| Abdomen 2 views (74019) |
$78.80 |
$197 |
0.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$444.80 |
$1,112 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$164 |
$410 |
0.1× |
| Angiography extremity unilateral rs&i (75710) |
$152.40 |
$381 |
0.1× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$214.40 |
$536 |
0.0× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$109.20 |
$273 |
0.0× |
| Aortography abdominal serialography rs&i (75625) |
$102.80 |
$257 |
0.0× |
| Arthrogram elbow (73085) |
$392.40 |
$981 |
1.2× |
| Arthrogram hip (73525) |
$378 |
$945 |
1.2× |
| Arthrogram shoulder (73040) |
$378 |
$945 |
1.2× |
| Arthrography knee lt (73580) |
$378 |
$945 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$445.20 |
$1,113 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$445.20 |
$1,113 |
1.2× |
| Bone age studies (77072) |
$78.80 |
$197 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$445.20 |
$1,113 |
1.2× |
| Bone survey complete (77075) |
$125.20 |
$313 |
1.3× |
| Brain Imaging Vascular Flow Only (78610) |
$354 |
$885 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$78.80 |
$197 |
1.0× |
| Chest 1 view (71045) |
$78.80 |
$197 |
1.0× |
| Chest 3 views (71047) |
$88.80 |
$222 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$139.60 |
$349 |
0.9× |
| Clavicle complete (73000) |
$78.80 |
$197 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,256 |
$3,140 |
4.0× |
| CT abdomen and pelvis without contrast (74176) |
$778.80 |
$1,947 |
3.6× |
| CT abdomen w contrast (74160) |
$801.60 |
$2,004 |
5.0× |
| CT abdomen w wo contrast (74170) |
$903.40 |
$2,258.50 |
5.7× |
| CT abdomen w/o contrast (74150) |
$407.40 |
$1,018.50 |
4.3× |
| CT angio hrt w/3d image (75574) |
$368 |
$920 |
1.2× |
| CT angiography upper extremity lt (73206) |
$940.40 |
$2,351 |
5.9× |
| CT c-spine w/o contrast (72125) |
$407.20 |
$1,018 |
4.3× |
| CT cervical spine w&w/o contrast (72127) |
$868.80 |
$2,172 |
5.5× |
| CT cervical spine with contrast (72126) |
$801.60 |
$2,004 |
2.5× |
| CT chest w/wo contrast (71270) |
$903.40 |
$2,258.50 |
5.7× |
| CT chest with contrast (71260) |
$801.60 |
$2,004 |
5.0× |
| CT head/brain with contrast (70460) |
$801.60 |
$2,004 |
5.0× |
| CT head/brain without and with contrast (70470) |
$903.20 |
$2,258 |
5.7× |
| CT iac w contrast (70481) |
$801.60 |
$2,004 |
5.0× |
| CT lower ext w/o (73700) |
$407.20 |
$1,018 |
4.3× |
| CT lower extremity with contrast (73701) |
$801.60 |
$2,004 |
5.0× |
| CT lumbar spine w & w/o contrast (72133) |
$903.20 |
$2,258 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$407.20 |
$1,018 |
4.3× |
| CT lumbar spine with contrast (72132) |
$801.60 |
$2,004 |
2.5× |
| CT maxillofacial w contrast (70487) |
$774.80 |
$1,937 |
4.9× |
| CT maxillofacial w/o contrast (70486) |
$407.20 |
$1,018 |
4.3× |
| CT maxillofacial w/wo contrast (70488) |
$903.20 |
$2,258 |
5.7× |
| CT neck soft tissue w contrast (70491) |
$801.60 |
$2,004 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$903.20 |
$2,258 |
5.7× |
| CT orbits w/o contrast (70480) |
$407.20 |
$1,018 |
4.3× |
| CT pelvis w & w/o contrast (72194) |
$903.20 |
$2,258 |
5.7× |
| CT pelvis w/o contrast (72192) |
$407.20 |
$1,018 |
4.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$903.40 |
$2,258.50 |
5.7× |
| CT soft tissue neck w/o contrast (70490) |
$407.40 |
$1,018.50 |
4.3× |
| CT thoracic spine w/contrast (72129) |
$801.60 |
$2,004 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$407.20 |
$1,018 |
4.3× |
| CT thoracic spine w/wo contrast (72130) |
$903.20 |
$2,258 |
5.7× |
| CT thorax w/o contrast (71250) |
$407.20 |
$1,018 |
4.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$540.40 |
$1,351 |
3.4× |
| CT upper extremity w/o contrast rt (73200) |
$407.20 |
$1,018 |
4.3× |
| CT upper extremity with contrast (73201) |
$797.80 |
$1,994.50 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$756.40 |
$1,891 |
4.8× |
| Cta Abdomen (74175) |
$940.60 |
$2,351.50 |
5.9× |
| CTA abdomen pelvis (74174) |
$940.40 |
$2,351 |
3.0× |
| CTA chest (71275) |
$940.60 |
$2,351.50 |
5.9× |
| Cta Head (70496) |
$940.60 |
$2,351.50 |
5.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,238 |
$3,095 |
3.9× |
| CTA lwr ext w&w/o contrast (73706) |
$940.40 |
$2,351 |
5.9× |
| Cta Neck (70498) |
$940.60 |
$2,351.50 |
5.9× |
| Cta Pelvis (72191) |
$940.40 |
$2,351 |
5.9× |
| Cystography minimum 3 views rs&i (74430) |
$354.40 |
$886 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$100.40 |
$251 |
1.1× |
| Esophagus (74220) |
$139.60 |
$349 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$205.60 |
$514 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$215.20 |
$538 |
1.0× |
| Forearm 2 views (73090) |
$78.80 |
$197 |
1.0× |
| Gated Heart Planar Single (78472) |
$526.40 |
$1,316 |
1.5× |
