| Abdomen 2 views (74019) |
$109.20 |
$182 |
1.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$574.20 |
$957 |
1.5× |
| Ankle 2 views (73600) |
$189.60 |
$316 |
2.3× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,142.80 |
$5,238 |
1.0× |
| Arthrogram hip (73525) |
$210 |
$350 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$810.60 |
$1,351 |
2.1× |
| Bone age studies (77072) |
$126.60 |
$211 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$848.40 |
$1,414 |
2.2× |
| Bone survey complete (77075) |
$213 |
$355 |
2.1× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$630 |
$1,050 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$126.60 |
$211 |
1.5× |
| Chest 1 view (71045) |
$76.80 |
$128 |
0.9× |
| Chest 3 views (71047) |
$126.60 |
$211 |
1.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$193.20 |
$322 |
1.1× |
| Clavicle complete (73000) |
$189.60 |
$316 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$200 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,810.80 |
$3,018 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$644.40 |
$1,074 |
2.8× |
| CT abdomen w contrast (74160) |
$805.20 |
$1,342 |
4.8× |
| CT abdomen w wo contrast (74170) |
$873.60 |
$1,456 |
5.2× |
| CT abdomen w/o contrast (74150) |
$730.20 |
$1,217 |
7.3× |
| CT angio hrt w/3d image (75574) |
$644.40 |
$1,074 |
1.9× |
| CT angiography upper extremity lt (73206) |
$496.80 |
$828 |
2.9× |
| CT c-spine w/o contrast (72125) |
$759 |
$1,265 |
7.5× |
| CT cervical spine w&w/o contrast (72127) |
$873.60 |
$1,456 |
5.2× |
| CT cervical spine with contrast (72126) |
$759 |
$1,265 |
2.3× |
| CT chest w/wo contrast (71270) |
$873.60 |
$1,456 |
5.2× |
| CT chest with contrast (71260) |
$773.40 |
$1,289 |
4.6× |
| CT head/brain with contrast (70460) |
$751.80 |
$1,253 |
4.5× |
| CT head/brain without and with contrast (70470) |
$966.60 |
$1,611 |
5.7× |
| CT heart contrast eval cardiac structure&morph (75572) |
$644.40 |
$1,074 |
1.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$647.40 |
$1,079 |
7.7× |
| CT hrt w/3d image congen (75573) |
$904.80 |
$1,508 |
2.7× |
| CT iac w contrast (70481) |
$751.80 |
$1,253 |
4.5× |
| CT lower ext w/o (73700) |
$546 |
$910 |
5.4× |
| CT lower extremity w wo contrast (73702) |
$873.60 |
$1,456 |
5.2× |
| CT lower extremity with contrast (73701) |
$748.80 |
$1,248 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$967.20 |
$1,612 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$759 |
$1,265 |
7.5× |
| CT lumbar spine with contrast (72132) |
$759 |
$1,265 |
2.3× |
| CT maxillofacial w contrast (70487) |
$734.40 |
$1,224 |
4.4× |
| CT maxillofacial w/o contrast (70486) |
$680.40 |
$1,134 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$873.60 |
$1,456 |
5.2× |
| CT neck soft tissue w contrast (70491) |
$823.20 |
$1,372 |
4.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$873.60 |
$1,456 |
5.2× |
| CT orbits w/o contrast (70480) |
$680.40 |
$1,134 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$937.80 |
$1,563 |
5.6× |
| CT pelvis w/o contrast (72192) |
$751.80 |
$1,253 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$930.60 |
$1,551 |
5.5× |
| CT soft tissue neck w/o contrast (70490) |
$745.20 |
$1,242 |
7.4× |
| CT thoracic spine w/contrast (72129) |
$759 |
$1,265 |
4.5× |
| CT thoracic spine w/o contrast (72128) |
$759 |
$1,265 |
7.5× |
| CT thoracic spine w/wo contrast (72130) |
$967.20 |
$1,612 |
5.7× |
| CT thorax w/o contrast (71250) |
$702 |
$1,170 |
7.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$615.60 |
$1,026 |
3.6× |
| CT upper extremity w/o contrast rt (73200) |
$615.60 |
$1,026 |
6.1× |
| CT upper extremity with contrast (73201) |
$748.80 |
$1,248 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$644.40 |
$1,074 |
3.8× |
| Cta Abdomen (74175) |
$945.60 |
$1,576 |
5.6× |
| CTA abdomen pelvis (74174) |
$644.40 |
$1,074 |
1.9× |
| CTA chest (71275) |
$644.40 |
$1,074 |
3.8× |
| Cta Head (70496) |
$644.40 |
$1,074 |
3.8× |
| CTA lwr ext w&w/o contrast (73706) |
$873.60 |
$1,456 |
5.2× |
| Cta Neck (70498) |
$644.40 |
$1,074 |
3.8× |
| Cta Pelvis (72191) |
$751.80 |
$1,253 |
4.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$205.20 |
$342 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$90 |
$150 |
1.1× |
| Esophagus (74220) |
$193.20 |
$322 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$270 |
$450 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$198 |
$330 |
0.9× |
| Foot 2 views (73620) |
$189.60 |
$316 |
2.3× |
| Forearm 2 views (73090) |
$189.60 |
$316 |
2.3× |
| Gated Heart Planar Single (78472) |
$530.24 |
$883.73 |
1.4× |
| Hand 2 views (73120) |
$189.60 |
$316 |
1.9× |
| Hand 3 views (73130) |
$189.60 |
$316 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$704.40 |
$1,174 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$631.20 |
$1,052 |
1.6× |
| Ht muscle image spect sing (78451) |
$1,615.20 |
