6× |
| CT cervical spine with contrast (72126) |
$1,169.55 |
$2,599 |
3.9× |
| CT chest w/wo contrast (71270) |
$900.45 |
$2,001 |
6.0× |
| CT chest with contrast (71260) |
$947.70 |
$2,106 |
6.3× |
| CT head/brain with contrast (70460) |
$710.55 |
$1,579 |
4.7× |
| CT head/brain without and with contrast (70470) |
$887.85 |
$1,973 |
5.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$121.05 |
$269 |
1.6× |
| CT iac w contrast (70481) |
$1,394.10 |
$3,098 |
9.2× |
| CT limited/localized follow up study (76380) |
$162 |
$360 |
2.2× |
| CT lower ext w/o (73700) |
$829.35 |
$1,843 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$1,754.55 |
$3,899 |
11.6× |
| CT lower extremity with contrast (73701) |
$947.70 |
$2,106 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$863.10 |
$1,918 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$829.35 |
$1,843 |
9.2× |
| CT lumbar spine with contrast (72132) |
$1,535.40 |
$3,412 |
5.1× |
| CT maxillofacial w contrast (70487) |
$599.40 |
$1,332 |
4.0× |
| CT maxillofacial w/o contrast (70486) |
$666.90 |
$1,482 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$739.80 |
$1,644 |
4.9× |
| CT neck soft tissue w contrast (70491) |
$829.35 |
$1,843 |
5.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$756 |
$1,680 |
5.0× |
| CT orbits w/o contrast (70480) |
$641.25 |
$1,425 |
7.1× |
| CT pelvis w & w/o contrast (72194) |
$1,124.55 |
$2,499 |
7.4× |
| CT pelvis w/o contrast (72192) |
$1,071.90 |
$2,382 |
11.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$364.05 |
$809 |
4.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$887.85 |
$1,973 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$769.50 |
$1,710 |
8.5× |
| CT thoracic spine w/contrast (72129) |
$1,066.05 |
$2,369 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$829.35 |
$1,843 |
9.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,302.75 |
$2,895 |
8.6× |
| CT thorax w/o contrast (71250) |
$748.12 |
$1,662.50 |
8.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$953.10 |
$2,118 |
6.3× |
| CT upper extremity w/o contrast rt (73200) |
$829.35 |
$1,843 |
9.2× |
| CT upper extremity with contrast (73201) |
$947.70 |
$2,106 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,539.90 |
$3,422 |
10.2× |
| Cta Abdomen (74175) |
$1,302.75 |
$2,895 |
8.6× |
| CTA abdomen pelvis (74174) |
$1,362.60 |
$3,028 |
4.5× |
| CTA chest (71275) |
$1,242.90 |
$2,762 |
8.2× |
| Cta Head (70496) |
$972.90 |
$2,162 |
6.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,539.90 |
$3,422 |
10.2× |
| Cta Neck (70498) |
$972.90 |
$2,162 |
6.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$384.75 |
$855 |
4.3× |
| Esophagus (74220) |
$153.90 |
$342 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$330.30 |
$734 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$281.25 |
$625 |
3.1× |
| Fluoroscopy up to 1 hr (76000) |
$187.65 |
$417 |
0.9× |
| Foot 2 views (73620) |
$106.20 |
$236 |
1.4× |
| Forearm 2 views (73090) |
$96.08 |
$213.50 |
1.3× |
| Hand 2 views (73120) |
$185.18 |
$411.50 |
2.1× |
| Hand 3 views (73130) |
$112.95 |
$251 |
1.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$710.55 |
$1,579 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$710.55 |
$1,579 |
2.1× |
| Ht muscle image spect sing (78451) |
$1,115.10 |
$2,478 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$111.15 |
$247 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$652.50 |
$1,450 |
1.4× |
| Knee 3 views (73562) |
$118.35 |
$263 |
1.6× |
| Liver & spleen imaging static only (78215) |
$515.70 |
$1,146 |
1.5× |
| Lung Ventilation Imaging (78579) |
$532.80 |
$1,184 |
1.5× |
| MRA head w & w/o contrast (70546) |
$2,155.95 |
$4,791 |
7.2× |
| MRA head w/o contrast (70544) |
$1,093.50 |
$2,430 |
5.3× |
| MRA head with contrast (70545) |
$1,046.70 |
$2,326 |
3.5× |
| MRA neck w contrast (70548) |
$1,046.70 |
$2,326 |
3.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,131.65 |
$4,737 |
7.1× |
| MRA neck w/o contrast (70547) |
$1,093.50 |
$2,430 |
5.3× |
| MRI abdomen w contrast (74182) |
$1,223.55 |
$2,719 |
4.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,131.65 |
$4,737 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$1,090.80 |
$2,424 |
5.3× |
| MRI c-spine with contrast (72142) |
$1,332 |
$2,960 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,124.10 |
$2,498 |
5.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,131.65 |
$4,737 |
7.1× |
| MRI chest w/o contrast (71550) |
$1,090.80 |
$2,424 |
5.3× |
| MRI chest with contrast (71551) |
$1,838.25 |
$4,085 |
2.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,206 |
$2,680 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,184.40 |
$2,632 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$833.40 |
$1,852 |
4.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,503.68 |
$3,341.50 |
5.0× |
| MRI orbit/face/neck w/contrast (70542) |
$1,296.90 |
$2,882 |
4.3× |
| MRI pelvis w contrast (72196) |
$1,818.45 |
$4,041 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,131.65 |
$4,737 |
7.1× |
| MRI pelvis w/o contrast (72195) |
$1,111.05 |
$2,469 |
5.4× |
| MRI scan of arm joint before and after contrast (73223) |
$2,131.65 |
$4,737 |
7.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,131.65 |
$4,737 |
7.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,131.65 |
$4,737 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,332.90 |
$2,962 |
4.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,131.65 |
$4,737 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,346.85 |
$2,993 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,717.10 |
$6,038 |
9.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,226.70 |
$2,726 |
6.0× |
| MRI tmj (70336) |
$1,654.65 |
$3,677 |
8.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,096.20 |
$2,436 |
5.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,212.20 |
$4,916 |
7.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,096.20 |
$2,436 |
5.3× |
| Myocardial Spect Multiple Studies (78452) |
$1,302.75 |
$2,895 |
1.2× |
| Neck soft tissue (70360) |
$182.70 |
$406 |
2.4× |
| Nm gastric emptying study (78264) |
$399.60 |
$888 |
1.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$292.05 |
$649 |
3.2× |
