| Abdomen 2 views (74019) |
$102 |
$255 |
1.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$649.60 |
$1,624 |
1.7× |
| Ankle 2 views (73600) |
$95.20 |
$238 |
1.1× |
| Arthrogram hip (73525) |
$322.40 |
$806 |
1.0× |
| Arthrogram shoulder (73040) |
$208 |
$520 |
0.6× |
| Arthrogram wrist (73115) |
$322.40 |
$806 |
1.0× |
| Arthrography knee lt (73580) |
$322.40 |
$806 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$594.40 |
$1,486 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$800.80 |
$2,002 |
2.1× |
| Bone age studies (77072) |
$95.20 |
$238 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$649.60 |
$1,624 |
1.7× |
| Bone survey complete (77075) |
$234.40 |
$586 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$98 |
$245 |
1.2× |
| Chest 1 view (71045) |
$95.20 |
$238 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$218.80 |
$547 |
1.3× |
| Clavicle complete (73000) |
$95.20 |
$238 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,711.20 |
$4,278 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,656.40 |
$4,141 |
7.2× |
| CT abdomen w contrast (74160) |
$1,494 |
$3,735 |
8.9× |
| CT abdomen w wo contrast (74170) |
$1,656.40 |
$4,141 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,374.40 |
$3,436 |
13.7× |
| CT angiography upper extremity lt (73206) |
$420 |
$1,050 |
2.5× |
| CT c-spine w/o contrast (72125) |
$726.40 |
$1,816 |
7.2× |
| CT cervical spine w&w/o contrast (72127) |
$457.60 |
$1,144 |
2.7× |
| CT cervical spine with contrast (72126) |
$618.80 |
$1,547 |
1.8× |
| CT chest w/wo contrast (71270) |
$1,662.80 |
$4,157 |
9.9× |
| CT chest with contrast (71260) |
$715.60 |
$1,789 |
4.2× |
| CT head/brain with contrast (70460) |
$930 |
$2,325 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,166.80 |
$2,917 |
6.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$124.40 |
$311 |
1.5× |
| CT iac w contrast (70481) |
$688.40 |
$1,721 |
4.1× |
| CT lower ext w/o (73700) |
$1,032.80 |
$2,582 |
10.3× |
| CT lower extremity w wo contrast (73702) |
$686.40 |
$1,716 |
4.1× |
| CT lower extremity with contrast (73701) |
$765.20 |
$1,913 |
4.5× |
| CT lumbar spine w & w/o contrast (72133) |
$857.20 |
$2,143 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$726.40 |
$1,816 |
7.2× |
| CT lumbar spine with contrast (72132) |
$726.40 |
$1,816 |
2.2× |
| CT maxillofacial w contrast (70487) |
$688.40 |
$1,721 |
4.1× |
| CT maxillofacial w/o contrast (70486) |
$688.40 |
$1,721 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$857.20 |
$2,143 |
5.1× |
| CT neck soft tissue w contrast (70491) |
$783.20 |
$1,958 |
4.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$688.40 |
$1,721 |
4.1× |
| CT orbits w/o contrast (70480) |
$688.40 |
$1,721 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$857.20 |
$2,143 |
5.1× |
| CT pelvis w/o contrast (72192) |
$688.40 |
$1,721 |
6.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$715.60 |
$1,789 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$688.40 |
$1,721 |
6.8× |
| CT thoracic spine w/contrast (72129) |
$726.40 |
$1,816 |
4.3× |
| CT thoracic spine w/o contrast (72128) |
$726.40 |
$1,816 |
7.2× |
| CT thoracic spine w/wo contrast (72130) |
$861.20 |
$2,153 |
5.1× |
| CT thorax w/o contrast (71250) |
$688.80 |
$1,722 |
6.9× |
| CT upper extremity w/o contrast rt (73200) |
$688.40 |
$1,721 |
6.8× |
| CT upper extremity with contrast (73201) |
$765.20 |
$1,913 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,130.40 |
$2,826 |
6.7× |
| Cta Abdomen (74175) |
$1,130.40 |
$2,826 |
6.7× |
| CTA abdomen pelvis (74174) |
$1,130.40 |
$2,826 |
3.4× |
| CTA chest (71275) |
$1,318.40 |
$3,296 |
7.8× |
| Cta Head (70496) |
$989.60 |
$2,474 |
5.9× |
| CTA lwr ext w&w/o contrast (73706) |
$1,005.20 |
$2,513 |
6.0× |
| Cta Neck (70498) |
$1,042.80 |
$2,607 |
6.2× |
| Cystography minimum 3 views rs&i (74430) |
$216.80 |
$542 |
0.6× |
| Diskography lumbar (72295) |
$2,305.20 |
$5,763 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$156 |
$390 |
1.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$156 |
$390 |
1.9× |
| Echoencephalography real time imaging (76506) |
$222 |
$555 |
2.2× |
| Esophagus (74220) |
$192.40 |
$481 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$187.20 |
$468 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$211.20 |
$528 |
0.9× |
| Foot 2 views (73620) |
$95.20 |
$238 |
1.1× |
| Forearm 2 views (73090) |
$95.20 |
$238 |
1.1× |
| Hand 2 views (73120) |
$95.20 |
$238 |
0.9× |
| Hand 3 views (73130) |
$108.40 |
$271 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,202.40 |
