| Abdomen 2 views (74019) |
$55.50 |
$277.50 |
0.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$298.70 |
$1,493.50 |
0.8× |
| Acute venous thrombus image (78456) |
$589.60 |
$2,948 |
0.5× |
| Ankle 2 views (73600) |
$58.70 |
$293.50 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$242.40 |
$1,212 |
0.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$275 |
$1,375 |
0.8× |
| Bone &/joint imaging whole body (78306) |
$306.80 |
$1,534 |
0.8× |
| Bone age studies (77072) |
$55.30 |
$276.50 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$435 |
$2,175 |
1.2× |
| Bone survey complete (77075) |
$133.20 |
$666 |
1.4× |
| Brain image w/flow 4 + views (78606) |
$271.80 |
$1,359 |
0.6× |
| Brain imaging < 4 static views w vascular flow (78601) |
$227.70 |
$1,138.50 |
0.6× |
| Brain Imaging Minimum 4 Static Views (78605) |
$249.75 |
$1,248.75 |
0.5× |
| Chest 1 view (71045) |
$55.50 |
$277.50 |
0.7× |
| Chest 3 views (71047) |
$70.40 |
$352 |
0.9× |
| Clavicle complete (73000) |
$81.90 |
$409.50 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$127.70 |
$638.50 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$874.50 |
$4,372.50 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$399.25 |
$1,996.25 |
1.8× |
| CT abdomen w contrast (74160) |
$566.50 |
$2,832.50 |
3.6× |
| CT abdomen w wo contrast (74170) |
$632.50 |
$3,162.50 |
4.0× |
| CT abdomen w/o contrast (74150) |
$511.50 |
$2,557.50 |
5.4× |
| CT angiography upper extremity lt (73206) |
$561 |
$2,805 |
3.5× |
| CT c-spine w/o contrast (72125) |
$561 |
$2,805 |
5.9× |
| CT cervical spine w&w/o contrast (72127) |
$665.30 |
$3,326.50 |
4.2× |
| CT cervical spine with contrast (72126) |
$561 |
$2,805 |
1.8× |
| CT chest w/wo contrast (71270) |
$731.80 |
$3,659 |
4.6× |
| CT chest with contrast (71260) |
$731.80 |
$3,659 |
4.6× |
| CT head/brain with contrast (70460) |
$537.20 |
$2,686 |
3.4× |
| CT head/brain without and with contrast (70470) |
$559.40 |
$2,797 |
3.5× |
| CT iac w contrast (70481) |
$537.20 |
$2,686 |
3.4× |
| CT lower ext w/o (73700) |
$899.30 |
$4,496.50 |
9.5× |
| CT lower extremity w wo contrast (73702) |
$886.80 |
$4,434 |
5.6× |
| CT lower extremity with contrast (73701) |
$899.30 |
$4,496.50 |
5.7× |
| CT lumbar spine w & w/o contrast (72133) |
$731.80 |
$3,659 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$562.80 |
$2,814 |
5.9× |
| CT lumbar spine with contrast (72132) |
$665.30 |
$3,326.50 |
2.1× |
| CT maxillofacial w contrast (70487) |
$625.30 |
$3,126.50 |
3.9× |
| CT maxillofacial w/o contrast (70486) |
$562.80 |
$2,814 |
5.9× |
| CT maxillofacial w/wo contrast (70488) |
$731.80 |
$3,659 |
4.6× |
| CT neck soft tissue w contrast (70491) |
$495 |
$2,475 |
3.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$559.40 |
$2,797 |
3.5× |
| CT orbits w/o contrast (70480) |
$516.30 |
$2,581.50 |
5.5× |
| CT pelvis w & w/o contrast (72194) |
$562.80 |
$2,814 |
3.5× |
| CT pelvis w/o contrast (72192) |
$473 |
$2,365 |
5.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$516.30 |
$2,581.50 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$442.30 |
$2,211.50 |
4.7× |
| CT thoracic spine w/contrast (72129) |
$561 |
$2,805 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$516.30 |
$2,581.50 |
5.5× |
| CT thoracic spine w/wo contrast (72130) |
$645.40 |
$3,227 |
4.1× |
| CT thorax w/o contrast (71250) |
$316.40 |
$1,582 |
3.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$639.50 |
$3,197.50 |
4.0× |
| CT upper extremity w/o contrast rt (73200) |
$741.05 |
$3,705.25 |
7.8× |
| CT upper extremity with contrast (73201) |
$899.30 |
$4,496.50 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$627 |
$3,135 |
3.9× |
| Cta Abdomen (74175) |
$629.75 |
$3,148.75 |
4.0× |
| CTA abdomen pelvis (74174) |
$830.50 |
$4,152.50 |
2.6× |
| CTA chest (71275) |
$594 |
$2,970 |
3.7× |
| Cta Head (70496) |
$561 |
$2,805 |
