| Abdomen 2 views (74019) |
$100 |
$310.88 |
1.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$525.99 |
$525.99 |
1.4× |
| Ankle 2 views (73600) |
$100 |
$167.60 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$362.06 |
$362.06 |
0.9× |
| Bone &/joint imaging whole body (78306) |
$1,069.21 |
$1,069.21 |
2.8× |
| Bone age studies (77072) |
$96.49 |
$96.49 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$1,056.23 |
$1,056.23 |
2.7× |
| Bone survey complete (77075) |
$100 |
$330.81 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$100 |
$222.53 |
1.2× |
| Chest 1 view (71045) |
$100 |
$213.34 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$331.50 |
$331.50 |
2.0× |
| Clavicle complete (73000) |
$100 |
$203.64 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$650 |
$3,483.25 |
1.9× |
| CT abdomen and pelvis without contrast (74176) |
$575 |
$2,387.80 |
2.5× |
| CT abdomen w contrast (74160) |
$650 |
$1,722.11 |
3.9× |
| CT abdomen w wo contrast (74170) |
$650 |
$2,270.93 |
3.9× |
| CT abdomen w/o contrast (74150) |
$500 |
$1,508.21 |
5.0× |
| CT angiography upper extremity lt (73206) |
$1,189.19 |
$1,189.19 |
7.0× |
| CT c-spine w/o contrast (72125) |
$500 |
$1,538.38 |
5.0× |
| CT cervical spine w&w/o contrast (72127) |
$650 |
$1,505.87 |
3.9× |
| CT cervical spine with contrast (72126) |
$650 |
$1,422.82 |
1.9× |
| CT chest w/wo contrast (71270) |
$650 |
$1,961.58 |
3.9× |
| CT chest with contrast (71260) |
$650 |
$1,604.93 |
3.9× |
| CT head/brain with contrast (70460) |
$650 |
$1,604.15 |
3.9× |
| CT head/brain without and with contrast (70470) |
$650 |
$1,801.09 |
3.9× |
| CT iac w contrast (70481) |
$650 |
$1,024.44 |
3.9× |
| CT lower ext w/o (73700) |
$500 |
$1,308.31 |
5.0× |
| CT lower extremity w wo contrast (73702) |
$650 |
$1,324.06 |
3.9× |
| CT lower extremity with contrast (73701) |
$650 |
$1,125.14 |
3.9× |
| CT lumbar spine w & w/o contrast (72133) |
$650 |
$1,846.05 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$500 |
$1,538.38 |
5.0× |
| CT lumbar spine with contrast (72132) |
$650 |
$1,691.48 |
1.9× |
| CT maxillofacial w contrast (70487) |
$650 |
$1,265.62 |
3.9× |
| CT maxillofacial w/o contrast (70486) |
$500 |
$1,284.92 |
5.0× |
| CT maxillofacial w/wo contrast (70488) |
$650 |
$1,427.02 |
3.9× |
| CT neck soft tissue w contrast (70491) |
$650 |
$1,534.30 |
3.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$650 |
$1,208.43 |
3.9× |
| CT orbits w/o contrast (70480) |
$500 |
$1,232.71 |
5.0× |
| CT pelvis w & w/o contrast (72194) |
$650 |
$1,511.19 |
3.9× |
| CT pelvis w/o contrast (72192) |
$500 |
$1,265.62 |
5.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$650 |
$1,701.02 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$500 |
$1,550.20 |
5.0× |
| CT thoracic spine w/contrast (72129) |
$650 |
$1,536.03 |
3.9× |
| CT thoracic spine w/o contrast (72128) |
$500 |
$1,847.08 |
5.0× |
| CT thoracic spine w/wo contrast (72130) |
$650 |
$1,945.52 |
3.9× |
| CT thorax w/o contrast (71250) |
$500 |
$1,415.66 |
5.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$650 |
$1,216.22 |
3.9× |
| CT upper extremity w/o contrast rt (73200) |
$500 |
$1,400.75 |
5.0× |
| CT upper extremity with contrast (73201) |
$650 |
$1,137.57 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,827.53 |
$1,827.53 |
10.8× |
| Cta Abdomen (74175) |
$1,803.71 |
$1,803.71 |
10.7× |
| CTA abdomen pelvis (74174) |
$2,071.11 |
$2,071.11 |
6.2× |
| CTA chest (71275) |
$1,859.86 |
$1,859.86 |
11.0× |
| Cta Head (70496) |
$1,070.26 |
$1,070.26 |
6.3× |
| CTA lwr ext w&w/o contrast (73706) |
$2,635.01 |
$2,635.01 |
15.6× |
| Cta Neck (70498) |
$1,850.29 |
$1,850.29 |
11.0× |
| Cta Pelvis (72191) |
$972.97 |
$972.97 |
5.8× |
| Echoencephalography real time imaging (76506) |
$235.16 |
$235.16 |
2.3× |
| Esophagus (74220) |
$100 |
$301.92 |
0.6× |
| Fetal biophysical profile non-stress testing (76818) |
$250 |
$809.29 |
2.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$250 |
$809.29 |
2.5× |
| Foot 2 views (73620) |
$100 |
$173.43 |
1.2× |
| Forearm 2 views (73090) |
$100 |
$205.62 |
1.2× |
| Hand 2 views (73120) |
$100 |
$182.12 |
1.0× |
| Hand 3 views (73130) |
$100 |
$215.28 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$913.17 |
$913.17 |
1.7× |
| Ht muscle image spect sing (78451) |
$2,374.81 |
$2,374.81 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$100 |
