| Abdomen 2 views (74019) |
$158.90 |
$227 |
1.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,073.80 |
$1,534 |
3.1× |
| Ankle 2 views (73600) |
$143.50 |
$205 |
1.9× |
| Arthrogram elbow (73085) |
$332.50 |
$475 |
1.1× |
| Arthrogram hip (73525) |
$249.20 |
$356 |
0.8× |
| Arthrogram shoulder (73040) |
$832.30 |
$1,189 |
2.7× |
| Arthrogram wrist (73115) |
$249.20 |
$356 |
0.8× |
| Arthrography knee lt (73580) |
$515.20 |
$736 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$716.80 |
$1,024 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$716.80 |
$1,024 |
2.0× |
| Bone age studies (77072) |
$238 |
$340 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$716.80 |
$1,024 |
2.0× |
| Bone survey complete (77075) |
$470.40 |
$672 |
5.1× |
| Cervical spine 2 or 3 views (72040) |
$288.40 |
$412 |
3.8× |
| Chest 1 view (71045) |
$123.90 |
$177 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$249.20 |
$356 |
1.6× |
| Clavicle complete (73000) |
$175 |
$250 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$305.90 |
$437 |
3.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,604.70 |
$3,721 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,249.10 |
$3,213 |
10.8× |
| CT abdomen w contrast (74160) |
$1,102.50 |
$1,575 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,192.80 |
$1,704 |
7.8× |
| CT abdomen w/o contrast (74150) |
$936.60 |
$1,338 |
10.2× |
| CT c-spine w/o contrast (72125) |
$1,217.30 |
$1,739 |
13.3× |
| CT cervical spine with contrast (72126) |
$1,383.20 |
$1,976 |
4.5× |
| CT chest w/wo contrast (71270) |
$1,316 |
$1,880 |
8.6× |
| CT chest with contrast (71260) |
$1,526.70 |
$2,181 |
9.9× |
| CT head/brain with contrast (70460) |
$1,010.80 |
$1,444 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,107.40 |
$1,582 |
7.2× |
| CT iac w contrast (70481) |
$980 |
$1,400 |
6.4× |
| CT lower ext w/o (73700) |
$1,328.60 |
$1,898 |
14.5× |
| CT lower extremity w wo contrast (73702) |
$1,276.80 |
$1,824 |
8.3× |
| CT lower extremity with contrast (73701) |
$1,194.20 |
$1,706 |
7.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,963.50 |
$2,805 |
12.8× |
| CT lumbar spine w/o contrast (72131) |
$1,328.60 |
$1,898 |
14.5× |
| CT maxillofacial w contrast (70487) |
$1,022 |
$1,460 |
6.6× |
| CT maxillofacial w/o contrast (70486) |
$1,067.50 |
$1,525 |
11.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,192.80 |
$1,704 |
7.8× |
| CT neck soft tissue w contrast (70491) |
$1,704.50 |
$2,435 |
11.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,064.70 |
$1,521 |
6.9× |
| CT orbits w/o contrast (70480) |
$1,022 |
$1,460 |
11.2× |
| CT pelvis w & w/o contrast (72194) |
$1,276.80 |
$1,824 |
8.3× |
| CT pelvis w/o contrast (72192) |
$884.10 |
$1,263 |
9.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,404.20 |
$2,006 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$809.90 |
$1,157 |
8.8× |
| CT thoracic spine w/contrast (72129) |
$1,732.50 |
$2,475 |
11.3× |
| CT thoracic spine w/o contrast (72128) |
$1,550.50 |
$2,215 |
16.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,183.70 |
$1,691 |
7.7× |
| CT thorax w/o contrast (71250) |
$893.90 |
$1,277 |
9.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$752.50 |
$1,075 |
4.9× |
| CT upper extremity w/o contrast rt (73200) |
$936.60 |
$1,338 |
10.2× |
| CT upper extremity with contrast (73201) |
$1,022 |
$1,460 |
3.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$749.70 |
$1,071 |
4.9× |
| Cta Abdomen (74175) |
$1,192.80 |
$1,704 |
7.8× |
| CTA abdomen pelvis (74174) |
$1,542.80 |
$2,204 |
5.0× |
| CTA chest (71275) |
$1,992.90 |
$2,847 |
13.0× |
| Cta Head (70496) |
$968.80 |
$1,384 |
6.3× |
| CTA lwr ext w&w/o contrast (73706) |
$663.60 |
$948 |
4.3× |
| Cta Neck (70498) |
$968.80 |
$1,384 |
6.3× |
| Cta Pelvis (72191) |
$1,381.80 |
$1,974 |
9.0× |
| Cystography minimum 3 views rs&i (74430) |
$454.30 |
$649 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$245 |
$350 |
2.7× |
| Esophagus (74220) |
$256.20 |
$366 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$282.45 |
$403.50 |
3.1× |
| Fluoroscopy up to 1 hr (76000) |
$454.30 |
$649 |
2.2× |
| Foot 2 views (73620) |
$143.50 |
$205 |
1.9× |
| Forearm 2 views (73090) |
$216.30 |
$309 |
2.8× |
| Hand 2 views (73120) |
$238 |
$340 |
2.6× |
| Hand 3 views (73130) |
$448 |
$640 |
5.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,001.70 |
$1,431 |
2.1× |
| Humerus Min 2 Views Left (73060) |