| Osseous survey infant (77076) |
$174.60 |
$388 |
1.9× |
| Parathyroid imaging (78070) |
$515.70 |
$1,146 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$112.95 |
$251 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,131.65 |
$4,737 |
7.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$473.40 |
$1,052 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$947.70 |
$2,106 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$171.90 |
$382 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$229.05 |
$509 |
2.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$222.30 |
$494 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$283.50 |
$630 |
3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$153.90 |
$342 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$129.60 |
$288 |
1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$147.60 |
$328 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$127.35 |
$283 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$127.35 |
$283 |
1.7× |
| Ribs bilateral 3 views (71110) |
$136.35 |
$303 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$131.85 |
$293 |
1.5× |
| Scapula complete (73010) |
$86.62 |
$192.50 |
1.0× |
| Screening digital breast tomosynthesis (77063) |
$45.45 |
$101 |
1.9× |
| Small bowel series (74250) |
$162.90 |
$362 |
1.1× |
| Spine thoracic 3 views (72072) |
$136.35 |
$303 |
1.5× |
| Thoracolumbar 2 views (72080) |
$161.10 |
$358 |
2.1× |
| Thyroid Imaging With Vascular Flow (78013) |
$384.75 |
$855 |
1.1× |
| Thyroid uptake measurement (78012) |
$296.10 |
$658 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$473.40 |
$1,052 |
1.4× |
| Tmj unilateral (70328) |
$77.85 |
$173 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$330.75 |
$735 |
3.7× |
| Upper Extremity Infant (73092) |
$75.60 |
$168 |
0.8× |
| Us abdl aorta screen aaa (76706) |
$180 |
$400 |
2.0× |
| Us breast unilateral complete (76641) |
$186.75 |
$415 |
2.1× |
| Us breast unilateral limited (76642) |
$213.30 |
$474 |
2.8× |
| Us chest (76604) |
$306.45 |
$681 |
3.4× |
| Us compl joint r-t w/image documentation (76881) |
$219.15 |
$487 |
2.4× |
| Us kidney transplant (76776) |
$399.15 |
$887 |
4.4× |
| Us ob detailed single fetus (76811) |
$292.95 |
$651 |
1.4× |
| Us ob transvaginal (76817) |
$319.95 |
$711 |
3.5× |
| Us pelvic non ob complete (76856) |
$281.25 |
$625 |
3.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$287.32 |
$638.50 |
3.2× |
| Us pregnancy ltd (76815) |
$253.80 |
$564 |
2.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$331.65 |
$737 |
3.7× |
| Us retroperitoneal complete (76770) |
$374.85 |
$833 |
4.2× |
| Us retroperitoneal limited (76775) |
$351.90 |
$782 |
3.9× |
| Us scrotum and contents (76870) |
$306 |
$680 |
3.4× |
| Us soft tissue head/neck (76536) |
$278.10 |
$618 |
3.1× |
| Us xtr non-vasc lmtd (76882) |
$281.25 |
$625 |
3.1× |
| Wrist 2 views (73100) |
$75.60 |
$168 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$162.45 |
$361 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$124.65 |
$277 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$118.35 |
$263 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$279.45 |
$621 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$88.42 |
$196.50 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$103.95 |
$231 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$294.75 |
$655 |
3.3× |
| X-ray exam hip uni 1 view (73501) |
$106.20 |
$236 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$124.20 |
$276 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$306 |
$680 |
3.4× |
| X-ray exam of femur 1 (73551) |
$106.20 |
$236 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$141.30 |
$314 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$112.95 |
$251 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$118.35 |
$263 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$106.20 |
$236 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$142.20 |
$316 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$130.50 |
$290 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$94.50 |
$210 |
1.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$106.20 |
$236 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$153.45 |
$341 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$482.85 |
$1,073 |
5.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$153.90 |
$342 |
2.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$86.40 |
$192 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$112.95 |
$251 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$131.40 |
$292 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$127.35 |
$283 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$136.35 |
$303 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$148.05 |
$329 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$148.05 |
$329 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$140.40 |
$312 |
1.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$105.30 |
$234 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$142.20 |
$316 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$212.40 |
$472 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$144 |
$320 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$148.05 |
$329 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$106.20 |
$236 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$127.35 |
$283 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$127.35 |
$283 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$236.70 |
$526 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$106.20 |
$236 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$118.35 |
$263 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$283.95 |
$631 |
3.2× |
| Xr chest 4+ views (71048) |
$142.20 |
$316 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$78.75 |
$175 |
1.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$192.60 |
$428 |
2.1× |
| Xr shoulder 1 view (73020) |
$84.60 |
$188 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$272.25 |
$605 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$106.20 |
$236 |
1.4× |
| Xr tmj bilateral (70330) |
$144 |
$320 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$106.20 |
$236 |
1.4× |