| Acute gi blood loss imaging (78278) |
$322.75 |
$1,291 |
0.8× |
| Angio extremity unilateral (75710) |
$953.75 |
$3,815 |
0.3× |
| Ankle 2 views (73600) |
$100.50 |
$402 |
1.1× |
| Barium enema (74270) |
$298.25 |
$1,193 |
1.6× |
| Bone age studies (77072) |
$93.25 |
$373 |
0.9× |
| Bone imaging limited area (78300) |
$295.75 |
$1,183 |
0.7× |
| Bone survey complete (77075) |
$301.50 |
$1,206 |
2.8× |
| Bowel imaging (78290) |
$204.75 |
$819 |
0.5× |
| Brain flow imaging only - nm brain flow only brain death (78610) |
$180 |
$720 |
0.3× |
| Card MRI w/stress img & dye (75563) |
$731.25 |
$2,925 |
0.9× |
| Cardiac MRI w/wo contrast & further seq (75561) |
$716.75 |
$2,867 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$238 |
$952 |
1.3× |
| Clavicle complete (73000) |
$96.25 |
$385 |
1.1× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$598.50 |
$2,394 |
3.3× |
| Contrast exam abdominl aorta (75625) |
$1,114.75 |
$4,459 |
0.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,430 |
$5,720 |
3.9× |
| CT abdomen and pelvis without contrast (74176) |
$997.75 |
$3,991 |
4.0× |
| CT abdomen w wo contrast (74170) |
$649.50 |
$2,598 |
3.5× |
| CT abdomen w/contrast (74160) |
$551.75 |
$2,207 |
3.0× |
| CT abdomen w/o contrast (74150) |
$353.50 |
$1,414 |
3.2× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$1,128.50 |
$4,514 |
3.1× |
| CT angio abdom w/o & w/dye (74175) |
$791 |
$3,164 |
4.3× |
| CT angio abdominal arteries (75635) |
$956.75 |
$3,827 |
5.2× |
| CT angio hrt w/3d image (75574) |
$863.25 |
$3,453 |
2.4× |
| CT angiograph pelv w/o&w/dye (72191) |
$239.25 |
$957 |
1.3× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$112 |
$448 |
0.6× |
| CT cervical spine w/contrast (72126) |
$412.50 |
$1,650 |
1.1× |
| CT cervical spine w/o contrast (72125) |
$563 |
$2,252 |
5.2× |
| CT chest w/contrast (71260) |
$626 |
$2,504 |
3.4× |
| CT extremity upper w & w/o contrast (73202) |
$481 |
$1,924 |
2.6× |
| CT head/brain with contrast (70460) |
$602 |
$2,408 |
3.3× |
| CT head/brain without and with contrast (70470) |
$730.50 |
$2,922 |
4.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$112 |
$448 |
1.2× |
| CT lower ext w/wo contrast (73702) |
$537.25 |
$2,149 |
2.9× |
| CT lower extremity w contrast (73701) |
$524.25 |
$2,097 |
2.9× |
| CT lower extremity w/o contrast unilateral (73700) |
$423 |
$1,692 |
3.9× |
| CT lumbar spine w/contrast (72132) |
$511.25 |
$2,045 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$510 |
$2,040 |
4.7× |
| CT maxillofacial area w/o contrast (70486) |
$544 |
$2,176 |
5.0× |
| CT maxillofacial w/contrast (70487) |
$565.75 |
$2,263 |
3.1× |
| CT maxillofacial w/o then w/ con (70488) |
$583.75 |
$2,335 |
3.2× |
| CT orbit sella ear w/o con (70480) |
$421.50 |
$1,686 |
3.9× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$605.50 |
$2,422 |
3.3× |
| CT pelvis w & w/o contrast (72194) |
$783.25 |
$3,133 |
4.3× |
| CT pelvis w/o contrast (72192) |
$529 |
$2,116 |
4.8× |
| CT soft tissue neck w/contrast (70491) |
$571.25 |
$2,285 |
3.1× |
| CT soft tissue neck w/o contrast (70490) |
$401.25 |
$1,605 |
3.7× |
| CT spine cervical w/wo contrast (72127) |
$646.50 |
$2,586 |
3.5× |
| CT thoracic spine w/contrast (72129) |
$526.25 |
$2,105 |
2.9× |
| CT thoracic spine w/o contrast (72128) |
$514.25 |
$2,057 |
4.7× |
| CT thorax w/o contrast (71250) |
$418.25 |
$1,673 |
3.8× |
| CT upper extremity w/dye (73201) |
$447.25 |
$1,789 |
1.2× |
| CT upper extremity w/o contrast rt (73200) |
