| Abdomen 2 views (74019) |
$397.60 |
$497 |
4.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,009.60 |
$1,262 |
2.6× |
| Ankle 2 views (73600) |
$131.60 |
$164.50 |
1.6× |
| Arthrogram hip (73525) |
$1,388.80 |
$1,736 |
4.1× |
| Arthrogram shoulder (73040) |
$564.80 |
$706 |
1.7× |
| Arthrogram wrist (73115) |
$448 |
$560 |
1.3× |
| Arthrography knee lt (73580) |
$736.40 |
$920.50 |
2.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,009.60 |
$1,262 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$1,009.60 |
$1,262 |
2.6× |
| Bone age studies (77072) |
$79.20 |
$99 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,009.60 |
$1,262 |
2.6× |
| Bone survey complete (77075) |
$455.20 |
$569 |
4.5× |
| Brain image w/flow 4 + views (78606) |
$2,186.40 |
$2,733 |
4.2× |
| Brain imaging < 4 static views (78600) |
$2,622.40 |
$3,278 |
6.8× |
| Brain imaging < 4 static views w vascular flow (78601) |
$2,736 |
$3,420 |
7.1× |
| Cervical spine 2 or 3 views (72040) |
$167.60 |
$209.50 |
2.0× |
| Chest 1 view (71045) |
$182.80 |
$228.50 |
2.2× |
| Chest 3 views (71047) |
$216.40 |
$270.50 |
2.6× |
| Clavicle complete (73000) |
$136.40 |
$170.50 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,242 |
$1,552.50 |
3.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,202.40 |
$1,503 |
5.2× |
| CT abdomen w contrast (74160) |
$892 |
$1,115 |
5.3× |
| CT abdomen w wo contrast (74170) |
$991.20 |
$1,239 |
5.9× |
| CT abdomen w/o contrast (74150) |
$689.60 |
$862 |
6.9× |
| CT angio hrt w/3d image (75574) |
$1,336 |
$1,670 |
4.0× |
| CT angiography upper extremity lt (73206) |
$1,128.80 |
$1,411 |
6.7× |
| CT c-spine w/o contrast (72125) |
$851.20 |
$1,064 |
8.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,808.80 |
$2,261 |
10.7× |
| CT cervical spine with contrast (72126) |
$1,555.20 |
$1,944 |
4.6× |
| CT chest w/wo contrast (71270) |
$991.20 |
$1,239 |
5.9× |
| CT chest with contrast (71260) |
$892 |
$1,115 |
5.3× |
| CT colonography w/o cntrst (74261) |
$689.60 |
$862 |
6.9× |
| CT head/brain with contrast (70460) |
$892 |
$1,115 |
5.3× |
| CT head/brain without and with contrast (70470) |
$991.20 |
$1,239 |
5.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$60 |
$75 |
0.7× |
| CT limited/localized follow up study (76380) |
$408.80 |
$511 |
4.9× |
| CT lower ext w/o (73700) |
$1,246.40 |
$1,558 |
12.4× |
| CT lower extremity w wo contrast (73702) |
$1,831.20 |
$2,289 |
10.9× |
| CT lower extremity with contrast (73701) |
$1,775.20 |
$2,219 |
10.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,848.80 |
$2,311 |
11.0× |
| CT lumbar spine w/o contrast (72131) |
$845.60 |
$1,057 |
8.4× |
| CT lumbar spine with contrast (72132) |
$1,555.20 |
$1,944 |
4.6× |
| CT maxillofacial w contrast (70487) |
$892 |
$1,115 |
5.3× |
| CT maxillofacial w/o contrast (70486) |
$568.80 |
$711 |
5.7× |
| CT maxillofacial w/wo contrast (70488) |
$991.20 |
$1,239 |
5.9× |
| CT neck soft tissue w contrast (70491) |
$892 |
$1,115 |
5.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$991.20 |
$1,239 |
5.9× |
| CT orbits w/o contrast (70480) |
$628.80 |
$786 |
6.3× |
| CT pelvis w & w/o contrast (72194) |
$1,044.80 |
$1,306 |
6.2× |
| CT pelvis w/o contrast (72192) |
$752 |
$940 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$991.20 |
$1,239 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$568.80 |
$711 |
5.7× |
| CT thoracic spine w/contrast (72129) |
$1,020 |
$1,275 |
6.0× |
| CT thoracic spine w/o contrast (72128) |
$848.80 |
$1,061 |
8.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,248.80 |
$1,561 |
7.4× |
| CT thorax w/o contrast (71250) |
$727.60 |
$909.50 |
7.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$991.20 |
$1,239 |
5.9× |
| CT upper extremity w/o contrast rt (73200) |
$568.80 |
$711 |
5.7× |
| CT upper extremity with contrast (73201) |
$892 |
