| Acute gi blood loss imaging (78278) |
$729 |
$1,458 |
1.7× |
| Ankle 2 views (73600) |
$150 |
$300 |
1.7× |
| Barium enema (74270) |
$265 |
$476 |
1.4× |
| Bone age studies (77072) |
$156 |
$300 |
1.4× |
| Bone imaging limited area (78300) |
$729 |
$1,458 |
1.7× |
| Bone survey complete (77075) |
$150 |
$503 |
1.4× |
| Bowel imaging (78290) |
$729 |
$1,458 |
1.7× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$729 |
$1,458 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$238 |
$530 |
1.3× |
| Clavicle complete (73000) |
$142 |
$284 |
1.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$729 |
$1,510 |
4.0× |
| CT - st neck w&wo contr (70492) |
$755 |
$1,563 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$768.25 |
$1,510.50 |
2.1× |
| CT abdomen and pelvis without contrast (74176) |
$729 |
$1,458 |
2.9× |
| CT abdomen w wo contrast (74170) |
$755 |
$1,563 |
4.1× |
| CT abdomen w/contrast (74160) |
$729 |
$1,510 |
4.0× |
| CT abdomen w/o contrast (74150) |
$150 |
$1,458 |
1.4× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$781.50 |
$1,060 |
2.1× |
| CT angio abdom w/o & w/dye (74175) |
$530 |
$1,458 |
2.9× |
| CT angio abdominal arteries (75635) |
$52 |
$1,458 |
0.3× |
| CT angiograph pelv w/o&w/dye (72191) |
$150 |
$1,563 |
0.8× |
| CT cervical spine w/contrast (72126) |
$729 |
$1,510 |
2.0× |
| CT cervical spine w/o contrast (72125) |
$150 |
$1,458 |
1.4× |
| CT chest w/contrast (71260) |
$729 |
$1,510 |
4.0× |
| CT extremity upper w & w/o contrast (73202) |
$781.50 |
$1,563 |
4.3× |
| CT head/brain with contrast (70460) |
$729 |
$1,510 |
4.0× |
| CT head/brain without and with contrast (70470) |
$755 |
$1,563 |
4.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$532 |
$104 |
5.9× |
| CT lower ext w/wo contrast (73702) |
$1,119.50 |
$2,239 |
6.1× |
| CT lower extremity w contrast (73701) |
$755 |
$1,510 |
4.1× |
| CT lower extremity w/o contrast unilateral (73700) |
$729 |
$1,458 |
6.7× |
| CT lumbar spine w/contrast (72132) |
$729 |
$1,510 |
2.0× |
| CT lumbar spine w/o contrast (72131) |
$781.50 |
$1,458 |
7.2× |
| CT lumbar spine w/o then w/ con (72133) |
$755 |
$1,563 |
4.1× |
| CT maxillofacial area w/o contrast (70486) |
$755.25 |
$1,458 |
6.9× |
| CT maxillofacial w/contrast (70487) |
$742 |
$1,510 |
4.1× |
| CT maxillofacial w/o then w/ con (70488) |
$755 |
$1,563 |
4.1× |
| CT orbit sella ear w/o con (70480) |
$729 |
$1,458 |
6.7× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$768.25 |
$1,563 |
4.2× |
| CT pelvis w & w/o contrast (72194) |
$755 |
$1,563 |
4.1× |
| CT pelvis w/o contrast (72192) |
$781.50 |
$1,458 |
7.2× |
| CT soft tissue neck w/contrast (70491) |
$729 |
$1,510 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$781.50 |
$1,458 |
7.2× |
| CT spine cervical w/wo contrast (72127) |
$755 |
$1,563 |
4.1× |
| CT thoracic spine w/contrast (72129) |
$729 |
$1,510 |
4.0× |
| CT thoracic spine w/o contrast (72128) |
$781.50 |
$1,458 |
7.2× |
| CT thoracic spine w/o then w/ con (72130) |
$755 |
$1,563 |
4.1× |
| CT thorax lung cancer scr c- (71271) |
$755.25 |
$1,458 |
6.9× |
| CT thorax w/o contrast (71250) |
$142 |
$1,458 |
1.3× |
| CT thorax w/o then w/ contrast (71270) |
$755 |
$1,563 |
4.1× |
| CT upper extremity w/dye (73201) |
$1,106.25 |
$1,510 |
3.0× |
| CT upper extremity w/o contrast rt (73200) |
$729 |
$1,458 |
6.7× |
| CTA chest w/wo contrast (71275) |
$729 |
$1,458 |
4.0× |
| CTA head w contrast (70496) |
$781.50 |
$1,458 |
4.3× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$781.50 |
$1,458 |
