| Abdomen 2 views (74019) |
$198.09 |
$330.15 |
2.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$988.22 |
$1,647.04 |
2.6× |
| Ankle 2 views (73600) |
$182.65 |
$304.42 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,102.92 |
$1,838.20 |
2.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,206.69 |
$2,011.15 |
3.2× |
| Bone &/joint imaging whole body (78306) |
$1,105.17 |
$1,841.95 |
2.9× |
| Bone age studies (77072) |
$239.89 |
$399.82 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,056.98 |
$1,761.63 |
2.8× |
| Bone survey complete (77075) |
$892.68 |
$1,487.80 |
9.1× |
| Cervical spine 2 or 3 views (72040) |
$261.11 |
$435.19 |
3.2× |
| Chest 1 view (71045) |
$177.50 |
$295.84 |
2.2× |
| Clavicle complete (73000) |
$214.81 |
$358.01 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$540 |
$900 |
5.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,937.40 |
$3,229 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,435.20 |
$2,392 |
6.4× |
| CT abdomen w contrast (74160) |
$1,113 |
$1,855 |
6.8× |
| CT abdomen w wo contrast (74170) |
$1,672.80 |
$2,788 |
10.2× |
| CT abdomen w/o contrast (74150) |
$1,227 |
$2,045 |
12.5× |
| CT angiography upper extremity lt (73206) |
$1,722.60 |
$2,871 |
10.5× |
| CT c-spine w/o contrast (72125) |
$1,018.80 |
$1,698 |
10.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,176 |
$1,960 |
7.1× |
| CT cervical spine with contrast (72126) |
$1,377 |
$2,295 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,642.20 |
$2,737 |
10.0× |
| CT chest with contrast (71260) |
$1,377 |
$2,295 |
8.4× |
| CT head/brain with contrast (70460) |
$1,072.20 |
$1,787 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,642.20 |
$2,737 |
10.0× |
| CT iac w contrast (70481) |
$1,291.80 |
$2,153 |
7.8× |
| CT lower ext w/o (73700) |
$955.20 |
$1,592 |
9.7× |
| CT lower extremity w wo contrast (73702) |
$1,015.80 |
$1,693 |
6.2× |
| CT lower extremity with contrast (73701) |
$967.20 |
$1,612 |
5.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,384.20 |
$2,307 |
8.4× |
| CT lumbar spine w/o contrast (72131) |
$1,384.20 |
$2,307 |
14.1× |
| CT lumbar spine with contrast (72132) |
$1,392.60 |
$2,321 |
4.3× |
| CT maxillofacial w contrast (70487) |
$1,465.20 |
$2,442 |
8.9× |
| CT maxillofacial w/o contrast (70486) |
$1,170 |
$1,950 |
11.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,782.80 |
$4,638 |
16.9× |
| CT neck soft tissue w contrast (70491) |
$1,243.80 |
$2,073 |
7.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,620 |
$2,700 |
9.8× |
| CT orbits w/o contrast (70480) |
$1,113 |
$1,855 |
11.3× |
| CT pelvis w & w/o contrast (72194) |
$1,597.80 |
$2,663 |
9.7× |
| CT pelvis w/o contrast (72192) |
$966.60 |
$1,611 |
9.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,642.20 |
$2,737 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,018.80 |
$1,698 |
10.4× |
| CT thoracic spine w/contrast (72129) |
$1,018.80 |
$1,698 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$901.80 |
$1,503 |
9.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,032.60 |
$1,721 |
6.3× |
| CT thorax w/o contrast (71250) |
$1,081.80 |
$1,803 |
11.0× |
| CT unlisted procedure (76497) |
$276.30 |
$460.50 |
3.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,067.60 |
$3,446 |
12.6× |
| CT upper extremity w/o contrast rt (73200) |
$887.40 |
$1,479 |
9.0× |
| CT upper extremity with contrast (73201) |
$1,291.80 |
$2,153 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,812.20 |
$4,687 |
17.1× |
| CTA abdomen pelvis (74174) |
$2,812.20 |
$4,687 |
8.6× |
| CTA chest (71275) |
$1,329 |
$2,215 |
8.1× |
| Cta Head (70496) |
$1,984.20 |
$3,307 |
12.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,722 |
$2,870 |
10.5× |
| Cta Neck (70498) |
$1,722.60 |
$2,871 |
10.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$561.13 |
$935.22 |
5.7× |
| Dxa bone density study axial skeleton (77085) |
$561.13 |
$935.22 |
5.7× |
| Esophagus (74220) |
$270.12 |
$450.20 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$13.20 |
$22 |
0.1× |
| Foot 2 views (73620) |
$229.60 |
$382.67 |
2.8× |
| Forearm 2 views (73090) |
$182.01 |
$303.35 |
2.2× |
| Gated Heart Planar Single (78472) |
$1,397.53 |
$2,329.21 |
3.7× |
| Hand 2 views (73120) |
$176.22 |
$293.70 |
1.8× |
| Hand 3 views (73130) |
$229.60 |
$382.67 |
2.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,378.89 |
$2,298.15 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,186.13 |
$1,976.88 |
3.2× |
| Humerus Min 2 Views Left (73060) |
$180.72 |
$301.20 |
2.2× |
| Kidney imaging morphology (78700) |
$672.74 |
$1,121.23 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,581.29 |
$2,635.48 |
3.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$983.41 |
$1,639.02 |
1.9× |
| Knee 3 views (73562) |
$237.32 |
$395.53 |
2.9× |
| Liver & spleen imaging static only (78215) |
$1,175.85 |
$1,959.75 |
3.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$723.50 |
$1,205.83 |
1.9× |
| Meckels Diverticulum (78290) |
$758.20 |
$1,263.66 |
2.0× |
| MRA head w & w/o contrast (70546) |