$1,115 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,515.20 |
$1,894 |
9.0× |
| Cta Abdomen (74175) |
$1,257.60 |
$1,572 |
7.5× |
| CTA abdomen pelvis (74174) |
$1,722.40 |
$2,153 |
5.1× |
| CTA chest (71275) |
$1,336 |
$1,670 |
7.9× |
| Cta Head (70496) |
$1,180 |
$1,475 |
7.0× |
| CTA lwr ext w&w/o contrast (73706) |
$2,290.40 |
$2,863 |
13.6× |
| Cta Neck (70498) |
$1,177.60 |
$1,472 |
7.0× |
| Cta Pelvis (72191) |
$1,364.80 |
$1,706 |
8.1× |
| Cystography minimum 3 views rs&i (74430) |
$309.20 |
$386.50 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$392.80 |
$491 |
3.9× |
| Echoencephalography real time imaging (76506) |
$372.80 |
$466 |
3.7× |
| Esophagus (74220) |
$359.20 |
$449 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$443.20 |
$554 |
4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$384 |
$480 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$20 |
$25 |
0.1× |
| Foot 2 views (73620) |
$152.80 |
$191 |
1.8× |
| Forearm 2 views (73090) |
$158 |
$197.50 |
1.9× |
| Gated Heart Planar Single (78472) |
$788 |
$985 |
2.0× |
| Hand 2 views (73120) |
$206.80 |
$258.50 |
2.1× |
| Hand 3 views (73130) |
$170 |
$212.50 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$760.40 |
$950.50 |
1.5× |
| Ht muscle image spect sing (78451) |
$219.20 |
$274 |
0.2× |
| Humerus Min 2 Views Left (73060) |
$150.40 |
$188 |
1.8× |
| Hysterosalpingogram (74740) |
$396.40 |
$495.50 |
1.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,720 |
$2,150 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,763.20 |
$2,204 |
3.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,783.20 |
$2,229 |
3.4× |
| Knee 3 views (73562) |
$174 |
$217.50 |
2.1× |
| Liver & spleen imaging static only (78215) |
$984.80 |
$1,231 |
2.6× |
| Lung Ventilation Imaging (78579) |
$532.80 |
$666 |
1.4× |
| Mammary ductogram or galactogram multiple (77054) |
$644 |
$805 |
2.8× |
| Mammary ductogram or galactogram single (77053) |
$676 |
$845 |
2.9× |
| Meckels Diverticulum (78290) |
$563.60 |
$704.50 |
1.5× |
| MRA head w & w/o contrast (70546) |
$2,624.80 |
$3,281 |
7.8× |
| MRA head w/o contrast (70544) |
$1,820 |
$2,275 |
7.9× |
| MRA head with contrast (70545) |
$2,022.40 |
$2,528 |
6.0× |
| MRA neck w contrast (70548) |
$1,844 |
$2,305 |
5.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,624.80 |
$3,281 |
7.8× |
| MRA neck w/o contrast (70547) |
$1,792 |
$2,240 |
7.8× |
| MRI abdomen w contrast (74182) |
$1,753.60 |
$2,192 |
5.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,070.40 |
$2,588 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,468 |
$1,835 |
6.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,338.40 |
$1,673 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,075.20 |
$2,594 |
2.8× |
| MRI c-spine with contrast (72142) |
$1,927.20 |
$2,409 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,716 |
$2,145 |
7.5× |
| MRI chest w/o contrast (71550) |
$757.60 |
$947 |
3.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,352.80 |
$1,691 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,188 |
$1,485 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,978 |
$2,472.50 |
8.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,944.80 |
$3,681 |
8.8× |
| MRI orbit/face/neck w/contrast (70542) |
$2,352 |
$2,940 |
7.0× |
| MRI pelvis w contrast (72196) |
$2,002.40 |
$2,503 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,552 |
$3,190 |
7.6× |
| MRI pelvis w/o contrast (72195) |
$1,811.20 |
$2,264 |
7.9× |
| MRI scan of arm joint before and after contrast (73223) |
$1,837.60 |
$2,297 |
5.5× |
| MRI scan of leg joint before and after contrast (73723) |
$1,683.20 |
$2,104 |
5.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,499.20 |
$3,124 |
7.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$406.40 |
$508 |
1.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,617.60 |