| Hand 3 views (73130) |
$78.80 |
$197 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$512 |
$1,280 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$512 |
$1,280 |
1.4× |
| Ht muscle image spect sing (78451) |
$390.40 |
$976 |
0.3× |
| Humerus Min 2 Views Left (73060) |
$75.20 |
$188 |
1.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$72.40 |
$181 |
0.8× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$418.40 |
$1,046 |
0.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$386.40 |
$966 |
0.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$494.60 |
$1,236.50 |
1.0× |
| Knee 3 views (73562) |
$78.80 |
$197 |
1.0× |
| Liver & spleen imaging static only (78215) |
$512 |
$1,280 |
1.4× |
| Lung Ventilation Imaging (78579) |
$416.40 |
$1,041 |
1.2× |
| MRA head w & w/o contrast (70546) |
$752.80 |
$1,882 |
2.4× |
| MRA head w/o contrast (70544) |
$450.40 |
$1,126 |
2.1× |
| MRA head with contrast (70545) |
$651.20 |
$1,628 |
2.1× |
| MRA neck w contrast (70548) |
$651.20 |
$1,628 |
2.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$752.80 |
$1,882 |
2.4× |
| MRA neck w/o contrast (70547) |
$450.40 |
$1,126 |
2.1× |
| MRI abdomen w contrast (74182) |
$651.20 |
$1,628 |
2.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$752.80 |
$1,882 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$377.80 |
$944.50 |
1.7× |
| MRI any jnt lwr ext with con lt (73722) |
$651.20 |
$1,628 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$651.20 |
$1,628 |
0.9× |
| MRI c-spine with contrast (72142) |
$651.20 |
$1,628 |
2.1× |
| MRI cervical spine w/o contrast (72141) |
$450.40 |
$1,126 |
2.1× |
| MRI chest w/o & w/contrast material (71552) |
$752.80 |
$1,882 |
2.4× |
| MRI chest w/o contrast (71550) |
$450.40 |
$1,126 |
2.1× |
| MRI chest with contrast (71551) |
$651.20 |
$1,628 |
0.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$651.20 |
$1,628 |
2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$651.20 |
$1,628 |
2.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$450.40 |
$1,126 |
2.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$450.40 |
$1,126 |
2.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$752.80 |
$1,882 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$651.20 |
$1,628 |
2.1× |
| MRI pelvis w contrast (72196) |
$651.20 |
$1,628 |
2.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$752.80 |
$1,882 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$450.40 |
$1,126 |
2.1× |
| MRI scan of arm joint before and after contrast (73223) |
$752.80 |
$1,882 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$752.80 |
$1,882 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$752.80 |
$1,882 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$651.20 |
$1,628 |
2.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$752.80 |
$1,882 |
2.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$651.20 |
$1,628 |
2.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$752.80 |
$1,882 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$450.40 |
$1,126 |
2.1× |
| MRI tmj (70336) |
$450.40 |
$1,126 |
2.1× |
| MRI upper ext joint w/o contrast (73221) |
$450.40 |
$1,126 |
2.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$752.80 |
$1,882 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$450.40 |
$1,126 |
2.1× |
| Myocardial Spect Multiple Studies (78452) |
$540 |
$1,350 |
0.5× |
| Neck soft tissue (70360) |
$78.80 |
$197 |
1.0× |
| Nm gastric emptying study (78264) |
$444.80 |
$1,112 |
1.2× |
| Osseous survey infant (77076) |
$125.20 |
$313 |
1.3× |
| Osseous survey limited (77074) |
$125.20 |
$313 |
1.3× |
| Parathyroid imaging (78070) |
$394.40 |
$986 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$78.80 |
$197 |
0.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$752.80 |
$1,882 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$420.40 |
$1,051 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$592 |
$1,480 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$78.80 |
$197 |
0.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$125.20 |
$313 |
1.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$78.80 |
$197 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$125.20 |
$313 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$78.80 |
$197 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$154.80 |
$387 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$78.80 |
$197 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$208 |
$520 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$207 |
$517.50 |
1.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$208 |
$520 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$78.80 |
$197 |
1.0× |
| Radiological examination surgical specimen (76098) |
$354.40 |
$886 |
0.7× |
| Ribs bilateral 3 views (71110) |
