| Abdomen 2 views (74019) |
$109.12 |
$145.50 |
1.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$289.50 |
$386 |
0.8× |
| Ankle 2 views (73600) |
$93 |
$124 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$351 |
$468 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$301.50 |
$402 |
0.9× |
| Bone &/joint imaging whole body (78306) |
$493.12 |
$657.50 |
1.4× |
| Bone age studies (77072) |
$54 |
$72 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$516.38 |
$688.50 |
1.5× |
| Brain Imaging Minimum 4 Static Views (78605) |
$410.62 |
$547.50 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$88.88 |
$118.50 |
1.2× |
| Chest 1 view (71045) |
$73.88 |
$98.50 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$244.50 |
$326 |
1.6× |
| Clavicle complete (73000) |
$102.75 |
$137 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$145.50 |
$194 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,575 |
$2,100 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,968.75 |
$2,625 |
9.6× |
| CT abdomen w contrast (74160) |
$1,096.50 |
$1,462 |
7.3× |
| CT abdomen w wo contrast (74170) |
$1,280.25 |
$1,707 |
8.5× |
| CT abdomen w/o contrast (74150) |
$525.75 |
$701 |
5.8× |
| CT angiography upper extremity lt (73206) |
$761.62 |
$1,015.50 |
5.0× |
| CT c-spine w/o contrast (72125) |
$829.50 |
$1,106 |
9.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,194 |
$1,592 |
7.9× |
| CT cervical spine with contrast (72126) |
$835.50 |
$1,114 |
2.8× |
| CT chest w/wo contrast (71270) |
$1,400.25 |
$1,867 |
9.3× |
| CT chest with contrast (71260) |
$1,104 |
$1,472 |
7.3× |
| CT head/brain with contrast (70460) |
$1,056 |
$1,408 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,119.75 |
$1,493 |
7.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$28.12 |
$37.50 |
0.4× |
| CT iac w contrast (70481) |
$1,014.75 |
$1,353 |
6.7× |
| CT limited/localized follow up study (76380) |
$154.50 |
$206 |
2.1× |
| CT lower ext w/o (73700) |
$495.75 |
$661 |
5.5× |
| CT lower extremity w wo contrast (73702) |
$1,193.25 |
$1,591 |
7.9× |
| CT lower extremity with contrast (73701) |
$882 |
$1,176 |
5.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,303.50 |
$1,738 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$590.25 |
$787 |
6.5× |
| CT lumbar spine with contrast (72132) |
$1,205.25 |
$1,607 |
4.0× |
| CT maxillofacial w contrast (70487) |
$637.50 |
$850 |
4.2× |
| CT maxillofacial w/o contrast (70486) |
$793.50 |
$1,058 |
8.8× |
| CT maxillofacial w/wo contrast (70488) |
$704.25 |
$939 |
4.7× |
| CT neck soft tissue w contrast (70491) |
$857.25 |
$1,143 |
5.7× |
| CT orbits w/o contrast (70480) |
$496.88 |
$662.50 |
5.5× |
| CT pelvis w & w/o contrast (72194) |
$1,285.50 |
$1,714 |
8.5× |
| CT pelvis w/o contrast (72192) |
$484.88 |
$646.50 |
5.4× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$199.50 |
$266 |
2.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,221.75 |
$1,629 |
8.1× |
| CT soft tissue neck w/o contrast (70490) |
$538.12 |
$717.50 |
6.0× |
| CT thoracic spine w/contrast (72129) |
$998.25 |
$1,331 |
6.6× |
| CT thoracic spine w/o contrast (72128) |
$582 |
$776 |
6.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,177.50 |
$1,570 |
7.8× |
| CT thorax w/o contrast (71250) |
$516.75 |
$689 |
5.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,193.25 |
$1,591 |
7.9× |
| CT upper extremity w/o contrast rt (73200) |
$495.75 |
$661 |
5.5× |
| CT upper extremity with contrast (73201) |
$882 |
$1,176 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$884.62 |
$1,179.50 |
5.8× |
| Cta Abdomen (74175) |
$713.62 |
$951.50 |
4.7× |
| CTA abdomen pelvis (74174) |
$903.38 |
$1,204.50 |
3.0× |
| CTA chest (71275) |
$697.12 |
$929.50 |
4.6× |
| Cta Head (70496) |
$684.38 |
$912.50 |
4.5× |
| CTA lwr ext w&w/o contrast (73706) |
$818.62 |
$1,091.50 |
5.4× |
| Cta Neck (70498) |
$682.12 |
$909.50 |
4.5× |
| Cta Pelvis (72191) |
$709.50 |
$946 |
4.7× |
| Cystography minimum 3 views rs&i (74430) |
$124.50 |
$166 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$159 |
$212 |
1.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$57.38 |
$76.50 |
0.8× |
| Esophagus (74220) |
$129.75 |
$173 |
0.9× |
| Fetal biophysical profile non-stress testing (76818) |
$188.62 |
$251.50 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$208.50 |
