| Abdomen 2 views (74019) |
$291 |
$485 |
3.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,170 |
$1,950 |
3.1× |
| Ankle 2 views (73600) |
$163.80 |
$273 |
2.0× |
| Arthrogram shoulder (73040) |
$691.20 |
$1,152 |
2.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,414.20 |
$2,357 |
3.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,668 |
$2,780 |
4.4× |
| Bone &/joint imaging whole body (78306) |
$2,177.40 |
$3,629 |
5.8× |
| Bone age studies (77072) |
$202.20 |
$337 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,949.40 |
$3,249 |
5.2× |
| Bone Marrow Imaging Limited Area (78102) |
$991.80 |
$1,653 |
2.6× |
| Bone survey complete (77075) |
$591.60 |
$986 |
6.0× |
| Cerebrospinal Fluid Flow W/O Matl Shunt Evaltj (78645) |
$1,074 |
$1,790 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$293.40 |
$489 |
3.6× |
| Chest 1 view (71045) |
$186.60 |
$311 |
2.3× |
| Chest 3 views (71047) |
$286.80 |
$478 |
3.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$528.60 |
$881 |
3.2× |
| Clavicle complete (73000) |
$218.40 |
$364 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$127.80 |
$213 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,491.20 |
$4,152 |
7.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,407 |
$2,345 |
6.3× |
| CT abdomen w contrast (74160) |
$712.20 |
$1,187 |
4.3× |
| CT abdomen w wo contrast (74170) |
$1,245.60 |
$2,076 |
7.6× |
| CT abdomen w/o contrast (74150) |
$879 |
$1,465 |
9.0× |
| CT angiography upper extremity lt (73206) |
$1,197.60 |
$1,996 |
7.3× |
| CT c-spine w/o contrast (72125) |
$907.80 |
$1,513 |
9.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,549.80 |
$2,583 |
9.4× |
| CT cervical spine with contrast (72126) |
$1,135.80 |
$1,893 |
3.5× |
| CT chest w/wo contrast (71270) |
$1,245.60 |
$2,076 |
7.6× |
| CT chest with contrast (71260) |
$526.80 |
$878 |
3.2× |
| CT head/brain with contrast (70460) |
$1,135.80 |
$1,893 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,285.80 |
$2,143 |
7.8× |
| CT iac w contrast (70481) |
$1,464 |
$2,440 |
8.9× |
| CT lower ext w/o (73700) |
$703.20 |
$1,172 |
7.2× |
| CT lower extremity w wo contrast (73702) |
$1,477.80 |
$2,463 |
9.0× |
| CT lower extremity with contrast (73701) |
$1,453.80 |
$2,423 |
8.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,449 |
$2,415 |
8.8× |
| CT lumbar spine w/o contrast (72131) |
$703.20 |
$1,172 |
7.2× |
| CT lumbar spine with contrast (72132) |
$1,098 |
$1,830 |
3.4× |
| CT maxillofacial w contrast (70487) |
$1,135.80 |
$1,893 |
6.9× |
| CT maxillofacial w/o contrast (70486) |
$726.60 |
$1,211 |
7.4× |
| CT neck soft tissue w contrast (70491) |
$1,135.80 |
$1,893 |
6.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,285.80 |
$2,143 |
7.8× |
| CT orbits w/o contrast (70480) |
$907.80 |
$1,513 |
9.3× |
| CT pelvis w & w/o contrast (72194) |
$1,245.60 |
$2,076 |
7.6× |
| CT pelvis w/o contrast (72192) |
$879 |
$1,465 |
9.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,285.80 |
$2,143 |
7.8× |
| CT soft tissue neck w/o contrast (70490) |
$907.80 |
$1,513 |
9.3× |
| CT thoracic spine w/contrast (72129) |
$1,098 |
$1,830 |
6.7× |
| CT thoracic spine w/o contrast (72128) |
$879 |
$1,465 |
9.0× |
| CT thorax w/o contrast (71250) |
$703.20 |
$1,172 |
7.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,245.60 |
$2,076 |
7.6× |
| CT upper extremity w/o contrast rt (73200) |
$879 |
$1,465 |
9.0× |
| CT upper extremity with contrast (73201) |
$1,098 |
$1,830 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,296.20 |
$3,827 |
14.0× |
| Cta Abdomen (74175) |
$2,296.20 |
$3,827 |
14.0× |
| CTA abdomen pelvis (74174) |
$1,245.60 |
$2,076 |
3.8× |
| CTA chest (71275) |
$996.60 |
$1,661 |
6.1× |
| Cta Head (70496) |
$1,285.80 |
$2,143 |
7.8× |
| CTA lwr ext w&w/o contrast (73706) |
$1,602.60 |
