| Abdomen 2 views (74019) |
$207.38 |
$276.50 |
2.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$468.75 |
$625 |
1.3× |
| Ankle 2 views (73600) |
$281.25 |
$375 |
3.5× |
| Arthrogram shoulder (73040) |
$450 |
$600 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$468.75 |
$625 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$860.25 |
$1,147 |
2.3× |
| Bone age studies (77072) |
$243.75 |
$325 |
2.5× |
| Bone Imaging 3 Phase (78315) |
$491.25 |
$655 |
1.3× |
| Bone survey complete (77075) |
$885 |
$1,180 |
9.2× |
| Cervical spine 2 or 3 views (72040) |
$400.50 |
$534 |
5.0× |
| Chest 1 view (71045) |
$155.25 |
$207 |
1.9× |
| Chest 3 views (71047) |
$390 |
$520 |
4.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$351 |
$468 |
2.2× |
| Clavicle complete (73000) |
$322.12 |
$429.50 |
4.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$514.50 |
$686 |
5.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,975.50 |
$2,634 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,975.50 |
$2,634 |
9.0× |
| CT abdomen w contrast (74160) |
$1,546.50 |
$2,062 |
9.6× |
| CT abdomen w wo contrast (74170) |
$1,546.50 |
$2,062 |
9.6× |
| CT abdomen w/o contrast (74150) |
$1,546.50 |
$2,062 |
16.1× |
| CT c-spine w/o contrast (72125) |
$981.75 |
$1,309 |
10.2× |
| CT cervical spine with contrast (72126) |
$981.75 |
$1,309 |
3.1× |
| CT chest w/wo contrast (71270) |
$1,472.63 |
$1,963.50 |
9.1× |
| CT chest with contrast (71260) |
$1,104.38 |
$1,472.50 |
6.8× |
| CT head/brain with contrast (70460) |
$883.50 |
$1,178 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,128.75 |
$1,505 |
7.0× |
| CT iac w contrast (70481) |
$981.75 |
$1,309 |
6.1× |
| CT lower ext w/o (73700) |
$1,155.38 |
$1,540.50 |
12.0× |
| CT lower extremity w wo contrast (73702) |
$981.75 |
$1,309 |
6.1× |
| CT lower extremity with contrast (73701) |
$883.50 |
$1,178 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,128.75 |
$1,505 |
11.7× |
| CT lumbar spine with contrast (72132) |
$1,677.75 |
$2,237 |
5.2× |
| CT maxillofacial w contrast (70487) |
$1,539.75 |
$2,053 |
9.5× |
| CT maxillofacial w/o contrast (70486) |
$883.50 |
$1,178 |
9.2× |
| CT maxillofacial w/wo contrast (70488) |
$981.75 |
$1,309 |
6.1× |
| CT neck soft tissue w contrast (70491) |
$1,546.50 |
$2,062 |
9.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$981.75 |
$1,309 |
6.1× |
| CT orbits w/o contrast (70480) |
$1,183.50 |
$1,578 |
12.3× |
| CT pelvis w & w/o contrast (72194) |
$1,641 |
$2,188 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,641 |
$2,188 |
17.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,128.75 |
$1,505 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$883.50 |
$1,178 |
9.2× |
| CT thoracic spine w/contrast (72129) |
$981.75 |
$1,309 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$981.75 |
$1,309 |
10.2× |
| CT thorax w/o contrast (71250) |
$1,104.38 |
$1,472.50 |
11.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,128.75 |
$1,505 |
7.0× |
| CT upper extremity w/o contrast rt (73200) |
$981.75 |
$1,309 |
10.2× |
| CT upper extremity with contrast (73201) |
$981.75 |
$1,309 |
3.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,231.25 |
$2,975 |
13.8× |
| Cta Abdomen (74175) |
$1,560 |
$2,080 |
9.7× |
| CTA abdomen pelvis (74174) |
$2,400 |
$3,200 |
7.5× |
| CTA chest (71275) |
$1,753.50 |
$2,338 |
10.9× |
| Cta Head (70496) |
$1,968.75 |
$2,625 |
12.2× |
| Cta Neck (70498) |
$1,968.75 |
$2,625 |
12.2× |
| Cta Pelvis (72191) |
$1,560 |
$2,080 |
9.7× |
| Cystography minimum 3 views rs&i (74430) |
$90 |
$120 |
0.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$122.25 |
$163 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$37.88 |
$50.50 |
0.5× |
| Echoencephalography real time imaging (76506) |
$540.75 |
$721 |
5.6× |
| Esophagus (74220) |
$589.50 |
$786 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$270 |
$360 |
2.8× |
| Fluoroscopy up to 1 hr (76000) |
$176.62 |
$235.50 |
0.8× |
| Foot 2 views (73620) |
$295.50 |
$394 |
3.7× |
| Forearm 2 views (73090) |
$304.12 |
$405.50 |
3.8× |
| Hand 2 views (73120) |
$281.25 |
$375 |
2.9× |
| Hand 3 views (73130) |
$246 |
$328 |
3.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,042.50 |
$1,390 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$596.25 |
$795 |
1.6× |
| Ht muscle image spect sing (78451) |
$1,989 |
$2,652 |
1.7× |
| Humerus Min 2 Views Left (73060) |
$288 |
$384 |
3.6× |
| Hysterosalpingogram (74740) |
$637.50 |
$850 |
2.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$171.94 |
$229.25 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$686.25 |
$915 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$945 |
$1,260 |
1.9× |
| Knee 3 views (73562) |
$380.62 |
$507.50 |
4.8× |
