| Abdomen 2 views (74019) |
$216 |
$270 |
2.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$672 |
$840 |
1.7× |
| Ankle 2 views (73600) |
$130.40 |
$163 |
1.5× |
| Arthrogram elbow (73085) |
$308.80 |
$386 |
0.9× |
| Arthrogram hip (73525) |
$308.80 |
$386 |
0.9× |
| Arthrogram shoulder (73040) |
$237.60 |
$297 |
0.7× |
| Arthrogram wrist (73115) |
$179.20 |
$224 |
0.5× |
| Arthrography knee lt (73580) |
$308.80 |
$386 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$612.80 |
$766 |
1.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,366.40 |
$1,708 |
3.4× |
| Bone &/joint imaging whole body (78306) |
$797.20 |
$996.50 |
2.0× |
| Bone age studies (77072) |
$156 |
$195 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$912.80 |
$1,141 |
2.3× |
| Bone Marrow Imaging Limited Area (78102) |
$542.40 |
$678 |
1.4× |
| Bone survey complete (77075) |
$344.80 |
$431 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$142.40 |
$178 |
1.6× |
| Chest 1 view (71045) |
$116.80 |
$146 |
1.3× |
| Chest 3 views (71047) |
$152 |
$190 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$200.80 |
$251 |
1.1× |
| Clavicle complete (73000) |
$148.80 |
$186 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,876.80 |
$2,346 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,604.80 |
$2,006 |
6.7× |
| CT abdomen w contrast (74160) |
$877.60 |
$1,097 |
5.0× |
| CT abdomen w wo contrast (74170) |
$938.40 |
$1,173 |
5.3× |
| CT abdomen w/o contrast (74150) |
$802.40 |
$1,003 |
7.7× |
| CT angiography upper extremity lt (73206) |
$802.40 |
$1,003 |
4.6× |
| CT c-spine w/o contrast (72125) |
$802.40 |
$1,003 |
7.7× |
| CT cervical spine w&w/o contrast (72127) |
$938.40 |
$1,173 |
5.3× |
| CT cervical spine with contrast (72126) |
$877.60 |
$1,097 |
2.5× |
| CT chest w/wo contrast (71270) |
$938.40 |
$1,173 |
5.3× |
| CT chest with contrast (71260) |
$877.60 |
$1,097 |
5.0× |
| CT head/brain with contrast (70460) |
$877.60 |
$1,097 |
5.0× |
| CT head/brain without and with contrast (70470) |
$938.40 |
$1,173 |
5.3× |
| CT iac w contrast (70481) |
$826.40 |
$1,033 |
4.7× |
| CT lower ext w/o (73700) |
$802.40 |
$1,003 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$883.20 |
$1,104 |
5.0× |
| CT lower extremity with contrast (73701) |
$826.40 |
$1,033 |
4.7× |
| CT lumbar spine w & w/o contrast (72133) |
$883.20 |
$1,104 |
5.0× |
| CT lumbar spine w/o contrast (72131) |
$802.40 |
$1,003 |
7.7× |
| CT lumbar spine with contrast (72132) |
$826.40 |
$1,033 |
2.4× |
| CT maxillofacial w contrast (70487) |
$877.60 |
$1,097 |
5.0× |
| CT maxillofacial w/o contrast (70486) |
$802.40 |
$1,003 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$883.20 |
$1,104 |
5.0× |
| CT neck soft tissue w contrast (70491) |
$877.60 |
$1,097 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$938.40 |
$1,173 |
5.3× |
| CT orbits w/o contrast (70480) |
$802.40 |
$1,003 |
7.7× |
| CT pelvis w & w/o contrast (72194) |
$938.40 |
$1,173 |
5.3× |
| CT pelvis w/o contrast (72192) |
$802.40 |
$1,003 |
7.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$938.40 |
$1,173 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$802.40 |
$1,003 |
7.7× |
| CT thoracic spine w/contrast (72129) |
$877.60 |
$1,097 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$802.40 |
$1,003 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$883.20 |
$1,104 |
5.0× |
| CT thorax w/o contrast (71250) |
$802.40 |
$1,003 |
7.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$883.20 |
$1,104 |
5.0× |
| CT upper extremity w/o contrast rt (73200) |
$802.40 |
$1,003 |
7.7× |
| CT upper extremity with contrast (73201) |
$877.60 |
$1,097 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,648 |
$2,060 |
9.4× |
| Cta Abdomen (74175) |
$1,024.80 |
$1,281 |
5.8× |
| CTA abdomen pelvis (74174) |
$1,648 |
$2,060 |
4.7× |
| CTA chest (71275) |
$958.40 |
$1,198 |
5.5× |
| Cta Head (70496) |
$988.80 |
$1,236 |
5.6× |
| Cta Neck (70498) |
$988.80 |
$1,236 |
5.6× |
| Cta Pelvis (72191) |
$1,030.40 |
$1,288 |
5.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$320 |
$400 |
3.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$112.80 |
$141 |
1.3× |
| Dxa bone density study axial skeleton (77085) |
$296 |
$370 |
2.8× |
| Esophagus (74220) |
$212.80 |
$266 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$252 |
$315 |
1.1× |
| Foot 2 views (73620) |
$95.20 |
$119 |
1.1× |
| Forearm 2 views (73090) |
$130.40 |
$163 |
1.5× |
| Gated Heart Planar Single (78472) |
$1,297.60 |
$1,622 |
3.2× |
| Hand 2 views (73120) |
$101.60 |
$127 |
1.0× |
| Hand 3 views (73130) |
$130.40 |
$163 |
1.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$741.60 |
$927 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$735.20 |
$919 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$140.80 |
$176 |
1.6× |
| Hysterosalpingogram (74740) |
$432 |
$540 |
1.8× |
| Knee 3 views (73562) |
$116.80 |
$146 |
1.3× |
| Liver & spleen imaging static only (78215) |
$425.60 |
$532 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$588 |