$2,692 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$189.60 |
$316 |
2.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$574.20 |
$957 |
1.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$574.20 |
$957 |
1.1× |
| Knee 3 views (73562) |
$222.60 |
$371 |
2.7× |
| MRA head w & w/o contrast (70546) |
$1,778.40 |
$2,964 |
5.3× |
| MRA head w/o contrast (70544) |
$1,029 |
$1,715 |
4.5× |
| MRA head with contrast (70545) |
$2,074.80 |
$3,458 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,482 |
$2,470 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,029 |
$1,715 |
4.5× |
| MRI abdomen w contrast (74182) |
$1,146 |
$1,910 |
3.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,482 |
$2,470 |
4.4× |
| MRI abdomen w/o contrast (74181) |
$1,029 |
$1,715 |
4.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,322.40 |
$2,204 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,322.40 |
$2,204 |
1.8× |
| MRI breast w/o contrast bilateral (77047) |
$390 |
$650 |
1.7× |
| MRI breast w/o contrast unilat (77046) |
$291 |
$485 |
1.3× |
| MRI c-spine with contrast (72142) |
$1,146 |
$1,910 |
3.4× |
| MRI cardiac w/o cont stress (75559) |
$750 |
$1,250 |
1.4× |
| MRI cardiac w/o contrast (75557) |
$450 |
$750 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$1,029 |
$1,715 |
4.5× |
| MRI chest w/o & w/contrast material (71552) |
$1,140 |
$1,900 |
3.4× |
| MRI chest w/o contrast (71550) |
$1,029 |
$1,715 |
4.5× |
| MRI chest with contrast (71551) |
$1,029 |
$1,715 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,146 |
$1,910 |
3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,233 |
$2,055 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,174.50 |
$1,957.50 |
5.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,029 |
$1,715 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,482 |
$2,470 |
4.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,146 |
$1,910 |
3.4× |
| MRI pelvis w contrast (72196) |
$1,146 |
$1,910 |
3.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,482 |
$2,470 |
4.4× |
| MRI pelvis w/o contrast (72195) |
$1,029 |
$1,715 |
4.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,482 |
$2,470 |
4.4× |
| MRI scan of heart before and after contrast with stress imaging (75563) |
$1,080 |
$1,800 |
1.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,482 |
$2,470 |
4.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,482 |
$2,470 |
4.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,482 |
$2,470 |
4.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,482 |
$2,470 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,070.40 |
$1,784 |
4.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,029 |
$1,715 |
4.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,482 |
$2,470 |
4.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,309.50 |
$2,182.50 |
5.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,615.20 |
$2,692 |
1.3× |
| Neck soft tissue (70360) |
$126.60 |
$211 |
1.5× |
| Nm gastric emptying study (78264) |
$445.80 |
$743 |
1.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$87 |
$145 |
0.9× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$119.84 |
$199.74 |
1.2× |
| Osseous survey infant (77076) |
$145.10 |
$241.84 |
1.4× |
| Osseous survey limited (77074) |
$97.27 |
$162.12 |
1.0× |
| Parathyrd planar w/wo subtrj (78071) |
$379.80 |
$633 |
1.0× |
| Parathyroid imaging (78070) |
$379.80 |
$633 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$126.60 |
$211 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,401 |
$2,335 |
4.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$543.60 |
$906 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$75 |
$125 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$90 |
$150 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$252.60 |
$421 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$99 |
$165 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$252.60 |
$421 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$105 |
$175 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$126.60 |
$211 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$85.20 |
$142 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$193.20 |
$322 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$193.20 |
$322 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$321 |
$535 |
3.8× |
| Ribs bilateral 3 views (71110) |
$96 |
$160 |
1.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$810.60 |
$1,351 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$96 |
$160 |
1.0× |
| Scapula complete (73010) |
$126.60 |
$211 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$120 |
$200 |
5.1× |
| Sella turcica (70240) |
$90 |
$150 |
1.1× |
| Small bowel series (74250) |
$256.80 |
$428 |
1.5× |
| Spine thoracic 3 views (72072) |
$126.60 |
$211 |
1.3× |
| Thoracolumbar 2 views (72080) |
$90 |
$150 |
1.1× |
| Tmj unilateral (70328) |
$90 |
$150 |
1.1× |