$1,516.80 |
$2,528 |
4.6× |
| MRA head w/o contrast (70544) |
$1,127.40 |
$1,879 |
5.0× |
| MRA head with contrast (70545) |
$1,914.60 |
$3,191 |
5.8× |
| MRA neck w contrast (70548) |
$1,914.60 |
$3,191 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,038.80 |
$3,398 |
6.2× |
| MRA neck w/o contrast (70547) |
$1,206 |
$2,010 |
5.4× |
| MRI abdomen w contrast (74182) |
$1,585.20 |
$2,642 |
4.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,276.40 |
$3,794 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$1,806.60 |
$3,011 |
8.1× |
| MRI any jnt lwr ext with con lt (73722) |
$1,476 |
$2,460 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,914.60 |
$3,191 |
2.6× |
| MRI c-spine with contrast (72142) |
$1,566 |
$2,610 |
4.8× |
| MRI cervical spine w/o contrast (72141) |
$1,555.20 |
$2,592 |
6.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,038.80 |
$3,398 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,737.60 |
$2,896 |
7.8× |
| MRI chest with contrast (71551) |
$1,737.60 |
$2,896 |
2.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,914.60 |
$3,191 |
5.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,914.60 |
$3,191 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,737.60 |
$2,896 |
7.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,506.60 |
$2,511 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,038.80 |
$3,398 |
6.2× |
| MRI orbit/face/neck w/contrast (70542) |
$1,653.60 |
$2,756 |
5.1× |
| MRI pelvis w contrast (72196) |
$1,827.60 |
$3,046 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,038.80 |
$3,398 |
6.2× |
| MRI pelvis w/o contrast (72195) |
$1,506.60 |
$2,511 |
6.7× |
| MRI scan of arm joint before and after contrast (73223) |
$2,038.80 |
$3,398 |
6.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,038.80 |
$3,398 |
6.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,276.40 |
$3,794 |
7.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,914.60 |
$3,191 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,276.40 |
$3,794 |
7.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,897.20 |
$3,162 |
5.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,276.40 |
$3,794 |
7.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,994.40 |
$3,324 |
8.9× |
| MRI tmj (70336) |
$1,737.60 |
$2,896 |
7.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,816.80 |
$3,028 |
8.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,038.80 |
$3,398 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,297.20 |
$2,162 |
5.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,637.62 |
$4,396.04 |
2.2× |
| Neck soft tissue (70360) |
$215.45 |
$359.09 |
2.6× |
| Nm adrenal scan (78075) |
$663.10 |
$1,105.17 |
0.5× |
| Nm gastric emptying study (78264) |
$1,439.29 |
$2,398.82 |
3.8× |
| Nm gastroesophageal reflux study (78262) |
$506.96 |
$844.94 |
1.4× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$23.13 |
$38.55 |
0.0× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$489.62 |
$816.03 |
0.4× |
| Osseous survey infant (77076) |
$239.89 |
$399.82 |
2.4× |
| Osseous survey limited (77074) |
$882.39 |
$1,470.65 |
9.0× |
| Parathyroid imaging (78070) |
$663.10 |
$1,105.17 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$182.32 |
$303.88 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,038.80 |
$3,398 |
6.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,078.62 |
$3,464.36 |
4.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$211.20 |
$352 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$273.34 |
$455.56 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$421.25 |
$702.09 |
4.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$291.98 |
$486.64 |
3.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$229.60 |
$382.67 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$184.58 |
$307.64 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$255 |
$425 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$215.45 |
$359.09 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$210.95 |
$351.58 |
2.6× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$113.09 |
$188.48 |
0.5× |
| Ribs bilateral 3 views (71110) |
$305.49 |
$509.15 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$820.52 |
$1,367.54 |
2.2× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$820.52 |
$1,367.54 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$516.60 |
$861 |
1.0× |
| Scanogram (77073) |
$387.17 |
$645.28 |
3.9× |
| Scapula complete (73010) |
$210.31 |
$350.51 |
2.1× |
| Screening digital breast tomosynthesis (77063) |
$185.57 |
$309.28 |
7.9× |
| Spine thoracic 3 views (72072) |
$301.63 |
$502.72 |
3.1× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$882.85 |
$1,471.42 |
1.7× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$411.87 |
$686.45 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$540 |
$900 |
5.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$30.23 |
$50.38 |
0.4× |
| Unlisted magnetic resonance procedure (76498) |
$28.20 |
$47 |