| Lymphoscintigraphy (78195) |
$1,207.50 |
$1,610 |
2.4× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$181.13 |
$241.50 |
2.3× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$52.50 |
$70 |
2.0× |
| MRA head w & w/o contrast (70546) |
$770.25 |
$1,027 |
2.4× |
| MRA head w/o contrast (70544) |
$770.25 |
$1,027 |
3.5× |
| MRA head with contrast (70545) |
$815.06 |
$1,086.75 |
2.5× |
| MRA neck w contrast (70548) |
$770.25 |
$1,027 |
2.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$883.50 |
$1,178 |
2.8× |
| MRA neck w/o contrast (70547) |
$1,506 |
$2,008 |
6.9× |
| MRI abdomen w contrast (74182) |
$963 |
$1,284 |
3.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,730.25 |
$2,307 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$770.25 |
$1,027 |
3.5× |
| MRI any jnt lwr ext with con lt (73722) |
$770.25 |
$1,027 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,059.38 |
$1,412.50 |
1.5× |
| MRI c-spine with contrast (72142) |
$770.25 |
$1,027 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$1,551.75 |
$2,069 |
7.1× |
| MRI chest w/o & w/contrast material (71552) |
$981.75 |
$1,309 |
3.1× |
| MRI chest w/o contrast (71550) |
$770.25 |
$1,027 |
3.5× |
| MRI chest with contrast (71551) |
$801 |
$1,068 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$770.25 |
$1,027 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$770.25 |
$1,027 |
2.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,219.12 |
$1,625.50 |
5.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$770.25 |
$1,027 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$770.25 |
$1,027 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$885.94 |
$1,181.25 |
2.8× |
| MRI pelvis w contrast (72196) |
$885.94 |
$1,181.25 |
2.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$770.25 |
$1,027 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$886.50 |
$1,182 |
4.0× |
| MRI scan of arm joint before and after contrast (73223) |
$987 |
$1,316 |
3.1× |
| MRI scan of leg joint before and after contrast (73723) |
$987 |
$1,316 |
3.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$999.75 |
$1,333 |
3.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$770.25 |
$1,027 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,749.75 |
$2,333 |
5.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$770.25 |
$1,027 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$999.75 |
$1,333 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$886.50 |
$1,182 |
4.0× |
| MRI tmj (70336) |
$1,348.50 |
$1,798 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,219.12 |
$1,625.50 |
5.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,357.12 |
$1,809.50 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$886.50 |
$1,182 |
4.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,890.50 |
$3,854 |
2.4× |
| Neck soft tissue (70360) |
$169.31 |
$225.75 |
2.1× |
| Nm gastric emptying study (78264) |
$873 |
$1,164 |
2.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$461.25 |
$615 |
4.8× |
| Osseous survey limited (77074) |
$283.50 |
$378 |
2.9× |
| Parathyroid imaging (78070) |
$619.50 |
$826 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$181.13 |
$241.50 |
1.9× |
| Peritoneogram rs&i (74190) |
$336.75 |
$449 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$987 |
$1,316 |
3.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$799.50 |
$1,066 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$411.75 |
$549 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$187.50 |
$250 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$258.75 |
$345 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$433.13 |
$577.50 |
4.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$405 |
$540 |
4.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$291.75 |
$389 |
3.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$225 |
$300 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$185.63 |
$247.50 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$1,133.25 |
$1,511 |
7.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$449.62 |
$599.50 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$480 |
$640 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$278.44 |
$371.25 |
3.5× |
| Radiological examination surgical specimen (76098) |
$450 |
$600 |
0.9× |
| Ribs bilateral 3 views (71110) |
$435 |
$580 |
4.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$591.38 |
$788.50 |
1.2× |
| Sacroiliac Joints < 3 Views (72200) |
$187.69 |
$250.25 |
2.0× |
| Scanogram (77073) |
$270 |
$360 |
2.8× |
| Scapula complete (73010) |
$201.83 |
$269.10 |
2.1× |
| Screening digital breast tomosynthesis (77063) |
$87.75 |
$117 |
3.8× |
| Small bowel series (74250) |
$487.50 |
$650 |
3.0× |
