| Abdomen 2 views (74019) |
$365.60 |
$457 |
3.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$755.20 |
$944 |
2.1× |
| Ankle 2 views (73600) |
$206.40 |
$258 |
2.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$304 |
$380 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$640 |
$800 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$800 |
$1,000 |
2.2× |
| Bone age studies (77072) |
$167.20 |
$209 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$720 |
$900 |
2.0× |
| Bone survey complete (77075) |
$688 |
$860 |
7.2× |
| Cervical spine 2 or 3 views (72040) |
$388 |
$485 |
4.8× |
| Chest 1 view (71045) |
$125.20 |
$156.50 |
1.6× |
| Chest 3 views (71047) |
$245.60 |
$307 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$537.60 |
$672 |
3.3× |
| Clavicle complete (73000) |
$264.80 |
$331 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,464 |
$1,830 |
15.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,100.86 |
$3,876.08 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,660 |
$3,325 |
12.1× |
| CT abdomen w contrast (74160) |
$1,813.60 |
$2,267 |
11.2× |
| CT abdomen w wo contrast (74170) |
$2,068 |
$2,585 |
12.8× |
| CT abdomen w/o contrast (74150) |
$1,522.40 |
$1,903 |
15.8× |
| CT angiography upper extremity lt (73206) |
$1,432 |
$1,790 |
8.9× |
| CT c-spine w/o contrast (72125) |
$1,636.80 |
$2,046 |
17.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,988.80 |
$2,486 |
12.3× |
| CT cervical spine with contrast (72126) |
$1,695.20 |
$2,119 |
5.3× |
| CT chest w/wo contrast (71270) |
$1,988.80 |
$2,486 |
12.3× |
| CT chest with contrast (71260) |
$1,791.20 |
$2,239 |
11.1× |
| CT head/brain with contrast (70460) |
$1,695.20 |
$2,119 |
10.5× |
| CT head/brain without and with contrast (70470) |
$1,988.80 |
$2,486 |
12.3× |
| CT iac w contrast (70481) |
$1,695.20 |
$2,119 |
10.5× |
| CT limited/localized follow up study (76380) |
$859.20 |
$1,074 |
10.7× |
| CT lower ext w/o (73700) |
$1,538.40 |
$1,923 |
16.0× |
| CT lower extremity w wo contrast (73702) |
$1,988.80 |
$2,486 |
12.3× |
| CT lower extremity with contrast (73701) |
$1,695.20 |
$2,119 |
10.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,988.80 |
$2,486 |
12.3× |
| CT lumbar spine w/o contrast (72131) |
$1,611.20 |
$2,014 |
16.8× |
| CT lumbar spine with contrast (72132) |
$1,695.20 |
$2,119 |
5.3× |
| CT maxillofacial w contrast (70487) |
$1,695.20 |
$2,119 |
10.5× |
| CT maxillofacial w/o contrast (70486) |
$1,464 |
$1,830 |
15.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,988.80 |
$2,486 |
12.3× |
| CT neck soft tissue w contrast (70491) |
$1,695.20 |
$2,119 |
10.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,988.80 |
$2,486 |
12.3× |
| CT orbits w/o contrast (70480) |
$1,502.40 |
$1,878 |
15.6× |
| CT pelvis w & w/o contrast (72194) |
$1,912 |
$2,390 |
11.9× |
| CT pelvis w/o contrast (72192) |
$1,588 |
$1,985 |
16.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,988.80 |
$2,486 |
12.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,464 |
$1,830 |
15.2× |
| CT thoracic spine w/contrast (72129) |
$1,695.20 |
$2,119 |
10.5× |
| CT thoracic spine w/o contrast (72128) |
$1,628.80 |
$2,036 |
16.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,988.80 |
$2,486 |
12.3× |
| CT thorax w/o contrast (71250) |
$1,601.60 |
$2,002 |
16.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,784 |
$2,230 |
11.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,432.80 |
$1,791 |
14.9× |
| CT upper extremity with contrast (73201) |
$1,584.80 |
$1,981 |
4.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,620.80 |
$3,276 |
16.2× |
| Cta Abdomen (74175) |
$2,185.60 |
$2,732 |
13.5× |
| CTA abdomen pelvis (74174) |
$2,204 |
$2,755 |
6.9× |
| CTA chest (71275) |
$2,280 |
$2,850 |
14.1× |
| Cta Head (70496) |
$2,202.40 |
$2,753 |
13.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,432 |
$1,790 |
8.9× |
| Cta Neck (70498) |
$2,045.60 |
$2,557 |
12.7× |
| Cta Pelvis (72191) |
$2,202.40 |
$2,753 |
13.7× |
| Cystography minimum 3 views rs&i (74430) |
$291.20 |
$364 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$49.60 |
$62 |
0.5× |
| Esophagus (74220) |
$450.40 |
$563 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$547.20 |
$684 |
5.7× |
| Fluoroscopy up to 1 hr (76000) |
$473.60 |
$592 |
2.2× |
| Foot 2 views (73620) |
$200.80 |
$251 |
2.5× |
| Forearm 2 views (73090) |
$225.60 |
$282 |
2.8× |
| Hand 2 views (73120) |
$200.80 |
$251 |
2.1× |
| Hand 3 views (73130) |
$232 |
$290 |
2.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$629.60 |
$787 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$629.60 |
$787 |
1.7× |
| Ht muscle image spect sing (78451) |
$2,375.20 |
$2,969 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$285.60 |
$357 |
3.6× |
| Hysterosalpingogram (74740) |
$427.20 |
$534 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$95.20 |
