| Acute gastrointestinal blood loss imaging (78278) |
$329.87 |
$942.50 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$679.35 |
$1,941 |
0.2× |
| Angiography extremity unilateral rs&i (75710) |
$582.75 |
$1,665 |
0.2× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$776.12 |
$2,217.50 |
0.3× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$776.12 |
$2,217.50 |
0.3× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$776.12 |
$2,217.50 |
0.2× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$368.55 |
$1,053 |
0.1× |
| Ankle 2 views (73600) |
$77.04 |
$220.13 |
1.0× |
| Aortogram thoracic (75605) |
$776.12 |
$2,217.50 |
0.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$834.40 |
$2,384 |
0.3× |
| Aortography abdominal serialography rs&i (75625) |
$776.12 |
$2,217.50 |
0.3× |
| Aortography thoracic w/o serialography rs&i (75600) |
$407.75 |
$1,165 |
0.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$140.87 |
$402.50 |
0.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$793.10 |
$2,266 |
2.3× |
| Bone &/joint imaging whole body (78306) |
$853.47 |
$2,438.50 |
2.5× |
| Bone age studies (77072) |
$124.66 |
$356.18 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$521.50 |
$1,490 |
1.5× |
| Bone survey complete (77075) |
$240.36 |
$686.75 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$77.04 |
$220.13 |
1.0× |
| Chest 1 view (71045) |
$77.04 |
$220.13 |
1.0× |
| Chest 3 views (71047) |
$207.20 |
$592 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$256.20 |
$732 |
1.7× |
| Clavicle complete (73000) |
$77.04 |
$220.13 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$93.04 |
$265.85 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$312.49 |
$892.83 |
1.0× |
| CT abdomen and pelvis without contrast (74176) |
$211.50 |
$604.30 |
1.0× |
| CT abdomen w contrast (74160) |
$155.76 |
$445.05 |
1.0× |
| CT abdomen w wo contrast (74170) |
$155.76 |
$445.05 |
1.0× |
| CT abdomen w/o contrast (74150) |
$93.04 |
$265.85 |
1.0× |
| CT angiography upper extremity lt (73206) |
$761.69 |
$2,176.28 |
5.0× |
| CT c-spine w/o contrast (72125) |
$93.04 |
$265.85 |
1.0× |
| CT cervical spine w&w/o contrast (72127) |
$477.68 |
$1,364.81 |
3.2× |
| CT cervical spine with contrast (72126) |
$1,037.05 |
$2,963 |
3.4× |
| CT chest w/wo contrast (71270) |
$155.76 |
$445.05 |
1.0× |
| CT chest with contrast (71260) |
$155.76 |
$445.05 |
1.0× |
| CT head/brain with contrast (70460) |
$155.76 |
$445.05 |
1.0× |
| CT head/brain without and with contrast (70470) |
$155.76 |
$445.05 |
1.0× |
| CT iac w contrast (70481) |
$853.47 |
$2,438.50 |
5.6× |
| CT lower ext w/o (73700) |
$93.04 |
$265.85 |
1.0× |
| CT lower extremity w wo contrast (73702) |
$1,003.10 |
$2,866 |
6.6× |
| CT lower extremity with contrast (73701) |
$155.76 |
$445.05 |
1.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,311.45 |
$3,747 |
8.7× |
| CT lumbar spine w/o contrast (72131) |
$93.04 |
$265.85 |
1.0× |
| CT lumbar spine with contrast (72132) |
$1,085.35 |
$3,101 |
3.6× |
| CT maxillofacial w contrast (70487) |
$853.47 |
$2,438.50 |
5.6× |
| CT maxillofacial w/o contrast (70486) |
$93.04 |
$265.85 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
$155.76 |
$445.05 |
1.0× |
| CT neck soft tissue w contrast (70491) |
$155.76 |
$445.05 |
1.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,024.80 |
$2,928 |
6.8× |
| CT orbits w/o contrast (70480) |
$271.04 |
$774.42 |
3.0× |
| CT pelvis w & w/o contrast (72194) |
$1,293.07 |
$3,694.50 |
8.6× |
| CT pelvis w/o contrast (72192) |
$93.04 |
$265.85 |
1.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$155.76 |
$445.05 |
1.0× |
| CT soft tissue neck w/o contrast (70490) |
$93.04 |
$265.85 |
1.0× |
| CT thoracic spine w/contrast (72129) |
$1,037.05 |
$2,963 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$93.04 |
$265.85 |
1.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,320.02 |
$3,771.50 |
8.7× |
| CT thorax w/o contrast (71250) |
$93.04 |
$265.85 |
1.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$526.92 |
$1,505.50 |
3.5× |
| CT upper extremity w/o contrast rt (73200) |
$93.04 |
$265.85 |
1.0× |
| CT upper extremity with contrast (73201) |
$312.49 |
$892.83 |
1.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$155.76 |
$445.05 |
1.0× |
| Cta Abdomen (74175) |
$155.76 |
$445.05 |
1.0× |
| CTA abdomen pelvis (74174) |
$312.49 |
$892.83 |
1.0× |
| CTA chest (71275) |
$155.76 |
$445.05 |
1.0× |
| Cta Head (70496) |
$155.76 |
$445.05 |
1.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,367.62 |