$2,671 |
9.7× |
| Cta Neck (70498) |
$1,362 |
$2,270 |
8.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$150.60 |
$251 |
1.5× |
| Esophagus (74220) |
$753 |
$1,255 |
4.6× |
| Fluoroscopy up to 1 hr (76000) |
$754.20 |
$1,257 |
3.4× |
| Foot 2 views (73620) |
$163.80 |
$273 |
2.0× |
| Forearm 2 views (73090) |
$218.40 |
$364 |
2.7× |
| Gastric mucosa imaging (78261) |
$1,093.20 |
$1,822 |
2.9× |
| Gated Heart Planar Single (78472) |
$1,608.60 |
$2,681 |
4.3× |
| Hand 2 views (73120) |
$163.80 |
$273 |
1.7× |
| Hand 3 views (73130) |
$313.80 |
$523 |
3.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,828.80 |
$3,048 |
3.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,828.80 |
$3,048 |
4.9× |
| Ht muscle image spect sing (78451) |
$2,098.20 |
$3,497 |
1.7× |
| Humerus Min 2 Views Left (73060) |
$251.40 |
$419 |
3.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,671 |
$2,785 |
3.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,791.60 |
$2,986 |
3.5× |
| Knee 3 views (73562) |
$313.20 |
$522 |
3.8× |
| Liver & spleen imaging static only (78215) |
$1,371.60 |
$2,286 |
3.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,500.60 |
$2,501 |
4.0× |
| Liver imaging static only (78201) |
$916.80 |
$1,528 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$1,763.40 |
$2,939 |
3.5× |
| Meckels Diverticulum (78290) |
$1,500.60 |
$2,501 |
4.0× |
| Mr safety determination physician/other qhp (76016) |
$138.60 |
$231 |
1.7× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$93.60 |
$156 |
1.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$38.40 |
$64 |
1.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$144 |
$240 |
1.6× |
| Mr safety med physics xm customization plng&mntr (76017) |
$380.40 |
$634 |
1.7× |
| MRA head w & w/o contrast (70546) |
$2,511.60 |
$4,186 |
7.7× |
| MRA head w/o contrast (70544) |
$1,729.80 |
$2,883 |
7.7× |
| MRA head with contrast (70545) |
$2,161.80 |
$3,603 |
6.6× |
| MRA neck w contrast (70548) |
$2,161.80 |
$3,603 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,511.60 |
$4,186 |
7.7× |
| MRA neck w/o contrast (70547) |
$1,729.80 |
$2,883 |
7.7× |
| MRI abdomen w contrast (74182) |
$2,724 |
$4,540 |
8.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,166.80 |
$5,278 |
9.7× |
| MRI abdomen w/o contrast (74181) |
$2,179.80 |
$3,633 |
9.7× |
| MRI any jnt lwr ext with con lt (73722) |
$2,724 |
$4,540 |
3.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,433 |
$4,055 |
3.3× |
| MRI breast w/o contrast bilateral (77047) |
$1,962 |
$3,270 |
8.8× |
| MRI breast w/o contrast unilat (77046) |
$2,256.60 |
$3,761 |
10.1× |
| MRI c-spine with contrast (72142) |
$2,335.20 |
$3,892 |
7.1× |
| MRI cervical spine w/o contrast (72141) |
$1,867.20 |
$3,112 |
8.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,166.80 |
$5,278 |
9.7× |
| MRI chest w/o contrast (71550) |
$2,179.80 |
$3,633 |
9.7× |
| MRI chest with contrast (71551) |
$2,724 |
$4,540 |
3.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,724 |
$4,540 |
8.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,724 |
$4,540 |
8.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,179.80 |
$3,633 |
9.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,752 |
$2,920 |
7.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,166.20 |
$5,277 |
9.7× |
| MRI orbit/face/neck w/contrast (70542) |
$2,638.20 |
$4,397 |
8.1× |
| MRI pelvis w contrast (72196) |
$2,477.40 |
$4,129 |
7.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,879.40 |
$4,799 |
8.8× |
| MRI pelvis w/o contrast (72195) |
$1,768.80 |
$2,948 |
7.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,829.60 |
$4,716 |
8.6× |
| MRI scan of leg joint before and after contrast (73723) |
$3,166.80 |
$5,278 |
9.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,714.40 |
$4,524 |