4.3× |
| Cta Neck (70498) |
$729 |
$1,458 |
4.0× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$729 |
$1,458 |
4.0× |
| Esophogram (74220) |
$590.75 |
$503 |
3.2× |
| Fetal biophysical profile w/o nst (76819) |
$253.50 |
$426 |
2.3× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$729 |
$503 |
2.9× |
| Gastric emptying study (78264) |
$729 |
$1,458 |
1.7× |
| Gated heart planar single (78472) |
$1,798 |
$1,458 |
4.3× |
| Hepatobil syst image w/drug (78227) |
$729 |
$1,458 |
1.3× |
| Hepatobiliary system imaging (78226) |
$1,093.25 |
$1,458 |
2.6× |
| Humerus min 2 views (73060) |
$150 |
$284 |
1.7× |
| Hysterosalpingography (74740) |
$419 |
$1,064 |
1.7× |
| Ivp (74400) |
$142 |
$836 |
0.8× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$729 |
$1,458 |
1.3× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$729 |
$2,426 |
1.3× |
| Lung ventilat&perfus imaging (78582) |
$729 |
$1,458 |
1.3× |
| Lung ventilation imaging (78579) |
$729 |
$1,458 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$1,832.50 |
$1,833 |
5.0× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$916.50 |
$1,833 |
2.5× |
| MRA head w/o contrast (70544) |
$916.50 |
$1,728 |
3.7× |
| MRA neck w/o contrast (70547) |
$864 |
$1,728 |
3.5× |
| MRI abdomen w/contrast (74182) |
$864 |
$1,780 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$890 |
$1,833 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$796.50 |
$1,728 |
3.2× |
| MRI any jnt lwr ext with con lt (73722) |
$890 |
$1,780 |
1.1× |
| MRI cervical spine w/o contrast (72141) |
$781.50 |
$1,728 |
3.1× |
| MRI cervical spine with contrast (72142) |
$864 |
$1,780 |
2.4× |
| MRI chest w & w/o contrast (71552) |
$864 |
$1,833 |
2.4× |
| MRI chest w/o contrast (71550) |
$729 |
$1,728 |
2.9× |
| MRI joint upper ext w/contrast (73222) |
$877 |
$1,780 |
1.1× |
| MRI joint upr extr w/o&w/dye (73223) |
$903.25 |
$1,833 |
2.5× |
| MRI joint upr extrem w/o dye (73221) |
$916.50 |
$1,728 |
3.7× |
| Mri Lower Extremity W/O Dye (73718) |
$890 |
$1,780 |
3.6× |
| MRI lumbar spine with contrast (72149) |
$864 |
$1,780 |
2.4× |
| MRI lumbar w/wo contrast (72158) |
$916.50 |
$1,833 |
2.5× |
| MRI lwr ext w/o jnts with con rt (73719) |
$1,296.25 |
$1,756 |
3.6× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$890.25 |
$1,833 |
2.4× |
| MRI orbit/face/neck w/o contrast (70540) |
$864 |
$1,728 |
3.5× |
| MRI pelvis w/o contrast (72195) |
$822.75 |
$1,728 |
3.3× |
| MRI pelvis w/wo contrast (72197) |
$864 |
$1,833 |
2.4× |
| MRI spine cervical wo/w contrast (72156) |
$890 |
$1,833 |
2.4× |
| MRI spine thoracic w/contrast (72147) |
$864 |
$1,780 |
2.4× |
| MRI thoracic spine w wo contrast (72157) |
$916.50 |
$1,833 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$890 |
$1,728 |
3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$864 |
$1,728 |
3.5× |
| Mri Upper Extremity W/Dye (73219) |
$877 |
$1,780 |
2.4× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$916.50 |
$1,833 |
2.5× |
| Myocardial spect single study at rest or stress (78451) |
$781.50 |
$3,594 |
0.6× |
| Nm bone 3 phase (78315) |
$807.50 |
$1,563 |
1.9× |
| Nm bone imaging whole body (78306) |
$729 |
$1,615 |
1.7× |
| Nm heart perfusion spect stress rest (78452) |
$1,797 |
$3,595 |
1.3× |
| Nm lymph system (78195) |
$667.75 |
$2,186.50 |
1.2× |
| Nm thyroid imaging only (78013) |
$142 |
$1,458 |
0.3× |
| Nose to rectum for fb child (76010) |
$201 |
$281 |
2.2× |
| Nuclear rx IV admin (79101) |
$1,113 |
$728 |
4.6× |
| Ob us < 14 wks single fetus (76801) |
$106.50 |
