| Abdomen 2 views (74019) |
$233.80 |
$334 |
2.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$762.30 |
$1,089 |
1.9× |
| Acute venous thrombus image (78456) |
$616 |
$880 |
0.5× |
| Ankle 2 views (73600) |
$173.60 |
$248 |
2.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$528.50 |
$755 |
1.5× |
| Arthrography knee lt (73580) |
$19.60 |
$28 |
0.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$762.30 |
$1,089 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$762.30 |
$1,089 |
1.9× |
| Bone age studies (77072) |
$138.60 |
$198 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$762.30 |
$1,089 |
1.9× |
| Brain image w/flow 4 + views (78606) |
$1,782.90 |
$2,547 |
3.3× |
| Brain Imaging Minimum 4 Static Views (78605) |
$606.20 |
$866 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$173.60 |
$248 |
2.0× |
| Chest 1 view (71045) |
$173.60 |
$248 |
2.0× |
| Chest 3 views (71047) |
$173.60 |
$248 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$382.90 |
$547 |
2.2× |
| Clavicle complete (73000) |
$173.60 |
$248 |
2.0× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$269.50 |
$385 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,316 |
$1,880 |
3.8× |
| CT abdomen and pelvis without contrast (74176) |
$822.50 |
$1,175 |
3.4× |
| CT abdomen w contrast (74160) |
$638.40 |
$912 |
3.6× |
| CT abdomen w wo contrast (74170) |
$700 |
$1,000 |
4.0× |
| CT abdomen w/o contrast (74150) |
$389.20 |
$556 |
3.7× |
| CT angiography upper extremity lt (73206) |
$646.10 |
$923 |
3.7× |
| CT c-spine w/o contrast (72125) |
$389.20 |
$556 |
3.7× |
| CT cervical spine w&w/o contrast (72127) |
$638.40 |
$912 |
3.6× |
| CT cervical spine with contrast (72126) |
$1,316 |
$1,880 |
3.8× |
| CT chest w/wo contrast (71270) |
$700 |
$1,000 |
4.0× |
| CT chest with contrast (71260) |
$638.40 |
$912 |
3.6× |
| CT head/brain with contrast (70460) |
$638.40 |
$912 |
3.6× |
| CT head/brain without and with contrast (70470) |
$700 |
$1,000 |
4.0× |
| CT iac w contrast (70481) |
$638.40 |
$912 |
3.6× |
| CT lower ext w/o (73700) |
$389.20 |
$556 |
3.7× |
| CT lower extremity w wo contrast (73702) |
$638.40 |
$912 |
3.6× |
| CT lower extremity with contrast (73701) |
$638.40 |
$912 |
3.6× |
| CT lumbar spine w & w/o contrast (72133) |
$638.40 |
$912 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$389.20 |
$556 |
3.7× |
| CT lumbar spine with contrast (72132) |
$1,316 |
$1,880 |
3.8× |
| CT maxillofacial w contrast (70487) |
$638.40 |
$912 |
3.6× |
| CT maxillofacial w/o contrast (70486) |
$389.20 |
$556 |
3.7× |
| CT maxillofacial w/wo contrast (70488) |
$700 |
$1,000 |
4.0× |
| CT neck soft tissue w contrast (70491) |
$638.40 |
$912 |
3.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$700 |
$1,000 |
4.0× |
| CT orbits w/o contrast (70480) |
$494.90 |
$707 |
4.7× |
| CT pelvis w & w/o contrast (72194) |
$700 |
$1,000 |
4.0× |
| CT pelvis w/o contrast (72192) |
$389.20 |
$556 |
3.7× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$223.30 |
$319 |
2.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$700 |
$1,000 |
4.0× |
| CT soft tissue neck w/o contrast (70490) |
$389.20 |
$556 |
3.7× |
| CT thoracic spine w/o contrast (72128) |
$389.20 |
$556 |
3.7× |
| CT thorax w/o contrast (71250) |
$389.20 |
$556 |
3.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$638.40 |
$912 |
3.6× |
| CT upper extremity w/o contrast rt (73200) |
$389.20 |
$556 |
3.7× |
| CT upper extremity with contrast (73201) |
$1,316 |
$1,880 |
3.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$980 |
$1,400 |
5.6× |
| Cta Abdomen (74175) |
$1,049.30 |
$1,499 |
6.0× |
| CTA abdomen pelvis (74174) |
$762.30 |
$1,089 |
2.2× |
| CTA chest (71275) |
$822.50 |
$1,175 |
4.7× |
| Cta Head (70496) |
$840 |
$1,200 |
4.8× |
| CTA lwr ext w&w/o contrast (73706) |
$840 |
$1,200 |
4.8× |
| Cta Neck (70498) |
$840 |
$1,200 |
4.8× |
| Cta Pelvis (72191) |
$1,049.30 |
$1,499 |
6.0× |
| Cystography minimum 3 views rs&i (74430) |
$528.50 |
$755 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$389.20 |
$556 |
3.7× |
| Esophagus (74220) |
$173.60 |
$248 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$299.60 |
$428 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$250.60 |
$358 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$263.20 |
$232.50 |
1.1× |
| Foot 2 views (73620) |
$173.60 |
$248 |
2.0× |
| Forearm 2 views (73090) |
$173.60 |
$248 |
2.0× |
| Gated Heart Planar Single (78472) |
$942.20 |
$1,346 |
2.4× |
| Hand 2 views (73120) |
$233.80 |
$334 |
2.2× |
| Hand 3 views (73130) |
$173.60 |
$248 |
2.0× |
| Heart Infarct Image (78466) |
$412.30 |
$589 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$896 |
$1,280 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$896 |
$1,280 |
2.2× |
| Humerus Min 2 Views Left (73060) |
$173.60 |
$248 |
2.0× |
| Hysterosalpingogram (74740) |
$648.20 |