$193.95 |
1.2× |
| Hysterosalpingogram (74740) |
$131.72 |
$131.72 |
0.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$713.59 |
$713.59 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$618.04 |
$618.04 |
1.2× |
| Knee 3 views (73562) |
$100 |
$245.82 |
1.2× |
| Liver & spleen imaging static only (78215) |
$455.50 |
$455.50 |
1.2× |
| Liver imaging static only (78201) |
$754.79 |
$754.79 |
1.4× |
| Liver imaging w/vascular flow (78202) |
$415.53 |
$415.53 |
0.8× |
| MRA head w & w/o contrast (70546) |
$1,346.46 |
$1,346.46 |
4.0× |
| MRA head w/o contrast (70544) |
$1,681.50 |
$1,681.50 |
7.3× |
| MRA head with contrast (70545) |
$1,494.57 |
$1,494.57 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,540.03 |
$1,540.03 |
6.7× |
| MRI abdomen w contrast (74182) |
$800 |
$2,446.46 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$800 |
$3,889.74 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$1,990.96 |
$1,990.96 |
8.7× |
| MRI any jnt lwr ext with con lt (73722) |
$800 |
$1,620.83 |
1.1× |
| MRI c-spine with contrast (72142) |
$800 |
$1,790.25 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$700 |
$1,905.19 |
3.1× |
| MRI chest w/o & w/contrast material (71552) |
$800 |
$1,466.75 |
2.4× |
| MRI chest w/o contrast (71550) |
$700 |
$1,500.69 |
3.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$700 |
$2,056.86 |
3.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$700 |
$1,516.75 |
3.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$800 |
$2,063.72 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$800 |
$1,459.87 |
2.4× |
| MRI pelvis w contrast (72196) |
$800 |
$1,374.45 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$800 |
$1,810.37 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$700 |
$1,810.37 |
3.1× |
| MRI scan of arm joint before and after contrast (73223) |
$800 |
$1,730.60 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$800 |
$1,589.77 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$800 |
$2,695.51 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$800 |
$2,250.60 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$800 |
$2,870.41 |
2.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$800 |
$2,250.60 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$800 |
$2,708.77 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$700 |
$1,918.44 |
3.1× |
| MRI upper ext joint w/o contrast (73221) |
$700 |
$1,112.20 |
3.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$800 |
$1,730.60 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$750 |
$1,160.96 |
3.3× |
| Myocardial Spect Multiple Studies (78452) |
$2,374.81 |
$2,374.81 |
1.9× |
| Neck soft tissue (70360) |
$100 |
$250.64 |
1.2× |
| Nm gastric emptying study (78264) |
$681.50 |
$681.50 |
1.8× |
| Nm gastroesophageal reflux study (78262) |
$261.47 |
$261.47 |
0.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$250 |
$677.51 |
2.5× |
| Osseous survey infant (77076) |
$100 |
$115.79 |
1.0× |
| Osseous survey limited (77074) |
$100 |
$115.79 |
1.0× |
| Parathyroid imaging (78070) |
$894.94 |
$894.94 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$100 |
$194.65 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$800 |
$1,473.47 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$461.35 |
$461.35 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$762.99 |
$762.99 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$100 |
$247.65 |
1.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$100 |
$261.82 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$100 |
$254.37 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$100 |
$198.19 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$100 |
$164.75 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$100 |
$210.73 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$250 |
$591.92 |
1.1× |
| Scanogram (77073) |
$100 |
$180.54 |
1.0× |
| Scapula complete (73010) |
$100 |
$216.07 |
1.0× |
| Screening digital breast tomosynthesis (77063) |
$80 |
$80 |
3.4× |
| Sella turcica (70240) |
$100 |
$156.88 |
1.2× |
| Spine thoracic 3 views (72072) |
$100 |
$294.81 |
1.0× |
| Spleen imaging only (78185) |
$260.14 |
$260.14 |
0.7× |
| Thyroid uptake measurement (78012) |
$299.16 |
$299.16 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$585.64 |
$585.64 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$250 |
$434.93 |