3.5× |
| CTA lwr ext w&w/o contrast (73706) |
$561 |
$2,805 |
3.5× |
| Cta Neck (70498) |
$561 |
$2,805 |
3.5× |
| Cta Pelvis (72191) |
$539 |
$2,695 |
3.4× |
| Cystography minimum 3 views rs&i (74430) |
$187 |
$935 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$126.90 |
$634.50 |
1.3× |
| Esophageal motility (78258) |
$1,712.20 |
$8,561 |
4.7× |
| Esophagus (74220) |
$68.20 |
$341 |
0.4× |
| Fetal biophysical profile non-stress testing (76818) |
$110.60 |
$553 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$127.70 |
$638.50 |
0.6× |
| Foot 2 views (73620) |
$52.90 |
$264.50 |
0.7× |
| Forearm 2 views (73090) |
$63 |
$315 |
0.8× |
| Gated Heart Planar Single (78472) |
$215.70 |
$1,078.50 |
0.6× |
| Hand 2 views (73120) |
$52.90 |
$264.50 |
0.6× |
| Hand 3 views (73130) |
$57.30 |
$286.50 |
0.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$264.20 |
$1,321 |
0.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$209 |
$1,045 |
0.6× |
| Ht muscle image spect sing (78451) |
$569.10 |
$2,845.50 |
0.5× |
| Humerus Min 2 Views Left (73060) |
$82.20 |
$411 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$266.30 |
$1,331.50 |
0.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$332.20 |
$1,661 |
0.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$481.50 |
$2,407.50 |
1.0× |
| Knee 3 views (73562) |
$74.90 |
$374.50 |
1.0× |
| Liver & spleen imaging static only (78215) |
$258.10 |
$1,290.50 |
0.7× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$301.20 |
$1,506 |
0.8× |
| Lung perf&ventilat diferentl (78598) |
$229.90 |
$1,149.50 |
0.5× |
| Lung Ventilation Imaging (78579) |
$271.80 |
$1,359 |
0.8× |
| Lymphoscintigraphy (78195) |
$298.20 |
$1,491 |
0.6× |
| Meckels Diverticulum (78290) |
$255.20 |
$1,276 |
0.7× |
| MRA head w & w/o contrast (70546) |
$776.70 |
$3,883.50 |
2.5× |
| MRA head w/o contrast (70544) |
$627 |
$3,135 |
2.9× |
| MRA head with contrast (70545) |
$724.40 |
$3,622 |
2.3× |
| MRA neck w contrast (70548) |
$724.40 |
$3,622 |
2.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$711.20 |
$3,556 |
2.3× |
| MRA neck w/o contrast (70547) |
$615.70 |
$3,078.50 |
2.8× |
| MRI abdomen w contrast (74182) |
$752.40 |
$3,762 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$795.60 |
$3,978 |
2.5× |
| MRI abdomen w/o contrast (74181) |
$693.70 |
$3,468.50 |
3.2× |
| MRI any jnt lwr ext with con lt (73722) |
$833.30 |
$4,166.50 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$891 |
$4,455 |
1.3× |
| MRI breast w/o contrast unilat (77046) |
$241.70 |
$1,208.50 |
1.1× |
| MRI c-spine with contrast (72142) |
$501.70 |
$2,508.50 |
1.6× |
| MRI cervical spine w/o contrast (72141) |
$736.60 |
$3,683 |
3.4× |
| MRI chest w/o & w/contrast material (71552) |
$537.80 |
$2,689 |
1.7× |
| MRI chest w/o contrast (71550) |
$468.80 |
$2,344 |
2.2× |
| MRI chest with contrast (71551) |
$491.80 |
$2,459 |
0.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$789.15 |
$3,945.75 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$649.10 |
$3,245.50 |
2.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$690.20 |
$3,451 |
3.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$582.70 |
$2,913.50 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$710.70 |
$3,553.50 |
2.2× |
| MRI orbit/face/neck w/contrast (70542) |
$668.10 |
$3,340.50 |
2.1× |
| MRI pelvis w contrast (72196) |
$766.70 |
$3,833.50 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$759.50 |
$3,797.50 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$662.10 |
$3,310.50 |
3.1× |
| MRI scan of arm joint before and after contrast (73223) |
$935 |
$4,675 |
3.0× |
| MRI scan of leg joint before and after contrast (73723) |
$926.20 |
$4,631 |
2.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$752 |
$3,760 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$693 |
$3,465 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$745.80 |
