| Abdomen 2 views (74019) |
$210 |
$502 |
1.9× |
| Acute gi blood loss imaging (78278) |
$1,086 |
$2,596 |
2.6× |
| Ankle 2 views (73600) |
$175 |
$417 |
1.9× |
| Arthrogram hip (73525) |
$266 |
$634 |
0.7× |
| Arthrogram knee (73580) |
$617 |
$1,475 |
1.7× |
| Arthrogram shoulder (73040) |
$420 |
$1,004 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$541 |
$1,294 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$760 |
$1,816 |
1.8× |
| Bone age studies (77072) |
$53 |
$126 |
0.5× |
| Bone Imaging 3 Phase (78315) |
$1,074 |
$2,567 |
2.6× |
| Bone survey complete (77075) |
$915 |
$2,187 |
8.4× |
| Bone survey infant (77076) |
$276 |
$659 |
2.5× |
| Bowel imaging (78290) |
$1,080 |
$2,582 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$190 |
$454 |
2.1× |
| Chest 1 view (71045) |
$173.50 |
$414 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$388 |
$927 |
2.1× |
| Clavicle complete (73000) |
$155 |
$370 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,317 |
$3,149 |
12.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,569 |
$6,144 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,087 |
$4,992 |
8.4× |
| CT abdomen w contrast (74160) |
$1,151 |
$2,753 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,253 |
$2,996 |
6.8× |
| CT abdomen w/o contrast (74150) |
$1,045 |
$2,500 |
9.5× |
| CT c-spine w/o contrast (72125) |
$1,101 |
$2,633 |
10.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,293 |
$3,091 |
7.0× |
| CT chest w contrast (71260) |
$1,313 |
$3,141 |
7.1× |
| CT chest w/wo contrast (71270) |
$1,317 |
$3,149 |
7.2× |
| CT head/brain with contrast (70460) |
$1,101 |
$2,633 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,231 |
$2,944 |
6.7× |
| CT iac w contrast (70481) |
$1,045 |
$2,500 |
5.7× |
| CT limited/localized follow up study (76380) |
$510 |
$1,219 |
5.6× |
| CT lower ext w/o (73700) |
$1,045 |
$2,500 |
9.5× |
| CT lower extremity w wo contrast (73702) |
$1,101 |
$2,633 |
6.0× |
| CT lower extremity w/contrast material (73701) |
$1,101 |
$2,633 |
6.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,317 |
$3,149 |
7.2× |
| CT lumbar spine w/contrast (72132) |
$1,313 |
$3,141 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,101 |
$2,633 |
10.1× |
| CT maxillofacial w contrast (70487) |
$1,045 |
$2,500 |
5.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,165 |
$2,785 |
6.3× |
| CT maxillofacial wo contrast (70486) |
$1,045 |
$2,500 |
9.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,165 |
$2,785 |
6.3× |
| CT orbits w/o contrast (70480) |
$1,045 |
$2,500 |
9.5× |
| CT pelvis w/o contrast (72192) |
$1,045 |
$2,500 |
9.5× |
| CT pelvis w/wo contrast (72194) |
$1,253 |
$2,996 |
6.8× |
| CT soft tissue neck w contrast (70491) |
$1,084 |
$2,593 |
5.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,285 |
$3,073 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,170 |
$2,799 |
10.7× |
| CT thoracic spine w/contrast (72129) |
$1,313 |
$3,141 |
7.1× |
| CT thoracic spine w/o contrast (72128) |
$1,101 |
$2,633 |
10.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,317 |
$3,149 |
7.2× |
| CT thorax w/o contrast (71250) |
$1,076 |
$2,573 |
9.8× |
| CT upper ext wo (73200) |
$1,045 |
$2,500 |
9.5× |
| CT upper extremity with contrast (73201) |
$1,103 |
$2,637.50 |
3.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$714 |
$1,708 |
3.9× |
| CTA abdomen pelvis (74174) |
$2,569 |
$6,144 |
7.0× |
| CTA chest (71275) |
$1,313 |
$3,141 |
7.1× |
| Cta Head (70496) |
$1,115 |
$2,667 |
6.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,455 |
$5,871 |
6.7× |
| Cta Neck (70498) |
$1,340 |
$3,204 |
7.3× |
| Cystography minimum 3 views rs&i (74430) |
$267 |
$638 |
0.7× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$361 |
$862 |
3.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$280 |
$668 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$224 |
$534 |
2.5× |
| Dxa bone density study axial skeleton (77085) |
$410 |
$979 |
3.7× |
| Esophagus (74220) |
$291 |
$696 |
1.6× |
| Facial bones min 3 views (70150) |
$232 |
$555 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$380 |
$907 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$415 |
$991 |
1.7× |
| Foot 2 views (73620) |
$138 |
$329 |
1.5× |
| Forearm 2 views (73090) |
$175 |
$417 |
1.9× |
| Hand 2 views (73120) |
$138 |
$329 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,465 |
$3,504 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,066 |
$2,549 |
2.5× |
| Hysterosalpingogram (74740) |
$292 |
$697 |
1.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$418 |
$999 |
0.7× |
| Knee 3 views (73562) |
