| Abdomen 2 views (74019) |
$306.60 |
$511 |
3.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$996 |
$1,660 |
2.7× |
| Angiography extremity bilateral rs&i (75716) |
$4,248.60 |
$7,081 |
1.4× |
| Angiography extremity unilateral rs&i (75710) |
$2,695.80 |
$4,493 |
0.9× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$2,695.80 |
$4,493 |
0.5× |
| Ankle 2 views (73600) |
$212.40 |
$354 |
2.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,695.80 |
$4,493 |
0.9× |
| Aortography abdominal serialography rs&i (75625) |
$2,695.80 |
$4,493 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,108.80 |
$1,848 |
3.0× |
| Bone &/joint imaging whole body (78306) |
$1,330.20 |
$2,217 |
3.5× |
| Bone age studies (77072) |
$230.40 |
$384 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,228.80 |
$2,048 |
3.3× |
| Bone survey complete (77075) |
$1,219.80 |
$2,033 |
12.4× |
| Cervical spine 2 or 3 views (72040) |
$261.60 |
$436 |
3.2× |
| Chest 1 view (71045) |
$214.20 |
$357 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$555 |
$925 |
3.4× |
| Clavicle complete (73000) |
$230.40 |
$384 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,788 |
$2,980 |
18.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,989 |
$8,315 |
15.2× |
| CT abdomen and pelvis without contrast (74176) |
$3,258 |
$5,430 |
14.6× |
| CT abdomen w contrast (74160) |
$1,906.80 |
$3,178 |
11.6× |
| CT abdomen w wo contrast (74170) |
$2,275.80 |
$3,793 |
13.8× |
| CT abdomen w/o contrast (74150) |
$1,546.80 |
$2,578 |
15.8× |
| CT angiography upper extremity lt (73206) |
$2,115 |
$3,525 |
12.9× |
| CT c-spine w/o contrast (72125) |
$1,986.60 |
$3,311 |
20.3× |
| CT cervical spine w&w/o contrast (72127) |
$2,706.60 |
$4,511 |
16.4× |
| CT cervical spine with contrast (72126) |
$2,292 |
$3,820 |
7.0× |
| CT chest w/wo contrast (71270) |
$2,921.40 |
$4,869 |
17.8× |
| CT chest with contrast (71260) |
$2,444.40 |
$4,074 |
14.9× |
| CT head/brain with contrast (70460) |
$1,590.60 |
$2,651 |
9.7× |
| CT head/brain without and with contrast (70470) |
$2,260.20 |
$3,767 |
13.7× |
| CT iac w contrast (70481) |
$1,773.60 |
$2,956 |
10.8× |
| CT lower ext w/o (73700) |
$1,473.60 |
$2,456 |
15.0× |
| CT lower extremity w wo contrast (73702) |
$2,115 |
$3,525 |
12.9× |
| CT lower extremity with contrast (73701) |
$1,861.80 |
$3,103 |
11.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,713.80 |
$4,523 |
16.5× |
| CT lumbar spine w/o contrast (72131) |
$1,884 |
$3,140 |
19.2× |
| CT lumbar spine with contrast (72132) |
$1,360.80 |
$2,268 |
4.2× |
| CT maxillofacial w contrast (70487) |
$1,861.80 |
$3,103 |
11.3× |
| CT maxillofacial w/o contrast (70486) |
$1,473.60 |
$2,456 |
15.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,115 |
$3,525 |
12.9× |
| CT neck soft tissue w contrast (70491) |
$1,861.80 |
$3,103 |
11.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,014.80 |
$3,358 |
12.2× |
| CT orbits w/o contrast (70480) |
$1,473.60 |
$2,456 |
15.0× |
| CT pelvis w & w/o contrast (72194) |
$2,713.80 |
$4,523 |
16.5× |
| CT pelvis w/o contrast (72192) |
$1,714.20 |
$2,857 |
17.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,115 |
$3,525 |
12.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,473.60 |
$2,456 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$2,329.80 |
$3,883 |
14.2× |
| CT thoracic spine w/o contrast (72128) |
$2,027.40 |
$3,379 |
20.7× |
| CT thorax w/o contrast (71250) |
$1,788 |
$2,980 |
18.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,111.40 |
$3,519 |
12.8× |
| CT upper extremity w/o contrast rt (73200) |
$1,473.60 |
$2,456 |
15.0× |
| CT upper extremity with contrast (73201) |
$1,970.40 |
$3,284 |
6.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,115 |
$3,525 |
12.9× |
| Cta Abdomen (74175) |
$2,115 |
$3,525 |
12.9× |
| CTA abdomen pelvis (74174) |
$4,881 |
$8,135 |
14.9× |
| CTA chest (71275) |
$2,713.80 |
$4,523 |
16.5× |
| Cta Head (70496) |
$2,115 |
$3,525 |
12.9× |
| CTA lwr ext w&w/o contrast (73706) |
$2,115 |
$3,525 |
12.9× |
| Cta Neck (70498) |
$2,115 |
$3,525 |
12.9× |
| Cta Pelvis (72191) |
$2,764.80 |
$4,608 |
16.8× |
| Cystography minimum 3 views rs&i (74430) |
$277.80 |
$463 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$550.20 |
$917 |
5.6× |
| Esophagus (74220) |
$552.60 |
$921 |
3.4× |
| Fetal biophysical profile non-stress testing (76818) |
$868.80 |
$1,448 |
8.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$939 |
$1,565 |
9.6× |
| Foot 2 views (73620) |
$210.60 |
$351 |
2.6× |
| Forearm 2 views (73090) |
$223.20 |
$372 |
2.7× |
| Hand 2 views (73120) |
$194.40 |
$324 |
2.0× |
| Hand 3 views (73130) |
$231.60 |
$386 |
2.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,330.20 |