$415.25 |
$1,661 |
3.8× |
| CTA chest w/wo contrast (71275) |
$874 |
$3,496 |
4.8× |
| CTA head w contrast (70496) |
$606.75 |
$2,427 |
3.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$222.77 |
$891.07 |
0.6× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$599 |
$2,396 |
3.3× |
| Cta Neck (70498) |
$735.75 |
$2,943 |
4.0× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$910 |
$3,640 |
5.0× |
| Esophogram (74220) |
$205 |
$820 |
1.1× |
| Fetal biophysical profile w/o nst (76819) |
$120.75 |
$483 |
1.1× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$232.50 |
$930 |
0.9× |
| Gastric emptying study (78264) |
$493.25 |
$1,973 |
1.2× |
| Gated heart planar single (78472) |
$382 |
$1,528 |
0.9× |
| Hepatobil syst image w/drug (78227) |
$398.50 |
$1,594 |
0.7× |
| Hepatobiliary system imaging (78226) |
$283.50 |
$1,134 |
0.7× |
| Humerus min 2 views (73060) |
$106.75 |
$427 |
1.2× |
| Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid… (78808) |
$104.25 |
$417 |
0.2× |
| Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Age Under… (78707) |
$338.25 |
$1,353 |
0.6× |
| Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg,… (78708) |
$434.14 |
$1,736.55 |
0.8× |
| Lung ventilat&perfus imaging (78582) |
$458.25 |
$1,833 |
0.8× |
| Lung ventilation imaging (78579) |
$104.25 |
$417 |
0.2× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$951.75 |
$3,807 |
2.6× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$1,062.25 |
$4,249 |
2.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$15.25 |
$61 |
0.5× |
| MRA head w & w/o contrast (70546) |
$720.75 |
$2,883 |
2.0× |
| MRA head w/contrast (70545) |
$646 |
$2,584 |
1.8× |
| MRA head w/o contrast (70544) |
$627.50 |
$2,510 |
2.5× |
| MRA neck w/contrast (70548) |
$886 |
$3,544 |
2.4× |
| MRA neck w/o contrast (70547) |
$637.75 |
$2,551 |
2.6× |
| MRA neck w/wo contrast (70549) |
$1,040 |
$4,160 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$733 |
$2,932 |
2.0× |
| MRI abdomen w/o contrast (74181) |
$689.25 |
$2,757 |
2.8× |
| MRI any jnt lwr ext with con lt (73722) |
$881.25 |
$3,525 |
1.1× |
| MRI cervical spine w/o contrast (72141) |
$771.75 |
$3,087 |
3.1× |
| MRI cervical spine with contrast (72142) |
$792.50 |
$3,170 |
2.2× |
| MRI joint upr extr w/o&w/dye (73223) |
$979.50 |
$3,918 |
2.7× |
| MRI joint upr extrem w/o dye (73221) |
$725.25 |
$2,901 |
2.9× |
| Mri Lower Extremity W/O Dye (73718) |
$742 |
$2,968 |
3.0× |
| MRI lumbar spine with contrast (72149) |
$785.25 |
$3,141 |
2.2× |
| MRI lumbar w/wo contrast (72158) |
$984.75 |
$3,939 |
2.7× |
| MRI orbit/face/neck w/contrast (70542) |
$801 |
$3,204 |
2.2× |
| MRI orbit/face/neck w/o & w/contrast (70543) |
$1,028 |
$4,112 |
2.8× |
| MRI orbit/face/neck w/o contrast (70540) |
$719 |
$2,876 |
2.9× |
| MRI pelvis w/o contrast (72195) |
$696 |
$2,784 |
2.8× |
| MRI pelvis w/wo contrast (72197) |
$787.75 |
$3,151 |
2.2× |
| MRI spine cervical wo/w contrast (72156) |
$992.50 |
$3,970 |
2.7× |
| MRI spine thoracic w/contrast (72147) |
$758.75 |
$3,035 |
2.1× |
| MRI thoracic spine w wo contrast (72157) |
$992 |
$3,968 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$732.50 |
$2,930 |
2.9× |
| MRI tmj (70336) |
$744.75 |
$2,979 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$492.25 |
$1,969 |
2.0× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$1,046 |
$4,184 |
2.9× |
| Myocardial spect single study at rest or stress (78451) |
$934.25 |
$3,737 |
0.7× |
