| Acute gi blood loss imaging (78278) |
$889.60 |
$1,112 |
2.1× |
| Ankle 2 views (73600) |
$304.80 |
$381 |
3.4× |
| Barium enema (74270) |
$700.80 |
$876 |
3.8× |
| Bone age studies (77072) |
$198.40 |
$248 |
1.8× |
| Bone imaging limited area (78300) |
$680 |
$850 |
1.6× |
| Bone survey complete (77075) |
$1,311.20 |
$1,639 |
12.0× |
| Bowel imaging (78290) |
$1,347.20 |
$1,684 |
3.2× |
| Brain imaging, less than 4 static views; with vascular flow Age Under 21 (78601) |
$1,823.20 |
$2,279 |
4.4× |
| Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and… (78473) |
$2,084.80 |
$2,606 |
5.0× |
| Cholecystography, oral contrast Other Diagnostic Radiology FS (74290) |
$187.20 |
$234 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$793.60 |
$992 |
4.3× |
| Clavicle complete (73000) |
$420 |
$525 |
4.6× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Age Under 21 (77078) |
$151.20 |
$189 |
1.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$2,214.80 |
$2,768.50 |
12.1× |
| CT - st neck w&wo contr (70492) |
$2,442.40 |
$3,053 |
13.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,991.20 |
$3,739 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,167.20 |
$2,709 |
8.7× |
| CT abdomen w wo contrast (74170) |
$2,422.40 |
$3,028 |
13.2× |
| CT abdomen w/contrast (74160) |
$2,188 |
$2,735 |
11.9× |
| CT abdomen w/o contrast (74150) |
$1,812.80 |
$2,266 |
16.6× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$2,167.20 |
$2,709 |
5.9× |
| CT angio abdominal arteries (75635) |
$3,131.20 |
$3,914 |
17.1× |
| CT cervical spine w/contrast (72126) |
$2,451.20 |
$3,064 |
6.7× |
| CT cervical spine w/o contrast (72125) |
$2,451.20 |
$3,064 |
22.5× |
| CT chest w/contrast (71260) |
$3,008 |
$3,760 |
16.4× |
| CT extremity upper w & w/o contrast (73202) |
$2,949.60 |
$3,687 |
16.1× |
| CT head/brain with contrast (70460) |
$2,636.80 |
$3,296 |
14.4× |
| CT head/brain without and with contrast (70470) |
$2,636.80 |
$3,296 |
14.4× |
| CT limited/localized follow up study (76380) |
$618.40 |
$773 |
6.8× |
| CT lower ext w/wo contrast (73702) |
$2,357.60 |
$2,947 |
12.9× |
| CT lower extremity w contrast (73701) |
$1,331.20 |
$1,664 |
7.3× |
| CT lower extremity w/o contrast unilateral (73700) |
$1,341.60 |
$1,677 |
12.3× |
| CT lumbar spine w/contrast (72132) |
$2,451.20 |
$3,064 |
6.7× |
| CT lumbar spine w/o contrast (72131) |
$2,431.20 |
$3,039 |
22.3× |
| CT maxillofacial area w/o contrast (70486) |
$1,747.20 |
$2,184 |
16.0× |
| CT maxillofacial w/contrast (70487) |
$2,032 |
$2,540 |
11.1× |
| CT maxillofacial w/o then w/ con (70488) |
$2,281.60 |
$2,852 |
12.5× |
| CT orbit sella ear w/o con (70480) |
$2,224.80 |
$2,781 |
20.4× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$2,421.60 |
$3,027 |
13.2× |
| CT pelvis w & w/o contrast (72194) |
$2,686.40 |
$3,358 |
14.7× |
| CT pelvis w/o contrast (72192) |
$1,990.40 |
$2,488 |
18.2× |
| CT soft tissue neck w/contrast (70491) |
$2,224.80 |
$2,781 |
12.1× |
| CT soft tissue neck w/o contrast (70490) |
$2,068 |
$2,585 |
18.9× |
| CT spine cervical w/wo contrast (72127) |
$2,451.20 |
$3,064 |
13.4× |
| CT thoracic spine w/contrast (72129) |
$2,451.20 |
$3,064 |
13.4× |
| CT thoracic spine w/o contrast (72128) |
$2,636.80 |
$3,296 |
24.2× |
| CT thorax lung cancer scr c- (71271) |
$1,160 |
$1,450 |
10.6× |
| CT thorax w/o contrast (71250) |
$2,286.40 |
$2,858 |
20.9× |
| CT thorax w/o then w/ contrast (71270) |
$2,884 |
$3,605 |
15.7× |
| CT upper extremity w/dye (73201) |
$1,544.80 |
$1,931 |
4.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,874.40 |
$2,343 |
17.2× |
| CTA chest w/wo contrast (71275) |
$3,131.20 |
$3,914 |
17.1× |
| CTA head w contrast (70496) |
$2,453.60 |
$3,067 |
13.4× |
| Cta Neck (70498) |
$2,453.60 |
$3,067 |
13.4× |
| Esophogram (74220) |
$597.60 |
