| Abdomen 2 views (74019) |
$79.80 |
$266 |
0.8× |
| Angiography extremity bilateral rs&i (75716) |
$2,124.90 |
$7,083 |
0.7× |
| Angiography extremity unilateral rs&i (75710) |
$2,124.90 |
$7,083 |
0.7× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,542.10 |
$11,807 |
0.7× |
| Ankle 2 views (73600) |
$96.30 |
$321 |
1.2× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,124.90 |
$7,083 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$2,124.90 |
$7,083 |
0.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$447.30 |
$1,491 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$355.20 |
$1,184 |
1.0× |
| Bone age studies (77072) |
$111 |
$370 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$388.50 |
$1,295 |
1.1× |
| Bone survey complete (77075) |
$254.10 |
$847 |
2.7× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$190.20 |
$634 |
0.5× |
| Cervical spine 2 or 3 views (72040) |
$83.10 |
$277 |
1.1× |
| Chest 1 view (71045) |
$65.10 |
$217 |
0.8× |
| Chest 3 views (71047) |
$75 |
$250 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$253.80 |
$846 |
1.6× |
| Clavicle complete (73000) |
$94.95 |
$316.50 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$135.90 |
$453 |
1.4× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$90 |
$300 |
0.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$984.30 |
$3,281 |
3.1× |
| CT abdomen and pelvis without contrast (74176) |
$736.80 |
$2,456 |
3.4× |
| CT abdomen w contrast (74160) |
$574.20 |
$1,914 |
3.6× |
| CT abdomen w wo contrast (74170) |
$656.40 |
$2,188 |
4.1× |
| CT abdomen w/o contrast (74150) |
$491.40 |
$1,638 |
5.2× |
| CT angiography upper extremity lt (73206) |
$703.20 |
$2,344 |
4.4× |
| CT c-spine w/o contrast (72125) |
$539.40 |
$1,798 |
5.7× |
| CT cervical spine w&w/o contrast (72127) |
$650.40 |
$2,168 |
4.1× |
| CT chest w/wo contrast (71270) |
$703.20 |
$2,344 |
4.4× |
| CT chest with contrast (71260) |
$570.60 |
$1,902 |
3.6× |
| CT head/brain with contrast (70460) |
$333.30 |
$1,111 |
2.1× |
| CT head/brain without and with contrast (70470) |
$585.30 |
$1,951 |
3.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$60.30 |
$201 |
0.8× |
| CT iac w contrast (70481) |
$636.90 |
$2,123 |
4.0× |
| CT lower ext w/o (73700) |
$491.40 |
$1,638 |
5.2× |
| CT lower extremity w wo contrast (73702) |
$877.95 |
$2,926.50 |
5.5× |
| CT lower extremity with contrast (73701) |
$798.30 |
$2,661 |
5.0× |
| CT lumbar spine w & w/o contrast (72133) |
$650.40 |
$2,168 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$547.80 |
$1,826 |
5.8× |
| CT lumbar spine with contrast (72132) |
$562.20 |
$1,874 |
1.8× |
| CT maxillofacial w contrast (70487) |
$515.40 |
$1,718 |
3.2× |
| CT maxillofacial w/o contrast (70486) |
$564.30 |
$1,881 |
6.0× |
| CT maxillofacial w/wo contrast (70488) |
$584.10 |
$1,947 |
3.7× |
| CT neck soft tissue w contrast (70491) |
$499.80 |
$1,666 |
3.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$687.90 |
$2,293 |
4.3× |
| CT orbits w/o contrast (70480) |
$585.30 |
$1,951 |
6.2× |
| CT pelvis w & w/o contrast (72194) |
$656.40 |
$2,188 |
4.1× |
| CT pelvis w/o contrast (72192) |
$491.40 |
$1,638 |
5.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$687.90 |
$2,293 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$491.40 |
$1,638 |
5.2× |
| CT thoracic spine w/contrast (72129) |
$333.30 |
$1,111 |
2.1× |
| CT thoracic spine w/o contrast (72128) |
$520.20 |
$1,734 |
5.5× |
| CT thoracic spine w/wo contrast (72130) |
$650.40 |
$2,168 |
4.1× |
| CT thorax w/o contrast (71250) |
$508.20 |
$1,694 |
5.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$499.95 |
$1,666.50 |
3.1× |
| CT upper extremity w/o contrast rt (73200) |
$491.40 |
$1,638 |
5.2× |
| CT upper extremity with contrast (73201) |
$798.30 |
$2,661 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$614.40 |
$2,048 |
3.9× |
| Cta Abdomen (74175) |
$703.20 |
$2,344 |
4.4× |
| CTA abdomen pelvis (74174) |
$276.30 |
$921 |
0.9× |
| CTA chest (71275) |
$703.20 |
$2,344 |
4.4× |
| Cta Head (70496) |
$703.20 |
$2,344 |
4.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,054.80 |
$3,516 |
6.6× |
| Cta Neck (70498) |
$703.20 |
$2,344 |
4.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$139.80 |
$466 |
1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$85.20 |
$284 |
1.1× |
| Dxa bone density study axial skeleton (77085) |
$54.90 |
$183 |
0.6× |
| Esophagus (74220) |
$145.80 |
$486 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$159 |
$530 |
0.7× |
| Foot 2 views (73620) |
$96.30 |
$321 |
1.2× |
