| Acute gi blood loss imaging (78278) |
$877.72 |
$1,950.50 |
2.1× |
| Ankle 2 views (73600) |
$41.85 |
$93 |
0.5× |
| Arthrography wrist lt (73115) |
$274.95 |
$611 |
0.8× |
| Barium enema (74270) |
$254.70 |
$566 |
1.4× |
| Bone age studies (77072) |
$85.05 |
$189 |
0.8× |
| Bone imaging limited area (78300) |
$928.80 |
$2,064 |
2.2× |
| Bone survey complete (77075) |
$293.85 |
$653 |
2.7× |
| Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or… (78481) |
$825.75 |
$1,835 |
1.5× |
| Clavicle complete (73000) |
$162.90 |
$362 |
1.8× |
| CT - st neck w&wo contr (70492) |
$68.85 |
$153 |
0.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,263.95 |
$5,031 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$68.85 |
$153 |
0.3× |
| CT abdomen w wo contrast (74170) |
$68.85 |
$153 |
0.4× |
| CT abdomen w/contrast (74160) |
$68.85 |
$153 |
0.4× |
| CT abdomen w/o contrast (74150) |
$68.85 |
$153 |
0.6× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$68.85 |
$153 |
0.2× |
| CT angio abdom w/o & w/dye (74175) |
$68.85 |
$153 |
0.4× |
| CT angio abdominal arteries (75635) |
$68.85 |
$153 |
0.4× |
| CT cervical spine w/contrast (72126) |
$991.35 |
$2,203 |
2.7× |
| CT cervical spine w/o contrast (72125) |
$68.85 |
$153 |
0.6× |
| CT chest w/contrast (71260) |
$68.85 |
$153 |
0.4× |
| CT extremity upper w & w/o contrast (73202) |
$68.85 |
$153 |
0.4× |
| CT head/brain with contrast (70460) |
$68.85 |
$153 |
0.4× |
| CT head/brain without and with contrast (70470) |
$68.85 |
$153 |
0.4× |
| CT lower ext w/wo contrast (73702) |
$1,683.45 |
$3,741 |
9.2× |
| CT lower extremity w contrast (73701) |
$68.85 |
$153 |
0.4× |
| CT lower extremity w/o contrast unilateral (73700) |
$68.85 |
$153 |
0.6× |
| CT lumbar spine w/contrast (72132) |
$960.30 |
$2,134 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$68.85 |
$153 |
0.6× |
| CT lumbar spine w/o then w/ con (72133) |
$1,053 |
$2,340 |
5.7× |
| CT maxillofacial area w/o contrast (70486) |
$68.85 |
$153 |
0.6× |
| CT maxillofacial w/contrast (70487) |
$873.45 |
$1,941 |
4.8× |
| CT maxillofacial w/o then w/ con (70488) |
$991.35 |
$2,203 |
5.4× |
| CT orbit sella ear w/o con (70480) |
$68.85 |
$153 |
0.6× |
| CT pelvis w & w/o contrast (72194) |
$68.85 |
$153 |
0.4× |
| CT pelvis w/o contrast (72192) |
$68.85 |
$153 |
0.6× |
| CT soft tissue neck w/contrast (70491) |
$68.85 |
$153 |
0.4× |
| CT soft tissue neck w/o contrast (70490) |
$68.85 |
$153 |
0.6× |
| CT spine cervical w/wo contrast (72127) |
$1,114.65 |
$2,477 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$68.85 |
$153 |
0.6× |
| CT thoracic spine w/o then w/ con (72130) |
$1,404.90 |
$3,122 |
7.7× |
| CT thorax lung cancer scr c- (71271) |
$824.40 |
$1,832 |
7.6× |
| CT thorax w/o contrast (71250) |
$68.85 |
$153 |
0.6× |
| CT thorax w/o then w/ contrast (71270) |
$68.85 |
$153 |
0.4× |
| CT upper extremity w/dye (73201) |
$68.85 |
$153 |
0.2× |
| CT upper extremity w/o contrast rt (73200) |
$68.85 |
$153 |
0.6× |
| CTA chest w/wo contrast (71275) |
$68.85 |
$153 |
0.4× |
| CTA head w contrast (70496) |
$68.85 |
$153 |
0.4× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$2,725.20 |
$6,056 |
14.9× |
| Cta Neck (70498) |
$68.85 |
$153 |
0.4× |
| Diskography lumbar (72295) |
$817.65 |
$1,817 |
0.4× |
| Dxa bone density study axial skeleton (77085) |
$119.70 |
$266 |
1.1× |
| Esophogram (74220) |
$153.90 |
$342 |
