| Abdomen 2 views (74019) |
$394.80 |
$658 |
4.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,153.80 |
$1,923 |
3.1× |
| Ankle 2 views (73600) |
$276 |
$460 |
3.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,288.80 |
$2,148 |
3.4× |
| Bone &/joint imaging whole body (78306) |
$1,539.60 |
$2,566 |
4.1× |
| Bone age studies (77072) |
$302.40 |
$504 |
3.1× |
| Bone Imaging 3 Phase (78315) |
$1,425 |
$2,375 |
3.8× |
| Bone survey complete (77075) |
$1,586.40 |
$2,644 |
16.2× |
| Cervical spine 2 or 3 views (72040) |
$336.60 |
$561 |
4.1× |
| Chest 1 view (71045) |
$258.60 |
$431 |
3.2× |
| Chest 3 views (71047) |
$302.40 |
$504 |
3.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$722.40 |
$1,204 |
4.4× |
| Clavicle complete (73000) |
$302.40 |
$504 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,080.20 |
$3,467 |
21.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,093 |
$10,155 |
18.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,796.80 |
$6,328 |
17.0× |
| CT abdomen w contrast (74160) |
$2,220.60 |
$3,701 |
13.5× |
| CT abdomen w wo contrast (74170) |
$2,650.80 |
$4,418 |
16.1× |
| CT abdomen w/o contrast (74150) |
$1,801.80 |
$3,003 |
18.4× |
| CT angiography upper extremity lt (73206) |
$2,464.20 |
$4,107 |
15.0× |
| CT c-spine w/o contrast (72125) |
$2,521.80 |
$4,203 |
25.7× |
| CT cervical spine w&w/o contrast (72127) |
$3,442.80 |
$5,738 |
20.9× |
| CT chest w/wo contrast (71270) |
$3,404.40 |
$5,674 |
20.7× |
| CT chest with contrast (71260) |
$2,847.60 |
$4,746 |
17.3× |
| CT head/brain with contrast (70460) |
$1,852.80 |
$3,088 |
11.3× |
| CT head/brain without and with contrast (70470) |
$2,631.60 |
$4,386 |
16.0× |
| CT iac w contrast (70481) |
$2,361.60 |
$3,936 |
14.3× |
| CT lower ext w/o (73700) |
$1,869 |
$3,115 |
19.1× |
| CT lower extremity w wo contrast (73702) |
$2,686.20 |
$4,477 |
16.3× |
| CT lower extremity with contrast (73701) |
$2,361.60 |
$3,936 |
14.3× |
| CT lumbar spine w & w/o contrast (72133) |
$3,442.80 |
$5,738 |
20.9× |
| CT lumbar spine w/o contrast (72131) |
$2,389.20 |
$3,982 |
24.4× |
| CT lumbar spine with contrast (72132) |
$2,910.60 |
$4,851 |
8.9× |
| CT maxillofacial w contrast (70487) |
$2,361.60 |
$3,936 |
14.3× |
| CT maxillofacial w/o contrast (70486) |
$1,869 |
$3,115 |
19.1× |
| CT maxillofacial w/wo contrast (70488) |
$2,686.20 |
$4,477 |
16.3× |
| CT neck soft tissue w contrast (70491) |
$2,361.60 |
$3,936 |
14.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,686.20 |
$4,477 |
16.3× |
| CT orbits w/o contrast (70480) |
$1,869 |
$3,115 |
19.1× |
| CT pelvis w & w/o contrast (72194) |
$3,442.80 |
$5,738 |
20.9× |
| CT pelvis w/o contrast (72192) |
$1,997.40 |
$3,329 |
20.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,686.20 |
$4,477 |
16.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,869 |
$3,115 |
19.1× |
| CT thoracic spine w/contrast (72129) |
$2,910.60 |
$4,851 |
17.7× |
| CT thoracic spine w/o contrast (72128) |
$2,566.80 |
$4,278 |
26.2× |
| CT thoracic spine w/wo contrast (72130) |
$3,442.80 |
$5,738 |
20.9× |
| CT thorax w/o contrast (71250) |
$2,080.20 |
$3,467 |
21.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,686.20 |
$4,477 |
16.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,869 |
$3,115 |
19.1× |
| CT upper extremity with contrast (73201) |
$2,361.60 |
$3,936 |
7.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,464.20 |
$4,107 |
15.0× |
| Cta Abdomen (74175) |
$2,464.20 |
$4,107 |
15.0× |
| CTA abdomen pelvis (74174) |
$5,686.80 |
$9,478 |
17.4× |
| CTA chest (71275) |
$3,163.20 |
$5,272 |
19.2× |
| Cta Head (70496) |
$2,464.20 |
$4,107 |
15.0× |
| CTA lwr ext w&w/o contrast (73706) |
$2,464.20 |
$4,107 |
15.0× |
| Cta Neck (70498) |
$2,464.20 |
$4,107 |
15.0× |
| Cystography minimum 3 views rs&i (74430) |
$291.60 |
$486 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$170.40 |
$284 |
1.7× |
| Echoencephalography real time imaging (76506) |
$852 |
$1,420 |
8.7× |
| Esophagus (74220) |
$721.20 |
$1,202 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$943.80 |
$1,573 |
9.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$943.80 |
$1,573 |
9.6× |
| Fluoroscopy up to 1 hr (76000) |
$489.60 |
$816 |
2.2× |
| Foot 2 views (73620) |
$260.10 |
$433.50 |
3.2× |
| Forearm 2 views (73090) |
$288 |
$480 |
3.5× |
| Gated Heart Planar Single (78472) |
$1,542.60 |
$2,571 |
4.1× |
| Hand 2 views (73120) |
$247.50 |
$412.50 |
2.5× |
| Hand 3 views (73130) |
$303 |
$505 |
3.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,539.60 |