$3,907.50 |
9.0× |
| Cta Neck (70498) |
$155.76 |
$445.05 |
1.0× |
| Cta Pelvis (72191) |
$1,562.57 |
$4,464.50 |
10.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$88.96 |
$254.18 |
1.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$57.60 |
$164.56 |
0.8× |
| Dxa bone density study axial skeleton (77085) |
$80.85 |
$231 |
0.9× |
| Esophagus (74220) |
$249.37 |
$712.50 |
1.6× |
| Foot 2 views (73620) |
$77.04 |
$220.13 |
1.0× |
| Forearm 2 views (73090) |
$77.04 |
$220.13 |
1.0× |
| Hand 2 views (73120) |
$93.04 |
$265.85 |
1.0× |
| Hand 3 views (73130) |
$77.04 |
$220.13 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$528.85 |
$1,511 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$886.02 |
$2,531.50 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$111.12 |
$317.50 |
1.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$71.92 |
$205.50 |
0.8× |
| Knee 3 views (73562) |
$77.04 |
$220.13 |
1.0× |
| Liver & spleen imaging static only (78215) |
$949.72 |
$2,713.50 |
2.8× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$528.85 |
$1,511 |
1.5× |
| Liver imaging static only (78201) |
$528.85 |
$1,511 |
1.1× |
| Liver imaging w/vascular flow (78202) |
$521.50 |
$1,490 |
1.1× |
| Lung perfusion differential (78597) |
$380.97 |
$1,088.50 |
1.1× |
| Meckels Diverticulum (78290) |
$529.72 |
$1,513.50 |
1.5× |
| MRA head w & w/o contrast (70546) |
$576.71 |
$1,647.75 |
1.9× |
| MRA head w/o contrast (70544) |
$302.24 |
$863.55 |
1.5× |
| MRA head with contrast (70545) |
$373.27 |
$1,066.50 |
1.2× |
| MRA neck w contrast (70548) |
$429.08 |
$1,225.95 |
1.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$663.07 |
$1,894.50 |
2.2× |
| MRA neck w/o contrast (70547) |
$317.31 |
$906.60 |
1.5× |
| MRI any jnt lwr ext with con lt (73722) |
$361.09 |
$1,031.70 |
0.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$521.48 |
$1,489.95 |
0.8× |
| MRI c-spine with contrast (72142) |
$439.79 |
$1,256.55 |
1.5× |
| MRI cervical spine w/o contrast (72141) |
$211.50 |
$604.30 |
1.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$491.82 |
$1,405.20 |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$492.18 |
$1,406.25 |
1.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$367.72 |
$1,050.65 |
1.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$183.64 |
$524.70 |
0.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$576.71 |
$1,647.75 |
1.9× |
| MRI orbit/face/neck w/contrast (70542) |
$432.49 |
$1,235.70 |
1.4× |
| MRI pelvis w contrast (72196) |
$317.31 |
$906.60 |
1.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$663.07 |
$1,894.50 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$314 |
$897.15 |
1.5× |
| MRI scan of arm joint before and after contrast (73223) |
$663.07 |
$1,894.50 |
2.2× |
| MRI scan of leg joint before and after contrast (73723) |
$663.07 |
$1,894.50 |
2.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$312.49 |
$892.83 |
1.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$695.86 |
$1,988.18 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$312.49 |
$892.83 |
1.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$439.79 |
$1,256.55 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$673.99 |
$1,925.70 |
2.2× |
| MRI thoracic spine w/o contrast (72146) |
$211.50 |
$604.30 |
1.0× |
| MRI tmj (70336) |
$155.92 |
$445.50 |
0.8× |
| MRI upper ext joint w/o contrast (73221) |
$820.88 |
$2,345.40 |
4.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$449.35 |
$1,283.86 |
1.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$211.50 |
$604.30 |
1.0× |
| Neck soft tissue (70360) |
$77.04 |
$220.13 |
1.0× |
| Osseous survey infant (77076) |
$160.12 |
$457.50 |
1.8× |
| Osseous survey limited (77074) |
$78.75 |
$225 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$439.95 |
$1,257 |
1.3× |
| Parathyroid imaging (78070) |
$483.52 |
$1,381.50 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$136.20 |
$389.18 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$523.95 |
$1,497 |
1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$215.95 |
$617 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$291.55 |
$833 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$77.04 |
$220.13 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$186.34 |
$532.42 |
2.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$333.02 |
$951.50 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$93.04 |
$265.85 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$77.04 |