8.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,616 |
$4,360 |
8.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,039.60 |
$5,066 |
9.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,616 |
$4,360 |
8.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,039.60 |
$5,066 |
9.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,091.60 |
$3,486 |
9.3× |
| MRI upper ext joint w/o contrast (73221) |
$2,179.80 |
$3,633 |
9.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,439.80 |
$5,733 |
10.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,179.80 |
$3,633 |
9.7× |
| Myelogram Cervical (72240) |
$2,156.40 |
$3,594 |
2.9× |
| Myocardial Spect Multiple Studies (78452) |
$4,393.80 |
$7,323 |
3.6× |
| Neck soft tissue (70360) |
$235.80 |
$393 |
2.9× |
| Nm gastric emptying study (78264) |
$1,999.80 |
$3,333 |
5.3× |
| Nm peritoneal-venous shunt patency (78291) |
$1,206 |
$2,010 |
3.2× |
| Nuclear medicine study of limited area for thyroid cancer (78015) |
$1,121.40 |
$1,869 |
3.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$706.20 |
$1,177 |
7.2× |
| Osseous survey infant (77076) |
$378.60 |
$631 |
3.9× |
| Parathyrd planar w/wo subtrj (78071) |
$723 |
$1,205 |
1.9× |
| Parathyroid imaging (78070) |
$1,526.40 |
$2,544 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$250.20 |
$417 |
2.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,956.20 |
$4,927 |
9.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,600.80 |
$2,668 |
4.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$172.80 |
$288 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$205.20 |
$342 |
2.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$304.20 |
$507 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$516.60 |
$861 |
5.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$250.80 |
$418 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$267.60 |
$446 |
3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$381 |
$635 |
3.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$67.80 |
$113 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$441 |
$735 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$356.40 |
$594 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$338.40 |
$564 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$538.20 |
$897 |
6.6× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,018.40 |
$3,364 |
4.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,869.60 |
$3,116 |
3.7× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$2,218.80 |
$3,698 |
1.8× |
| Scapula complete (73010) |
$218.40 |
$364 |
2.2× |
| Screening digital breast tomosynthesis (77063) |
$24 |
$40 |
1.0× |
| Small bowel series (74250) |
$252.60 |
$421 |
1.5× |
| Spine thoracic 3 views (72072) |
$305.40 |
$509 |
3.1× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$780.60 |
$1,301 |
3.5× |
| Thyroid carcinoma metastases img whole body (78018) |
$2,317.80 |
$3,863 |
4.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$842.40 |
$1,404 |
2.2× |
| Thyroid uptake measurement (78012) |
$820.80 |
$1,368 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,570.80 |
$2,618 |
4.2× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$2,176.80 |
$3,628 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$646.20 |
$1,077 |
6.6× |
| Unlisted Ultrasound Procedure (76999) |
$468 |
$780 |
5.7× |
| Upper Extremity Infant (73092) |
$220.80 |
$368 |
2.3× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$1,012.80 |
$1,688 |
2.7× |
| Urethrocystography voiding (74455) |
$801 |
$1,335 |
3.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$700.20 |
$1,167 |
4.3× |
| Us abdl aorta screen aaa (76706) |
$789.60 |
$1,316 |
8.0× |
| Us breast unilateral complete (76641) |
$379.20 |
$632 |
3.9× |
| Us breast unilateral limited (76642) |
$379.20 |
$632 |
4.6× |