0.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$681.75 |
$1,515 |
2.7× |
| Gastric emptying study (78264) |
$2,147.40 |
$4,772 |
5.1× |
| Gated heart planar single (78472) |
$2,065.05 |
$4,589 |
4.9× |
| Hepatobil syst image w/drug (78227) |
$743.40 |
$1,652 |
1.3× |
| Hepatobiliary system imaging (78226) |
$818.55 |
$1,819 |
2.0× |
| Humerus min 2 views (73060) |
$126.45 |
$281 |
1.4× |
| Ivp (74400) |
$289.35 |
$643 |
1.6× |
| Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological… (78709) |
$1,500.30 |
$3,334 |
2.6× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,710.90 |
$3,802 |
3.0× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$3,067.65 |
$6,817 |
5.4× |
| Lung ventilation imaging (78579) |
$1,533.60 |
$3,408 |
3.7× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$2,201.40 |
$4,892 |
6.0× |
| MRA head w & w/o contrast (70546) |
$1,202.85 |
$2,673 |
3.3× |
| MRA head w/o contrast (70544) |
$977.40 |
$2,172 |
3.9× |
| MRA neck w/o contrast (70547) |
$977.40 |
$2,172 |
3.9× |
| MRI abdomen w/contrast (74182) |
$1,155.60 |
$2,568 |
3.2× |
| MRI abdomen w/o contrast (74181) |
$977.40 |
$2,172 |
3.9× |
| MRI cervical spine w/o contrast (72141) |
$977.40 |
$2,172 |
3.9× |
| MRI cervical spine with contrast (72142) |
$1,155.60 |
$2,568 |
3.2× |
| MRI chest w & w/o contrast (71552) |
$1,124.10 |
$2,498 |
3.1× |
| MRI chest w/contrast (71551) |
$1,080.45 |
$2,401 |
1.3× |
| MRI chest w/o contrast (71550) |
$913.05 |
$2,029 |
3.7× |
| MRI joint upr extrem w/o dye (73221) |
$977.40 |
$2,172 |
3.9× |
| Mri Lower Extremity W/O Dye (73718) |
$977.40 |
$2,172 |
3.9× |
| MRI lumbar spine with contrast (72149) |
$1,155.60 |
$2,568 |
3.2× |
| MRI lumbar w/wo contrast (72158) |
$1,202.85 |
$2,673 |
3.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,155.60 |
$2,568 |
3.2× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,202.85 |
$2,673 |
3.3× |
| MRI orbit/face/neck w/o contrast (70540) |
$977.40 |
$2,172 |
3.9× |
| MRI pelvis w/ contrast (72196) |
$1,155.60 |
$2,568 |
3.2× |
| MRI pelvis w/o contrast (72195) |
$977.40 |
$2,172 |
3.9× |
| MRI pelvis w/wo contrast (72197) |
$2,150.10 |
$4,778 |
5.9× |
| MRI spine cervical wo/w contrast (72156) |
$1,202.85 |
$2,673 |
3.3× |
| MRI spine thoracic w/contrast (72147) |
$1,155.60 |
$2,568 |
3.2× |
| MRI thoracic spine w wo contrast (72157) |
$1,202.85 |
$2,673 |
3.3× |
| MRI thoracic spine w/o contrast (72146) |
$977.40 |
$2,172 |
3.9× |
| MRI tmj (70336) |
$977.40 |
$2,172 |
3.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$977.40 |
$2,172 |
3.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,710.90 |
$3,802 |
1.3× |
| Nm bone 3 phase (78315) |
$1,233.90 |
$2,742 |
3.0× |
| Nm bone imaging whole body (78306) |
$926.55 |
$2,059 |
2.2× |
| Nm heart perfusion spect stress rest (78452) |
$2,537.10 |
$5,638 |
1.9× |
| Nm kidney imaging morphology (78700) |
$885.15 |
$1,967 |
2.1× |
| Nm liver image static only (78201) |
$1,297.80 |
$2,884 |
2.3× |
| Nm thyroid imaging only (78013) |
$943.65 |
$2,097 |
2.3× |
| Nose to rectum for fb child (76010) |
$232.20 |
$516 |
2.6× |
| Ob us < 14 wks single fetus (76801) |
$219.15 |
$487 |
2.0× |
| Parathyroid imaging (78070) |
$1,339.65 |
$2,977 |
3.2× |
| Pulmonary perfusion imaging particulate (78580) |
$818.55 |
$1,819 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$101.70 |
$226 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$126.90 |