$735 |
1.5× |
| Liver imaging static only (78201) |
$425.60 |
$532 |
0.8× |
| Liver imaging w/vascular flow (78202) |
$564.80 |
$706 |
1.0× |
| Lymphoscintigraphy (78195) |
$700.80 |
$876 |
1.3× |
| Meckels Diverticulum (78290) |
$516.80 |
$646 |
1.3× |
| MRA head w & w/o contrast (70546) |
$2,146.40 |
$2,683 |
6.1× |
| MRA head w/o contrast (70544) |
$1,524.80 |
$1,906 |
6.4× |
| MRA head with contrast (70545) |
$1,665.60 |
$2,082 |
4.8× |
| MRA neck w contrast (70548) |
$1,436 |
$1,795 |
4.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,524.80 |
$1,906 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,524.80 |
$1,906 |
6.4× |
| MRI abdomen w contrast (74182) |
$1,667.20 |
$2,084 |
4.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,029.60 |
$2,537 |
5.8× |
| MRI abdomen w/o contrast (74181) |
$1,511.20 |
$1,889 |
6.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,435.20 |
$1,794 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,436 |
$1,795 |
1.8× |
| MRI c-spine with contrast (72142) |
$2,152.80 |
$2,691 |
6.2× |
| MRI cervical spine w/o contrast (72141) |
$1,906.40 |
$2,383 |
8.0× |
| MRI chest w/o & w/contrast material (71552) |
$2,152.80 |
$2,691 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,524.80 |
$1,906 |
6.4× |
| MRI chest with contrast (71551) |
$1,906.40 |
$2,383 |
2.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,436 |
$1,795 |
4.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,436 |
$1,795 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,464 |
$1,830 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,220.80 |
$1,526 |
5.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,768.80 |
$2,211 |
5.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,525.60 |
$1,907 |
4.4× |
| MRI pelvis w contrast (72196) |
$1,721.60 |
$2,152 |
4.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,115.20 |
$2,644 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,422.40 |
$1,778 |
6.0× |
| MRI scan of arm joint before and after contrast (73223) |
$1,768.80 |
$2,211 |
5.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,665.60 |
$2,082 |
4.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,280.80 |
$2,851 |
6.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,991.20 |
$2,489 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,395.20 |
$2,994 |
6.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,073.60 |
$2,592 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,254.40 |
$2,818 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,464 |
$1,830 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,422.40 |
$1,778 |
6.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,464 |
$1,830 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,464 |
$1,830 |
6.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,848 |
$3,560 |
2.2× |
| Neck soft tissue (70360) |
$89.60 |
$112 |
1.0× |
| Nm bone marrow wb (78104) |
$595.20 |
$744 |
1.5× |
| Nm gastric emptying study (78264) |
$750.40 |
$938 |
1.9× |
| Nm gastroesophageal reflux study (78262) |
$375.20 |
$469 |
0.9× |
| Nuclear medicine of heart muscle at rest with stress (78454) |
$1,776.80 |
$2,221 |
1.4× |
| Nuclear medicine of heart pumping function (78473) |
$1,452 |
$1,815 |
3.6× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,460 |
$1,825 |
1.1× |
| Osseous survey infant (77076) |
$166.40 |
$208 |
1.6× |
| Osseous survey limited (77074) |
$208 |
$260 |
2.0× |
| Parathyroid imaging (78070) |
$580.80 |
$726 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$134.40 |
$168 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,524.80 |
$1,906 |
4.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$635.20 |
$794 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,532 |
$1,915 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$196 |
$245 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$308 |
$385 |
2.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$174.40 |
$218 |
1.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$172 |
$215 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$140 |
$175 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$133.60 |
$167 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$164.80 |
$206 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$152 |
$190 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$303.20 |
$379 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$321.60 |
$402 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$130.40 |
$163 |
1.5× |
| Ribs bilateral 3 views (71110) |
$200.80 |
$251 |
1.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$918.40 |
$1,148 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$117.60 |
$147 |
1.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$148 |
$185 |
0.6× |
| Salivary gland imaging (78230) |
$1,187.20 |
$1,484 |
3.0× |
| Salivary gland imaging serial images (78231) |
$1,073.60 |
$1,342 |
2.7× |
| Scapula complete (73010) |
$142.40 |
$178 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$64 |