$2,217 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$696 |
$1,160 |
1.9× |
| Ht muscle image spect sing (78451) |
$1,899.60 |
$3,166 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$230.40 |
$384 |
2.8× |
| Hysterosalpingogram (74740) |
$413.40 |
$689 |
1.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,330.20 |
$2,217 |
2.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,459.20 |
$2,432 |
2.9× |
| Knee 3 views (73562) |
$246.60 |
$411 |
3.0× |
| Lung perfusion differential (78597) |
$690.60 |
$1,151 |
1.8× |
| Lymphoscintigraphy (78195) |
$801.60 |
$1,336 |
1.6× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$188.40 |
$314 |
2.3× |
| MRA head w & w/o contrast (70546) |
$2,623.80 |
$4,373 |
8.0× |
| MRA head w/o contrast (70544) |
$2,475 |
$4,125 |
11.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,623.80 |
$4,373 |
8.0× |
| MRA neck w/o contrast (70547) |
$2,475 |
$4,125 |
11.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,518.20 |
$4,197 |
7.7× |
| MRI abdomen w/o contrast (74181) |
$2,376.60 |
$3,961 |
10.6× |
| MRI any jnt lwr ext with con lt (73722) |
$3,022.20 |
$5,037 |
4.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,022.20 |
$5,037 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$2,851.80 |
$4,753 |
12.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,609.40 |
$4,349 |
8.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,610 |
$4,350 |
8.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,045.40 |
$3,409 |
9.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,609.40 |
$4,349 |
11.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,441 |
$5,735 |
10.5× |
| MRI orbit/face/neck w/contrast (70542) |
$3,022.20 |
$5,037 |
9.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,840.20 |
$8,067 |
14.8× |
| MRI pelvis w/o contrast (72195) |
$2,184.60 |
$3,641 |
9.8× |
| MRI scan of arm joint before and after contrast (73223) |
$3,022.20 |
$5,037 |
9.2× |
| MRI scan of leg joint before and after contrast (73723) |
$3,022.20 |
$5,037 |
9.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,588.80 |
$7,648 |
14.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,151.80 |
$5,253 |
9.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,774 |
$6,290 |
11.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,588.80 |
$7,648 |
14.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,851.80 |
$4,753 |
12.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,851.80 |
$4,753 |
12.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,022.20 |
$5,037 |
9.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,053.80 |
$3,423 |
9.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,185.60 |
$1,976 |
1.0× |
| Neck soft tissue (70360) |
$212.40 |
$354 |
2.6× |
| Nm gastric emptying study (78264) |
$1,356.60 |
$2,261 |
3.6× |
| Nuclear medicine study of kidney and blood flow (78701) |
$898.80 |
$1,498 |
2.4× |
| Osseous survey infant (77076) |
$306.60 |
$511 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$230.40 |
$384 |
2.3× |
| PET image w/CT, skull-thigh (78815) |
$5,751 |
$9,585 |
4.3× |
| PET imaging for CT attenuation whole body (78816) |
$5,751 |
$9,585 |
4.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,022.20 |
$5,037 |
9.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$690.60 |
$1,151 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,247.40 |
$2,079 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$526.80 |
$878 |
5.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$450.90 |
$751.50 |
4.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$715.80 |
$1,193 |
7.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$378 |
$630 |
3.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$230.40 |
$384 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$319.80 |
$533 |
3.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$251.40 |
$419 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$843 |
$1,405 |
5.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,225.20 |
$2,042 |
7.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,149 |
$1,915 |
7.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$230.40 |
$384 |
2.8× |
| Radiological examination surgical specimen (76098) |
$1,081.20 |
$1,802 |
2.1× |
| Ribs bilateral 3 views (71110) |
$455.40 |
$759 |
4.6× |
| Sacroiliac Joints < 3 Views (72200) |
$230.40 |
$384 |
2.3× |
| Scanogram (77073) |
$268.20 |
$447 |
2.7× |
| Scapula complete (73010) |
$230.40 |
$384 |
2.3× |
| Screening digital breast tomosynthesis (77063) |
$42 |
$70 |
1.8× |
| Small bowel series (74250) |
$446.40 |
$744 |
2.7× |
| Spine thoracic 3 views (72072) |
$355.20 |
$592 |
3.6× |
| Thoracolumbar 2 views (72080) |
$315.60 |
$526 |
3.9× |
| Thyroid Imaging With Vascular Flow (78013) |
$663 |
$1,105 |