$119 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,196.80 |
$1,496 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,330.40 |
$1,663 |
2.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$716.80 |
$896 |
1.4× |
| Knee 3 views (73562) |
$325.60 |
$407 |
4.1× |
| Lymphoscintigraphy (78195) |
$448 |
$560 |
0.9× |
| Meckels Diverticulum (78290) |
$603.20 |
$754 |
1.6× |
| MRA head w & w/o contrast (70546) |
$2,915.20 |
$3,644 |
9.1× |
| MRA head w/o contrast (70544) |
$2,300.80 |
$2,876 |
10.5× |
| MRA head with contrast (70545) |
$2,204 |
$2,755 |
6.9× |
| MRA neck w contrast (70548) |
$2,204 |
$2,755 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,915.20 |
$3,644 |
9.1× |
| MRA neck w/o contrast (70547) |
$2,097.60 |
$2,622 |
9.6× |
| MRI abdomen w contrast (74182) |
$2,204 |
$2,755 |
6.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,915.20 |
$3,644 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$2,181.60 |
$2,727 |
9.9× |
| MRI any jnt lwr ext with con lt (73722) |
$2,204 |
$2,755 |
3.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,204 |
$2,755 |
3.1× |
| MRI c-spine with contrast (72142) |
$2,204 |
$2,755 |
6.9× |
| MRI cervical spine w/o contrast (72141) |
$2,399.20 |
$2,999 |
10.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,091.20 |
$2,614 |
6.5× |
| MRI chest w/o contrast (71550) |
$1,325.60 |
$1,657 |
6.0× |
| MRI chest with contrast (71551) |
$1,381.60 |
$1,727 |
1.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,204 |
$2,755 |
6.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,204 |
$2,755 |
6.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,097.60 |
$2,622 |
9.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,097.60 |
$2,622 |
9.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,915.20 |
$3,644 |
9.1× |
| MRI orbit/face/neck w/contrast (70542) |
$2,204 |
$2,755 |
6.9× |
| MRI pelvis w contrast (72196) |
$2,204 |
$2,755 |
6.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,915.20 |
$3,644 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$2,112 |
$2,640 |
9.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,915.20 |
$3,644 |
9.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,915.20 |
$3,644 |
9.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,944 |
$3,680 |
9.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,292 |
$2,865 |
7.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,915.20 |
$3,644 |
9.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,204 |
$2,755 |
6.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,944 |
$3,680 |
9.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,405.60 |
$3,007 |
11.0× |
| MRI tmj (70336) |
$1,274.40 |
$1,593 |
5.8× |
| MRI upper ext joint w/o contrast (73221) |
$2,506.40 |
$3,133 |
11.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,915.20 |
$3,644 |
9.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,097.60 |
$2,622 |
9.6× |
| Myocardial Spect Multiple Studies (78452) |
$3,148.80 |
$3,936 |
2.6× |
| Neck soft tissue (70360) |
$236.80 |
$296 |
3.0× |
| Nm gastric emptying study (78264) |
$631.20 |
$789 |
1.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$160 |
$200 |
1.7× |
| Osseous survey infant (77076) |
$688 |
$860 |
7.2× |
| Parathyroid imaging (78070) |
$680.80 |
$851 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$229.60 |
$287 |
2.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,915.20 |
$3,644 |
9.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$675.20 |
$844 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$324.80 |
$406 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$177.60 |
$222 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$268 |
$335 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$215.20 |
$269 |
2.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$235.20 |
$294 |
2.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$278.40 |
$348 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$232 |
$290 |
2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$365.60 |
$457 |
3.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$219.60 |
$274.50 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$1,063.20 |
$1,329 |
6.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$423.20 |
$529 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$515.20 |
$644 |
3.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$336.80 |
$421 |
4.2× |
| Radiological examination surgical specimen (76098) |
$155.20 |
$194 |
0.3× |
| Ribs bilateral 3 views (71110) |
$341.60 |
$427 |
3.6× |
| Sacroiliac Joints < 3 Views (72200) |
$333.60 |
$417 |
3.5× |
| Scapula complete (73010) |
$180 |
$225 |
1.9× |
| Screening digital breast tomosynthesis (77063) |
$92.80 |
$116 |
4.0× |
| Small bowel series (74250) |
$569.60 |
$712 |
3.5× |
| Spine thoracic 3 views (72072) |
$412.80 |
$516 |
