| Abdomen 2 views (74019) |
$62.25 |
$83 |
0.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$606 |
$808 |
1.7× |
| Ankle 2 views (73600) |
$54.75 |
$73 |
0.7× |
| Arthrogram shoulder (73040) |
$207.75 |
$277 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$399 |
$532 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$523.50 |
$698 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$602.25 |
$803 |
1.7× |
| Brain image w/flow 4 + views (78606) |
$572.25 |
$763 |
1.2× |
| Brain Imaging Minimum 4 Static Views (78605) |
$346.50 |
$462 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$66 |
$88 |
0.9× |
| Chest 1 view (71045) |
$45 |
$60 |
0.6× |
| Chest 3 views (71047) |
$71.25 |
$95 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$222.75 |
$297 |
1.5× |
| Clavicle complete (73000) |
$54 |
$72 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$636 |
$848 |
2.1× |
| CT abdomen and pelvis without contrast (74176) |
$350.25 |
$467 |
1.7× |
| CT abdomen w contrast (74160) |
$427.50 |
$570 |
2.8× |
| CT abdomen w wo contrast (74170) |
$481.50 |
$642 |
3.2× |
| CT abdomen w/o contrast (74150) |
$261 |
$348 |
2.9× |
| CT angiography upper extremity lt (73206) |
$567.75 |
$757 |
3.7× |
| CT c-spine w/o contrast (72125) |
$270 |
$360 |
3.0× |
| CT cervical spine with contrast (72126) |
$339 |
$452 |
1.1× |
| CT chest w/wo contrast (71270) |
$402.75 |
$537 |
2.6× |
| CT chest with contrast (71260) |
$340.50 |
$454 |
2.2× |
| CT head/brain with contrast (70460) |
$283.50 |
$378 |
1.9× |
| CT head/brain without and with contrast (70470) |
$332.25 |
$443 |
2.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$75 |
$100 |
1.0× |
| CT iac w contrast (70481) |
$386.25 |
$515 |
2.5× |
| CT limited/localized follow up study (76380) |
$251.25 |
$335 |
3.3× |
| CT lower ext w/o (73700) |
$269.25 |
$359 |
3.0× |
| CT lower extremity with contrast (73701) |
$336 |
$448 |
2.2× |
| CT lumbar spine w/o contrast (72131) |
$269.25 |
$359 |
3.0× |
| CT lumbar spine with contrast (72132) |
$339.75 |
$453 |
1.1× |
| CT maxillofacial w contrast (70487) |
$290.25 |
$387 |
1.9× |
| CT maxillofacial w/o contrast (70486) |
$241.50 |
$322 |
2.7× |
| CT maxillofacial w/wo contrast (70488) |
$353.25 |
$471 |
2.3× |
| CT neck soft tissue w contrast (70491) |
$352.50 |
$470 |
2.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$427.50 |
$570 |
2.8× |
| CT orbits w/o contrast (70480) |
$348 |
$464 |
3.8× |
| CT pelvis w & w/o contrast (72194) |
$468.75 |
$625 |
3.1× |
| CT pelvis w/o contrast (72192) |
$253.50 |
$338 |
2.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$425.25 |
$567 |
2.8× |
| CT soft tissue neck w/o contrast (70490) |
$287.25 |
$383 |
3.2× |
| CT thoracic spine w/o contrast (72128) |
$270 |
$360 |
3.0× |
| CT thorax w/o contrast (71250) |
$276 |
$368 |
3.0× |
| CT upper extremity w/o contrast rt (73200) |
$309 |
$412 |
3.4× |
| CT upper extremity with contrast (73201) |
$384.75 |
$513 |
1.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$767.25 |
$1,023 |
5.0× |
| Cta Abdomen (74175) |
$560.25 |
$747 |
3.7× |
| CTA abdomen pelvis (74174) |
$767.25 |
$1,023 |
2.5× |
| CTA chest (71275) |
$525 |
$700 |
3.5× |
| Cta Head (70496) |
$513.75 |
$685 |
3.4× |
| CTA lwr ext w&w/o contrast (73706) |
$614.25 |
$819 |
4.0× |
| Cta Neck (70498) |
$513.75 |
$685 |
3.4× |
| Cta Pelvis (72191) |
$558.75 |
$745 |
3.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$67.50 |
$90 |
0.7× |
| Fluoroscopy up to 1 hr (76000) |
$72.75 |
$97 |
0.4× |
| Foot 2 views (73620) |
$48 |
$64 |
0.6× |
| Forearm 2 views (73090) |
$49.88 |
$66.50 |
0.7× |
| Gated Heart Planar Single (78472) |
$397.50 |
$530 |
1.1× |
| Hand 2 views (73120) |
$52.50 |
$70 |
0.6× |
| Hand 3 views (73130) |
$60 |
$80 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$585 |
$780 |
1.2× |
| Ht muscle image spect sing (78451) |
$588.75 |
$785 |
0.5× |
| Humerus Min 2 Views Left (73060) |
$54 |
$72 |
0.7× |
| Kidney imaging morphology (78700) |
$297 |
$396 |
0.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$641.25 |
$855 |
1.4× |
| Liver & spleen imaging static only (78215) |
$339 |
$452 |
1.0× |
| Liver imaging static only (78201) |
$330.75 |
$441 |
0.7× |
| Lung perf&ventilat diferentl (78598) |