$220 |
$524 |
2.4× |
| Lymphoscintigraphy (78195) |
$1,076 |
$2,573 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,014 |
$4,817 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,160 |
$5,167 |
5.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,637.50 |
$6,309.50 |
7.2× |
| MRA head w & w/o contrast (70546) |
$3,463 |
$8,283 |
9.5× |
| MRA head w/o contrast (70544) |
$2,255 |
$5,393 |
9.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,480 |
$8,324 |
9.5× |
| MRA neck w/o contrast (70547) |
$2,266 |
$5,420 |
9.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,669 |
$6,384 |
7.3× |
| MRI abdomen w/o contrast (74181) |
$1,761 |
$4,211 |
7.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,036 |
$4,869 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,464 |
$5,893 |
6.7× |
| MRI breast w/o contrast bilateral (77047) |
$503 |
$1,202 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$1,012 |
$2,420 |
4.0× |
| MRI chest w/o & w/contrast material (71552) |
$3,164 |
$7,568 |
8.7× |
| MRI chest w/o contrast (71550) |
$2,318 |
$5,544 |
9.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,679 |
$6,407 |
7.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,017 |
$4,824 |
8.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,369 |
$3,274 |
5.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,610 |
$6,244 |
7.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,661 |
$6,366 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$2,050 |
$4,904 |
8.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,793 |
$4,289 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,593 |
$3,811 |
4.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,782 |
$4,261 |
4.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,796 |
$4,295 |
4.9× |
| MRI temporomandibular joint (70336) |
$1,672 |
$3,998 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,012 |
$2,420 |
4.0× |
| MRI up ext w/o contrast (73218) |
$2,014 |
$4,817 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,135 |
$2,715 |
4.5× |
| MRI, joint upper extrem combo (73223) |
$2,448 |
$5,856 |
6.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,426 |
$3,411 |
1.1× |
| Myocardial spect single study at rest or stress (78451) |
$995 |
$2,378 |
0.7× |
| Neck soft tissue (70360) |
$151 |
$360 |
1.7× |
| Nm gastric emptying study (78264) |
$905 |
$2,164 |
2.2× |
| Osseous survey limited (77074) |
$185 |
$442 |
1.7× |
| Parathyroid Planar Imaging (78070) |
$943 |
$2,255 |
2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,082 |
$2,587 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$190.50 |
$453.50 |
1.7× |
| PET image w/CT, skull-thigh (78815) |
$1,708 |
$4,085 |
1.1× |
| PET imaging for CT attenuation whole body (78816) |
$1,708 |
$4,085 |
1.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$735 |
$1,756 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,021 |
$2,442 |
1.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$296 |
$706 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$203 |
$484 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$171 |
$409 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$199 |
$476 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$167 |
$398 |
1.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$175 |
$417 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$175 |
$417 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$307 |
$733 |
3.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$583 |
$1,393 |
5.3× |
| Radex Humerus Minimum 2 Views (73060) |
$175 |
$417 |
1.9× |
| Radex Kne 1/2 Views (73560) |
$167 |
$398 |
1.8× |
| Radex Kne Compl 4/More Views (73564) |
$244 |
$582 |
2.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$251 |
$600 |
2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$190 |
$454 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$286 |
$683 |
2.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$173 |
$412 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$151 |
$360 |
1.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$234 |
$558 |
2.6× |
| Radex Toe Minimum 2 Views (73660) |
$167 |
$398 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$156 |
$372 |
1.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$203 |
$484 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$145 |
$345 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$210 |
$502 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$354 |
$845 |
1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$315 |
$753 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$341 |