$2,566 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$706.20 |
$1,177 |
1.9× |
| Ht muscle image spect sing (78451) |
$2,023.20 |
$3,372 |
1.7× |
| Humerus Min 2 Views Left (73060) |
$302.40 |
$504 |
3.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,539.60 |
$2,566 |
3.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,695 |
$2,825 |
3.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,695 |
$2,825 |
3.3× |
| Knee 3 views (73562) |
$319.20 |
$532 |
3.9× |
| Liver & spleen imaging static only (78215) |
$1,539.60 |
$2,566 |
4.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,612.20 |
$2,687 |
4.3× |
| Lung Ventilation Imaging (78579) |
$748.80 |
$1,248 |
2.0× |
| Lymphoscintigraphy (78195) |
$852 |
$1,420 |
1.7× |
| MRA head w/o contrast (70544) |
$3,051.60 |
$5,086 |
13.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,265.80 |
$5,443 |
10.0× |
| MRA neck w/o contrast (70547) |
$3,051.60 |
$5,086 |
13.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,135 |
$5,225 |
9.6× |
| MRI abdomen w/o contrast (74181) |
$2,929.80 |
$4,883 |
13.1× |
| MRI cervical spine w/o contrast (72141) |
$3,517.20 |
$5,862 |
15.7× |
| MRI chest w/o contrast (71550) |
$3,763.20 |
$6,272 |
16.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,336.40 |
$3,894 |
10.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,763.20 |
$6,272 |
16.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$6,022.20 |
$10,037 |
18.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,763.20 |
$6,272 |
11.5× |
| MRI pelvis w/o contrast (72195) |
$3,517.20 |
$5,862 |
15.7× |
| MRI scan of arm joint before and after contrast (73223) |
$3,763.20 |
$6,272 |
11.5× |
| MRI scan of leg joint before and after contrast (73723) |
$3,763.20 |
$6,272 |
11.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,716.80 |
$9,528 |
17.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,315.80 |
$7,193 |
13.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,716.80 |
$9,528 |
17.5× |
| MRI thoracic spine w/o contrast (72146) |
$3,763.20 |
$6,272 |
16.8× |
| MRI upper ext joint w/o contrast (73221) |
$3,517.20 |
$5,862 |
15.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,766.80 |
$6,278 |
11.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,712.60 |
$4,521 |
12.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,185.60 |
$1,976 |
1.0× |
| Neck soft tissue (70360) |
$276 |
$460 |
3.4× |
| Nm gastric emptying study (78264) |
$1,569 |
$2,615 |
4.2× |
| Osseous survey infant (77076) |
$394.80 |
$658 |
4.0× |
| Parathyroid imaging (78070) |
$928.20 |
$1,547 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$302.40 |
$504 |
3.1× |
| PET image w/CT, skull-thigh (78815) |
$5,751 |
$9,585 |
4.3× |
| PET imaging for CT attenuation whole body (78816) |
$5,751 |
$9,585 |
4.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,763.20 |
$6,272 |
11.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$801.60 |
$1,336 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,641.60 |
$2,736 |
3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$550.20 |
$917 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$648 |
$1,080 |
6.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$577.80 |
$963 |
5.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$845.40 |
$1,409 |
8.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$489.60 |
$816 |
5.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$302.40 |
$504 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$405 |
$675 |
4.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$302.40 |
$504 |
3.7× |
| Radiologic exam colon single contrast study (74270) |
$1,018.80 |
$1,698 |
6.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,225.20 |
$2,042 |
7.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,149 |
$1,915 |
7.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$302.40 |
$504 |
3.7× |
| Radiological examination surgical specimen (76098) |
$1,066.80 |
$1,778 |
2.1× |
| Ribs bilateral 3 views (71110) |
$592.20 |
$987 |
6.0× |
| Sacroiliac Joints < 3 Views (72200) |
$302.40 |
$504 |
3.1× |
| Scanogram (77073) |
$305.40 |
$509 |
3.1× |
| Scapula complete (73010) |
$302.40 |
$504 |
3.1× |
| Screening digital breast tomosynthesis (77063) |
$40.20 |
$67 |
1.7× |
| Small bowel series (74250) |
$574.20 |
$957 |
3.5× |
| Spine thoracic 3 views (72072) |
$460.80 |
$768 |
4.7× |
| Thoracolumbar 2 views (72080) |
$406.80 |
$678 |
5.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,055.40 |
$1,759 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$616.20 |
$1,027 |
6.3× |
| Upper Extremity Infant (73092) |
