| Abdomen 2 views (74019) |
$105 |
$150 |
1.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$292.25 |
$417.50 |
0.8× |
| Ankle 2 views (73600) |
$94.50 |
$135 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$190.75 |
$272.50 |
0.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$201.25 |
$287.50 |
0.5× |
| Bone &/joint imaging whole body (78306) |
$224 |
$320 |
0.6× |
| Bone age studies (77072) |
$89.25 |
$127.50 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$203 |
$290 |
0.6× |
| Bone survey complete (77075) |
$281.75 |
$402.50 |
2.9× |
| Cervical spine 2 or 3 views (72040) |
$112 |
$160 |
1.4× |
| Chest 1 view (71045) |
$115.50 |
$165 |
1.4× |
| Chest 3 views (71047) |
$103.25 |
$147.50 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$294 |
$420 |
1.8× |
| Clavicle complete (73000) |
$105 |
$150 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$404.25 |
$577.50 |
4.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$568.75 |
$812.50 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$432.25 |
$617.50 |
2.0× |
| CT abdomen w contrast (74160) |
$358.75 |
$512.50 |
2.2× |
| CT abdomen w wo contrast (74170) |
$507.50 |
$725 |
3.1× |
| CT abdomen w/o contrast (74150) |
$337.75 |
$482.50 |
3.5× |
| CT angiography upper extremity lt (73206) |
$647.50 |
$925 |
4.0× |
| CT c-spine w/o contrast (72125) |
$337.75 |
$482.50 |
3.5× |
| CT cervical spine w&w/o contrast (72127) |
$390.25 |
$557.50 |
2.4× |
| CT cervical spine with contrast (72126) |
$355.25 |
$507.50 |
1.1× |
| CT chest w/wo contrast (71270) |
$402.50 |
$575 |
2.5× |
| CT chest with contrast (71260) |
$358.75 |
$512.50 |
2.2× |
| CT head/brain with contrast (70460) |
$358.75 |
$512.50 |
2.2× |
| CT head/brain without and with contrast (70470) |
$402.50 |
$575 |
2.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$282.80 |
$404 |
3.5× |
| CT iac w contrast (70481) |
$358.75 |
$512.50 |
2.2× |
| CT limited/localized follow up study (76380) |
$430.50 |
$615 |
5.4× |
| CT lower ext w/o (73700) |
$420 |
$600 |
4.4× |
| CT lower extremity w wo contrast (73702) |
$315 |
$450 |
2.0× |
| CT lower extremity with contrast (73701) |
$423.50 |
$605 |
2.6× |
| CT lumbar spine w & w/o contrast (72133) |
$390.25 |
$557.50 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$337.75 |
$482.50 |
3.5× |
| CT lumbar spine with contrast (72132) |
$355.25 |
$507.50 |
1.1× |
| CT maxillofacial w contrast (70487) |
$358.75 |
$512.50 |
2.2× |
| CT maxillofacial w/o contrast (70486) |
$337.75 |
$482.50 |
3.5× |
| CT maxillofacial w/wo contrast (70488) |
$402.50 |
$575 |
2.5× |
| CT neck soft tissue w contrast (70491) |
$358.75 |
$512.50 |
2.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$402.50 |
$575 |
2.5× |
| CT orbits w/o contrast (70480) |
$337.75 |
$482.50 |
3.5× |
| CT pelvis w & w/o contrast (72194) |
$402.50 |
$575 |
2.5× |
| CT pelvis w/o contrast (72192) |
$337.75 |
$482.50 |
3.5× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$420 |
$600 |
5.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$595 |
$850 |
3.7× |
| CT soft tissue neck w/o contrast (70490) |
$402.50 |
$575 |
4.2× |
| CT thoracic spine w/contrast (72129) |
$355.25 |
$507.50 |
2.2× |
| CT thoracic spine w/o contrast (72128) |
$337.75 |
$482.50 |
3.5× |
| CT thoracic spine w/wo contrast (72130) |
$402.50 |
$575 |
2.5× |
| CT thorax w/o contrast (71250) |
$337.75 |
$482.50 |
3.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$402.50 |
$575 |
2.5× |
| CT upper extremity w/o contrast rt (73200) |
$420 |
$600 |
4.4× |
| CT upper extremity with contrast (73201) |
$423.50 |
$605 |
1.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$910 |
$1,300 |
5.6× |
| Cta Abdomen (74175) |
$820.75 |
$1,172.50 |
5.1× |
| CTA abdomen pelvis (74174) |
$1,268.75 |
$1,812.50 |
4.0× |
| CTA chest (71275) |
$694.75 |
$992.50 |
4.3× |
| Cta Head (70496) |
$701.75 |
$1,002.50 |
4.4× |
| CTA lwr ext w&w/o contrast (73706) |
$647.50 |
$925 |
4.0× |
| Cta Neck (70498) |
$701.75 |
$1,002.50 |
4.4× |
| Cta Pelvis (72191) |
$638.75 |
$912.50 |
4.0× |
| Cystography minimum 3 views rs&i (74430) |
$329 |
$470 |
1.0× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$66.50 |
$95 |
0.7× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$87.50 |
$125 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$124.25 |
$177.50 |
1.3× |
| Esophagus (74220) |
$255.50 |
$365 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$108.50 |
$155 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$92.75 |
$132.50 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$220.50 |
$315 |
1.0× |
| Foot 2 views (73620) |
$87.50 |
$125 |
1.1× |
| Forearm 2 views (73090) |
$115.50 |
$165 |
1.4× |
| Gated Heart Planar Single (78472) |
$273 |
$390 |
0.7× |
| Hand 2 views (73120) |
$94.50 |
$135 |
1.0× |
| Hand 3 views (73130) |
$126 |
$180 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$285.25 |
$407.50 |
0.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$285.25 |