| Spine thoracic 3 views (72072) |
$493.50 |
$658 |
5.1× |
| Tmj unilateral (70328) |
$108 |
$144 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$572.25 |
$763 |
6.0× |
| Unlisted Ultrasound Procedure (76999) |
$256.50 |
$342 |
3.2× |
| Upper Extremity Infant (73092) |
$271.69 |
$362.25 |
2.8× |
| Urethrocystography voiding (74455) |
$456.75 |
$609 |
2.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$637.50 |
$850 |
4.0× |
| Us abdl aorta screen aaa (76706) |
$238.50 |
$318 |
2.5× |
| Us breast unilateral complete (76641) |
$270 |
$360 |
2.8× |
| Us breast unilateral limited (76642) |
$506.25 |
$675 |
6.3× |
| Us chest (76604) |
$125.25 |
$167 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$326.25 |
$435 |
3.4× |
| Us infant hips dynamic (76885) |
$540.75 |
$721 |
6.8× |
| Us ob transvaginal (76817) |
$331.88 |
$442.50 |
3.5× |
| Us pelvic non ob complete (76856) |
$609 |
$812 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$387.75 |
$517 |
4.0× |
| Us pregnancy ltd (76815) |
$245.44 |
$327.25 |
2.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$522 |
$696 |
5.4× |
| Us retroperitoneal complete (76770) |
$337.50 |
$450 |
3.5× |
| Us retroperitoneal limited (76775) |
$256.50 |
$342 |
2.7× |
| Us scrotum and contents (76870) |
$556.50 |
$742 |
5.8× |
| Us soft tissue head/neck (76536) |
$581.25 |
$775 |
6.0× |
| Us spinal canal and contents (76800) |
$326.25 |
$435 |
3.4× |
| Us transrectal (76872) |
$363.75 |
$485 |
3.8× |
| Us xtr non-vasc lmtd (76882) |
$350.34 |
$467.12 |
3.6× |
| Wrist 2 views (73100) |
$222 |
$296 |
2.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$440.25 |
$587 |
4.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$223.13 |
$297.50 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$364.12 |
$485.50 |
4.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,133.25 |
$1,511 |
7.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$271.69 |
$362.25 |
3.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$343.50 |
$458 |
4.3× |
| X-ray exam hip uni 1 view (73501) |
$216.38 |
$288.50 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$353.25 |
$471 |
4.4× |
| X-ray eye for foreign body (70030) |
$141.75 |
$189 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$234.38 |
$312.50 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$253.13 |
$337.50 |
3.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$346.12 |
$461.50 |
4.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$304.32 |
$405.75 |
3.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$283.13 |
$377.50 |
3.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$440.25 |
$587 |
4.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$224.44 |
$299.25 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$265.50 |
$354 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$466.50 |
$622 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$652.50 |
$870 |
6.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$327 |
$436 |
4.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$181.13 |
$241.50 |
2.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$500.25 |
$667 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$297 |
$396 |
3.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$397.50 |
$530 |
4.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$397.36 |
$529.81 |
4.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$324.38 |
$432.50 |
4.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$340.60 |
$454.12 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$352.50 |
$470 |
4.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$315 |
$420 |
3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$352.50 |
$470 |
3.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$324.38 |
$432.50 |
3.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$258.75 |
$345 |
3.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$164.06 |
$218.75 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$201.83 |
$269.10 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$150.75 |
$201 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$352.50 |
$470 |
3.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$219.38 |
$292.50 |
2.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$336.75 |
$449 |
4.2× |
| Xr c-spine 6 or more views (72052) |
$442.50 |
$590 |
4.6× |
| Xr chest 4+ views (71048) |
$222.75 |
$297 |
2.3× |
| Xr finger(s) 2+ views (73140) |
$295.88 |
$394.50 |
3.7× |
| Xr shoulder 1 view (73020) |
$236.25 |
$315 |
3.0× |
| Xr spine cervical 4 or 5 views (72050) |
$384.38 |
$512.50 |
4.0× |
| Xr tibia/fibula 2 views (73590) |
$288.75 |
$385 |
3.6× |
| Xr tmj bilateral (70330) |
$123 |
$164 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$328.88 |
$438.50 |
4.1× |