0.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$153.88 |
$256.48 |
0.4× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$34.06 |
$56.76 |
0.1× |
| Unlisted Ultrasound Procedure (76999) |
$30.16 |
$50.27 |
0.4× |
| Upper Extremity Infant (73092) |
$289.42 |
$482.36 |
3.0× |
| Urethrocystography voiding (74455) |
$569.18 |
$948.63 |
2.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$526.09 |
$876.81 |
3.2× |
| Us abdl aorta screen aaa (76706) |
$410.05 |
$683.41 |
4.2× |
| Us breast unilateral complete (76641) |
$290.69 |
$484.48 |
3.0× |
| Us breast unilateral limited (76642) |
$290.69 |
$484.48 |
3.6× |
| Us chest (76604) |
$576.25 |
$960.41 |
5.9× |
| Us compl joint r-t w/image documentation (76881) |
$540 |
$900 |
5.5× |
| Us ob transvaginal (76817) |
$517.80 |
$863 |
5.3× |
| Us pelvic non ob complete (76856) |
$417.74 |
$696.24 |
4.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$360 |
$600 |
3.7× |
| Us pregnancy ltd (76815) |
$561.49 |
$935.81 |
5.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$634 |
$1,056.67 |
6.5× |
| Us retroperitoneal complete (76770) |
$484.48 |
$807.47 |
4.9× |
| Us retroperitoneal limited (76775) |
$462.67 |
$771.11 |
4.7× |
| Us scrotum and contents (76870) |
$437 |
$728.33 |
4.5× |
| Us soft tissue head/neck (76536) |
$374.11 |
$623.52 |
3.8× |
| Us xtr non-vasc lmtd (76882) |
$417.74 |
$696.24 |
4.3× |
| Venography caval inferior serialography rs&i (75825) |
$4,140 |
$6,900 |
1.4× |
| Venography caval superior serialography rs&i (75827) |
$1,920 |
$3,200 |
1.3× |
| Wrist 2 views (73100) |
$200.66 |
$334.43 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$337.65 |
$562.75 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$232.82 |
$388.03 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$229.60 |
$382.67 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$162.07 |
$270.12 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$229.60 |
$382.67 |
2.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$308.06 |
$513.44 |
3.1× |
| X-ray exam hip uni 1 view (73501) |
$141.49 |
$235.82 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$210.95 |
$351.58 |
2.6× |
| X-ray eye for foreign body (70030) |
$207.09 |
$345.15 |
2.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$291.98 |
$486.64 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$207.09 |
$345.15 |
2.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$297.13 |
$495.22 |
3.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$177.50 |
$295.84 |
2.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$555.67 |
$926.12 |
3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$206.45 |
$344.08 |
2.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$290.06 |
$483.43 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$237.32 |
$395.53 |
2.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$308.06 |
$513.44 |
3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$284.58 |
$474.32 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$308.06 |
$513.44 |
3.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$308.06 |
$513.44 |
3.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$210.95 |
$351.58 |
2.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$90.04 |
$150.07 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$316.42 |
$527.37 |
3.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$240.53 |
$400.89 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$263.69 |
$439.48 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$337.65 |
$562.75 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$229.60 |
$382.67 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$207.09 |
$345.15 |
2.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$229.60 |
$382.67 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$243.11 |
$405.18 |
3.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$232.18 |
$386.96 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$297.13 |
$495.22 |
3.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$291.98 |
$486.64 |
3.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$142.78 |
$237.96 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$291.98 |
$486.64 |
3.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$225.10 |
$375.17 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$301.63 |
$502.72 |
3.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$301.63 |
$502.72 |
3.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$168.50 |
$280.84 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$231.53 |
$385.88 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$319.64 |
$532.73 |
3.3× |
| Xr chest 4+ views (71048) |
$387.17 |
$645.28 |
3.9× |
| Xr finger(s) 2+ views (73140) |
$187.15 |
$311.92 |
2.3× |
| Xr shoulder 1 view (73020) |
$112.20 |
$187 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$333.79 |
$556.32 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$182.01 |
$303.35 |
2.2× |
| Xr tmj bilateral (70330) |
$268.19 |
$446.98 |
3.3× |
| Xray knee 1 or 2 views rt (73560) |
$216.10 |
$360.16 |
2.6× |