$747 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$859.20 |
$1,074 |
7.9× |
| Fetal biophysical profile w/o nst (76819) |
$654.40 |
$818 |
6.0× |
| Fetal echo complete (76825) |
$100 |
$125 |
0.2× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$839.20 |
$1,049 |
3.4× |
| Functional MRI brain by tech (70554) |
$2,732.80 |
$3,416 |
11.0× |
| Gastric emptying study (78264) |
$1,277.60 |
$1,597 |
3.1× |
| Gated heart planar single (78472) |
$1,343.20 |
$1,679 |
3.2× |
| Hepatobil syst image w/drug (78227) |
$1,044.80 |
$1,306 |
1.8× |
| Hepatobiliary system imaging (78226) |
$763.20 |
$954 |
1.8× |
| Humerus min 2 views (73060) |
$346.40 |
$433 |
3.8× |
| Ivp (74400) |
$851.20 |
$1,064 |
4.6× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$1,848.80 |
$2,311 |
3.3× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$1,417.60 |
$1,772 |
2.5× |
| Liver & spleen; static only (78215) |
$496.80 |
$621 |
1.2× |
| Liver & spleen; w vasc flow (78216) |
$1,000 |
$1,250 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$3,220.80 |
$4,026 |
8.8× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$3,220.80 |
$4,026 |
8.8× |
| MRA head w & w/o contrast (70546) |
$3,220.80 |
$4,026 |
8.8× |
| MRA head w/contrast (70545) |
$2,636.80 |
$3,296 |
7.2× |
| MRA head w/o contrast (70544) |
$2,484.80 |
$3,106 |
10.0× |
| MRA neck w/contrast (70548) |
$2,636.80 |
$3,296 |
7.2× |
| MRA neck w/o contrast (70547) |
$2,484.80 |
$3,106 |
10.0× |
| MRA neck w/wo contrast (70549) |
$3,220.80 |
$4,026 |
8.8× |
| MRI abdomen w/contrast (74182) |
$2,636.80 |
$3,296 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,220.80 |
$4,026 |
8.8× |
| MRI abdomen w/o contrast (74181) |
$2,482.40 |
$3,103 |
10.0× |
| MRI any jnt lwr ext with con lt (73722) |
$2,636.80 |
$3,296 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$2,482.40 |
$3,103 |
10.0× |
| MRI cervical spine with contrast (72142) |
$2,636.80 |
$3,296 |
7.2× |
| MRI chest w & w/o contrast (71552) |
$3,220.80 |
$4,026 |
8.8× |
| MRI chest w/contrast (71551) |
$2,636.80 |
$3,296 |
3.2× |
| MRI chest w/o contrast (71550) |
$1,780 |
$2,225 |
7.1× |
| MRI joint upper ext w/contrast (73222) |
$2,636.80 |
$3,296 |
3.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$3,220.80 |
$4,026 |
8.8× |
| MRI joint upr extrem w/o dye (73221) |
$2,484.80 |
$3,106 |
10.0× |
| Mri Lower Extremity W/O Dye (73718) |
$2,484.80 |
$3,106 |
10.0× |
| MRI lumbar spine with contrast (72149) |
$3,090.40 |
$3,863 |
8.5× |
| MRI lumbar w/wo contrast (72158) |
$3,220.80 |
$4,026 |
8.8× |
| MRI lwr ext w/o jnts with con rt (73719) |
$2,636.80 |
$3,296 |
7.2× |
| MRI orbit/face/neck w/contrast (70542) |
$2,636.80 |
$3,296 |
7.2× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$3,220.80 |
$4,026 |
8.8× |
| MRI orbit/face/neck w/o contrast (70540) |
$2,484.80 |
$3,106 |
10.0× |
| MRI pelvis w/ contrast (72196) |
$2,636.80 |
$3,296 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$2,484.80 |
$3,106 |
10.0× |
| MRI pelvis w/wo contrast (72197) |
$3,220.80 |
$4,026 |
8.8× |
| MRI spine cervical wo/w contrast (72156) |
$3,220.80 |
$4,026 |
8.8× |
| MRI spine thoracic w/contrast (72147) |
$2,610.40 |
$3,263 |
7.2× |
| MRI thoracic spine w wo contrast (72157) |
$3,220.80 |
$4,026 |
8.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,482.40 |
$3,103 |
10.0× |
| MRI tmj (70336) |
$2,482.40 |
$3,103 |
10.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,484.80 |
$3,106 |
10.0× |
| Mri Upper Extremity W/Dye (73219) |
$742.40 |
$928 |
2.0× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$2,389.60 |
$2,987 |
6.6× |
| Myelogram thoracic (72255) |
$600.80 |
$751 |
0.7× |
| Myelography 2 or more regions (72270) |
$869.60 |
$1,087 |
1.1× |
| Myelography lumbosacral (72265) |
$600.80 |
$751 |
0.7× |
| Myocardial perfusion planar 1 study rest/stress (78453) |