$814 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$285 |
$681 |
1.6× |
| Radiologic examination femur 1 view (73551) |
$56 |
$133 |
0.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$181 |
$432 |
2.0× |
| Ribs bilateral 3 views (71110) |
$266 |
$634 |
2.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$530 |
$1,267 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$992 |
$2,372 |
1.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$640 |
$1,530 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$469.50 |
$1,122 |
1.9× |
| Scapula (73010) |
$173 |
$413 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$82 |
$195 |
3.5× |
| Shoulder 1 view (73020) |
$137 |
$326 |
1.5× |
| Small bowel series (74250) |
$310 |
$740 |
1.7× |
| Spine thoracic 3 views (72072) |
$260 |
$622 |
2.4× |
| Testicular Imaging With Vascular Flow (78761) |
$634 |
$1,516 |
1.5× |
| Thoracolumbar 2 views (72080) |
$234 |
$558 |
2.6× |
| Thyroid uptake measurement (78012) |
$255 |
$608 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$783 |
$1,872 |
1.9× |
| Ultrasound breast complete (76641) |
$643 |
$1,538 |
5.9× |
| Ultrasound Exam Aaa Screen (76706) |
$610 |
$1,459 |
5.6× |
| Ultrasound, abdomen limited (76705) |
$443 |
$1,058 |
4.0× |
| Umbilical-artery Doppler (OB) (76820) |
$443 |
$1,058 |
4.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$72 |
$171 |
0.8× |
| Unlisted ultrasound procedure (76999) |
$443 |
$1,058 |
4.9× |
| Urethrocystogram voiding (74455) |
$401 |
$959 |
1.6× |
| Us breast unilateral limited (76642) |
$495 |
$1,183 |
5.4× |
| Us chest (76604) |
$216 |
$516 |
2.0× |
| Us infant hips w manipulation (76885) |
$454 |
$1,086 |
5.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$443 |
$1,058 |
4.0× |
| Us ob detailed single fetus (76811) |
$839 |
$2,007 |
3.4× |
| Us ob limited (76815) |
$144 |
$343 |
1.3× |
| Us ob transvaginal (76817) |
$173 |
$412 |
1.6× |
| Us pelvic non ob complete (76856) |
$443 |
$1,058 |
4.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$74 |
$176 |
0.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$443 |
$1,058 |
4.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$380 |
$907 |
3.5× |
| Us retroperitoneal complete (76770) |
$443 |
$1,058 |
4.0× |
| Us retroperitoneal limited (76775) |
$352 |
$842 |
3.2× |
| Us scrotum and contents (76870) |
$443 |
$1,058 |
4.0× |
| Us soft tissue head/neck (76536) |
$443 |
$1,058 |
4.0× |
| Us spinal canal and contents (76800) |
$260 |
$621 |
2.4× |
| Us, eye b-scan (76512) |
$136 |
$324 |
1.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$553 |
$1,321 |
5.1× |
| Wrist 2 views (73100) |
$156 |
$372 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$359 |
$857 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$185 |
$442 |
2.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$482 |
$1,151 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$155 |
$370 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$378 |
$903 |
4.1× |
| X-ray exam of femur 2/> (73552) |
$191 |
$456 |
2.1× |
| X-ray eye for foreign body (70030) |
$123 |
$293 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$190 |
$454 |
2.1× |
| X-ray IV pyelogram (ivp) (74400) |
$385 |
$919 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$234 |
$558 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$176 |
$421 |
1.9× |
| X-ray leg, infant (73592) |
$156 |
$372 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$260 |
$622 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$321 |
$767 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$232 |
$555 |
2.1× |
| X-ray retrograde pyelogram (74420) |
$360 |
$859 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$210 |
$502 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$359 |
$857 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$414 |
$990 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$214 |
$511 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$181 |
$432 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$238 |
$567 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$275 |
$656 |
2.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$222 |
$529 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$123 |
$293 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$191 |
$456 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$191 |
$456 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$232 |
$555 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$232 |
$555 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$260 |
$621 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$326 |
$778 |
3.0× |