$282 |
1.2× |
| Radex hip unilateral with pelvis 1 view (73501) |
$41.85 |
$93 |
0.5× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$41.85 |
$93 |
0.5× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$100.80 |
$224 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$113.18 |
$251.50 |
1.0× |
| Radex spine cervical 2 or 3 views (72040) |
$41.85 |
$93 |
0.5× |
| Radex spine cervical 4 or 5 views (72050) |
$41.85 |
$93 |
0.4× |
| Radex spine cervical 6 or more views (72052) |
$212.40 |
$472 |
1.9× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$93.60 |
$208 |
0.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$254.70 |
$566 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$337.50 |
$750 |
1.8× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$41.85 |
$93 |
0.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$102.38 |
$227.50 |
1.1× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$107.55 |
$239 |
1.0× |
| Radiologic examination, spine; thoracic, minimum of 4 views Other Diagnostic Radiology FS (72074) |
$41.85 |
$93 |
0.4× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$217.80 |
$484 |
9.3× |
| Small bowel series (74250) |
$219.60 |
$488 |
1.2× |
| Thyroid uptake single/multiple quant measurement (78012) |
$1,744.65 |
$3,877 |
4.2× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,050.75 |
$2,335 |
2.5× |
| Ultrasound breast limited (76642) |
$247.95 |
$551 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$201.15 |
$447 |
1.8× |
| Unlisted diagnostic radiographic procedure (76499) |
$31.50 |
$70 |
0.3× |
| Us abdominal aorta real time screen study aaa (76706) |
$257.40 |
$572 |
2.4× |
| Us breast uni real time with image complete (76641) |
$274.50 |
$610 |
2.5× |
| Us chest (76604) |
$207.45 |
$461 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$41.85 |
$93 |
0.4× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$41.85 |
$93 |
0.4× |
| Us ob detailed single fetus (76811) |
$292.95 |
$651 |
1.2× |
| Us ob followup per fetus (76816) |
$94.50 |
$210 |
0.9× |
| Us ob limited 1 or more fetuses (76815) |
$41.85 |
$93 |
0.4× |
| Us obstetric transvaginal (76817) |
$259.65 |
$577 |
2.4× |
| Us pelvic limited or f/u non-ob (76857) |
$192.60 |
$428 |
1.8× |
| Us pelvis complete (76856) |
$318.15 |
$707 |
2.9× |
| Us retroperitoneal complete (76770) |
$265.95 |
$591 |
2.4× |
| Us scrotum (76870) |
$266.85 |
$593 |
2.4× |
| Us soft tissue head/neck (76536) |
$198.90 |
$442 |
1.8× |
| Us spinal canal (76800) |
$495.45 |
$1,101 |
4.5× |
| Vascular flow imaging (78445) |
$791.55 |
$1,759 |
1.9× |
| Venography ext unilateral (75820) |
$310.95 |
$691 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$66.60 |
$148 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$96.75 |
$215 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$41.85 |
$93 |
0.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$307.35 |
$683 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$41.85 |
$93 |
0.5× |
| X-ray exam hips bi 3-4 views (73522) |
$129.60 |
$288 |
1.2× |
| X-ray exam of finger(s) (73140) |
$41.85 |
$93 |
0.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$41.85 |
$93 |
0.5× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$41.85 |
$93 |
0.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$41.85 |
$93 |
0.5× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$41.85 |