$3,006 |
2.3× |
| Ht muscle image spect sing (78451) |
$2,260.40 |
$5,651 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$95.20 |
$238 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$838.40 |
$2,096 |
1.6× |
| Knee 3 views (73562) |
$104.40 |
$261 |
1.2× |
| Liver & spleen imaging static only (78215) |
$649.60 |
$1,624 |
1.7× |
| Liver imaging static only (78201) |
$2,260.40 |
$5,651 |
4.3× |
| Meckels Diverticulum (78290) |
$620 |
$1,550 |
1.6× |
| MRA head w/o contrast (70544) |
$905.20 |
$2,263 |
3.9× |
| MRA neck w/o contrast (70547) |
$905.20 |
$2,263 |
3.9× |
| MRI abdomen w contrast (74182) |
$1,028 |
$2,570 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,499.20 |
$3,748 |
4.5× |
| MRI abdomen w/o contrast (74181) |
$1,077.60 |
$2,694 |
4.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,075.20 |
$2,688 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,075.20 |
$2,688 |
1.4× |
| MRI breast w/o contrast bilateral (77047) |
$549.60 |
$1,374 |
2.4× |
| MRI breast w/o contrast unilat (77046) |
$549.60 |
$1,374 |
2.4× |
| MRI c-spine with contrast (72142) |
$1,034.80 |
$2,587 |
3.1× |
| MRI cervical spine w/o contrast (72141) |
$920.40 |
$2,301 |
4.0× |
| MRI chest with contrast (71551) |
$1,028 |
$2,570 |
1.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,612.40 |
$4,031 |
4.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$898.40 |
$2,246 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$898.40 |
$2,246 |
3.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,496 |
$3,740 |
4.5× |
| MRI pelvis w contrast (72196) |
$870.80 |
$2,177 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,499.20 |
$3,748 |
4.5× |
| MRI pelvis w/o contrast (72195) |
$900.40 |
$2,251 |
3.9× |
| MRI scan of arm joint before and after contrast (73223) |
$1,496 |
$3,740 |
4.5× |
| MRI scan of leg joint before and after contrast (73723) |
$1,496 |
$3,740 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,508 |
$3,770 |
4.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,038 |
$2,595 |
3.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,508 |
$3,770 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,508 |
$3,770 |
4.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,003.60 |
$2,509 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,177 |
$2,942.50 |
5.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,496 |
$3,740 |
4.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$898.40 |
$2,246 |
3.9× |
| Myelogram Cervical (72240) |
$380 |
$950 |
0.5× |
| Myelogram Lumbar (72265) |
$365.60 |
$914 |
0.5× |
| Myelogram thoracic (72255) |
$500.40 |
$1,251 |
0.7× |
| Myelography 2 or more regions (72270) |
$500.40 |
$1,251 |
0.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,635.60 |
$6,589 |
2.1× |
| Neck soft tissue (70360) |
$95.20 |
$238 |
1.1× |
| Nm gastric emptying study (78264) |
$758 |
$1,895 |
2.0× |
| Nuclear medicine study of kidney and blood flow (78701) |
$649.60 |
$1,624 |
1.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$166.40 |
$416 |
1.7× |
| Osseous survey infant (77076) |
$120 |
$300 |
1.2× |
| Parathyroid imaging (78070) |
$649.60 |
$1,624 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$96.80 |
$242 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,496 |
$3,740 |
4.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$649.60 |
$1,624 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$838.40 |
$2,096 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$281.60 |
$704 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$166.80 |
$417 |
1.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$118.20 |
$295.50 |
1.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$122.80 |
$307 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$95.20 |
$238 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$102 |
$255 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$276.80 |
$692 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$172 |
$430 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$239.20 |
$598 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$104.40 |
$261 |
1.2× |
| Radiological examination surgical specimen (76098) |
$273.20 |
$683 |
0.5× |
| Ribs bilateral 3 views (71110) |
$128.80 |
$322 |
1.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,549.40 |
$3,873.50 |
3.0× |
| Sacroiliac Joints < 3 Views (72200) |
$95.20 |
$238 |
0.9× |
| Scapula complete (73010) |
$95.20 |
$238 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$118.80 |
$297 |
5.1× |