$407.50 |
0.8× |
| Ht muscle image spect sing (78451) |
$1,221.50 |
$1,745 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$126 |
$180 |
1.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$150.50 |
$215 |
1.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$390.25 |
$557.50 |
0.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$432.25 |
$617.50 |
0.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$533.75 |
$762.50 |
1.1× |
| Knee 3 views (73562) |
$112 |
$160 |
1.4× |
| Mammary ductogram or galactogram single (77053) |
$286.30 |
$409 |
1.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$68.25 |
$97.50 |
0.9× |
| Meckels Diverticulum (78290) |
$197.75 |
$282.50 |
0.5× |
| MRA head w/o contrast (70544) |
$360.50 |
$515 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$379.75 |
$542.50 |
1.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$330.75 |
$472.50 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$413 |
$590 |
1.9× |
| MRI cervical spine w/o contrast (72141) |
$413 |
$590 |
1.9× |
| MRI chest w/o contrast (71550) |
$315 |
$450 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$409.50 |
$585 |
1.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$409.50 |
$585 |
1.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$684.53 |
$977.90 |
3.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$322 |
$460 |
1.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$309.75 |
$442.50 |
1.0× |
| MRI pelvis w contrast (72196) |
$399 |
$570 |
1.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$330.75 |
$472.50 |
1.0× |
| MRI pelvis w/o contrast (72195) |
$311.50 |
$445 |
1.4× |
| MRI scan of arm joint before and after contrast (73223) |
$362.25 |
$517.50 |
1.1× |
| MRI scan of leg joint before and after contrast (73723) |
$432.25 |
$617.50 |
1.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$372.75 |
$532.50 |
1.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$442.75 |
$632.50 |
1.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$483 |
$690 |
1.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$442.75 |
$632.50 |
1.4× |
| MRI thoracic spine w/o contrast (72146) |
$483 |
$690 |
2.2× |
| MRI upper ext joint w/o contrast (73221) |
$406 |
$580 |
1.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$362.25 |
$517.50 |
1.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$336 |
$480 |
1.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,379 |
$1,970 |
1.2× |
| Neck soft tissue (70360) |
$84 |
$120 |
1.0× |
| Nm gastric emptying study (78264) |
$172.20 |
$246 |
0.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$92.75 |
$132.50 |
1.0× |
| Osseous survey infant (77076) |
$134.75 |
$192.50 |
1.4× |
| Osseous survey limited (77074) |
$157.50 |
$225 |
1.6× |
| Parathyroid imaging (78070) |
$278.25 |
$397.50 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$82.25 |
$117.50 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$560 |
$800 |
1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$292.25 |
$417.50 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$651 |
$930 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$84 |
$120 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$134.75 |
$192.50 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$88.20 |
$126 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$127.75 |
$182.50 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$85.75 |
$122.50 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$99.75 |
$142.50 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$94.50 |
$135 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$945 |
$1,350 |
5.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$402.50 |
$575 |
2.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$124.25 |
$177.50 |
1.6× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$89.95 |
$128.50 |
1.1× |
| Ribs bilateral 3 views (71110) |
$89.25 |
$127.50 |
0.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$194.25 |
$277.50 |
0.4× |
| Sacroiliac Joints < 3 Views (72200) |
$91 |
$130 |
0.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$451.50 |
$645 |
2.1× |
| Scanogram (77073) |
$227.50 |
$325 |
2.4× |
| Scapula complete (73010) |
$80.50 |
$115 |
0.8× |
| Screening digital breast tomosynthesis (77063) |
$54.60 |
$78 |
2.3× |
| Sella turcica (70240) |
$64.75 |
$92.50 |
0.8× |
| Small bowel series (74250) |
$190.75 |
$272.50 |
1.2× |
| Speech evaluation complex (70371) |
$360.50 |
$515 |
1.6× |
| Spine thoracic 3 views (72072) |
$124.25 |
$177.50 |
1.3× |
| Thoracolumbar 2 views (72080) |
$115.50 |
$165 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$175 |
$250 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$217 |
$310 |
0.6× |
| Tmj unilateral (70328) |
$98 |
$140 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$122.50 |
$175 |
1.3× |
| Unlisted Ultrasound Procedure (76999) |
$49 |
$70 |
0.6× |
| Upper Extremity Infant (73092) |