4.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$630.40 |
$788 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$547.20 |
$684 |
5.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$280 |
$350 |
3.5× |
| Upper Extremity Infant (73092) |
$156.80 |
$196 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$180 |
$225 |
0.8× |
| Urethrocystography voiding (74455) |
$459.20 |
$574 |
2.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$680.80 |
$851 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$541.60 |
$677 |
5.6× |
| Us breast unilateral limited (76642) |
$547.20 |
$684 |
6.8× |
| Us chest (76604) |
$498.40 |
$623 |
5.2× |
| Us compl joint r-t w/image documentation (76881) |
$648.80 |
$811 |
6.7× |
| Us guided compression repair (76936) |
$116.40 |
$145.50 |
0.6× |
| Us infant hips dynamic (76885) |
$571.20 |
$714 |
7.1× |
| Us ob transvaginal (76817) |
$433.60 |
$542 |
4.5× |
| Us pelvic non ob complete (76856) |
$736.80 |
$921 |
7.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$694.40 |
$868 |
7.2× |
| Us pregnancy ltd (76815) |
$227.20 |
$284 |
2.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$180 |
$225 |
1.9× |
| Us retroperitoneal complete (76770) |
$621.60 |
$777 |
6.5× |
| Us retroperitoneal limited (76775) |
$541.60 |
$677 |
5.6× |
| Us scrotum and contents (76870) |
$547.20 |
$684 |
5.7× |
| Us soft tissue head/neck (76536) |
$571.20 |
$714 |
5.9× |
| Us spinal canal and contents (76800) |
$766.40 |
$958 |
8.0× |
| Us transrectal (76872) |
$624 |
$780 |
6.5× |
| Us xtr non-vasc lmtd (76882) |
$547.20 |
$684 |
5.7× |
| Wrist 2 views (73100) |
$216 |
$270 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$384.80 |
$481 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.80 |
$251 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$261.60 |
$327 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$981.60 |
$1,227 |
6.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$347.20 |
$434 |
4.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$281.60 |
$352 |
3.5× |
| X-ray exam hip uni 1 view (73501) |
$173.60 |
$217 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$237.60 |
$297 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$298.40 |
$373 |
3.1× |
| X-ray exam of femur 1 (73551) |
$284 |
$355 |
3.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$392.80 |
$491 |
4.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$250.40 |
$313 |
3.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$200.80 |
$251 |
2.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$194.40 |
$243 |
2.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$312.80 |
$391 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$296 |
$370 |
3.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$166.40 |
$208 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$430.40 |
$538 |
4.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$751.20 |
$939 |
7.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$496.80 |
$621 |
5.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$368.80 |
$461 |
4.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$198.40 |
$248 |
2.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$248 |
$310 |
2.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,064.80 |
$1,331 |
3.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$315.20 |
$394 |
3.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$399.20 |
$499 |
4.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$572.80 |
$716 |
6.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$233.60 |
$292 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$369.60 |
$462 |
4.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$284 |
$355 |
3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$455.20 |
$569 |
5.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$172 |
$215 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$243.20 |
$304 |
2.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$267.20 |
$334 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$315.20 |
$394 |
3.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$160.80 |
$201 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$235.20 |
$294 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$392.80 |
$491 |
4.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$453.60 |
$567 |
4.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$200.80 |
$251 |
2.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$244 |
$305 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$716 |
$895 |
7.4× |
| Xr finger(s) 2+ views (73140) |
$200.80 |
$251 |
2.5× |
| Xr shoulder 1 view (73020) |
$231.20 |
$289 |
2.9× |
| Xr spine cervical 4 or 5 views (72050) |
$554.40 |
$693 |
5.8× |
| Xr tibia/fibula 2 views (73590) |
$284.80 |
$356 |
3.6× |
| Xr tmj bilateral (70330) |
$203.20 |
$254 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$262.40 |
$328 |
3.3× |