$1,976 |
$2,470 |
1.5× |
| Myocardial perfusion planar multiple studies (78454) |
$2,917.60 |
$3,647 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$2,219.20 |
$2,774 |
1.6× |
| Nm bone 3 phase (78315) |
$1,971.20 |
$2,464 |
4.7× |
| Nm bone imaging whole body (78306) |
$1,040 |
$1,300 |
2.5× |
| Nm heart perfusion spect stress rest (78452) |
$3,223.20 |
$4,029 |
2.4× |
| Nm lymph system (78195) |
$1,114.40 |
$1,393 |
2.0× |
| Nm thyroid imaging only (78013) |
$1,009.60 |
$1,262 |
2.4× |
| Ob us < 14 wks single fetus (76801) |
$792.80 |
$991 |
7.3× |
| Parathyroid imaging (78070) |
$822.40 |
$1,028 |
2.0× |
| Pulmonary perfusion imaging particulate (78580) |
$868.40 |
$1,085.50 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$259.20 |
$324 |
2.4× |
| Radex hip unilateral with pelvis 1 view (73501) |
$244.80 |
$306 |
2.7× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$416.80 |
$521 |
4.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$486.40 |
$608 |
4.5× |
| Radex spine cervical 2 or 3 views (72040) |
$379.20 |
$474 |
4.2× |
| Radex spine cervical 4 or 5 views (72050) |
$514.40 |
$643 |
4.7× |
| Radex spine cervical 6 or more views (72052) |
$618.40 |
$773 |
5.7× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$515.20 |
$644 |
4.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$838.40 |
$1,048 |
4.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$364 |
$455 |
4.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$618.40 |
$773 |
5.7× |
| Radiologic examination, mastoids; less than 3 views per side Other Diagnostic Radiology FS (70120) |
$360.80 |
$451 |
3.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$448.80 |
$561 |
0.8× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$105.60 |
$132 |
4.5× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,452 |
$1,815 |
13.3× |
| Small bowel series (74250) |
$808.80 |
$1,011 |
4.4× |
| Thyroid uptake w/blood flow sngle/mult quan meas (78014) |
$1,652.80 |
$2,066 |
4.0× |
| Ultrasound breast limited (76642) |
$557.60 |
$697 |
6.1× |
| Ultrasound, abdomen limited (76705) |
$532 |
$665 |
4.9× |
| Unlisted fluoroscopic procedure (76496) |
$280 |
$350 |
3.1× |
| Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine UNSCHEDULED (78199) |
$448.80 |
$561 |
1.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$412 |
$515 |
3.8× |
| Us breast uni real time with image complete (76641) |
$557.60 |
$697 |
5.1× |
| Us chest (76604) |
$278.40 |
$348 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$484.80 |
$606 |
4.4× |
| Us encephalogram (76506) |
$763.20 |
$954 |
7.0× |
| Us ob followup per fetus (76816) |
$148 |
$185 |
1.4× |
| Us ob limited 1 or more fetuses (76815) |
$94.40 |
$118 |
0.9× |
| Us obstetric transvaginal (76817) |
$588.80 |
$736 |
5.4× |
| Us pelvic limited or f/u non-ob (76857) |
$457.60 |
$572 |
4.2× |
| Us pelvis complete (76856) |
$680 |
$850 |
6.2× |
| Us retroperitoneal complete (76770) |
$891.20 |
$1,114 |
8.2× |
| Us retroperitoneal limited (76775) |
$412 |
$515 |
3.8× |
| Us scrotum (76870) |
$572.80 |
$716 |
5.2× |
| Us soft tissue head/neck (76536) |
$519.60 |
$649.50 |
4.8× |
| Us spinal canal (76800) |
$763.20 |
$954 |
7.0× |
| Us transrectal (76872) |
$626.40 |
$783 |
5.7× |
| Venogram extremity bilateral (75822) |
$799.20 |
$999 |
0.5× |
| Venography ext unilateral (75820) |
$799.20 |
$999 |
0.5× |
| Venography venous sinus/jugular cath rs&i (75860) |
$1,500.80 |
$1,876 |
0.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$268 |
$335 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$420 |
$525 |
4.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$927.20 |
$1,159 |
5.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$404 |
$505 |
4.4× |
| X-ray exam of finger(s) (73140) |
$341.60 |
$427 |