2.5× |
| Unlisted Ultrasound Procedure (76999) |
$121.62 |
$121.62 |
1.5× |
| Upper Extremity Infant (73092) |
$65.59 |
$65.59 |
0.7× |
| Us abdl aorta screen aaa (76706) |
$250 |
$291.36 |
2.5× |
| Us breast unilateral limited (76642) |
$75.22 |
$75.22 |
0.9× |
| Us chest (76604) |
$177.29 |
$177.29 |
1.8× |
| Us elastography parenchyma (76981) |
$250 |
$416.83 |
2.5× |
| Us infant hips limited static (76886) |
$250 |
$319.18 |
3.0× |
| Us kidney transplant (76776) |
$250 |
$508.61 |
2.5× |
| Us ob transvaginal (76817) |
$250 |
$358.31 |
2.5× |
| Us pelvic non ob complete (76856) |
$250 |
$513.14 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$233.61 |
$233.61 |
2.3× |
| Us pregnancy ltd (76815) |
$157.68 |
$157.68 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$250 |
$560.82 |
2.5× |
| Us retroperitoneal complete (76770) |
$250 |
$555.78 |
2.5× |
| Us retroperitoneal limited (76775) |
$250 |
$335.69 |
2.5× |
| Us scrotum and contents (76870) |
$250 |
$554.71 |
2.5× |
| Us soft tissue head/neck (76536) |
$250 |
$447.04 |
2.5× |
| Us spinal canal and contents (76800) |
$250 |
$393.51 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$250 |
$490.96 |
2.5× |
| Wrist 2 views (73100) |
$100 |
$163.22 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$100 |
$326.37 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$100 |
$240.70 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$100 |
$200.59 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$100 |
$207.29 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$100 |
$235.72 |
1.2× |
| X-ray exam hip uni 1 view (73501) |
$100 |
$102.54 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$100 |
$222.57 |
1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$100 |
$322.17 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$100 |
$398.91 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$100 |
$164.11 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$100 |
$213.68 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$100 |
$213.34 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$100 |
$342.02 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$100 |
$315.99 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$81.37 |
$81.37 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$100 |
$246.96 |
1.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$100 |
$199.82 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$100 |
$254.37 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$100 |
$225.02 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$100 |
$182.63 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$100 |
$255.52 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$100 |
$277.23 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$100 |
$361.04 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$100 |
$160.54 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$100 |
$213.36 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$100 |
$231.73 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$100 |
$320.29 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$100 |
$196.92 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$100 |
$351.21 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$100 |
$228.40 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$100 |
$185.52 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$100 |
$154.93 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$100 |
$205.14 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$100 |
$280.77 |
1.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$100 |
$301.07 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$100 |
$205.14 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$100 |
$208.17 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$100 |
$392.50 |
1.0× |
| Xr chest 4+ views (71048) |
$100 |
$499.93 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$100 |
$205.14 |
1.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$100 |
$192.10 |
1.0× |
| Xr optic foramina (70190) |
$78.59 |
$78.59 |
0.9× |
| Xr shoulder 1 view (73020) |
$100 |
$157.80 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$100 |
$396.92 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$100 |
$250.26 |
1.2× |
| Xr tmj bilateral (70330) |
$100 |
$136.95 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$100 |
$202.64 |
1.2× |