| Forearm 2 views (73090) |
$41.70 |
$139 |
0.5× |
| Gated Heart Planar Single (78472) |
$280.20 |
$934 |
0.8× |
| Hand 2 views (73120) |
$96.30 |
$321 |
1.0× |
| Hand 3 views (73130) |
$96.30 |
$321 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$363.60 |
$1,212 |
0.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$741.30 |
$2,471 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$64.20 |
$214 |
0.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$414 |
$1,380 |
0.8× |
| Knee 3 views (73562) |
$119.70 |
$399 |
1.5× |
| Liver & spleen imaging static only (78215) |
$280.20 |
$934 |
0.8× |
| Lung Ventilation Imaging (78579) |
$354.90 |
$1,183 |
1.0× |
| MRA head w & w/o contrast (70546) |
$1,309.20 |
$4,364 |
4.1× |
| MRA head w/o contrast (70544) |
$840.90 |
$2,803 |
3.9× |
| MRA neck w contrast (70548) |
$332.40 |
$1,108 |
1.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,637.10 |
$5,457 |
5.2× |
| MRA neck w/o contrast (70547) |
$273.90 |
$913 |
1.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,506.60 |
$5,022 |
4.8× |
| MRI abdomen w/o contrast (74181) |
$801.30 |
$2,671 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$801.30 |
$2,671 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,244.25 |
$4,147.50 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$450 |
$1,500 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,506.60 |
$5,022 |
4.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$940.50 |
$3,135 |
3.0× |
| MRI pelvis w/o contrast (72195) |
$801.30 |
$2,671 |
3.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,915.20 |
$6,384 |
6.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,915.20 |
$6,384 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,794.30 |
$5,981 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,794.30 |
$5,981 |
5.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,016.70 |
$3,389 |
3.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,794.30 |
$5,981 |
5.7× |
| MRI thoracic spine w/o contrast (72146) |
$801.30 |
$2,671 |
3.7× |
| MRI upper ext joint w/o contrast (73221) |
$829.50 |
$2,765 |
3.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$829.50 |
$2,765 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,915.20 |
$6,384 |
8.9× |
| Myocardial Spect Multiple Studies (78452) |
$925.20 |
$3,084 |
0.8× |
| Neck soft tissue (70360) |
$64.20 |
$214 |
0.8× |
| Nm gastric emptying study (78264) |
$421.20 |
$1,404 |
1.2× |
| Osseous survey infant (77076) |
$147 |
$490 |
1.6× |
| Osseous survey limited (77074) |
$81 |
$270 |
0.9× |
| Parathyrd planar w/wo subtrj (78071) |
$233.70 |
$779 |
0.6× |
| Parathyroid imaging (78070) |
$511.50 |
$1,705 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$65.10 |
$217 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,276.80 |
$4,256 |
4.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$303 |
$1,010 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$450.60 |
$1,502 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$36.30 |
$121 |
0.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$83.10 |
$277 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$80.10 |
$267 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$89.40 |
$298 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$272.40 |
$908 |
3.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$79.80 |
$266 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$184.50 |
$615 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$264.30 |
$881 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$153.30 |
$511 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$108.90 |
$363 |
1.4× |
| Ribs bilateral 3 views (71110) |
$58.20 |
$194 |
0.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$969.90 |
$3,233 |
2.0× |
| Sacroiliac Joints < 3 Views (72200) |
$81 |
$270 |
0.9× |
| Scapula complete (73010) |
$64.20 |
$214 |
0.7× |
| Screening digital breast tomosynthesis (77063) |
$66.60 |
$222 |
2.8× |
| Small bowel series (74250) |
$145.80 |
$486 |
0.9× |
| Spine thoracic 3 views (72072) |
$264 |
$880 |
2.8× |
| Tbs Technical Calculation Only (77091) |
$119.40 |
$398 |
1.5× |
| Thoracolumbar 2 views (72080) |
$71.70 |
$239 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$326.70 |
$1,089 |
0.9× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$280.20 |
$934 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$199.80 |
$666 |
2.1× |
| Unlisted Ultrasound Procedure (76999) |
$37.50 |
$125 |
0.5× |
| Upper Extremity Infant (73092) |
$114.75 |
$382.50 |
1.2× |
| Urethrocystography retrograde rs&i (74450) |