$926 |
2.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$743.75 |
$1,062.50 |
1.4× |
| Knee 3 views (73562) |
$138.60 |
$198 |
1.6× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$896 |
$1,280 |
2.2× |
| Meckels Diverticulum (78290) |
$762.30 |
$1,089 |
1.9× |
| MRA head w & w/o contrast (70546) |
$1,649.90 |
$2,357 |
4.7× |
| MRA head w/o contrast (70544) |
$1,076.60 |
$1,538 |
4.5× |
| MRA head with contrast (70545) |
$1,306.20 |
$1,866 |
3.7× |
| MRA neck w contrast (70548) |
$1,306.20 |
$1,866 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,649.90 |
$2,357 |
4.7× |
| MRA neck w/o contrast (70547) |
$1,076.60 |
$1,538 |
4.5× |
| MRI abdomen w contrast (74182) |
$1,306.20 |
$1,866 |
3.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,649.90 |
$2,357 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$947.10 |
$1,353 |
4.0× |
| MRI any jnt lwr ext with con lt (73722) |
$2,592.80 |
$3,704 |
3.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,592.80 |
$3,704 |
3.3× |
| MRI c-spine with contrast (72142) |
$1,289.40 |
$1,842 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$817.60 |
$1,168 |
3.4× |
| MRI chest w/o & w/contrast material (71552) |
$1,649.90 |
$2,357 |
4.7× |
| MRI chest w/o contrast (71550) |
$1,076.60 |
$1,538 |
4.5× |
| MRI chest with contrast (71551) |
$1,306.20 |
$1,866 |
1.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,289.40 |
$1,842 |
3.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,289.40 |
$1,842 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$817.60 |
$1,168 |
3.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$817.60 |
$1,168 |
3.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,761.20 |
$2,516 |
5.0× |
| MRI orbit/face/neck w/contrast (70542) |
$1,289.40 |
$1,842 |
3.7× |
| MRI pelvis w contrast (72196) |
$1,289.40 |
$1,842 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$17.50 |
$25 |
0.1× |
| MRI pelvis w/o contrast (72195) |
$947.10 |
$1,353 |
4.0× |
| MRI scan of arm joint before and after contrast (73223) |
$1,289.40 |
$1,842 |
3.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,289.40 |
$1,842 |
3.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,761.20 |
$2,516 |
5.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,289.40 |
$1,842 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,761.20 |
$2,516 |
5.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,289.40 |
$1,842 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,761.20 |
$2,516 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$817.60 |
$1,168 |
3.4× |
| MRI tmj (70336) |
$1,076.60 |
$1,538 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$817.60 |
$1,168 |
3.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,761.20 |
$2,516 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$817.60 |
$1,168 |
3.4× |
| Myocardial Spect Multiple Studies (78452) |
$2,387 |
$3,410 |
1.8× |
| Neck soft tissue (70360) |
$173.60 |
$248 |
2.0× |
| Nm gastric emptying study (78264) |
$762.30 |
$1,089 |
1.9× |
| Nuclear medicine study of kidney and blood flow (78701) |
$1,001 |
$1,430 |
2.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$260.40 |
$372 |
2.5× |
| Osseous survey infant (77076) |
$245 |
$350 |
2.3× |
| Parathyroid imaging (78070) |
$683.20 |
$976 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$233.80 |
$334 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,761.20 |
$2,516 |
5.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$636.30 |
$909 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$173.60 |
$248 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$233.80 |
$334 |
2.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$138.60 |
$198 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$173.60 |
$248 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$173.60 |
$248 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$173.60 |
$248 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$269.50 |
$385 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$269.50 |
$385 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$269.50 |
$385 |
1.5× |
| Radiological examination surgical specimen (76098) |
$1,162.70 |
$1,661 |
2.1× |
| Radiopharmaceutical therapy, by intracavitary administration Age Under 21 (79200) |
$1,080.10 |
$1,543 |
4.6× |
| Ribs bilateral 3 views (71110) |
$233.80 |
$334 |
2.2× |
| Scanogram (77073) |
$138.60 |
$198 |
1.3× |
| Scapula complete (73010) |
$173.60 |
$248 |
1.7× |
| Small bowel series (74250) |
$382.90 |
$547 |
2.2× |
| Spine thoracic 3 views (72072) |
$233.80 |
$334 |
2.2× |
| Testicular Imaging With Vascular Flow (78761) |
$1,001 |
$1,430 |
2.5× |
| Thyroid Imaging With Vascular Flow (78013) |
$448.70 |
$641 |
1.1× |
| Thyroid uptake measurement (78012) |
$683.20 |
$976 |
1.7× |
| Tmj unilateral (70328) |
$173.60 |
$248 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$299.60 |
