| Abdomen 2 views (74019) |
$128.40 |
$321 |
1.3× |
| Acute gastrointestinal blood loss imaging (78278) |
$466.80 |
$1,167 |
1.3× |
| Ankle 2 views (73600) |
$104.40 |
$261 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$466.80 |
$1,167 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$466.80 |
$1,167 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$603.87 |
$1,509.67 |
1.7× |
| Bone age studies (77072) |
$128.40 |
$321 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$535.90 |
$1,339.74 |
1.5× |
| Bone survey complete (77075) |
$140.78 |
$351.96 |
1.5× |
| Brain image w/flow 4 + views (78606) |
$605.60 |
$1,514 |
1.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$605.60 |
$1,514 |
1.2× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,830 |
$4,575 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$104.40 |
$261 |
1.3× |
| Chest 1 view (71045) |
$104.40 |
$261 |
1.3× |
| Chest 3 views (71047) |
$104.40 |
$261 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$216.80 |
$542 |
1.4× |
| Clavicle complete (73000) |
$104.40 |
$261 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,552 |
$3,880 |
4.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,152 |
$2,880 |
5.3× |
| CT abdomen w contrast (74160) |
$604.88 |
$1,512.20 |
3.8× |
| CT abdomen w wo contrast (74170) |
$847.54 |
$2,118.84 |
5.3× |
| CT abdomen w/o contrast (74150) |
$596.94 |
$1,492.36 |
6.3× |
| CT angiography upper extremity lt (73206) |
$218.20 |
$545.50 |
1.4× |
| CT c-spine w/o contrast (72125) |
$508.32 |
$1,270.80 |
5.3× |
| CT cervical spine w&w/o contrast (72127) |
$775.92 |
$1,939.80 |
4.9× |
| CT cervical spine with contrast (72126) |
$624.24 |
$1,560.60 |
2.0× |
| CT chest w/wo contrast (71270) |
$775.96 |
$1,939.90 |
4.9× |
| CT chest with contrast (71260) |
$702.13 |
$1,755.33 |
4.4× |
| CT head/brain with contrast (70460) |
$601.33 |
$1,503.33 |
3.8× |
| CT head/brain without and with contrast (70470) |
$740.76 |
$1,851.89 |
4.6× |
| CT iac w contrast (70481) |
$216.80 |
$542 |
1.4× |
| CT limited/localized follow up study (76380) |
$341.72 |
$854.30 |
4.3× |
| CT lower ext w/o (73700) |
$469.10 |
$1,172.75 |
4.9× |
| CT lower extremity w wo contrast (73702) |
$654.08 |
$1,635.20 |
4.1× |
| CT lower extremity with contrast (73701) |
$524.76 |
$1,311.90 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$775.92 |
$1,939.80 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$508.32 |
$1,270.80 |
5.3× |
| CT lumbar spine with contrast (72132) |
$624.24 |
$1,560.60 |
2.0× |
| CT maxillofacial w contrast (70487) |
$503.20 |
$1,258 |
3.2× |
| CT maxillofacial w/o contrast (70486) |
$442.84 |
$1,107.10 |
4.7× |
| CT maxillofacial w/wo contrast (70488) |
$670.40 |
$1,676 |
4.2× |
| CT neck soft tissue w contrast (70491) |
$503.20 |
$1,258 |
3.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$670.40 |
$1,676 |
4.2× |
| CT orbits w/o contrast (70480) |
$670.40 |
$1,676 |
7.0× |
| CT pelvis w & w/o contrast (72194) |
$782.55 |
$1,956.38 |
4.9× |
| CT pelvis w/o contrast (72192) |
$554.35 |
$1,385.87 |
5.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$624.24 |
$1,560.60 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$442.84 |
$1,107.10 |
4.7× |
| CT thoracic spine w/contrast (72129) |
$624.24 |
$1,560.60 |
3.9× |
| CT thoracic spine w/o contrast (72128) |
$508.32 |
$1,270.80 |
5.3× |
| CT thoracic spine w/wo contrast (72130) |
$775.92 |
$1,939.80 |
4.9× |
| CT thorax w/o contrast (71250) |
$508.32 |
$1,270.80 |
5.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$654.08 |
$1,635.20 |
4.1× |
| CT upper extremity w/o contrast rt (73200) |
$405.76 |
$1,014.40 |
4.3× |
| CT upper extremity with contrast (73201) |
$524.96 |
$1,312.40 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$536.80 |
$1,342 |
3.4× |
| Cta Abdomen (74175) |
$686.40 |
$1,716 |
4.3× |
| CTA abdomen pelvis (74174) |
$579.10 |
$1,447.74 |
1.8× |
| CTA chest (71275) |
$624 |
$1,560 |
3.9× |
| Cta Head (70496) |
$624 |
$1,560 |
3.9× |
| CTA lwr ext w&w/o contrast (73706) |
$218.20 |
$545.50 |
1.4× |
| Cta Neck (70498) |
$624 |
$1,560 |
3.9× |
| Cta Pelvis (72191) |
$624 |
$1,560 |
3.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$128.40 |
$321 |
1.3× |
| Esophagus (74220) |
$216.80 |
$542 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$280.40 |
$701 |
1.3× |
| Foot 2 views (73620) |
$104.40 |
$261 |
1.3× |
| Forearm 2 views (73090) |
$104.40 |
$261 |
1.3× |
| Gated Heart Planar Single (78472) |
$466.80 |
$1,167 |
1.3× |
| Hand 2 views (73120) |
$128.40 |
$321 |
1.3× |
| Hand 3 views (73130) |
$104.40 |
$261 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$605.60 |
$1,514 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$466.80 |
$1,167 |
1.3× |
| Ht muscle image spect sing (78451) |
$1,592.80 |
$3,982 |
1.4× |
| Humerus Min 2 Views Left (73060) |
$104.40 |
$261 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$605.60 |
$1,514 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$605.60 |
$1,514 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$605.60 |
