| Ankle 2 views (73600) |
$247.80 |
$413 |
2.7× |
| Arthrogram elbow (73085) |
$323.40 |
$539 |
0.9× |
| Arthrogram hip (73525) |
$678 |
$1,130 |
1.8× |
| Arthrogram shoulder (73040) |
$320.40 |
$534 |
0.9× |
| Arthrogram wrist (73115) |
$178.20 |
$297 |
0.5× |
| Arthrography knee lt (73580) |
$385.20 |
$642 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$370.20 |
$617 |
0.9× |
| Bone &/joint imaging whole body (78306) |
$709.20 |
$1,182 |
1.7× |
| Bone age studies (77072) |
$121.20 |
$202 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$780 |
$1,300 |
1.8× |
| Bone survey complete (77075) |
$397.80 |
$663 |
3.6× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,776 |
$2,960 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$240 |
$400 |
2.6× |
| Chest 1 view (71045) |
$97.20 |
$162 |
1.1× |
| Chest 3 views (71047) |
$108 |
$180 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$144 |
$240 |
0.8× |
| Clavicle complete (73000) |
$303 |
$505 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$905.40 |
$1,509 |
8.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,034.20 |
$5,057 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,098.20 |
$3,497 |
8.3× |
| CT abdomen w contrast (74160) |
$1,483.80 |
$2,473 |
8.0× |
| CT abdomen w wo contrast (74170) |
$1,937.40 |
$3,229 |
10.5× |
| CT abdomen w/o contrast (74150) |
$906 |
$1,510 |
8.2× |
| CT angiography upper extremity lt (73206) |
$805.20 |
$1,342 |
4.4× |
| CT c-spine w/o contrast (72125) |
$1,684.80 |
$2,808 |
15.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,396.80 |
$2,328 |
7.5× |
| CT cervical spine with contrast (72126) |
$1,221 |
$2,035 |
3.3× |
| CT chest w/wo contrast (71270) |
$2,808 |
$4,680 |
15.2× |
| CT chest with contrast (71260) |
$1,227 |
$2,045 |
6.6× |
| CT head/brain with contrast (70460) |
$1,271.40 |
$2,119 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,938.60 |
$3,231 |
10.5× |
| CT iac w contrast (70481) |
$1,286.40 |
$2,144 |
7.0× |
| CT limited/localized follow up study (76380) |
$393 |
$655 |
4.3× |
| CT lower ext w/o (73700) |
$1,922.40 |
$3,204 |
17.4× |
| CT lower extremity w wo contrast (73702) |
$1,408.80 |
$2,348 |
7.6× |
| CT lower extremity with contrast (73701) |
$1,105.20 |
$1,842 |
6.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,197.60 |
$1,996 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$1,311.60 |
$2,186 |
11.9× |
| CT lumbar spine with contrast (72132) |
$1,118.40 |
$1,864 |
3.0× |
| CT maxillofacial w contrast (70487) |
$1,392 |
$2,320 |
7.5× |
| CT maxillofacial w/o contrast (70486) |
$1,587.60 |
$2,646 |
14.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,338.60 |
$2,231 |
7.2× |
| CT neck soft tissue w contrast (70491) |
$1,338.60 |
$2,231 |
7.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,287 |
$2,145 |
7.0× |
| CT orbits w/o contrast (70480) |
$952.20 |
$1,587 |
8.6× |
| CT pelvis w & w/o contrast (72194) |
$1,558.20 |
$2,597 |
8.4× |
| CT pelvis w/o contrast (72192) |
$1,311.60 |
$2,186 |
11.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,480.20 |
$2,467 |
8.0× |
| CT soft tissue neck w/o contrast (70490) |
$870.60 |
$1,451 |
7.9× |
| CT thoracic spine w/contrast (72129) |
$1,354.20 |
$2,257 |
7.3× |
| CT thoracic spine w/o contrast (72128) |
$1,309.80 |
$2,183 |
11.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,118.40 |
$1,864 |
6.0× |
| CT thorax w/o contrast (71250) |
$1,954.50 |
$3,257.50 |
17.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,525.80 |
$2,543 |
8.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,922.40 |
$3,204 |
17.4× |
| CT upper extremity with contrast (73201) |
$1,164 |
$1,940 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,011 |
$1,685 |
5.5× |
| Cta Abdomen (74175) |
$1,309.80 |
$2,183 |
7.1× |
| CTA abdomen pelvis (74174) |
$589.20 |
$982 |
1.6× |
| CTA chest (71275) |
$1,938 |
$3,230 |
10.5× |
| Cta Head (70496) |
$1,732.20 |
$2,887 |
9.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,062.60 |
$1,771 |
5.7× |
| Cta Neck (70498) |
$1,135.20 |
$1,892 |
6.1× |
| Cystography minimum 3 views rs&i (74430) |
$534 |
$890 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$297.60 |
$496 |
2.7× |
| Esophagus (74220) |
$184.20 |
$307 |
1.0× |
| Fetal biophysical profile non-stress testing (76818) |
$342 |
$570 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$314.40 |
$524 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$184.20 |
$307 |
0.7× |
| Foot 2 views (73620) |
$195 |
$325 |
2.1× |
| Forearm 2 views (73090) |
$300.60 |
$501 |
3.3× |
| Hand 2 views (73120) |
$168.60 |
$281 |
1.5× |
| Hand 3 views (73130) |
$222 |
$370 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$974.40 |
$1,624 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$813.60 |
$1,356 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$250.20 |
$417 |
2.7× |
| Hysterosalpingogram (74740) |
$249.60 |
$416 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$431.40 |
$719 |
0.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$516 |
$860 |