| Small bowel series (74250) |
$211.20 |
$528 |
1.3× |
| Spine thoracic 3 views (72072) |
$114.40 |
$286 |
1.1× |
| Testicular Imaging With Vascular Flow (78761) |
$426.80 |
$1,067 |
1.1× |
| Thoracolumbar 2 views (72080) |
$103.20 |
$258 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$649.60 |
$1,624 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$250.80 |
$627 |
2.5× |
| Us abdl aorta screen aaa (76706) |
$138.80 |
$347 |
1.4× |
| Us breast unilateral complete (76641) |
$222 |
$555 |
2.2× |
| Us chest (76604) |
$260 |
$650 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$275.60 |
$689 |
2.7× |
| Us infant hips dynamic (76885) |
$123.60 |
$309 |
1.5× |
| Us ob detailed single fetus (76811) |
$246.40 |
$616 |
1.1× |
| Us ob transvaginal (76817) |
$234.40 |
$586 |
2.3× |
| Us pelvic non ob complete (76856) |
$210.80 |
$527 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$172.80 |
$432 |
1.7× |
| Us pregnancy ltd (76815) |
$106.20 |
$265.50 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$192.80 |
$482 |
1.9× |
| Us retroperitoneal complete (76770) |
$243.60 |
$609 |
2.4× |
| Us retroperitoneal limited (76775) |
$78.80 |
$197 |
0.8× |
| Us scrotum and contents (76870) |
$222 |
$555 |
2.2× |
| Us soft tissue head/neck (76536) |
$222 |
$555 |
2.2× |
| Us xtr non-vasc lmtd (76882) |
$101.60 |
$254 |
1.0× |
| Vascular flow imaging (78445) |
$649.60 |
$1,624 |
1.7× |
| Wrist 2 views (73100) |
$95.20 |
$238 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$120 |
$300 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$108.40 |
$271 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$108.40 |
$271 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$95.20 |
$238 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$104.40 |
$261 |
1.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$148 |
$370 |
1.5× |
| X-ray exam hip uni 1 view (73501) |
$95.20 |
$238 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$111.20 |
$278 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$108.40 |
$271 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$128.80 |
$322 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$102 |
$255 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$92 |
$230 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$95.20 |
$238 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$102 |
$255 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$95.20 |
$238 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$108.40 |
$271 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$192.40 |
$481 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$95.20 |
$238 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$131.20 |
$328 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$128.80 |
$322 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$108.40 |
$271 |
1.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$423.60 |
$1,059 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$89.60 |
$224 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$108.40 |
$271 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$146 |
$365 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$102 |
$255 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$95.20 |
$238 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$111.20 |
$278 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$128.80 |
$322 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$102 |
$255 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$146 |
$365 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$102 |
$255 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$109.60 |
$274 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$116.80 |
$292 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$106.40 |
$266 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$106.40 |
$266 |
1.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$95.20 |
$238 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$108.40 |
$271 |
1.3× |
| Xr arthrogram ankle (73615) |
$322.40 |
$806 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$182.80 |
$457 |
1.8× |
| Xr finger(s) 2+ views (73140) |
$95.20 |
$238 |
1.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$97.20 |
$243 |
1.0× |
| Xr shoulder 1 view (73020) |
$95.20 |
$238 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$146 |
$365 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$95.20 |
$238 |
1.1× |
| Xr tmj bilateral (70330) |
$137.60 |
$344 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$95.20 |
$238 |
1.1× |