$1,514 |
1.2× |
| Knee 3 views (73562) |
$104.40 |
$261 |
1.3× |
| Liver & spleen imaging static only (78215) |
$466.80 |
$1,167 |
1.3× |
| Lung perf&ventilat diferentl (78598) |
$605.60 |
$1,514 |
1.2× |
| Lung Ventilation Imaging (78579) |
$466.80 |
$1,167 |
1.3× |
| Lymphoscintigraphy (78195) |
$605.60 |
$1,514 |
1.2× |
| Meckels Diverticulum (78290) |
$466.80 |
$1,167 |
1.3× |
| MRA head w & w/o contrast (70546) |
$800 |
$2,000 |
2.5× |
| MRA head w/o contrast (70544) |
$480 |
$1,200 |
2.2× |
| MRA head with contrast (70545) |
$640 |
$1,600 |
2.0× |
| MRA neck w contrast (70548) |
$640 |
$1,600 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$800 |
$2,000 |
2.5× |
| MRA neck w/o contrast (70547) |
$480 |
$1,200 |
2.2× |
| MRI abdomen w contrast (74182) |
$640 |
$1,600 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$800 |
$2,000 |
2.5× |
| MRI abdomen w/o contrast (74181) |
$480 |
$1,200 |
2.2× |
| MRI any jnt lwr ext with con lt (73722) |
$880 |
$2,200 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$880 |
$2,200 |
1.2× |
| MRI c-spine with contrast (72142) |
$640 |
$1,600 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$480 |
$1,200 |
2.2× |
| MRI chest w/o & w/contrast material (71552) |
$800 |
$2,000 |
2.5× |
| MRI chest w/o contrast (71550) |
$480 |
$1,200 |
2.2× |
| MRI chest with contrast (71551) |
$880 |
$2,200 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$640 |
$1,600 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$640 |
$1,600 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$480 |
$1,200 |
2.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$480 |
$1,200 |
2.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$800 |
$2,000 |
2.5× |
| MRI orbit/face/neck w/contrast (70542) |
$640 |
$1,600 |
2.0× |
| MRI pelvis w contrast (72196) |
$640 |
$1,600 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$800 |
$2,000 |
2.5× |
| MRI pelvis w/o contrast (72195) |
$480 |
$1,200 |
2.2× |
| MRI scan of arm joint before and after contrast (73223) |
$800 |
$2,000 |
2.5× |
| MRI scan of leg joint before and after contrast (73723) |
$800 |
$2,000 |
2.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$800 |
$2,000 |
2.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$640 |
$1,600 |
2.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$800 |
$2,000 |
2.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$640 |
$1,600 |
2.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$800 |
$2,000 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$480 |
$1,200 |
2.2× |
| MRI tmj (70336) |
$480 |
$1,200 |
2.2× |
| MRI upper ext joint w/o contrast (73221) |
$480 |
$1,200 |
2.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$800 |
$2,000 |
2.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$480 |
$1,200 |
2.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,592.80 |
$3,982 |
1.4× |
| Neck soft tissue (70360) |
$104.40 |
$261 |
1.3× |
| Nm gastric emptying study (78264) |
$466.80 |
$1,167 |
1.3× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,592.80 |
$3,982 |
1.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$466.80 |
$1,167 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$128.40 |
$321 |
1.3× |
| Osseous survey infant (77076) |
$128.40 |
$321 |
1.3× |
| Parathyrd planar w/wo subtrj (78071) |
$466.80 |
$1,167 |
1.3× |
| Parathyroid imaging (78070) |
$466.80 |
$1,167 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$128.40 |
$321 |
1.3× |
| PET image w/CT, skull-thigh (78815) |
$1,830 |
$4,575 |
1.4× |
| PET imaging for CT attenuation whole body (78816) |
$1,830 |
$4,575 |
1.4× |
| Pr heart first pass single,planar (78481) |
$605.60 |
$1,514 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$800 |
$2,000 |
2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$466.80 |
$1,167 |
1.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$668.36 |
$1,670.90 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$604 |
$1,510 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$104.40 |
$261 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$128.40 |
$321 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$128.40 |
$321 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$196 |
$490 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$128.40 |
$321 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$104.40 |
$261 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$104.40 |
$261 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$216.80 |
$542 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$216.80 |
$542 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$216.80 |
$542 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$104.40 |
$261 |
1.3× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$120.96 |
$302.40 |
1.5× |
| Ribs bilateral 3 views (71110) |
$128.40 |
$321 |
1.3× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$466.80 |
$1,167 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,592.80 |
$3,982 |