$220.13 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$93.04 |
$265.85 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$77.04 |
$220.13 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$77.04 |
$220.13 |
1.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$174.30 |
$498 |
2.3× |
| Radiological examination surgical specimen (76098) |
$540.57 |
$1,544.50 |
1.1× |
| Ribs bilateral 3 views (71110) |
$93.04 |
$265.85 |
1.0× |
| Scanogram (77073) |
$130.28 |
$372.25 |
1.4× |
| Scapula complete (73010) |
$126.58 |
$361.68 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$29.40 |
$84 |
1.3× |
| Small bowel series (74250) |
$366.97 |
$1,048.50 |
2.4× |
| Spine thoracic 3 views (72072) |
$133.14 |
$380.42 |
1.5× |
| Thoracolumbar 2 views (72080) |
$228.54 |
$653 |
3.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$225.57 |
$644.50 |
0.7× |
| Thyroid uptake measurement (78012) |
$161 |
$460 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$339.50 |
$970 |
1.0× |
| Tmj unilateral (70328) |
$132.65 |
$379 |
1.8× |
| Tomogram (76100) |
$316.22 |
$903.50 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$93.04 |
$265.85 |
1.0× |
| Us abdl aorta screen aaa (76706) |
$93.04 |
$265.85 |
1.0× |
| Us breast unilateral complete (76641) |
$194.60 |
$556 |
2.2× |
| Us breast unilateral limited (76642) |
$77.04 |
$220.13 |
1.0× |
| Us chest (76604) |
$93.04 |
$265.85 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$150.12 |
$428.92 |
1.7× |
| Us infant hips limited static (76886) |
$77.04 |
$220.13 |
1.0× |
| Us pelvic non ob complete (76856) |
$93.04 |
$265.85 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$93.04 |
$265.85 |
1.0× |
| Us pregnancy ltd (76815) |
$93.04 |
$265.85 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$93.04 |
$265.85 |
1.0× |
| Us retroperitoneal complete (76770) |
$93.04 |
$265.85 |
1.0× |
| Us retroperitoneal limited (76775) |
$93.04 |
$265.85 |
1.0× |
| Us scrotum and contents (76870) |
$93.04 |
$265.85 |
1.0× |
| Us soft tissue head/neck (76536) |
$93.04 |
$265.85 |
1.0× |
| Us spinal canal and contents (76800) |
$93.04 |
$265.85 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$93.04 |
$265.85 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$424.02 |
$1,211.50 |
0.2× |
| Venography caval superior serialography rs&i (75827) |
$430.15 |
$1,229 |
0.3× |
| Venography extremity unilateral rs&i (75820) |
$278.77 |
$796.50 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$36.40 |
$104 |
0.5× |
| Wrist 2 views (73100) |
$89.18 |
$254.82 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$119.17 |
$340.50 |
1.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$77.04 |
$220.13 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$104.30 |
$298 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$118.58 |
$338.82 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$141.05 |
$403 |
1.6× |
| X-ray exam of femur 1 (73551) |
$89.25 |
$255 |
1.2× |
| X-ray eye for foreign body (70030) |
$212.45 |
$607 |
2.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$178.67 |
$510.50 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$186.72 |
$533.50 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$599.90 |
$1,714 |
6.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$138.25 |
$395 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$74.48 |
$212.82 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$187.77 |
$536.50 |
2.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$93.04 |
$265.85 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$101.76 |
$290.75 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$176.40 |
$504 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$149.62 |
$427.50 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$111.44 |
$318.42 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$184.10 |
$526 |
2.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$77.04 |
$220.13 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$77.04 |
$220.13 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$93.04 |
$265.85 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$77.04 |
$220.13 |
1.0× |
| Xr optic foramina (70190) |
$62.65 |
$179 |
0.8× |
| Xr shoulder 1 view (73020) |
$77.04 |
$220.13 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$93.04 |
$265.85 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$77.04 |
$220.13 |
1.0× |
| Xr tmj bilateral (70330) |
$179.72 |
$513.50 |
2.4× |
| Xray knee 1 or 2 views rt (73560) |
$77.04 |
$220.13 |
1.0× |