$80 |
2.7× |
| Small bowel series (74250) |
$280.80 |
$351 |
1.6× |
| Spine thoracic 3 views (72072) |
$208 |
$260 |
2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,025.60 |
$1,282 |
2.6× |
| Tmj unilateral (70328) |
$132.80 |
$166 |
1.5× |
| Ultrasound scan to determine eye length and lens power (76519) |
$280 |
$350 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$448 |
$560 |
4.3× |
| Unlisted cardiovascular procedure, diagnostic nuclear medicine UNSCHEDULED (78499) |
$856.80 |
$1,071 |
2.1× |
| Unlisted fluoroscopic procedure (76496) |
$125.60 |
$157 |
1.4× |
| Unlisted Ultrasound Procedure (76999) |
$279.20 |
$349 |
3.2× |
| Urethrocystography voiding (74455) |
$321.60 |
$402 |
1.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$428 |
$535 |
2.4× |
| Us abdl aorta screen aaa (76706) |
$556 |
$695 |
5.3× |
| Us breast unilateral complete (76641) |
$140 |
$175 |
1.3× |
| Us breast unilateral limited (76642) |
$108 |
$135 |
1.2× |
| Us chest (76604) |
$421.60 |
$527 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$473.60 |
$592 |
4.5× |
| Us infant hips limited static (76886) |
$391.20 |
$489 |
4.5× |
| Us ob transvaginal (76817) |
$482.40 |
$603 |
4.6× |
| Us pelvic non ob complete (76856) |
$518.40 |
$648 |
5.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$224 |
$280 |
2.1× |
| Us pregnancy ltd (76815) |
$482.40 |
$603 |
4.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$531.20 |
$664 |
5.1× |
| Us retroperitoneal complete (76770) |
$556 |
$695 |
5.3× |
| Us retroperitoneal limited (76775) |
$404.80 |
$506 |
3.9× |
| Us scrotum and contents (76870) |
$484.80 |
$606 |
4.6× |
| Us soft tissue head/neck (76536) |
$448 |
$560 |
4.3× |
| Us xtr non-vasc lmtd (76882) |
$391.20 |
$489 |
3.7× |
| Vascular flow imaging (78445) |
$332 |
$415 |
0.8× |
| Vertebral fracture assessment via dxa (77086) |
$112.80 |
$141 |
1.3× |
| Wrist 2 views (73100) |
$100.80 |
$126 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$180.80 |
$226 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$198.40 |
$248 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$167.20 |
$209 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$494.40 |
$618 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.40 |
$163 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$148.80 |
$186 |
1.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$120.80 |
$151 |
1.2× |
| X-ray exam hip uni 1 view (73501) |
$256 |
$320 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$308 |
$385 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$300 |
$375 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$346.40 |
$433 |
3.3× |
| X-ray exam of femur 1 (73551) |
$96 |
$120 |
1.1× |
| X-ray eye for foreign body (70030) |
$95.20 |
$119 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$174.40 |
$218 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$130.40 |
$163 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$142.40 |
$178 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$106.40 |
$133 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$185.60 |
$232 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$185.60 |
$232 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$216 |
$270 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$224.80 |
$281 |
2.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$142.40 |
$178 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$185.60 |
$232 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$142.40 |
$178 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$258.40 |
$323 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$276 |
$345 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$127.20 |
$159 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$142.40 |
$178 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$142.40 |
$178 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$136.80 |
$171 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$166.40 |
$208 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$142.40 |
$178 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$200.80 |
$251 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$134.40 |
$168 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$125.60 |
$157 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$142.40 |
$178 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$85.60 |
$107 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$130.40 |
$163 |
1.5× |
| Xr arthrogram ankle (73615) |
$308.80 |
$386 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$215.20 |
$269 |
2.1× |
| Xr chest 4+ views (71048) |
$173.60 |
$217 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$102.40 |
$128 |
1.2× |
| Xr shoulder 1 view (73020) |
$121.60 |
$152 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$185.60 |
$232 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$128.80 |
$161 |
1.5× |
| Xr tmj bilateral (70330) |
$147.20 |
$184 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$108 |
$135 |
1.2× |