$94.50 |
$135 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$262.50 |
$375 |
1.2× |
| Us breast unilateral complete (76641) |
$91 |
$130 |
0.9× |
| Us breast unilateral limited (76642) |
$91 |
$130 |
1.1× |
| Us chest (76604) |
$78.75 |
$112.50 |
0.8× |
| Us compl joint r-t w/image documentation (76881) |
$80.50 |
$115 |
0.8× |
| Us fetal nuchal translucency 1st gestation (76813) |
$161 |
$230 |
1.7× |
| Us infant hips dynamic (76885) |
$451.50 |
$645 |
5.6× |
| Us infant hips limited static (76886) |
$87.50 |
$125 |
1.1× |
| Us kidney transplant (76776) |
$101.50 |
$145 |
1.1× |
| Us ob detailed single fetus (76811) |
$154 |
$220 |
0.7× |
| Us ob transvaginal (76817) |
$105 |
$150 |
1.1× |
| Us pelvic non ob complete (76856) |
$134.75 |
$192.50 |
1.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$75.25 |
$107.50 |
0.8× |
| Us pregnancy ltd (76815) |
$92.75 |
$132.50 |
1.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$96.25 |
$137.50 |
1.0× |
| Us retroperitoneal complete (76770) |
$98 |
$140 |
1.0× |
| Us retroperitoneal limited (76775) |
$75.25 |
$107.50 |
0.8× |
| Us scrotum and contents (76870) |
$85.75 |
$122.50 |
0.9× |
| Us soft tissue head/neck (76536) |
$302.75 |
$432.50 |
3.1× |
| Us spinal canal and contents (76800) |
$112 |
$160 |
1.2× |
| Us transrectal (76872) |
$98 |
$140 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$80.50 |
$115 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$166.25 |
$237.50 |
0.1× |
| Wrist 2 views (73100) |
$70 |
$100 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$152.25 |
$217.50 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94.50 |
$135 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$129.50 |
$185 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$105 |
$150 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$140 |
$200 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$91 |
$130 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$110.25 |
$157.50 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$171.50 |
$245 |
1.8× |
| X-ray exam of femur 1 (73551) |
$89.25 |
$127.50 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$113.75 |
$162.50 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$113.75 |
$162.50 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$122.50 |
$175 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$105 |
$150 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$75.95 |
$108.50 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$199.50 |
$285 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$75.25 |
$107.50 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$126 |
$180 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$56 |
$80 |
0.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$169.75 |
$242.50 |
1.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$138.25 |
$197.50 |
1.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$94.50 |
$135 |
1.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$70 |
$100 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$110.25 |
$157.50 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$92.75 |
$132.50 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$87.50 |
$125 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$122.50 |
$175 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$143.50 |
$205 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$96.25 |
$137.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$92.75 |
$132.50 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$129.50 |
$185 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$117.25 |
$167.50 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$73.50 |
$105 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$127.75 |
$182.50 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$92.75 |
$132.50 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$103.25 |
$147.50 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$101.50 |
$145 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$92.75 |
$132.50 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$87.50 |
$125 |
0.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$108.50 |
$155 |
1.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$73.50 |
$105 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$133 |
$190 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$155.75 |
$222.50 |
1.6× |
| Xr chest 4+ views (71048) |
$105 |
$150 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$73.50 |
$105 |
0.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$87.50 |
$125 |
0.9× |
| Xr optic foramina (70190) |
$75.60 |
$108 |
0.9× |
| Xr shoulder 1 view (73020) |
$98 |
$140 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$136.50 |
$195 |
1.4× |
| Xr tibia/fibula 2 views (73590) |
$129.50 |
$185 |
1.6× |
| Xr tmj bilateral (70330) |
$108.50 |
$155 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$98 |
$140 |
1.2× |