| Nm bone 3 phase (78315) |
$499.75 |
$1,999 |
1.2× |
| Nm bone imaging whole body (78306) |
$471 |
$1,884 |
1.1× |
| Nm heart perfusion spect stress rest (78452) |
$938.66 |
$3,754.65 |
0.7× |
| Nose to rectum for fb child (76010) |
$125 |
$500 |
1.4× |
| Ob us < 14 wks single fetus (76801) |
$261 |
$1,044 |
2.4× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$234.50 |
$938 |
0.6× |
| Pulmonary perfusion imaging particulate (78580) |
$279.75 |
$1,119 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$89 |
$356 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$117.50 |
$470 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 4/5 vw (72083) |
$142.50 |
$570 |
1.3× |
| Radex hip unilateral with pelvis 1 view (73501) |
$88.50 |
$354 |
1.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$121.50 |
$486 |
1.3× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$129 |
$516 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$150.25 |
$601 |
1.4× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$193.50 |
$774 |
1.8× |
| Radex spine cervical 2 or 3 views (72040) |
$122.25 |
$489 |
1.3× |
| Radex spine cervical 4 or 5 views (72050) |
$177.50 |
$710 |
1.6× |
| Radex spine cervical 6 or more views (72052) |
$236.75 |
$947 |
2.2× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$61.25 |
$245 |
0.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$339.50 |
$1,358 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$352.50 |
$1,410 |
1.9× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$83.75 |
$335 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$89.50 |
$358 |
1.0× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$226.75 |
$907 |
2.1× |
| Rp loclzj tum spect CT 2area/sep acquisj img (78832) |
$951 |
$3,804 |
0.6× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$626.50 |
$2,506 |
0.5× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$56.50 |
$226 |
2.4× |
| Small bowel series (74250) |
$209.25 |
$837 |
1.1× |
| Ultrasound breast limited (76642) |
$134.75 |
$539 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$208.25 |
$833 |
1.9× |
| Ultrasound, elastography; first target lesion (76982) |
$113.75 |
$455 |
1.0× |
| Urethrocystography voiding (74455) |
$350.75 |
$1,403 |
1.4× |
| Urography retrograde w/wo kub (74420) |
$297 |
$1,188 |
0.8× |
| Us breast uni real time with image complete (76641) |
$187.75 |
$751 |
1.7× |
| Us chest (76604) |
$90.50 |
$362 |
0.8× |
| Us elastography parenchyma (76981) |
$160.50 |
$642 |
1.5× |
| Us kidney transplanted (76776) |
$243.25 |
$973 |
2.2× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$172 |
$688 |
1.6× |
| Us ob detailed single fetus (76811) |
$105 |
$420 |
0.4× |
| Us ob followup per fetus (76816) |
$132.25 |
$529 |
1.2× |
| Us ob limited 1 or more fetuses (76815) |
$88.75 |
$355 |
0.8× |
| Us obstetric transvaginal (76817) |
$186.75 |
$747 |
1.7× |
| Us pelvic limited or f/u non-ob (76857) |
$133.75 |
$535 |
1.2× |
| Us pelvis complete (76856) |
$265 |
$1,060 |
2.4× |
| Us retroperitoneal complete (76770) |
$218.50 |
$874 |
2.0× |
| Us retroperitoneal limited (76775) |
$202.25 |
$809 |
1.9× |
| Us scrotum (76870) |
$213 |
$852 |
2.0× |
| Us soft tissue head/neck (76536) |
$206.75 |
$827 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$126.75 |
$507 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$370.50 |
$1,482 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$109 |
$436 |
1.2× |
| X-ray exam hips bi 3-4 views (73522) |
