| Abdomen 2 views (74019) |
$178 |
$274 |
1.7× |
| Acute gastrointestinal blood loss imaging (78278) |
$888 |
$1,366 |
2.2× |
| Ankle 2 views (73600) |
$167.50 |
$257.50 |
1.9× |
| Arthrogram shoulder (73040) |
$714 |
$1,098 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$767 |
$1,180 |
1.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$716 |
$1,102 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$1,035 |
$1,593 |
2.6× |
| Bone age studies (77072) |
$184 |
$282.50 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,035 |
$1,593 |
2.6× |
| Bone survey complete (77075) |
$484.50 |
$745.50 |
4.6× |
| Brain imaging < 4 static views (78600) |
$463 |
$713 |
1.2× |
| Brain Imaging Vascular Flow Only (78610) |
$386 |
$594 |
0.7× |
| Cervical spine 2 or 3 views (72040) |
$167.50 |
$257.50 |
1.9× |
| Chest 1 view (71045) |
$167.50 |
$257.50 |
1.9× |
| Chest 3 views (71047) |
$286 |
$440 |
3.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$341 |
$525 |
1.9× |
| Clavicle complete (73000) |
$171 |
$263.50 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$926 |
$1,425 |
8.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,393 |
$5,220 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,569 |
$3,952 |
10.7× |
| CT abdomen w contrast (74160) |
$1,513 |
$2,328 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,698 |
$2,612 |
9.6× |
| CT abdomen w/o contrast (74150) |
$1,284 |
$1,975 |
12.2× |
| CT angiography upper extremity lt (73206) |
$1,966 |
$3,025 |
11.2× |
| CT c-spine w/o contrast (72125) |
$1,433 |
$2,204 |
13.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,651 |
$2,540 |
9.4× |
| CT cervical spine with contrast (72126) |
$1,519 |
$2,337 |
4.3× |
| CT chest w/wo contrast (71270) |
$1,698 |
$2,612 |
9.6× |
| CT chest with contrast (71260) |
$1,513 |
$2,328 |
8.6× |
| CT head/brain with contrast (70460) |
$1,622 |
$2,496 |
9.2× |
| CT head/brain without and with contrast (70470) |
$1,698 |
$2,612 |
9.6× |
| CT iac w contrast (70481) |
$1,271 |
$1,956 |
7.2× |
| CT lower ext w/o (73700) |
$1,284 |
$1,975 |
12.2× |
| CT lower extremity w wo contrast (73702) |
$1,665 |
$2,562 |
9.4× |
| CT lower extremity with contrast (73701) |
$1,513 |
$2,328 |
8.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,651 |
$2,540 |
9.4× |
| CT lumbar spine w/o contrast (72131) |
$1,433 |
$2,204 |
13.6× |
| CT lumbar spine with contrast (72132) |
$1,519 |
$2,337 |
4.3× |
| CT maxillofacial w contrast (70487) |
$1,264 |
$1,945 |
7.2× |
| CT maxillofacial w/o contrast (70486) |
$1,030 |
$1,584 |
9.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,422 |
$2,188 |
8.1× |
| CT neck soft tissue w contrast (70491) |
$1,491 |
$2,294 |
8.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,747 |
$2,688 |
9.9× |
| CT orbits w/o contrast (70480) |
$1,069 |
$1,645 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,698 |
$2,612 |
9.6× |
| CT pelvis w/o contrast (72192) |
$1,284 |
$1,975 |
12.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,633 |
$2,512 |
9.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,376 |
$2,117 |
13.1× |
| CT thoracic spine w/contrast (72129) |
$1,519 |
$2,337 |
8.6× |
| CT thoracic spine w/o contrast (72128) |
$1,433 |
$2,204 |
13.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,651 |
$2,540 |
9.4× |
| CT thorax w/o contrast (71250) |
$1,377 |
$2,119 |
13.1× |
| CT unlisted procedure (76497) |
$386 |
$594 |
4.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,665 |
$2,562 |
9.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,284 |
$1,975 |
12.2× |
| CT upper extremity with contrast (73201) |
$1,513 |
$2,328 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,899 |
$2,921 |
10.8× |
| Cta Abdomen (74175) |
$1,935 |
$2,977.50 |
11.0× |
| CTA abdomen pelvis (74174) |
$2,865 |
$4,408 |
8.2× |
| CTA chest (71275) |
$1,651 |
$2,540 |
9.4× |
| Cta Head (70496) |
$1,690 |
$2,600 |
9.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,651 |
$2,540 |
9.4× |
| Cta Neck (70498) |
$2,428 |
$3,735 |
13.8× |
| Cta Pelvis (72191) |