$3,272 |
7.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$406.40 |
$508 |
1.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,632 |
$3,290 |
7.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,866.40 |
$2,333 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,205.60 |
$1,507 |
5.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,636.80 |
$2,046 |
4.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$648.40 |
$810.50 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,594.80 |
$3,243.50 |
2.1× |
| Neck soft tissue (70360) |
$138 |
$172.50 |
1.6× |
| Nm gastric emptying study (78264) |
$1,073.60 |
$1,342 |
2.8× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$3,484.80 |
$4,356 |
2.8× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$3,476.80 |
$4,346 |
2.8× |
| Nuclear medicine study of kidney and blood flow (78701) |
$548 |
$685 |
1.4× |
| Nuclear Rx Oral Admin (79005) |
$1,616 |
$2,020 |
7.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$464 |
$580 |
4.6× |
| Osseous survey infant (77076) |
$214.80 |
$268.50 |
2.1× |
| Osseous survey limited (77074) |
$348.80 |
$436 |
3.5× |
| Parathyroid imaging (78070) |
$626.40 |
$783 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$174.80 |
$218.50 |
1.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,713.60 |
$2,142 |
5.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,009.60 |
$1,262 |
2.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$728.80 |
$911 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$201.60 |
$252 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$419.20 |
$524 |
4.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$135.20 |
$169 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$220 |
$275 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$295.20 |
$369 |
3.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$247.20 |
$309 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$356.40 |
$445.50 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$506.40 |
$633 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$324.80 |
$406 |
3.9× |
| Radiological examination surgical specimen (76098) |
$578 |
$722.50 |
1.1× |
| Ribs bilateral 3 views (71110) |
$212.80 |
$266 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$186.80 |
$233.50 |
1.9× |
| Scapula complete (73010) |
$215.60 |
$269.50 |
2.1× |
| Sella turcica (70240) |
$112 |
$140 |
1.3× |
| Small bowel series (74250) |
$303.20 |
$379 |
1.8× |
| Spine thoracic 3 views (72072) |
$200.40 |
$250.50 |
2.0× |
| Testicular Imaging With Vascular Flow (78761) |
$564.80 |
$706 |
1.5× |
| Thyroid uptake measurement (78012) |
$78.74 |
$98.43 |
0.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$554.40 |
$693 |
1.4× |
| Tmj unilateral (70328) |
$111.20 |
$139 |
1.3× |
| Tomogram (76100) |
$416.80 |
$521 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$752.80 |
$941 |
7.5× |
| Umbilical-artery Doppler (OB) (76820) |
$257.60 |
$322 |
2.6× |
| Unlisted Ultrasound Procedure (76999) |
$382.40 |
$478 |
4.6× |
| Upper Extremity Infant (73092) |
$144.40 |
$180.50 |
1.4× |
| Urethrocystography voiding (74455) |
$328 |
$410 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$230.40 |
$288 |
1.4× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$100 |
$125 |
0.6× |
| Us breast unilateral complete (76641) |
$488.80 |
$611 |
4.9× |
| Us breast unilateral limited (76642) |
$140.80 |
$176 |
1.7× |
| Us compl joint r-t w/image documentation (76881) |
$401.60 |
$502 |
4.0× |
| Us infant hips dynamic (76885) |
$430.40 |
$538 |
5.1× |
| Us ob detailed single fetus (76811) |
$819.20 |
$1,024 |
3.6× |
| Us ob transvaginal (76817) |
$252.80 |
$316 |
2.5× |
| Us pelvic non ob complete (76856) |
$816.80 |
$1,021 |
8.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$384 |
$480 |
3.8× |
| Us pregnancy ltd (76815) |