$213 |
1.0× |
| Pulmonary perfusion imaging particulate (78580) |
$729 |
$1,458 |
1.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$130.50 |
$1,062 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$150 |
$284 |
1.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$529.25 |
$284 |
5.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$142 |
$284 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$146 |
$300 |
1.3× |
| Radex spine cervical 2 or 3 views (72040) |
$150 |
$300 |
1.7× |
| Radex spine cervical 4 or 5 views (72050) |
$251.50 |
$300 |
2.3× |
| Radex spine cervical 6 or more views (72052) |
$150 |
$503 |
1.4× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$150 |
$300 |
1.7× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$128 |
$384 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$238.50 |
$477 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$265 |
$476 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$142 |
$284 |
1.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$142 |
$300 |
1.3× |
| Radiologic examination, single plane body section (eg, tomography), other than with urography Other Diagnostic… (76100) |
$531 |
$300 |
4.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,213 |
$2,226 |
2.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$1,113 |
$2,226 |
2.0× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$729 |
$312 |
31.2× |
| Shoulder arthrogram (73040) |
$341.75 |
$1,067 |
0.9× |
| Small bowel series (74250) |
$212.75 |
$425.50 |
1.2× |
| Therapeutic enema barium or air (74283) |
$238 |
$476 |
1.3× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$729 |
$1,213 |
1.7× |
| Ultrasound breast limited (76642) |
$184.50 |
$369 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$239 |
$426 |
2.2× |
| Urethrocystography voiding (74455) |
$418 |
$838 |
1.7× |
| Urography antegrade (74425) |
$418 |
$837 |
1.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$213 |
$557 |
2.0× |
| Us breast uni real time with image complete (76641) |
$213 |
$369 |
2.0× |
| Us chest (76604) |
$213 |
$426 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$283.50 |
$565 |
2.6× |
| Us elastography parenchyma (76981) |
$184.50 |
$353 |
1.7× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$276.50 |
$455 |
2.5× |
| Us ob detailed single fetus (76811) |
$184.50 |
$683 |
0.7× |
| Us ob followup per fetus (76816) |
$213 |
$369 |
2.0× |
| Us ob limited 1 or more fetuses (76815) |
$341.50 |
$426 |
3.1× |
| Us obstetric transvaginal (76817) |
$184.50 |
$588 |
1.7× |
| Us pelvic limited or f/u non-ob (76857) |
$184.50 |
$369 |
1.7× |
| Us pelvis complete (76856) |
$288.50 |
$426 |
2.6× |
| Us retroperitoneal complete (76770) |
$285 |
$583 |
2.6× |
| Us retroperitoneal limited (76775) |
$291.50 |
$426 |
2.7× |
| Us scrotum (76870) |
$184.50 |
$567 |
1.7× |
| Us soft tissue head/neck (76536) |
$223.25 |
$490.50 |
2.0× |
| Us spinal canal (76800) |
$213 |
$426 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$533.50 |
$599 |
5.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$299.50 |
$300 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$238 |
$476 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$142 |
$284 |
1.6× |
| X-ray exam of finger(s) (73140) |
$142 |
$284 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$150 |
$284 |
1.7× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$142 |
$284 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$142 |
$284 |
1.6× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$142 |