$3,729 |
2.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$693 |
$3,465 |
2.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$741.60 |
$3,708 |
2.3× |
| MRI thoracic spine w/o contrast (72146) |
$726.40 |
$3,632 |
3.4× |
| MRI tmj (70336) |
$744.30 |
$3,721.50 |
3.4× |
| MRI upper ext joint w/o contrast (73221) |
$728.30 |
$3,641.50 |
3.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$821 |
$4,105 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$731.30 |
$3,656.50 |
3.4× |
| Myocardial Spect Multiple Studies (78452) |
$739.40 |
$3,697 |
0.6× |
| Neck soft tissue (70360) |
$63.30 |
$316.50 |
0.8× |
| Nm adrenal scan (78075) |
$569.10 |
$2,845.50 |
0.5× |
| Nm gastric emptying study (78264) |
$255.60 |
$1,278 |
0.7× |
| Nm gastroesophageal reflux study (78262) |
$422.60 |
$2,113 |
1.2× |
| Nuclear medicine of heart pumping function (78473) |
$491.40 |
$2,457 |
1.4× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$255.60 |
$1,278 |
0.7× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$567.60 |
$2,838 |
1.6× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$567.60 |
$2,838 |
1.2× |
| Osseous survey infant (77076) |
$133.20 |
$666 |
1.4× |
| Parathyrd planar w/wo subtrj (78071) |
$215.60 |
$1,078 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$82.60 |
$413 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$883 |
$4,415 |
2.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$271.80 |
$1,359 |
0.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$520.80 |
$2,604 |
1.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$96.20 |
$481 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$82.70 |
$413.50 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$46.70 |
$233.50 |
0.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$63.80 |
$319 |
0.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$56.10 |
$280.50 |
0.7× |
| Radiologic exam colon single contrast study (74270) |
$160.10 |
$800.50 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$143 |
$715 |
0.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$125.10 |
$625.50 |
0.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$82.20 |
$411 |
1.0× |
| Radiological examination surgical specimen (76098) |
$260.70 |
$1,303.50 |
0.5× |
| Ribs bilateral 3 views (71110) |
$107.70 |
$538.50 |
1.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$274.35 |
$1,371.75 |
0.8× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$568.90 |
$2,844.50 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,373.60 |
$6,868 |
2.8× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$364.10 |
$1,820.50 |
0.3× |
| Scanogram (77073) |
$127.30 |
$636.50 |
1.3× |
| Scapula complete (73010) |
$81.70 |
$408.50 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$24.90 |
$124.50 |
1.1× |
| Sella turcica (70240) |
$94.70 |
$473.50 |
1.2× |
| Small bowel series (74250) |
$140.70 |
$703.50 |
0.9× |
| Spine thoracic 3 views (72072) |
$95.80 |
$479 |
1.0× |
| Testicular Imaging With Vascular Flow (78761) |
$215.70 |
$1,078.50 |
0.6× |
| Thyroid carcinoma metastases img whole body (78018) |
$265.30 |
$1,326.50 |
0.5× |
| Thyroid uptake measurement (78012) |
$204.90 |
$1,024.50 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$215.60 |
$1,078 |
0.6× |
| Tumor Imaging Whole Body - Nm Tumor Local Whole Body Mult Days (78804) |
$332.30 |
$1,661.50 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$119.30 |
$596.50 |
1.3× |
| Upper Extremity Infant (73092) |
$66.10 |
$330.50 |
0.7× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$215.70 |
$1,078.50 |
0.6× |
| Urethrocystography voiding (74455) |
$187 |
$935 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$122.70 |
$613.50 |
0.8× |
| Us abdl aorta screen aaa (76706) |
$143 |
$715 |
1.5× |
| Us breast unilateral complete (76641) |
$97 |
$485 |
1.0× |