$222.60 |
$371 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$438.60 |
$731 |
4.5× |
| Us breast unilateral complete (76641) |
$426.60 |
$711 |
4.3× |
| Us breast unilateral limited (76642) |
$112.80 |
$188 |
1.4× |
| Us chest (76604) |
$1,012.20 |
$1,687 |
10.3× |
| Us compl joint r-t w/image documentation (76881) |
$246 |
$410 |
2.5× |
| Us elastography parenchyma (76981) |
$127.20 |
$212 |
1.3× |
| Us infant hips dynamic (76885) |
$733.20 |
$1,222 |
9.0× |
| Us ob transvaginal (76817) |
$879 |
$1,465 |
9.0× |
| Us pelvic non ob complete (76856) |
$844.80 |
$1,408 |
8.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$400.20 |
$667 |
4.1× |
| Us pregnancy ltd (76815) |
$702 |
$1,170 |
7.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$879 |
$1,465 |
9.0× |
| Us retroperitoneal complete (76770) |
$538.20 |
$897 |
5.5× |
| Us retroperitoneal limited (76775) |
$151.20 |
$252 |
1.5× |
| Us scrotum and contents (76870) |
$962.40 |
$1,604 |
9.8× |
| Us soft tissue head/neck (76536) |
$764.40 |
$1,274 |
7.8× |
| Us spinal canal and contents (76800) |
$436.80 |
$728 |
4.5× |
| Us transrectal prostate volume (76873) |
$192 |
$320 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$126.60 |
$211 |
1.3× |
| Wrist 2 views (73100) |
$273.60 |
$456 |
3.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$693 |
$1,155 |
7.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$320.40 |
$534 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,188 |
$1,980 |
7.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$260.40 |
$434 |
3.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$336.60 |
$561 |
4.1× |
| X-ray exam hip uni 1 view (73501) |
$291.60 |
$486 |
3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$294.60 |
$491 |
3.6× |
| X-ray exam hip uni 4/> views (73503) |
$305.40 |
$509 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$577.80 |
$963 |
5.9× |
| X-ray exam of femur 1 (73551) |
$148.80 |
$248 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$436.80 |
$728 |
4.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$302.40 |
$504 |
3.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$305.40 |
$509 |
3.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$288 |
$480 |
3.5× |
| X-ray IV pyelogram+drip infusn (74410) |
$937.80 |
$1,563 |
5.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$124.20 |
$207 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$366.60 |
$611 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$516 |
$860 |
6.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$273.60 |
$456 |
3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$349.80 |
$583 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$845.40 |
$1,409 |
8.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$478.20 |
$797 |
4.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$302.40 |
$504 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$499.20 |
$832 |
5.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$394.20 |
$657 |
4.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$385.20 |
$642 |
4.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$471 |
$785 |
4.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$678.60 |
$1,131 |
6.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$435.60 |
$726 |
4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$336.60 |
$561 |
4.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$302.40 |
$504 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$489 |
$815 |
6.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$302.40 |
$504 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$489.60 |
$816 |
5.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$302.40 |
$504 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$302.40 |
$504 |
3.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$302.40 |
$504 |
3.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$406.80 |
$678 |
4.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$574.20 |
$957 |
5.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$304.80 |
$508 |
3.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$334.80 |
$558 |
4.1× |
| Xr c-spine 6 or more views (72052) |
$592.20 |
$987 |
6.0× |
| Xr chest 4+ views (71048) |
$349.80 |
$583 |
3.6× |
| Xr finger(s) 2+ views (73140) |
$243.60 |
$406 |
3.0× |
| Xr shoulder 1 view (73020) |
$264 |
$440 |
3.2× |
| Xr spine cervical 4 or 5 views (72050) |
$441.60 |
$736 |
4.5× |
| Xr tibia/fibula 2 views (73590) |
$305.40 |
$509 |
3.7× |
| Xray knee 1 or 2 views rt (73560) |
$281.40 |
$469 |
3.4× |