$284 |
1.3× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$142 |
$284 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$212.75 |
$284 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$114.50 |
$284 |
1.3× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$283.50 |
$284 |
3.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$150 |
$300 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$299.50 |
$284 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$142 |
$300 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$150 |
$300 |
1.4× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$150 |
$300 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$167 |
$284 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$150 |
$384 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$916.50 |
$300 |
8.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$150 |
$284 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$150 |
$300 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$142 |
$300 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$150 |
$300 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$142 |
$284 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$212.75 |
$425.50 |
2.3× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$283.50 |
$284 |
3.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$142 |
$284 |
1.6× |
| Xr abdomen 1 view (74018) |
$142.50 |
$285 |
1.6× |
| Xr abdomen 2 views (74019) |
$150 |
$300 |
1.4× |
| Xr bone density appendicular (77081) |
$150 |
$284 |
1.7× |
| Xr bone density axial (77080) |
$150 |
$300 |
1.4× |
| Xr bone length study (77073) |
$150 |
$300 |
1.4× |
| Xr bone survey infant (77076) |
$251.50 |
$300 |
2.3× |
| Xr bone survey limited (77074) |
$150 |
$300 |
1.4× |
| Xr chest 1 view (71045) |
$128 |
$256 |
1.4× |
| Xr chest 2 views (71046) |
$128 |
$300 |
1.4× |
| Xr chest 3 views (71047) |
$150 |
$256 |
1.7× |
| Xr cystogram 3+ views (74430) |
$419 |
$836 |
1.2× |
| Xr facial bones 3 views (70150) |
$142 |
$300 |
1.3× |
| Xr lower extremity 2 views infant (73592) |
$283.50 |
$300 |
3.1× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$150 |
$300 |
1.4× |
| Xr mandible 4 views (70110) |
$142 |
$300 |
1.3× |
| Xr nasal bones (70160) |
$150 |
$284 |
1.7× |
| Xr pelvis 3 views (72190) |
$150 |
$300 |
1.4× |
| Xr spine 1 view (72020) |
$529.25 |
$284 |
5.8× |
| Xr sternum 2 views (71120) |
$192 |
$284 |
2.1× |
| Xr surgical specimen (76098) |
$531 |
$1,062 |
0.9× |
| Xr upper extremity 2 views infant (73092) |
$150 |
$300 |
1.4× |
| Xray elbow 2 views (73070) |
$142 |
$284 |
1.6× |
| Xray forearm 2 views (73090) |
$142 |
$284 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$142 |
$284 |
1.6× |
| Xray neck soft tissue (70360) |
$283.50 |
$284 |
3.1× |
| Xray orbits complete min 4 views (70200) |
$142 |
$300 |
1.3× |
| Xray pelvis 1 or 2 views (72170) |
$916.50 |
$300 |
8.4× |
| Xray ribs bilateral 3 views (71110) |
$150 |
$300 |
1.4× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$146 |
$300 |
1.3× |
| Xray scapula complete (73010) |
$142 |
$284 |
1.3× |
| Xray shoulder 1 view (73020) |
$142 |
$284 |
1.6× |
| Xray sinuses paranasal <3 views (70210) |
$150 |
$284 |
1.7× |
| Xray spine thoracic 2 views (72070) |
$251.50 |
$300 |
2.3× |
| Xray spine thoracic 3 views (72072) |
$150 |
$300 |
1.4× |
| Xray tibia-fibula 2 views bil (73590) |
$142 |
$284 |
1.6× |
| Xray tmj open - closed unilat (70328) |
$150 |
$284 |
1.7× |
| Xray tmj's bilateral open-clsc (70330) |
$142 |
$567 |
1.6× |