3.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,592.80 |
$3,982 |
3.2× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,592.80 |
$3,982 |
1.4× |
| Scapula complete (73010) |
$128.40 |
$321 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$54 |
$135 |
2.3× |
| Sella turcica (70240) |
$104.40 |
$261 |
1.3× |
| Small bowel series (74250) |
$216.80 |
$542 |
1.4× |
| Therapeutic Enema (74283) |
$220.28 |
$550.70 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$466.80 |
$1,167 |
1.3× |
| Thyroid uptake measurement (78012) |
$466.80 |
$1,167 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$466.80 |
$1,167 |
1.3× |
| Tomogram (76100) |
$107.36 |
$268.40 |
1.1× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$466.80 |
$1,167 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$241.63 |
$604.08 |
2.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$251.60 |
$629 |
1.6× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$234.07 |
$585.18 |
1.5× |
| Us breast unilateral complete (76641) |
$128.40 |
$321 |
1.3× |
| Us breast unilateral limited (76642) |
$104.40 |
$261 |
1.3× |
| Us chest (76604) |
$128.40 |
$321 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$128.40 |
$321 |
1.3× |
| Us ob transvaginal (76817) |
$196 |
$490 |
2.1× |
| Us pelvic non ob complete (76856) |
$131.56 |
$328.90 |
1.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$128.40 |
$321 |
1.3× |
| Us pregnancy ltd (76815) |
$180 |
$450 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$220 |
$550 |
2.3× |
| Us retroperitoneal complete (76770) |
$216.80 |
$542 |
2.3× |
| Us retroperitoneal limited (76775) |
$128.40 |
$321 |
1.3× |
| Us scrotum and contents (76870) |
$131.56 |
$328.90 |
1.4× |
| Us soft tissue head/neck (76536) |
$128.40 |
$321 |
1.3× |
| Us xtr non-vasc lmtd (76882) |
$128.40 |
$321 |
1.3× |
| Venogram extremity bilateral (75822) |
$220 |
$550 |
0.2× |
| Wrist 2 views (73100) |
$104.40 |
$261 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$200 |
$500 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$104.40 |
$261 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$104.40 |
$261 |
1.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$216.80 |
$542 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$104.40 |
$261 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$104.40 |
$261 |
1.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$196 |
$490 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$104.40 |
$261 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$104.40 |
$261 |
1.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$216.80 |
$542 |
1.4× |
| X-ray eye for foreign body (70030) |
$104.40 |
$261 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$128.40 |
$321 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$104.40 |
$261 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$104.40 |
$261 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$104.40 |
$261 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$104.40 |
$261 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$128.40 |
$321 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$104.40 |
$261 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$128.40 |
$321 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$104.40 |
$261 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$128.40 |
$321 |
1.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$442.40 |
$1,106 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$104.40 |
$261 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$128.40 |
$321 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$128.40 |
$321 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$128.40 |
$321 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$104.40 |
$261 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$109.76 |
$274.39 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$104.40 |
$261 |
1.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$104.40 |
$261 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$128.40 |
$321 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$128.40 |
$321 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$104.40 |
$261 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$104.40 |
$261 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$128.40 |
$321 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$104.40 |
$261 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$104.40 |
$261 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$128.40 |
$321 |
1.3× |
| Xr chest 4+ views (71048) |
$128.40 |
$321 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$104.40 |
$261 |
1.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$128.40 |
$321 |
1.3× |
| Xr shoulder 1 view (73020) |
$104.40 |
$261 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$176.97 |
$442.42 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$104.40 |
$261 |
1.3× |
| Xr tmj bilateral (70330) |
$104.40 |
$261 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$104.40 |
$261 |
1.3× |