3.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$62.40 |
$78 |
0.7× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$351.20 |
$439 |
3.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$404 |
$505 |
4.4× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$272.80 |
$341 |
2.5× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$424 |
$530 |
4.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$337.60 |
$422 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$108.80 |
$136 |
1.2× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$369.60 |
$462 |
4.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$456 |
$570 |
4.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$403.20 |
$504 |
3.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$679.20 |
$849 |
6.2× |
| X-Ray Mastoids 3+ Vw - Xr Mastoids 3+ Views (70130) |
$546.40 |
$683 |
5.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$618.40 |
$773 |
5.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$288.80 |
$361 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$350.40 |
$438 |
3.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$412 |
$515 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$473.60 |
$592 |
5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$426.40 |
$533 |
3.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$347.20 |
$434 |
3.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$76 |
$95 |
0.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$255.20 |
$319 |
2.8× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$304.80 |
$381 |
3.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$384 |
$480 |
4.2× |
| Xr abdomen 1 view (74018) |
$308.80 |
$386 |
3.4× |
| Xr abdomen 2 views (74019) |
$375.20 |
$469 |
3.4× |
| Xr abdomen 3 views (74021) |
$441.60 |
$552 |
4.0× |
| Xr bone density axial (77080) |
$220.80 |
$276 |
2.0× |
| Xr bone length study (77073) |
$156.80 |
$196 |
1.4× |
| Xr bone survey infant (77076) |
$805.60 |
$1,007 |
7.4× |
| Xr chest 1 view (71045) |
$268 |
$335 |
2.9× |
| Xr chest 2 views (71046) |
$350.40 |
$438 |
3.9× |
| Xr chest 3 views (71047) |
$432.80 |
$541 |
4.8× |
| Xr cystogram 3+ views (74430) |
$308.80 |
$386 |
0.8× |
| Xr eye foreign body (70030) |
$281.60 |
$352 |
3.1× |
| Xr facial bones 3 views (70150) |
$540 |
$675 |
4.9× |
| Xr lower extremity 2 views infant (73592) |
$319.20 |
$399 |
3.5× |
| Xr mandible 4 views (70110) |
$129.60 |
$162 |
1.2× |
| Xr myelogram c-spine (72240) |
$600.80 |
$751 |
0.7× |
| Xr nasal bones (70160) |
$341.60 |
$427 |
3.8× |
| Xr pelvis 3 views (72190) |
$426.40 |
$533 |
3.9× |
| Xr spine 1 view (72020) |
$235.20 |
$294 |
2.6× |
| Xr sternum 2 views (71120) |
$360.80 |
$451 |
4.0× |
| Xr surgical specimen (76098) |
$156.80 |
$196 |
0.3× |
| Xr upper extremity 2 views infant (73092) |
$314.40 |
$393 |
2.9× |
| Xray elbow 2 views (73070) |
$286.40 |
$358 |
3.2× |
| Xray forearm 2 views (73090) |
$371.20 |
$464 |
4.1× |
| Xray knee 1 or 2 views rt (73560) |
$296 |
$370 |
3.3× |
| Xray neck soft tissue (70360) |
$354.40 |
$443 |
3.9× |
| Xray optic foramina (70190) |
$352 |
$440 |
3.9× |
| Xray orbits complete min 4 views (70200) |
$141.60 |
$177 |
1.3× |
| Xray pelvis 1 or 2 views (72170) |
$453.60 |
$567 |
4.2× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$560 |
$700 |
5.1× |
| Xray scapula complete (73010) |
$461.60 |
$577 |
4.2× |
| Xray shoulder 1 view (73020) |
$148 |
$185 |
1.6× |
| Xray sinuses paranasal <3 views (70210) |
$309.60 |
$387 |
3.4× |
| Xray spine thoracic 2 views (72070) |
$207.20 |
$259 |
1.9× |
| Xray spine thoracic 3 views (72072) |
$375.20 |
$469 |
3.4× |
| Xray tibia-fibula 2 views bil (73590) |
$391.20 |
$489 |
4.3× |
| Xray tmj open - closed unilat (70328) |
$91.20 |
$114 |
1.0× |
| Xray tmj's bilateral open-clsc (70330) |
$500 |
$625 |
5.5× |