$428 |
2.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$138.60 |
$198 |
1.6× |
| Upper Extremity Infant (73092) |
$233.80 |
$334 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$528.50 |
$755 |
2.2× |
| Urethrocystography voiding (74455) |
$528.50 |
$755 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$528.50 |
$755 |
3.0× |
| Us abdl aorta screen aaa (76706) |
$84 |
$120 |
0.8× |
| Us breast unilateral complete (76641) |
$235.20 |
$336 |
2.2× |
| Us chest (76604) |
$192.50 |
$275 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$299.60 |
$428 |
2.9× |
| Us ob detailed single fetus (76811) |
$400.40 |
$572 |
1.7× |
| Us pelvic non ob complete (76856) |
$299.60 |
$428 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$192.50 |
$275 |
1.8× |
| Us pregnancy ltd (76815) |
$289.10 |
$413 |
2.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$308 |
$440 |
2.9× |
| Us retroperitoneal complete (76770) |
$246.05 |
$351.50 |
2.3× |
| Us retroperitoneal limited (76775) |
$299.60 |
$428 |
2.9× |
| Us scrotum and contents (76870) |
$299.60 |
$428 |
2.9× |
| Us soft tissue head/neck (76536) |
$299.60 |
$428 |
2.9× |
| Us transrectal (76872) |
$267.05 |
$381.50 |
2.6× |
| Venogram extremity bilateral (75822) |
$2,138.50 |
$3,055 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$2,138.50 |
$3,055 |
1.4× |
| Wrist 2 views (73100) |
$138.60 |
$198 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$233.80 |
$334 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$138.60 |
$198 |
1.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$173.60 |
$248 |
2.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$436.10 |
$623 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$173.60 |
$248 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$173.60 |
$248 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$203 |
$290 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$173.60 |
$248 |
2.0× |
| X-ray exam of femur 1 (73551) |
$173.60 |
$248 |
2.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$436.10 |
$623 |
2.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$233.80 |
$334 |
2.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$173.60 |
$248 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$173.60 |
$248 |
2.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$138.60 |
$198 |
1.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$528.50 |
$755 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$173.60 |
$248 |
2.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$233.80 |
$334 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$138.60 |
$198 |
1.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$173.60 |
$248 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$233.80 |
$334 |
2.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$173.60 |
$248 |
2.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$173.60 |
$248 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$173.60 |
$248 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$233.80 |
$334 |
2.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$406.35 |
$580.50 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$173.60 |
$248 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$233.80 |
$334 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$233.80 |
$334 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$233.80 |
$334 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$173.60 |
$248 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$173.60 |
$248 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$173.60 |
$248 |
2.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$173.60 |
$248 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$232.40 |
$332 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$233.80 |
$334 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$138.60 |
$198 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$138.60 |
$198 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$173.60 |
$248 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$233.80 |
$334 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$233.80 |
$334 |
2.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$138.60 |
$198 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$173.60 |
$248 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$233.80 |
$334 |
2.2× |
| Xr finger(s) 2+ views (73140) |
$173.60 |
$248 |
2.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$138.60 |
$198 |
1.3× |
| Xr optic foramina (70190) |
$138.60 |
$198 |
1.6× |
| Xr shoulder 1 view (73020) |
$173.60 |
$248 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$233.80 |
$334 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$173.60 |
$248 |
2.0× |
| Xr tmj bilateral (70330) |
$138.60 |
$198 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$173.60 |
$248 |
2.0× |