0.9× |
| Knee 3 views (73562) |
$211.20 |
$352 |
2.3× |
| Liver & spleen imaging static only (78215) |
$575.40 |
$959 |
1.4× |
| Lung Ventilation Imaging (78579) |
$525.60 |
$876 |
1.2× |
| Meckels Diverticulum (78290) |
$728.40 |
$1,214 |
1.7× |
| MRA head w & w/o contrast (70546) |
$2,400 |
$4,000 |
6.5× |
| MRA head w/o contrast (70544) |
$1,700.40 |
$2,834 |
6.8× |
| MRA neck w contrast (70548) |
$1,361.40 |
$2,269 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,488 |
$2,480 |
4.0× |
| MRA neck w/o contrast (70547) |
$1,220.40 |
$2,034 |
4.8× |
| MRI abdomen w contrast (74182) |
$1,059.60 |
$1,766 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,913 |
$4,855 |
7.9× |
| MRI abdomen w/o contrast (74181) |
$867 |
$1,445 |
3.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,585.80 |
$2,643 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,034 |
$3,390 |
2.5× |
| MRI c-spine with contrast (72142) |
$1,648.80 |
$2,748 |
4.5× |
| MRI cervical spine w/o contrast (72141) |
$1,459.80 |
$2,433 |
5.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,101.60 |
$1,836 |
3.0× |
| MRI chest w/o contrast (71550) |
$1,614 |
$2,690 |
6.4× |
| MRI fetal sngl/1st gestation (74712) |
$701.40 |
$1,169 |
2.8× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,256.40 |
$2,094 |
3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,174.20 |
$1,957 |
3.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$869.40 |
$1,449 |
3.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,159.20 |
$1,932 |
4.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,533.60 |
$2,556 |
4.2× |
| MRI orbit/face/neck w/contrast (70542) |
$780 |
$1,300 |
2.1× |
| MRI pelvis w contrast (72196) |
$1,525.80 |
$2,543 |
4.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,990.80 |
$3,318 |
5.4× |
| MRI pelvis w/o contrast (72195) |
$1,500 |
$2,500 |
6.0× |
| MRI scan of arm joint before and after contrast (73223) |
$1,994.40 |
$3,324 |
5.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,470 |
$2,450 |
4.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,788.60 |
$2,981 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,316.40 |
$2,194 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,612.40 |
$4,354 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,561.20 |
$2,602 |
4.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,158.20 |
$3,597 |
5.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,705.20 |
$2,842 |
6.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,886.40 |
$3,144 |
7.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,486.20 |
$2,477 |
4.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,663.20 |
$2,772 |
6.6× |
| Neck soft tissue (70360) |
$206.40 |
$344 |
2.2× |
| Nm gastric emptying study (78264) |
$582.60 |
$971 |
1.4× |
| Nuclear medicine study of kidney and blood flow (78701) |
$694.20 |
$1,157 |
1.6× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$925.20 |
$1,542 |
8.4× |
| Osseous survey limited (77074) |
$122.40 |
$204 |
1.1× |
| Parathyrd planar w/spect&CT (78072) |
$819 |
$1,365 |
1.4× |
| Parathyroid imaging (78070) |
$615 |
$1,025 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$123 |
$205 |
1.1× |
| PET image w/CT, skull-thigh (78815) |
$2,330.40 |
$3,884 |
1.5× |
| PET imaging CT for attenuation limited area (78814) |
$2,239.20 |
$3,732 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$2,820.60 |
$4,701 |
1.9× |
| PET whole body (78813) |
$1,776 |
$2,960 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,767 |
$2,945 |
4.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$417.60 |
$696 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$669 |
$1,115 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$162 |
$270 |
0.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$117 |
$195 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$183.60 |
$306 |
1.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$267 |
$445 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$350.40 |
$584 |
3.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$149.40 |
$249 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$172.80 |
$288 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$333.60 |
$556 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$320.40 |
$534 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$288 |
$480 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$174.60 |
$291 |
0.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$193.80 |
$323 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$96.60 |
$161 |
1.1× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$136.80 |
$228 |
1.5× |
| Ribs bilateral 3 views (71110) |
$474.60 |
$791 |
4.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$319.80 |
$533 |
1.3× |
| Scanogram (77073) |
$131.40 |
$219 |
1.2× |
| Scapula complete (73010) |
$233.40 |
$389 |
2.1× |
| Screening digital breast tomosynthesis (77063) |
$44.40 |
$74 |
1.9× |
| Sella turcica (70240) |
$111.60 |
$186 |
1.2× |
| Small bowel series (74250) |
$227.40 |
$379 |
1.2× |