$278 |
1.0× |
| Foot 2 views (73620) |
$72.75 |
$97 |
1.0× |
| Forearm 2 views (73090) |
$102.75 |
$137 |
1.4× |
| Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Age… (78266) |
$1,138.88 |
$1,518.50 |
2.4× |
| Gated Heart Planar Single (78472) |
$505.88 |
$674.50 |
1.5× |
| Hand 2 views (73120) |
$93 |
$124 |
1.0× |
| Hand 3 views (73130) |
$102.75 |
$137 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$480.38 |
$640.50 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$304.50 |
$406 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$102.75 |
$137 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$526.50 |
$702 |
1.1× |
| Knee 3 views (73562) |
$118.50 |
$158 |
1.6× |
| Liver & spleen imaging static only (78215) |
$406.12 |
$541.50 |
1.2× |
| Lymphoscintigraphy (78195) |
$432.38 |
$576.50 |
0.9× |
| Meckels Diverticulum (78290) |
$454.88 |
$606.50 |
1.3× |
| Myocardial Spect Multiple Studies (78452) |
$708.75 |
$945 |
0.6× |
| Neck soft tissue (70360) |
$68.25 |
$91 |
0.9× |
| Nm gastric emptying study (78264) |
$420.75 |
$561 |
1.2× |
| Nm whole blood volume (78122) |
$288.75 |
$385 |
0.6× |
| Nuclear medicine study of digestive tracts (78299) |
$349.88 |
$466.50 |
1.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$405 |
$540 |
1.2× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$959.25 |
$1,279 |
2.8× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$464.62 |
$619.50 |
1.3× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$405.38 |
$540.50 |
0.9× |
| Osseous survey infant (77076) |
$126 |
$168 |
1.4× |
| Osseous survey limited (77074) |
$211.50 |
$282 |
2.3× |
| Parathyroid imaging (78070) |
$525.75 |
$701 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$73.12 |
$97.50 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$408 |
$544 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$134.62 |
$179.50 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$89.25 |
$119 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$124.50 |
$166 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$97.12 |
$129.50 |
1.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$128.62 |
$171.50 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$187.50 |
$250 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$105 |
$140 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$66.75 |
$89 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$93.75 |
$125 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$172.88 |
$230.50 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$93.75 |
$125 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$152.62 |
$203.50 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$109.50 |
$146 |
1.5× |
| Radiological examination surgical specimen (76098) |
$324 |
$432 |
0.7× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$266.25 |
$355 |
0.8× |
| Ribs bilateral 3 views (71110) |
$87 |
$116 |
1.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$657.38 |
$876.50 |
1.4× |
| Sacroiliac Joints < 3 Views (72200) |
$79.88 |
$106.50 |
0.9× |
| Scapula complete (73010) |
$102.75 |
$137 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$57.38 |
$76.50 |
2.5× |
| Sella turcica (70240) |
$79.88 |
$106.50 |
1.1× |
| Small bowel series (74250) |
$147.38 |
$196.50 |
1.0× |
| Spine thoracic 3 views (72072) |
$97.12 |
$129.50 |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$433.50 |
$578 |
1.3× |
| Thoracolumbar 2 views (72080) |
$100.50 |
$134 |
1.3× |
| Thyroid carcinoma metastases img whole body (78018) |
$370.88 |
$494.50 |
0.8× |
| Thyroid Imaging With Vascular Flow (78013) |
$264.38 |
$352.50 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$433.50 |
$578 |
1.3× |
| Tmj unilateral (70328) |
$79.88 |
$106.50 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$191.62 |
$255.50 |
2.1× |
| Unlisted Ultrasound Procedure (76999) |
$30 |
$40 |
0.4× |
| Upper Extremity Infant (73092) |
$66.75 |
$89 |
0.7× |
| Urethrocystography voiding (74455) |
$145.12 |
$193.50 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$274.50 |
$366 |
1.8× |
| Us abdl aorta screen aaa (76706) |
$108.38 |
$144.50 |
1.2× |
| Us breast unilateral complete (76641) |
$155.25 |
$207 |
1.7× |
| Us breast unilateral limited (76642) |
$116.62 |
$155.50 |
1.6× |
| Us chest (76604) |
