| Abdomen 2 views (74019) |
$84.70 |
$84.70 |
0.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$762 |
$762 |
2.1× |
| Ankle 2 views (73600) |
$283 |
$283 |
3.5× |
| Arthrogram hip (73525) |
$1,478 |
$1,478 |
4.6× |
| Arthrogram shoulder (73040) |
$429 |
$429 |
1.3× |
| Arthrogram wrist (73115) |
$429 |
$429 |
1.3× |
| Arthrography knee lt (73580) |
$357 |
$357 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,183.60 |
$1,183.60 |
3.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$827 |
$827 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$805.20 |
$805.20 |
2.2× |
| Bone age studies (77072) |
$207.90 |
$207.90 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$1,863.40 |
$1,863.40 |
5.1× |
| Bone survey complete (77075) |
$1,510.30 |
$1,510.30 |
15.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,500 |
$1,500 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$247.50 |
$247.50 |
3.1× |
| Chest 1 view (71045) |
$135.30 |
$135.30 |
1.7× |
| Chest 3 views (71047) |
$231.95 |
$231.95 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$260.70 |
$260.70 |
1.6× |
| Clavicle complete (73000) |
$144.65 |
$144.65 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,384 |
$1,384 |
14.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,290 |
$4,290 |
13.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,722.50 |
$2,722.50 |
12.4× |
| CT abdomen w contrast (74160) |
$1,722 |
$1,722 |
10.7× |
| CT abdomen w wo contrast (74170) |
$2,480.50 |
$2,480.50 |
15.4× |
| CT abdomen w/o contrast (74150) |
$1,513 |
$1,513 |
15.7× |
| CT c-spine w/o contrast (72125) |
$2,573 |
$2,573 |
26.8× |
| CT cervical spine with contrast (72126) |
$1,760 |
$1,760 |
5.5× |
| CT chest w/wo contrast (71270) |
$2,480.50 |
$2,480.50 |
15.4× |
| CT chest with contrast (71260) |
$1,735.80 |
$1,735.80 |
10.8× |
| CT head/brain with contrast (70460) |
$1,082.40 |
$1,082.40 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,254 |
$1,254 |
7.8× |
| CT iac w contrast (70481) |
$1,265 |
$1,265 |
7.8× |
| CT limited/localized follow up study (76380) |
$982 |
$982 |
12.3× |
| CT lower ext w/o (73700) |
$1,433.30 |
$1,433.30 |
14.9× |
| CT lower extremity w wo contrast (73702) |
$1,567 |
$1,567 |
9.7× |
| CT lower extremity with contrast (73701) |
$1,293 |
$1,293 |
8.0× |
| CT lumbar spine w/o contrast (72131) |
$2,573 |
$2,573 |
26.8× |
| CT lumbar spine with contrast (72132) |
$1,955 |
$1,955 |
6.1× |
| CT maxillofacial w contrast (70487) |
$2,068 |
$2,068 |
12.8× |
| CT maxillofacial w/o contrast (70486) |
$2,271.50 |
$2,271.50 |
23.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,778 |
$1,778 |
11.0× |
| CT neck soft tissue w contrast (70491) |
$2,083.40 |
$2,083.40 |
12.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,449.80 |
$1,449.80 |
9.0× |
| CT orbits w/o contrast (70480) |
$1,377.20 |
$1,377.20 |
14.3× |
| CT pelvis w & w/o contrast (72194) |
$2,451 |
$2,451 |
15.2× |
| CT pelvis w/o contrast (72192) |
$1,384 |
$1,384 |
14.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,150.50 |
$2,150.50 |
13.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,629.10 |
$1,629.10 |
16.9× |
| CT thoracic spine w/contrast (72129) |
$1,955 |
$1,955 |
12.1× |
| CT thoracic spine w/o contrast (72128) |
$2,339 |
$2,339 |
24.3× |
| CT thorax w/o contrast (71250) |
$1,453.20 |
$1,453.20 |
15.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,045 |
$1,045 |
6.5× |
| CT upper extremity w/o contrast rt (73200) |
$869 |
$869 |
9.0× |
| CT upper extremity with contrast (73201) |
$862 |
$862 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,805 |
$2,805 |
17.4× |
| Cta Abdomen (74175) |
$2,480 |
$2,480 |
15.4× |
| CTA abdomen pelvis (74174) |
$2,805 |
$2,805 |
8.7× |
| CTA chest (71275) |
$1,735.80 |
$1,735.80 |
10.8× |
| Cta Head (70496) |
$1,576.30 |
$1,576.30 |
9.8× |
| Cta Neck (70498) |
$2,083.40 |
$2,083.40 |
12.9× |
| Cta Pelvis (72191) |
$2,451 |
$2,451 |
15.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$378.40 |
$378.40 |
3.9× |
| Echoencephalography real time imaging (76506) |
$746.90 |
$746.90 |
7.8× |
| Esophagus (74220) |
$479.60 |
$479.60 |
3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$665.50 |
$665.50 |
6.9× |
| Fluoroscopy up to 1 hr (76000) |
$341.81 |
$341.81 |
1.6× |
| Foot 2 views (73620) |
$196.35 |
$196.35 |
2.5× |
| Forearm 2 views (73090) |
$220 |
$220 |
2.7× |
| Gated Heart Planar Single (78472) |
$731 |
$731 |
2.0× |
| Hand 2 views (73120) |
$283 |
$283 |
2.9× |
| Hand 3 views (73130) |
$226.05 |
$226.05 |
2.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,144 |
$1,144 |
2.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$935 |
$935 |
2.5× |
| Ht muscle image spect sing (78451) |
$1,348 |
$1,348 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$210.65 |
$210.65 |
2.6× |