$84,871.20 |
$106,089 |
844.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$819.20 |
$1,024 |
8.1× |
| Us retroperitoneal complete (76770) |
$792.80 |
$991 |
7.9× |
| Us scrotum and contents (76870) |
$712.80 |
$891 |
7.1× |
| Us soft tissue head/neck (76536) |
$586.40 |
$733 |
5.8× |
| Us xtr non-vasc lmtd (76882) |
$308.80 |
$386 |
3.1× |
| Venogram extremity bilateral (75822) |
$1,894.40 |
$2,368 |
1.3× |
| Venography extremity unilateral rs&i (75820) |
$1,894.40 |
$2,368 |
1.3× |
| Wrist 2 views (73100) |
$157.60 |
$197 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$333.60 |
$417 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$115.20 |
$144 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$158 |
$197.50 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$538.80 |
$673.50 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$134.80 |
$168.50 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$153.60 |
$192 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$304.80 |
$381 |
3.6× |
| X-ray eye for foreign body (70030) |
$247.20 |
$309 |
3.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$221.20 |
$276.50 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$102.80 |
$128.50 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$159.20 |
$199 |
1.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$147.20 |
$184 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$106.40 |
$133 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$87.20 |
$109 |
0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$65.60 |
$82 |
0.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$112.80 |
$141 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$201.60 |
$252 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$306 |
$382.50 |
3.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$132.80 |
$166 |
1.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$1,442 |
$1,802.50 |
17.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$228.80 |
$286 |
2.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$218.40 |
$273 |
2.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$554.40 |
$693 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$76 |
$95 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$156.80 |
$196 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$169.20 |
$211.50 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$83.20 |
$104 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$234.40 |
$293 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$197.60 |
$247 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$188 |
$235 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$118.40 |
$148 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$308.80 |
$386 |
3.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$172 |
$215 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$212.40 |
$265.50 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$427.20 |
$534 |
4.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$109.60 |
$137 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$180.40 |
$225.50 |
2.2× |
| Xr arthrogram ankle (73615) |
$790.40 |
$988 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$290.80 |
$363.50 |
2.9× |
| Xr chest 4+ views (71048) |
$426.40 |
$533 |
4.2× |
| Xr Cholecystography Oral Contrast (74290) |
$228 |
$285 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$179.20 |
$224 |
2.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$348.80 |
$436 |
3.5× |
| Xr optic foramina (70190) |
$188.80 |
$236 |
2.3× |
| Xr shoulder 1 view (73020) |
$120.80 |
$151 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$257.60 |
$322 |
2.6× |
| Xr tibia/fibula 2 views (73590) |
$158 |
$197.50 |
1.9× |
| Xr tmj bilateral (70330) |
$183.60 |
$229.50 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$65.60 |
$82 |
0.8× |