| Us breast unilateral limited (76642) |
$49.70 |
$248.50 |
0.6× |
| Us chest (76604) |
$99 |
$495 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$110.60 |
$553 |
1.2× |
| Us ob transvaginal (76817) |
$243.10 |
$1,215.50 |
2.6× |
| Us pelvic non ob complete (76856) |
$178.50 |
$892.50 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$145.50 |
$727.50 |
1.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$244.10 |
$1,220.50 |
2.6× |
| Us retroperitoneal complete (76770) |
$143 |
$715 |
1.5× |
| Us retroperitoneal limited (76775) |
$245.70 |
$1,228.50 |
2.6× |
| Us scrotum and contents (76870) |
$171.90 |
$859.50 |
1.8× |
| Us soft tissue head/neck (76536) |
$143.70 |
$718.50 |
1.5× |
| Us transrectal (76872) |
$171.50 |
$857.50 |
1.8× |
| Us xtr non-vasc lmtd (76882) |
$118.30 |
$591.50 |
1.2× |
| Vascular flow imaging (78445) |
$215.70 |
$1,078.50 |
0.6× |
| Venogram extremity bilateral (75822) |
$563.20 |
$2,816 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$281.60 |
$1,408 |
0.2× |
| Wrist 2 views (73100) |
$48.40 |
$242 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$50.10 |
$250.50 |
0.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$62.50 |
$312.50 |
0.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$171.60 |
$858 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$55.50 |
$277.50 |
0.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$73 |
$365 |
0.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$99 |
$495 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$96.60 |
$483 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$105.70 |
$528.50 |
1.1× |
| X-ray eye for foreign body (70030) |
$55.10 |
$275.50 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$98.90 |
$494.50 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$47 |
$235 |
0.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$56.90 |
$284.50 |
0.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$69.30 |
$346.50 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$98.30 |
$491.50 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$55.50 |
$277.50 |
0.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$81.60 |
$408 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$74.50 |
$372.50 |
0.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$61.70 |
$308.50 |
0.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$80.10 |
$400.50 |
1.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$51.30 |
$256.50 |
0.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$82.90 |
$414.50 |
0.9× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$205.70 |
$1,028.50 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$96.20 |
$481 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$78.60 |
$393 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$70.70 |
$353.50 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$63.80 |
$319 |
0.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$29.60 |
$148 |
0.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$104.30 |
$521.50 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$51.90 |
$259.50 |
0.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$49.20 |
$246 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$70.70 |
$353.50 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$68.70 |
$343.50 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$54.30 |
$271.50 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$132 |
$660 |
1.4× |
| Xr chest 4+ views (71048) |
$82.70 |
$413.50 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$69.90 |
$349.50 |
0.9× |
| Xr optic foramina (70190) |
$50.20 |
$251 |
0.6× |
| Xr spine cervical 4 or 5 views (72050) |
$96.90 |
$484.50 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$81.60 |
$408 |
1.0× |
| Xr tmj bilateral (70330) |
$63.30 |
$316.50 |
0.8× |
| Xray knee 1 or 2 views rt (73560) |
$55.50 |
$277.50 |
0.7× |