$178.50 |
$255 |
2.3× |
| Hysterosalpingogram (74740) |
$832.30 |
$1,189 |
4.0× |
| Knee 3 views (73562) |
$142.10 |
$203 |
1.9× |
| Lung perf&ventilat diferentl (78598) |
$1,044.40 |
$1,492 |
2.2× |
| Lymphoscintigraphy (78195) |
$2,024.40 |
$2,892 |
4.3× |
| MRA head w/o contrast (70544) |
$851.90 |
$1,217 |
4.1× |
| MRA neck w contrast (70548) |
$1,577.10 |
$2,253 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,362.20 |
$1,946 |
4.5× |
| MRA neck w/o contrast (70547) |
$851.90 |
$1,217 |
4.1× |
| MRI abdomen w contrast (74182) |
$1,987.30 |
$2,839 |
6.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,957.90 |
$2,797 |
6.4× |
| MRI abdomen w/o contrast (74181) |
$1,192.80 |
$1,704 |
5.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,232.30 |
$3,189 |
3.2× |
| MRI breast w/o contrast bilateral (77047) |
$2,352 |
$3,360 |
11.2× |
| MRI c-spine with contrast (72142) |
$1,745.80 |
$2,494 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,550.50 |
$2,215 |
7.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,888.90 |
$4,127 |
9.4× |
| MRI chest w/o contrast (71550) |
$1,413.30 |
$2,019 |
6.8× |
| MRI chest with contrast (71551) |
$1,712.90 |
$2,447 |
2.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,980.30 |
$2,829 |
6.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,157.80 |
$1,654 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,022 |
$1,460 |
4.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,553.30 |
$2,219 |
7.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,617 |
$2,310 |
5.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,833.30 |
$2,619 |
6.0× |
| MRI pelvis w contrast (72196) |
$1,712.20 |
$2,446 |
5.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,873.20 |
$2,676 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,336.30 |
$1,909 |
6.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,447.60 |
$2,068 |
4.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,362.20 |
$1,946 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,873.20 |
$2,676 |
6.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,228.10 |
$3,183 |
7.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,873.20 |
$2,676 |
6.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,745.80 |
$2,494 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,873.20 |
$2,676 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,192.80 |
$1,704 |
5.7× |
| MRI tmj (70336) |
$1,272.60 |
$1,818 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,677.90 |
$2,397 |
8.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,447.60 |
$2,068 |
4.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,107.40 |
$1,582 |
5.3× |
| Neck soft tissue (70360) |
$144.20 |
$206 |
1.9× |
| Nm gastric emptying study (78264) |
$1,860.60 |
$2,658 |
5.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$201.60 |
$288 |
2.2× |
| Osseous survey limited (77074) |
$720.30 |
$1,029 |
7.9× |
| Pelvis 1 or 2 views (72170) |
$309.40 |
$442 |
3.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,852.20 |
$2,646 |
6.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$618.80 |
$884 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$233.10 |
$333 |
2.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$238 |
$340 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$206.50 |
$295 |
2.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$275.80 |
$394 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$291.90 |
$417 |
1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$319.20 |
$456 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$275.80 |
$394 |
1.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$319.20 |
$456 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$186.20 |
$266 |
2.4× |
| Radiological examination surgical specimen (76098) |
$832.30 |
$1,189 |
1.7× |
| Ribs bilateral 3 views (71110) |
$201.60 |
$288 |
2.2× |
| Scanogram (77073) |
$143.50 |
$205 |
1.6× |
| Scapula complete (73010) |
$177.80 |
$254 |
1.9× |
| Screening digital breast tomosynthesis (77063) |
$142.10 |
$203 |
6.1× |
| Small bowel series (74250) |
$238 |
$340 |
1.5× |
| Spine thoracic 3 views (72072) |
$309.40 |
$442 |
3.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$876.40 |
$1,252 |
2.5× |
| Ultrasound scan of cornea to determine thickness (76514) |
$57.40 |
$82 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$472.50 |
$675 |
5.2× |