1.8× |
| Thyroid uptake measurement (78012) |
$297 |
$495 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$828 |
$1,380 |
2.2× |
| Tmj unilateral (70328) |
$223.80 |
$373 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$519 |
$865 |
5.3× |
| Urethrocystography voiding (74455) |
$334.80 |
$558 |
1.5× |
| Us abdl aorta screen aaa (76706) |
$404.40 |
$674 |
4.1× |
| Us breast unilateral complete (76641) |
$359.40 |
$599 |
3.7× |
| Us breast unilateral limited (76642) |
$180.60 |
$301 |
2.2× |
| Us chest (76604) |
$857.40 |
$1,429 |
8.7× |
| Us compl joint r-t w/image documentation (76881) |
$230.40 |
$384 |
2.3× |
| Us infant hips dynamic (76885) |
$331.80 |
$553 |
4.1× |
| Us ob detailed single fetus (76811) |
$1,193.40 |
$1,989 |
5.3× |
| Us ob transvaginal (76817) |
$808.20 |
$1,347 |
8.2× |
| Us pelvic non ob complete (76856) |
$715.80 |
$1,193 |
7.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$574.20 |
$957 |
5.9× |
| Us pregnancy ltd (76815) |
$643.20 |
$1,072 |
6.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$808.20 |
$1,347 |
8.2× |
| Us retroperitoneal complete (76770) |
$454.20 |
$757 |
4.6× |
| Us retroperitoneal limited (76775) |
$606.30 |
$1,010.50 |
6.2× |
| Us scrotum and contents (76870) |
$808.20 |
$1,347 |
8.2× |
| Us soft tissue head/neck (76536) |
$643.20 |
$1,072 |
6.6× |
| Us transrectal prostate volume (76873) |
$192 |
$320 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$149.40 |
$249 |
1.5× |
| Wrist 2 views (73100) |
$210.60 |
$351 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$532.20 |
$887 |
5.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$251.40 |
$419 |
3.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$915.60 |
$1,526 |
5.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$199.80 |
$333 |
2.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$261.60 |
$436 |
3.2× |
| X-ray exam hip uni 1 view (73501) |
$225 |
$375 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$235.80 |
$393 |
2.9× |
| X-ray exam hip uni 4/> views (73503) |
$246 |
$410 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$452.40 |
$754 |
4.6× |
| X-ray exam of femur 1 (73551) |
$118.20 |
$197 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$339 |
$565 |
3.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$230.40 |
$384 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$239.40 |
$399 |
2.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$223.20 |
$372 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$124.20 |
$207 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$282.60 |
$471 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$232.20 |
$387 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$315.60 |
$526 |
3.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$267.60 |
$446 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$655.20 |
$1,092 |
6.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$400.20 |
$667 |
4.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$230.40 |
$384 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$387.60 |
$646 |
4.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$306.60 |
$511 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300.60 |
$501 |
3.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$365.40 |
$609 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$521.40 |
$869 |
5.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$335.40 |
$559 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$261.60 |
$436 |
3.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$230.40 |
$384 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$376.20 |
$627 |
4.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$230.40 |
$384 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$378 |
$630 |
3.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$230.40 |
$384 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$96.60 |
$161 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$306.60 |
$511 |
3.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$230.40 |
$384 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$315.60 |
$526 |
3.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$445.20 |
$742 |
4.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$174 |
$290 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$256.80 |
$428 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$455.40 |
$759 |
4.6× |
| Xr finger(s) 2+ views (73140) |
$186 |
$310 |
2.3× |
| Xr shoulder 1 view (73020) |
$201.60 |
$336 |
2.5× |
| Xr spine cervical 4 or 5 views (72050) |
$455.40 |
$759 |
4.6× |
| Xr tibia/fibula 2 views (73590) |
$239.40 |
$399 |
2.9× |
| Xr tmj bilateral (70330) |
$378 |
$630 |
4.6× |
| Xray knee 1 or 2 views rt (73560) |
$219 |
$365 |
2.7× |