$125.20 |
$313 |
1.3× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$894 |
$2,235 |
1.8× |
| Scapula complete (73010) |
$78.80 |
$197 |
0.8× |
| Screening digital breast tomosynthesis (77063) |
$56 |
$140 |
2.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$125.20 |
$313 |
1.3× |
| Small bowel series (74250) |
$139.60 |
$349 |
0.9× |
| Spine thoracic 3 views (72072) |
$125.20 |
$313 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$573.20 |
$1,433 |
1.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$252 |
$630 |
0.7× |
| Thyroid uptake measurement (78012) |
$193.20 |
$483 |
0.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$394.40 |
$986 |
1.1× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$656.40 |
$1,641 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$205.60 |
$514 |
2.2× |
| Urethrocystography retrograde rs&i (74450) |
$296.40 |
$741 |
1.4× |
| Urethrocystography voiding (74455) |
$354.40 |
$886 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$354.40 |
$886 |
2.2× |
| Us abdl aorta screen aaa (76706) |
$171.40 |
$428.50 |
1.8× |
| Us breast unilateral complete (76641) |
$137.60 |
$344 |
1.5× |
| Us chest (76604) |
$205.60 |
$514 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$170.40 |
$426 |
1.8× |
| Us infant hips limited static (76886) |
$137.60 |
$344 |
1.7× |
| Us kidney transplant (76776) |
$205.60 |
$514 |
2.2× |
| Us ob detailed single fetus (76811) |
$291.60 |
$729 |
1.3× |
| Us ob transvaginal (76817) |
$205.80 |
$514.50 |
2.2× |
| Us pelvic non ob complete (76856) |
$205.80 |
$514.50 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$137.60 |
$344 |
1.5× |
| Us pregnancy ltd (76815) |
$205.60 |
$514 |
2.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$205.80 |
$514.50 |
2.2× |
| Us retroperitoneal complete (76770) |
$205.60 |
$514 |
2.2× |
| Us soft tissue head/neck (76536) |
$205.60 |
$514 |
2.2× |
| Us spinal canal and contents (76800) |
$137.60 |
$344 |
1.5× |
| Us xtr non-vasc lmtd (76882) |
$137.60 |
$344 |
1.5× |
| Venogram extremity bilateral (75822) |
$439.20 |
$1,098 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$115.20 |
$288 |
0.0× |
| Venography extremity unilateral rs&i (75820) |
$260.20 |
$650.50 |
0.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$78.80 |
$197 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$78.80 |
$197 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$208 |
$520 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$78.80 |
$197 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$81.20 |
$203 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$78.80 |
$197 |
1.0× |
| X-ray exam of femur 1 (73551) |
$76 |
$190 |
1.0× |
| X-ray eye for foreign body (70030) |
$78.80 |
$197 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$125.20 |
$313 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$71.60 |
$179 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$78.80 |
$197 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$78.80 |
$197 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$78.80 |
$197 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$78.80 |
$197 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$125.20 |
$313 |
1.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$125.20 |
$313 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$78.80 |
$197 |
1.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$78.80 |
$197 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$78.80 |
$197 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$78.80 |
$197 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$78.80 |
$197 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$78.80 |
$197 |
1.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$78.80 |
$197 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$78.80 |
$197 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$125.20 |
$313 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$78.80 |
$197 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$78.80 |
$197 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$78.80 |
$197 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$78.80 |
$197 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$78.80 |
$197 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$78.80 |
$197 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$125.20 |
$313 |
1.3× |
| Xr chest 4+ views (71048) |
$125.20 |
$313 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$78.80 |
$197 |
1.0× |
| Xr shoulder 1 view (73020) |
$78.80 |
$197 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$125.20 |
$313 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$78.80 |
$197 |
1.0× |
| Xr tmj bilateral (70330) |
$78.80 |
$197 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$78.80 |
$197 |
1.0× |