| Unlisted Ultrasound Procedure (76999) |
$217.70 |
$311 |
2.9× |
| Upper Extremity Infant (73092) |
$238 |
$340 |
2.6× |
| Urethrocystography voiding (74455) |
$435.40 |
$622 |
2.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$532 |
$760 |
3.5× |
| Us abdl aorta screen aaa (76706) |
$197.40 |
$282 |
2.2× |
| Us breast unilateral complete (76641) |
$270.90 |
$387 |
3.0× |
| Us breast unilateral limited (76642) |
$282.80 |
$404 |
3.7× |
| Us chest (76604) |
$285.60 |
$408 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$452.20 |
$646 |
4.9× |
| Us infant hips dynamic (76885) |
$501.20 |
$716 |
6.6× |
| Us ob detailed single fetus (76811) |
$363.30 |
$519 |
1.7× |
| Us ob transvaginal (76817) |
$314.30 |
$449 |
3.4× |
| Us pelvic non ob complete (76856) |
$303.80 |
$434 |
3.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$296.80 |
$424 |
3.2× |
| Us pregnancy ltd (76815) |
$363.30 |
$519 |
4.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$363.30 |
$519 |
4.0× |
| Us retroperitoneal complete (76770) |
$472.50 |
$675 |
5.2× |
| Us retroperitoneal limited (76775) |
$252 |
$360 |
2.8× |
| Us scrotum and contents (76870) |
$742.70 |
$1,061 |
8.1× |
| Us soft tissue head/neck (76536) |
$472.50 |
$675 |
5.2× |
| Us spinal canal and contents (76800) |
$217.70 |
$311 |
2.4× |
| Us transrectal (76872) |
$363.30 |
$519 |
4.0× |
| Us xtr non-vasc lmtd (76882) |
$277.90 |
$397 |
3.0× |
| Venography extremity unilateral rs&i (75820) |
$539.70 |
$771 |
0.4× |
| Wrist 2 views (73100) |
$199.50 |
$285 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$389.20 |
$556 |
4.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.20 |
$186 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$252 |
$360 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$454.30 |
$649 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$177.80 |
$254 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$270.20 |
$386 |
3.5× |
| X-ray exam hip uni 1 view (73501) |
$143.50 |
$205 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$186.20 |
$266 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$238 |
$340 |
2.6× |
| X-ray exam of femur 1 (73551) |
$68.60 |
$98 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$238 |
$340 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$205.80 |
$294 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$158.20 |
$226 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$259 |
$370 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$221.90 |
$317 |
2.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$329 |
$470 |
4.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$309.40 |
$442 |
3.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$272.30 |
$389 |
3.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$226.80 |
$324 |
2.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$143.50 |
$205 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$175.70 |
$251 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$280 |
$400 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$166.60 |
$238 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$205.80 |
$294 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$238 |
$340 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$238 |
$340 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$202.30 |
$289 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$238 |
$340 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$289.80 |
$414 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$318.50 |
$455 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$238 |
$340 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$151.90 |
$217 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$102.20 |
$146 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$143.50 |
$205 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$170.10 |
$243 |
1.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$163.80 |
$234 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$259 |
$370 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$288.40 |
$412 |
3.1× |
| Xr chest 4+ views (71048) |
$222.60 |
$318 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$168 |
$240 |
2.2× |
| Xr shoulder 1 view (73020) |
$83.30 |
$119 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$288.40 |
$412 |
3.1× |
| Xr tibia/fibula 2 views (73590) |
$221.20 |
$316 |
2.9× |
| Xray knee 1 or 2 views rt (73560) |
$168 |
$240 |
2.2× |