$165.75 |
$663 |
1.5× |
| X-ray exam of finger(s) (73140) |
$81.50 |
$326 |
0.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$302.50 |
$1,210 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$92 |
$368 |
1.0× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$96.25 |
$385 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$100.25 |
$401 |
1.1× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$82.75 |
$331 |
0.8× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$99.75 |
$399 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$96.25 |
$385 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$98.50 |
$394 |
1.1× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$114.75 |
$459 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$118.75 |
$475 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$112 |
$448 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$118.25 |
$473 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$179 |
$716 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$127.75 |
$511 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$199.75 |
$799 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$98.25 |
$393 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$107.50 |
$430 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$104.50 |
$418 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$128.25 |
$513 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$149 |
$596 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$140.25 |
$561 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$64.50 |
$258 |
0.7× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$94 |
$376 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$97.50 |
$390 |
1.1× |
| Xr abdomen 1 view (74018) |
$115.25 |
$461 |
1.3× |
| Xr abdomen 2 views (74019) |
$116.25 |
$465 |
1.1× |
| Xr bone survey infant (77076) |
$68.75 |
$275 |
0.6× |
| Xr chest 1 view (71045) |
$107.75 |
$431 |
1.2× |
| Xr chest 2 views (71046) |
$140.50 |
$562 |
1.5× |
| Xr cystogram 3+ views (74430) |
$185 |
$740 |
0.5× |
| Xr facial bones 3 views (70150) |
$121.25 |
$485 |
1.1× |
| Xr lower extremity 2 views infant (73592) |
$43.25 |
$173 |
0.5× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$129.25 |
$517 |
1.2× |
| Xr mandible 4 views (70110) |
$121.25 |
$485 |
1.1× |
| Xr nasal bones (70160) |
$100.25 |
$401 |
1.1× |
| Xr pelvis 3 views (72190) |
$115.50 |
$462 |
1.1× |
| Xr spine 1 view (72020) |
$72.50 |
$290 |
0.8× |
| Xr sternum 2 views (71120) |
$103.75 |
$415 |
1.1× |
| Xr upper extremity 2 views infant (73092) |
$54.75 |
$219 |
0.5× |
| Xray elbow 2 views (73070) |
$91.75 |
$367 |
1.0× |
| Xray forearm 2 views (73090) |
$93 |
$372 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$109.50 |
$438 |
1.2× |
| Xray neck soft tissue (70360) |
$114.50 |
$458 |
1.3× |
| Xray orbits complete min 4 views (70200) |
$121.25 |
$485 |
1.1× |
| Xray pelvis 1 or 2 views (72170) |
$112.50 |
$450 |
1.0× |
| Xray ribs bilateral 3 views (71110) |
$132.25 |
$529 |
1.2× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$128.50 |
$514 |
1.2× |
| Xray scapula complete (73010) |
$94.75 |
$379 |
0.9× |
| Xray shoulder 1 view (73020) |
$72.75 |
$291 |
0.8× |
| Xray spine thoracic 2 views (72070) |
$111.25 |
$445 |
1.0× |
| Xray spine thoracic 3 views (72072) |
$111.25 |
$445 |
1.0× |
| Xray tibia-fibula 2 views bil (73590) |
$97.50 |
$390 |
1.1× |
| Xray tmj's bilateral open-clsc (70330) |
$112 |
$448 |
1.2× |