| Hysterosalpingogram (74740) |
$390 |
$390 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$847 |
$847 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$995 |
$995 |
2.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,152 |
$2,152 |
4.3× |
| Knee 3 views (73562) |
$299.20 |
$299.20 |
3.7× |
| Liver & spleen imaging static only (78215) |
$686 |
$686 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$827 |
$827 |
2.2× |
| Lymphoscintigraphy (78195) |
$935 |
$935 |
1.9× |
| Meckels Diverticulum (78290) |
$827 |
$827 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,363 |
$2,363 |
7.4× |
| MRA head w/o contrast (70544) |
$1,546.60 |
$1,546.60 |
7.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,363 |
$2,363 |
7.4× |
| MRA neck w/o contrast (70547) |
$1,546.60 |
$1,546.60 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,830.73 |
$1,830.73 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,664.30 |
$1,664.30 |
7.6× |
| MRI any jnt lwr ext with con lt (73722) |
$2,527 |
$2,527 |
3.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,859 |
$1,859 |
2.6× |
| MRI cervical spine w/o contrast (72141) |
$2,827 |
$2,827 |
12.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,830.73 |
$1,830.73 |
5.7× |
| MRI chest w/o contrast (71550) |
$2,728.55 |
$2,728.55 |
12.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,526.70 |
$2,526.70 |
11.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,807 |
$2,807 |
12.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,363 |
$2,363 |
7.4× |
| MRI pelvis w contrast (72196) |
$1,466 |
$1,466 |
4.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,612.60 |
$1,612.60 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,408 |
$1,408 |
6.4× |
| MRI scan of arm joint before and after contrast (73223) |
$2,044.90 |
$2,044.90 |
6.4× |
| MRI scan of leg joint before and after contrast (73723) |
$3,087.70 |
$3,087.70 |
9.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,774.10 |
$3,774.10 |
11.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,304.15 |
$2,304.15 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,572.90 |
$2,572.90 |
8.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,572.90 |
$2,572.90 |
8.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,339 |
$2,339 |
10.7× |
| MRI tmj (70336) |
$1,701 |
$1,701 |
7.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,859 |
$1,859 |
8.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,872 |
$1,872 |
5.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,816.10 |
$1,816.10 |
8.3× |
| Myelogram Lumbar (72265) |
$1,980 |
$1,980 |
2.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,069.10 |
$2,069.10 |
1.7× |
| Neck soft tissue (70360) |
$78.10 |
$78.10 |
1.0× |
| Nm gastric emptying study (78264) |
$847 |
$847 |
2.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$707.30 |
$707.30 |
7.4× |
| Osseous survey infant (77076) |
$311 |
$311 |
3.2× |
| Osseous survey limited (77074) |
$383.90 |
$383.90 |
4.0× |
| Parathyrd planar w/spect&CT (78072) |
$1,019 |
$1,019 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$292.60 |
$292.60 |
3.0× |
| PET image w/CT, skull-thigh (78815) |
$1,500 |
$1,500 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,500 |
$1,500 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,087.70 |
$3,087.70 |
9.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,157.20 |
$1,157.20 |
3.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$935 |
$935 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$267 |
$267 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$304.70 |
$304.70 |
3.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$588.50 |
$588.50 |
6.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$236 |
$236 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$267 |
$267 |
2.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$269.50 |
$269.50 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$188.65 |
$188.65 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$232.50 |
$232.50 |
2.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$117 |
$117 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$880 |
$880 |
5.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$671 |
$671 |
4.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$284.90 |
$284.90 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$370.26 |
$370.26 |
4.6× |
| Radiological examination surgical specimen (76098) |
$205.80 |
$205.80 |
0.4× |
| Ribs bilateral 3 views (71110) |
$399 |
$399 |
4.1× |
| Sacroiliac Joints < 3 Views (72200) |
$245 |
$245 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$390 |
$390 |
1.8× |
| Scapula complete (73010) |
$241.50 |
$241.50 |
2.5× |
| Screening digital breast tomosynthesis (77063) |
$65 |
$65 |
2.8× |
| Small bowel series (74250) |
$309.10 |
$309.10 |