| Ultrasound scan of cornea to determine thickness (76514) |
$23.11 |
$38.51 |
0.8× |
| Ultrasound scan to determine eye length and lens power (76519) |
$128.44 |
$214.07 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$389.40 |
$649 |
3.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$45 |
$75 |
0.5× |
| Upper Extremity Infant (73092) |
$90 |
$150 |
0.9× |
| Us abdl aorta screen aaa (76706) |
$126.01 |
$210.02 |
1.3× |
| Us breast unilateral complete (76641) |
$249.30 |
$415.50 |
2.5× |
| Us breast unilateral limited (76642) |
$166.20 |
$277 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$622.80 |
$1,038 |
6.2× |
| Us infant hips limited static (76886) |
$259.80 |
$433 |
3.1× |
| Us ob detailed single fetus (76811) |
$270 |
$450 |
1.2× |
| Us ob transvaginal (76817) |
$240.60 |
$401 |
2.4× |
| Us pelvic non ob complete (76856) |
$259.80 |
$433 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$166.20 |
$277 |
1.7× |
| Us pregnancy ltd (76815) |
$87 |
$145 |
0.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$188.09 |
$313.49 |
1.9× |
| Us retroperitoneal complete (76770) |
$393.30 |
$655.50 |
3.9× |
| Us retroperitoneal limited (76775) |
$519 |
$865 |
5.2× |
| Us scrotum and contents (76870) |
$259.80 |
$433 |
2.6× |
| Us soft tissue head/neck (76536) |
$259.80 |
$433 |
2.6× |
| Us transrectal (76872) |
$81 |
$135 |
0.8× |
| Us xtr non-vasc lmtd (76882) |
$259.80 |
$433 |
2.6× |
| Us, eye b-scan (76512) |
$140.80 |
$234.67 |
1.4× |
| Wrist 2 views (73100) |
$189.60 |
$316 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$213 |
$355 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$252.60 |
$421 |
3.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$210.90 |
$351.50 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$189.60 |
$316 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$126.60 |
$211 |
1.5× |
| X-ray exam hip uni 1 view (73501) |
$126.60 |
$211 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$126.60 |
$211 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$90 |
$150 |
0.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$576 |
$960 |
5.7× |
| X-ray exam of femur 1 (73551) |
$213 |
$355 |
2.5× |
| X-ray eye for foreign body (70030) |
$90 |
$150 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$130.20 |
$217 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$75 |
$125 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$189.60 |
$316 |
2.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$268.80 |
$448 |
3.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$250.20 |
$417 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$252.60 |
$421 |
3.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$75 |
$125 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$126.60 |
$211 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$213 |
$355 |
2.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$96 |
$160 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$126.60 |
$211 |
1.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$90 |
$150 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$120 |
$200 |
1.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$126.60 |
$211 |
1.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$748.80 |
$1,248 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$75 |
$125 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$126.60 |
$211 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$252.60 |
$421 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$126.60 |
$211 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$126.60 |
$211 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$210.90 |
$351.50 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$126.60 |
$211 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$75 |
$125 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$213 |
$355 |
2.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$126.60 |
$211 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$126.60 |
$211 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$90 |
$150 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$126.60 |
$211 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$126.60 |
$211 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$126.60 |
$211 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$189.60 |
$316 |
2.3× |
| Xr arthrogram ankle (73615) |
$75 |
$125 |
0.2× |
| Xr c-spine 6 or more views (72052) |
$96 |
$160 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$189.60 |
$316 |
2.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$93 |
$155 |
0.9× |
| Xr optic foramina (70190) |
$90 |
$150 |
1.1× |
| Xr shoulder 1 view (73020) |
$189.60 |
$316 |
2.3× |
| Xr spine cervical 4 or 5 views (72050) |
$213 |
$355 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$126.60 |
$211 |
1.5× |
| Xr tmj bilateral (70330) |
$105 |
$175 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$189.60 |
$316 |
2.3× |