$893.25 |
$1,191 |
1.9× |
| Meckels Diverticulum (78290) |
$572.25 |
$763 |
1.7× |
| MRA head w & w/o contrast (70546) |
$639 |
$852 |
2.1× |
| MRA head w/o contrast (70544) |
$423 |
$564 |
2.0× |
| MRA head with contrast (70545) |
$441.75 |
$589 |
1.5× |
| MRA neck w contrast (70548) |
$476.25 |
$635 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$672 |
$896 |
2.2× |
| MRA neck w/o contrast (70547) |
$425.25 |
$567 |
2.1× |
| MRI abdomen w contrast (74182) |
$607.50 |
$810 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$677.25 |
$903 |
2.2× |
| MRI abdomen w/o contrast (74181) |
$391.50 |
$522 |
1.9× |
| MRI any jnt lwr ext with con lt (73722) |
$631.50 |
$842 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$630 |
$840 |
0.9× |
| MRI c-spine with contrast (72142) |
$546 |
$728 |
1.8× |
| MRI cardiac w/o contrast (75557) |
$558.75 |
$745 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$377.25 |
$503 |
1.8× |
| MRI chest w/o & w/contrast material (71552) |
$952.50 |
$1,270 |
3.1× |
| MRI chest w/o contrast (71550) |
$681 |
$908 |
3.3× |
| MRI chest with contrast (71551) |
$752.25 |
$1,003 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$671.25 |
$895 |
2.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$444.75 |
$593 |
2.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$450.75 |
$601 |
2.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$667.50 |
$890 |
2.2× |
| MRI pelvis w contrast (72196) |
$537.75 |
$717 |
1.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$676.50 |
$902 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$460.50 |
$614 |
2.2× |
| MRI scan of arm joint before and after contrast (73223) |
$780 |
$1,040 |
2.6× |
| MRI scan of leg joint before and after contrast (73723) |
$778.50 |
$1,038 |
2.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$638.25 |
$851 |
2.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$537.75 |
$717 |
1.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$637.50 |
$850 |
2.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$542.25 |
$723 |
1.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$639.75 |
$853 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$377.25 |
$503 |
1.8× |
| MRI tmj (70336) |
$532.50 |
$710 |
2.6× |
| MRI upper ext joint w/o contrast (73221) |
$397.50 |
$530 |
1.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$675 |
$900 |
2.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$606 |
$808 |
2.9× |
| Myelogram Cervical (72240) |
$195 |
$260 |
0.3× |
| Myelogram Lumbar (72265) |
$180 |
$240 |
0.3× |
| Myelogram thoracic (72255) |
$197.25 |
$263 |
0.3× |
| Myocardial Spect Multiple Studies (78452) |
$1,618.88 |
$2,158.50 |
1.4× |
| Neck soft tissue (70360) |
$52.50 |
$70 |
0.7× |
| Nm gastric emptying study (78264) |
$577.50 |
$770 |
1.7× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$756 |
$1,008 |
0.7× |
| Nuclear medicine study of digestive tracts (78299) |
$299.25 |
$399 |
0.9× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$527.25 |
$703 |
0.5× |
| Osseous survey limited (77074) |
$110.25 |
$147 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$48.75 |
$65 |
0.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$675 |
$900 |
2.2× |
| Pr sono bone density measure,peripheral (76977) |
$12 |
$16 |
0.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$412.50 |
$550 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$72 |
$96 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$69 |
$92 |
0.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$103.50 |
$138 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$73.50 |
$98 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$50.25 |
$67 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$72 |
$96 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$56.25 |
$75 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$240.75 |
$321 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$219.75 |
$293 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$60 |
$80 |
0.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$488.25 |
$651 |
1.0× |
| Scapula complete (73010) |
$48 |
$64 |
0.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$61.50 |
$82 |
0.7× |