$213 |
$284 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$177.38 |
$236.50 |
2.0× |
| Us pelvic non ob complete (76856) |
$183.38 |
$244.50 |
2.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$106.50 |
$142 |
1.2× |
| Us pregnancy ltd (76815) |
$135 |
$180 |
1.5× |
| Us retroperitoneal complete (76770) |
$293.25 |
$391 |
3.3× |
| Us retroperitoneal limited (76775) |
$160.88 |
$214.50 |
1.8× |
| Us scrotum and contents (76870) |
$155.25 |
$207 |
1.7× |
| Us soft tissue head/neck (76536) |
$170.25 |
$227 |
1.9× |
| Us spinal canal and contents (76800) |
$126 |
$168 |
1.4× |
| Us xtr non-vasc lmtd (76882) |
$151.50 |
$202 |
1.7× |
| Venogram extremity bilateral (75822) |
$145.50 |
$194 |
0.1× |
| Wrist 2 views (73100) |
$93 |
$124 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$109.12 |
$145.50 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$84 |
$112 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$107.25 |
$143 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$216.75 |
$289 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$95.25 |
$127 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$102.75 |
$137 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$156.75 |
$209 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$77.25 |
$103 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$124.50 |
$166 |
1.7× |
| X-ray exam hip uni 4/> views (73503) |
$190.50 |
$254 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$112.50 |
$150 |
1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$130.88 |
$174.50 |
1.5× |
| X-ray exam of femur 1 (73551) |
$99 |
$132 |
1.3× |
| X-ray eye for foreign body (70030) |
$79.88 |
$106.50 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$105.38 |
$140.50 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$79.88 |
$106.50 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$110.25 |
$147 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$101.25 |
$135 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$79.88 |
$106.50 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$135 |
$180 |
1.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$66.75 |
$89 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$86.62 |
$115.50 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$135.38 |
$180.50 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$79.88 |
$106.50 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$59.62 |
$79.50 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$94.88 |
$126.50 |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$244.88 |
$326.50 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$83.25 |
$111 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$88.88 |
$118.50 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$95.25 |
$127 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$86.62 |
$115.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$79.88 |
$106.50 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$106.50 |
$142 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$98.62 |
$131.50 |
1.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$79.88 |
$106.50 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$120 |
$160 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$83.62 |
$111.50 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$68.25 |
$91 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$82.12 |
$109.50 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$75.38 |
$100.50 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$90.38 |
$120.50 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$93 |
$124 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$102.75 |
$137 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$138 |
$184 |
1.5× |
| Xr chest 4+ views (71048) |
$148.88 |
$198.50 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$81.75 |
$109 |
1.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$93.38 |
$124.50 |
1.0× |
| Xr optic foramina (70190) |
$97.12 |
$129.50 |
1.3× |
| Xr shoulder 1 view (73020) |
$77.25 |
$103 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$130.12 |
$173.50 |
1.4× |
| Xr tibia/fibula 2 views (73590) |
$102.75 |
$137 |
1.4× |
| Xr tmj bilateral (70330) |
$97.12 |
$129.50 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$101.25 |
$135 |
1.3× |