$93 |
0.4× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$41.85 |
$93 |
0.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$41.85 |
$93 |
0.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$106.20 |
$236 |
1.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$41.85 |
$93 |
0.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$41.85 |
$93 |
0.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$211.05 |
$469 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$41.85 |
$93 |
0.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$159.75 |
$355 |
1.5× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$155.70 |
$346 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$41.85 |
$93 |
0.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$41.85 |
$93 |
0.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$41.85 |
$93 |
0.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$41.85 |
$93 |
0.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$41.85 |
$93 |
0.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$41.85 |
$93 |
0.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$41.85 |
$93 |
0.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$131.85 |
$293 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$80.10 |
$178 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$41.85 |
$93 |
0.5× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$41.85 |
$93 |
0.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$41.85 |
$93 |
0.5× |
| Xr abdomen 1 view (74018) |
$41.85 |
$93 |
0.5× |
| Xr abdomen 2 views (74019) |
$114.75 |
$255 |
1.1× |
| Xr abdomen 3 views (74021) |
$155.70 |
$346 |
1.4× |
| Xr arthrogram hip (73525) |
$397.80 |
$884 |
1.1× |
| Xr bone density appendicular (77081) |
$66.60 |
$148 |
0.7× |
| Xr bone density axial (77080) |
$119.70 |
$266 |
1.1× |
| Xr bone survey infant (77076) |
$254.70 |
$566 |
2.3× |
| Xr bone survey limited (77074) |
$254.70 |
$566 |
2.3× |
| Xr chest 1 view (71045) |
$41.85 |
$93 |
0.5× |
| Xr chest 2 views (71046) |
$41.85 |
$93 |
0.5× |
| Xr chest 3 views (71047) |
$139.95 |
$311 |
1.5× |
| Xr cystogram 3+ views (74430) |
$256.05 |
$569 |
0.7× |
| Xr eye foreign body (70030) |
$64.35 |
$143 |
0.7× |
| Xr facial bones 3 views (70150) |
$41.85 |
$93 |
0.4× |
| Xr lower extremity 2 views infant (73592) |
$41.85 |
$93 |
0.5× |
| Xr mandible 4 views (70110) |
$129.15 |
$287 |
1.2× |
| Xr nasal bones (70160) |
$41.85 |
$93 |
0.5× |
| Xr pelvis 3 views (72190) |
$41.85 |
$93 |
0.4× |
| Xr spine 1 view (72020) |
$41.85 |
$93 |
0.5× |
| Xr sternum 2 views (71120) |
$41.85 |
$93 |
0.5× |
| Xray elbow 2 views (73070) |
$41.85 |
$93 |
0.5× |
| Xray forearm 2 views (73090) |
$41.85 |
$93 |
0.5× |
| Xray knee 1 or 2 views rt (73560) |
$41.85 |
$93 |
0.5× |
| Xray neck soft tissue (70360) |
$41.85 |
$93 |
0.5× |
| Xray orbits complete min 4 views (70200) |
$143.10 |
$318 |
1.3× |
| Xray pelvis 1 or 2 views (72170) |
$41.85 |
$93 |
0.4× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$41.85 |
$93 |
0.4× |
| Xray scapula complete (73010) |
$41.85 |
$93 |
0.4× |
| Xray shoulder 1 view (73020) |
$41.85 |
$93 |
0.5× |
| Xray sinuses paranasal <3 views (70210) |
$131.40 |
$292 |
1.4× |
| Xray spine thoracic 2 views (72070) |
$41.85 |
$93 |
0.4× |
| Xray tibia-fibula 2 views bil (73590) |
$41.85 |
$93 |
0.5× |
| Xray tmj's bilateral open-clsc (70330) |
$106.20 |
$236 |
1.2× |