1.9× |
| Spine thoracic 3 views (72072) |
$408.10 |
$408.10 |
4.2× |
| Spleen imaging only (78185) |
$827 |
$827 |
2.2× |
| Tomogram (76100) |
$348 |
$348 |
3.6× |
| Ultrasound scan to determine eye length and lens power (76519) |
$131 |
$131 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$709.50 |
$709.50 |
7.4× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$196 |
$196 |
0.5× |
| Unlisted Ultrasound Procedure (76999) |
$617.10 |
$617.10 |
7.7× |
| Urethrocystography voiding (74455) |
$523.60 |
$523.60 |
2.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$423.50 |
$423.50 |
2.6× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$534.60 |
$534.60 |
3.3× |
| Us abdl aorta screen aaa (76706) |
$425.70 |
$425.70 |
4.4× |
| Us breast unilateral complete (76641) |
$778.80 |
$778.80 |
8.1× |
| Us breast unilateral limited (76642) |
$778.80 |
$778.80 |
9.7× |
| Us chest (76604) |
$778.80 |
$778.80 |
8.1× |
| Us infant hips dynamic (76885) |
$746.90 |
$746.90 |
9.3× |
| Us ob detailed single fetus (76811) |
$579 |
$579 |
2.6× |
| Us ob transvaginal (76817) |
$778.80 |
$778.80 |
8.1× |
| Us pelvic non ob complete (76856) |
$519.20 |
$519.20 |
5.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$580.80 |
$580.80 |
6.0× |
| Us pregnancy ltd (76815) |
$646.80 |
$646.80 |
6.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$646.80 |
$646.80 |
6.7× |
| Us retroperitoneal complete (76770) |
$746.90 |
$746.90 |
7.8× |
| Us retroperitoneal limited (76775) |
$580 |
$580 |
6.0× |
| Us scrotum and contents (76870) |
$519.20 |
$519.20 |
5.4× |
| Us soft tissue head/neck (76536) |
$746.90 |
$746.90 |
7.8× |
| Us spinal canal and contents (76800) |
$617.10 |
$617.10 |
6.4× |
| Us transrectal (76872) |
$429 |
$429 |
4.5× |
| Us xtr non-vasc lmtd (76882) |
$392.70 |
$392.70 |
4.1× |
| Wrist 2 views (73100) |
$192.50 |
$192.50 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$300.30 |
$300.30 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$449.90 |
$449.90 |
5.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$220 |
$220 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$849.20 |
$849.20 |
5.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$198 |
$198 |
2.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$218.35 |
$218.35 |
2.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$315.70 |
$315.70 |
3.3× |
| X-ray exam hip uni 1 view (73501) |
$311.30 |
$311.30 |
3.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$355.30 |
$355.30 |
4.4× |
| X-ray exam of femur 1 (73551) |
$286.80 |
$286.80 |
3.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$260 |
$260 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$80.30 |
$80.30 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$220 |
$220 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$339.15 |
$339.15 |
4.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$368 |
$368 |
3.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$258 |
$258 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$251.35 |
$251.35 |
2.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$187.55 |
$187.55 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$281 |
$281 |
2.9× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$222.20 |
$222.20 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$225.50 |
$225.50 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$385 |
$385 |
4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$579.70 |
$579.70 |
6.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$253 |
$253 |
3.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$220 |
$220 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$270.05 |
$270.05 |
3.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$293.70 |
$293.70 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$260 |
$260 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$269.50 |
$269.50 |
2.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$235 |
$235 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$286 |
$286 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$228.25 |
$228.25 |
2.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$185 |
$185 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$224.40 |
$224.40 |
2.8× |
| Xr chest 4+ views (71048) |
$271.95 |
$271.95 |
2.8× |
| Xr Cholecystography Oral Contrast (74290) |
$269 |
$269 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$154 |
$154 |
1.9× |
| Xr internal auditory meati complete (70134) |
$354 |
$354 |
0.7× |
| Xr shoulder 1 view (73020) |
$190.85 |
$190.85 |
2.4× |
| Xr spine cervical 4 or 5 views (72050) |
$327.25 |
$327.25 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$235.40 |
$235.40 |
2.9× |
| Xr tmj bilateral (70330) |
$213 |
$213 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$190.85 |
$190.85 |
2.4× |