| Spine thoracic 3 views (72072) |
$258.60 |
$431 |
2.3× |
| Thoracolumbar 2 views (72080) |
$117.60 |
$196 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$746.40 |
$1,244 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$631.20 |
$1,052 |
5.7× |
| Umbilical-artery Doppler (OB) (76820) |
$172.80 |
$288 |
1.6× |
| Upper Extremity Infant (73092) |
$149.40 |
$249 |
1.4× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$612.60 |
$1,021 |
1.5× |
| Urethrocystography retrograde rs&i (74450) |
$346.80 |
$578 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$312.60 |
$521 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$184.20 |
$307 |
1.7× |
| Us breast unilateral complete (76641) |
$409.80 |
$683 |
3.7× |
| Us breast unilateral limited (76642) |
$658.20 |
$1,097 |
7.2× |
| Us chest (76604) |
$285.60 |
$476 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$589.80 |
$983 |
5.3× |
| Us fetal nuchal translucency 1st gestation (76813) |
$232.20 |
$387 |
2.1× |
| Us kidney transplant (76776) |
$255 |
$425 |
2.3× |
| Us ob detailed single fetus (76811) |
$731.40 |
$1,219 |
2.9× |
| Us ob transvaginal (76817) |
$270.60 |
$451 |
2.5× |
| Us pelvic non ob complete (76856) |
$1,114.20 |
$1,857 |
10.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$556.80 |
$928 |
5.0× |
| Us pregnancy ltd (76815) |
$544.20 |
$907 |
4.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$595.50 |
$992.50 |
5.4× |
| Us retroperitoneal complete (76770) |
$396 |
$660 |
3.6× |
| Us retroperitoneal limited (76775) |
$515.40 |
$859 |
4.7× |
| Us scrotum and contents (76870) |
$693 |
$1,155 |
6.3× |
| Us soft tissue head/neck (76536) |
$852.60 |
$1,421 |
7.7× |
| Us xtr non-vasc lmtd (76882) |
$228.60 |
$381 |
2.1× |
| Wrist 2 views (73100) |
$145.20 |
$242 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$452.40 |
$754 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$159 |
$265 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$345 |
$575 |
3.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$384.60 |
$641 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$263.40 |
$439 |
2.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$219.60 |
$366 |
2.4× |
| X-ray exam hip uni 1 view (73501) |
$169.80 |
$283 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$143.40 |
$239 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$228.60 |
$381 |
2.1× |
| X-ray exam of femur 1 (73551) |
$103.20 |
$172 |
1.1× |
| X-ray eye for foreign body (70030) |
$78 |
$130 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$340.20 |
$567 |
3.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$324.60 |
$541 |
3.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$267 |
$445 |
2.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$452.40 |
$754 |
4.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$225 |
$375 |
2.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$91.20 |
$152 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$369 |
$615 |
3.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$391.20 |
$652 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$205.80 |
$343 |
2.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$107.40 |
$179 |
1.2× |
| X-ray of voice box or throat (70370) |
$70.80 |
$118 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$130.80 |
$218 |
1.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$416.40 |
$694 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$352.80 |
$588 |
3.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$330.60 |
$551 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$552 |
$920 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$168.60 |
$281 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$141 |
$235 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$316.80 |
$528 |
3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$393.60 |
$656 |
4.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$123.60 |
$206 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$219 |
$365 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$140.40 |
$234 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$97.80 |
$163 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$129.60 |
$216 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$263.40 |
$439 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$187.80 |
$313 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$205.20 |
$342 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$273.60 |
$456 |
3.0× |
| Xr arthrogram ankle (73615) |
$175.20 |
$292 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$348.60 |
$581 |
3.2× |
| Xr chest 4+ views (71048) |
$235.20 |
$392 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$172.20 |
$287 |
1.9× |
| Xr shoulder 1 view (73020) |
$130.20 |
$217 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$360 |
$600 |
3.3× |
| Xr tibia/fibula 2 views (73590) |
$386.40 |
$644 |
4.2× |
| Xr tmj bilateral (70330) |
$274.80 |
$458 |
3.0× |
| Xray knee 1 or 2 views rt (73560) |
$204 |
$340 |
2.2× |