$171 |
$570 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$230.10 |
$767 |
1.4× |
| Us abdl aorta screen aaa (76706) |
$126 |
$420 |
1.3× |
| Us chest (76604) |
$166.50 |
$555 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$171.30 |
$571 |
1.8× |
| Us kidney transplant (76776) |
$83.70 |
$279 |
0.9× |
| Us ob transvaginal (76817) |
$204.30 |
$681 |
2.2× |
| Us pelvic non ob complete (76856) |
$212.70 |
$709 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$176.70 |
$589 |
1.9× |
| Us pregnancy ltd (76815) |
$176.70 |
$589 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$204.30 |
$681 |
2.2× |
| Us retroperitoneal complete (76770) |
$199.80 |
$666 |
2.1× |
| Us retroperitoneal limited (76775) |
$132.90 |
$443 |
1.4× |
| Us scrotum and contents (76870) |
$162.60 |
$542 |
1.7× |
| Us soft tissue head/neck (76536) |
$227.10 |
$757 |
2.4× |
| Us xtr non-vasc lmtd (76882) |
$162.60 |
$542 |
1.7× |
| Venogram extremity bilateral (75822) |
$1,044.30 |
$3,481 |
0.7× |
| Venography caval inferior serialography rs&i (75825) |
$2,124.90 |
$7,083 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$1,044.30 |
$3,481 |
0.7× |
| Venography renal unilateral selective rs&i (75831) |
$2,124.90 |
$7,083 |
0.7× |
| Wrist 2 views (73100) |
$96.30 |
$321 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$111 |
$370 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$64.20 |
$214 |
0.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$132.60 |
$442 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$96.30 |
$321 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$67.50 |
$225 |
0.9× |
| X-ray exam hip uni 1 view (73501) |
$66.90 |
$223 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$72.90 |
$243 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$54.90 |
$183 |
0.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$128.10 |
$427 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$73.20 |
$244 |
0.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$69.60 |
$232 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$96.30 |
$321 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$96.30 |
$321 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$23.10 |
$77 |
0.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$108.60 |
$362 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$132.30 |
$441 |
1.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$109.80 |
$366 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$84 |
$280 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$112.20 |
$374 |
1.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$84.60 |
$282 |
0.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$63.30 |
$211 |
0.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$60.30 |
$201 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$81 |
$270 |
0.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$83.10 |
$277 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$72.60 |
$242 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$94.80 |
$316 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$146.40 |
$488 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$79.80 |
$266 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$64.20 |
$214 |
0.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$108.90 |
$363 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$84 |
$280 |
1.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$60.30 |
$201 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$111 |
$370 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$63.30 |
$211 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$71.10 |
$237 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$72.60 |
$242 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$79.80 |
$266 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$43.80 |
$146 |
0.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$83.10 |
$277 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$64.20 |
$214 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$96.30 |
$321 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$105.30 |
$351 |
1.1× |
| Xr chest 4+ views (71048) |
$84 |
$280 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$64.20 |
$214 |
0.8× |
| Xr shoulder 1 view (73020) |
$102.60 |
$342 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$111 |
$370 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$64.20 |
$214 |
0.8× |
| Xr tmj bilateral (70330) |
$102.30 |
$341 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$66.60 |
$222 |
0.8× |