| Us chest (76604) |
$679.80 |
$1,133 |
6.9× |
| Us compl joint r-t w/image documentation (76881) |
$642.60 |
$1,071 |
6.6× |
| Us ob transvaginal (76817) |
$672 |
$1,120 |
6.9× |
| Us pelvic non ob complete (76856) |
$733.20 |
$1,222 |
7.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$745.80 |
$1,243 |
7.6× |
| Us pregnancy ltd (76815) |
$681.60 |
$1,136 |
6.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$1,137 |
$1,895 |
11.6× |
| Us retroperitoneal complete (76770) |
$817.20 |
$1,362 |
8.3× |
| Us retroperitoneal limited (76775) |
$817.20 |
$1,362 |
8.3× |
| Us scrotum and contents (76870) |
$693 |
$1,155 |
7.1× |
| Us soft tissue head/neck (76536) |
$776.40 |
$1,294 |
7.9× |
| Us transrectal (76872) |
$1,153.20 |
$1,922 |
11.8× |
| Us xtr non-vasc lmtd (76882) |
$455.40 |
$759 |
4.6× |
| Wrist 2 views (73100) |
$163.80 |
$273 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$388.20 |
$647 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$150 |
$250 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$348.60 |
$581 |
4.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$801 |
$1,335 |
4.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$289.20 |
$482 |
3.5× |
| X-ray exam entire spi 4/5 vw (72083) |
$205.20 |
$342 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$340.80 |
$568 |
4.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$309.60 |
$516 |
3.8× |
| X-ray exam hip uni 4/> views (73503) |
$385.20 |
$642 |
3.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$385.20 |
$642 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$577.20 |
$962 |
5.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$223.20 |
$372 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$207 |
$345 |
2.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$318 |
$530 |
3.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$194.40 |
$324 |
2.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$222.60 |
$371 |
2.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$391.20 |
$652 |
4.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$241.20 |
$402 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$354.60 |
$591 |
3.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$249 |
$415 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$203.40 |
$339 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$236.40 |
$394 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$286.80 |
$478 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$285.60 |
$476 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$202.20 |
$337 |
2.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$324.60 |
$541 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$175.80 |
$293 |
2.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$147.60 |
$246 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$218.40 |
$364 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$189.60 |
$316 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$166.20 |
$277 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$150 |
$250 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$292.80 |
$488 |
3.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$163.80 |
$273 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$313.80 |
$523 |
3.8× |
| Xr c-spine 6 or more views (72052) |
$457.20 |
$762 |
4.7× |
| Xr chest 4+ views (71048) |
$155.40 |
$259 |
1.6× |
| Xr Cholecystography Oral Contrast (74290) |
$296.40 |
$494 |
1.8× |
| Xr finger(s) 2+ views (73140) |
$163.80 |
$273 |
2.0× |
| Xr shoulder 1 view (73020) |
$145.20 |
$242 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$325.80 |
$543 |
3.3× |
| Xr tibia/fibula 2 views (73590) |
$354.60 |
$591 |
4.3× |
| Xr tmj bilateral (70330) |
$277.80 |
$463 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$194.40 |
$324 |
2.4× |