| Small bowel series (74250) |
$210 |
$280 |
1.4× |
| Spine thoracic 3 views (72072) |
$66 |
$88 |
0.7× |
| Spleen imaging only (78185) |
$296.25 |
$395 |
0.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$177 |
$236 |
0.5× |
| Thyroid uptake measurement (78012) |
$351.75 |
$469 |
1.0× |
| Tomogram (76100) |
$168.75 |
$225 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$159 |
$212 |
1.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$115.12 |
$153.50 |
1.5× |
| Upper Extremity Infant (73092) |
$52.50 |
$70 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$219.75 |
$293 |
1.4× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$261 |
$348 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$196.50 |
$262 |
2.2× |
| Us breast unilateral complete (76641) |
$186.75 |
$249 |
2.1× |
| Us breast unilateral limited (76642) |
$186.75 |
$249 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$135.75 |
$181 |
1.5× |
| Us ob transvaginal (76817) |
$213.75 |
$285 |
2.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$190.50 |
$254 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$243.75 |
$325 |
2.7× |
| Us retroperitoneal complete (76770) |
$197.25 |
$263 |
2.2× |
| Us retroperitoneal limited (76775) |
$196.50 |
$262 |
2.2× |
| Us scrotum and contents (76870) |
$182.25 |
$243 |
2.0× |
| Us soft tissue head/neck (76536) |
$200.25 |
$267 |
2.2× |
| Us xtr non-vasc lmtd (76882) |
$136.50 |
$182 |
1.5× |
| Vertebral fracture assessment via dxa (77086) |
$60 |
$80 |
0.8× |
| Wrist 2 views (73100) |
$56.25 |
$75 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$54 |
$72 |
0.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$60 |
$80 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$48.75 |
$65 |
0.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$53.25 |
$71 |
0.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$135 |
$180 |
1.5× |
| X-ray exam hip uni 1 view (73501) |
$54.75 |
$73 |
0.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$78 |
$104 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$208.50 |
$278 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$78.75 |
$105 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$54 |
$72 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$56.25 |
$75 |
0.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$48.75 |
$65 |
0.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$75 |
$100 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$66 |
$88 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$52.50 |
$70 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$66 |
$88 |
0.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$102.75 |
$137 |
1.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$62.25 |
$83 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$81 |
$108 |
0.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$69.75 |
$93 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$71.25 |
$95 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$88.50 |
$118 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$66 |
$88 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$54 |
$72 |
0.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$57 |
$76 |
0.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$63.75 |
$85 |
0.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$61.50 |
$82 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$41.25 |
$55 |
0.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$69 |
$92 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$56.25 |
$75 |
0.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$48.75 |
$65 |
0.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$66.75 |
$89 |
0.9× |
| Xr chest 4+ views (71048) |
$78 |
$104 |
0.9× |
| Xr Cholecystography Oral Contrast (74290) |
$141 |
$188 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$60.75 |
$81 |
0.8× |
| Xr internal auditory meati complete (70134) |
$97.50 |
$130 |
0.2× |
| Xr shoulder 1 view (73020) |
$37.50 |
$50 |
0.5× |
| Xr spine cervical 4 or 5 views (72050) |
$87.75 |
$117 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$52.50 |
$70 |
0.7× |
| Xr tmj bilateral (70330) |
$88.50 |
$118 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$57.75 |
$77 |
0.8× |