$1,808 |
$2,782 |
10.3× |
| Cystography minimum 3 views rs&i (74430) |
$370 |
$569 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$359 |
$552 |
3.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$192 |
$295 |
2.2× |
| Dxa bone density study axial skeleton (77085) |
$244 |
$375.50 |
2.3× |
| Echoencephalography real time imaging (76506) |
$400 |
$616 |
3.8× |
| Esophagus (74220) |
$414 |
$637 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$524 |
$806 |
5.0× |
| Fluoroscopy up to 1 hr (76000) |
$355 |
$546.50 |
1.5× |
| Foot 2 views (73620) |
$152 |
$233.50 |
1.7× |
| Forearm 2 views (73090) |
$153.50 |
$236 |
1.8× |
| Gated Heart Planar Single (78472) |
$803 |
$1,235 |
2.0× |
| Hand 2 views (73120) |
$175.50 |
$269.50 |
1.7× |
| Hand 3 views (73130) |
$173.50 |
$267 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,197 |
$1,842 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,197 |
$1,842 |
3.0× |
| Humerus Min 2 Views Left (73060) |
$167.50 |
$257.50 |
1.9× |
| Hysterosalpingogram (74740) |
$482 |
$742 |
2.0× |
| Kidney imaging morphology (78700) |
$803 |
$1,235 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$609 |
$937 |
1.1× |
| Knee 3 views (73562) |
$167.50 |
$257.50 |
1.9× |
| Liver & spleen imaging static only (78215) |
$909 |
$1,399 |
2.3× |
| Meckels Diverticulum (78290) |
$796 |
$1,225 |
2.0× |
| MRA head w/o contrast (70544) |
$1,676 |
$2,578 |
7.0× |
| MRA neck w/o contrast (70547) |
$1,676 |
$2,578 |
7.0× |
| MRI abdomen w contrast (74182) |
$2,010 |
$3,093 |
5.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,265 |
$3,484 |
6.5× |
| MRI abdomen w/o contrast (74181) |
$1,519.50 |
$2,337.50 |
6.3× |
| MRI any jnt lwr ext with con lt (73722) |
$2,010 |
$3,093 |
2.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,010 |
$3,093 |
2.6× |
| MRI c-spine with contrast (72142) |
$2,010 |
$3,093 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,676 |
$2,578 |
7.0× |
| MRI chest w/o & w/contrast material (71552) |
$2,265 |
$3,484 |
6.5× |
| MRI chest w/o contrast (71550) |
$1,676 |
$2,578 |
7.0× |
| MRI chest with contrast (71551) |
$2,010 |
$3,093 |
2.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,010 |
$3,093 |
5.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,010 |
$3,093 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,676 |
$2,578 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,676 |
$2,578 |
7.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,265 |
$3,484 |
6.5× |
| MRI orbit/face/neck w/contrast (70542) |
$2,010 |
$3,093 |
5.7× |
| MRI pelvis w contrast (72196) |
$2,010 |
$3,093 |
5.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,265 |
$3,484 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,676 |
$2,578 |
7.0× |
| MRI scan of arm joint before and after contrast (73223) |
$2,265 |
$3,484 |
6.5× |
| MRI scan of leg joint before and after contrast (73723) |
$2,265 |
$3,484 |
6.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,265 |
$3,484 |
6.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,010 |
$3,093 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,265 |
$3,484 |
6.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,010 |
$3,093 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,265 |
$3,484 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,676 |
$2,578 |
7.0× |
| MRI tmj (70336) |
$1,676 |
$2,578 |
7.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,676 |
$2,578 |
7.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,265 |
$3,484 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,676 |
$2,578 |
7.0× |
| Myelogram Cervical (72240) |
$1,093 |
$1,681 |
1.4× |
| Myelogram Lumbar (72265) |
$1,028 |
$1,582 |
1.3× |
| Myelogram thoracic (72255) |
$1,052 |
$1,619 |
1.3× |
| Myelography 2 or more regions (72270) |
$1,376 |
$2,117 |
1.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,633 |
$4,050 |
2.0× |
| Neck soft tissue (70360) |
$167.50 |
$257.50 |
1.9× |
| Nm bone marrow wb (78104) |
$636 |
$978 |
1.6× |
| Nm gastric emptying study (78264) |
$1,006 |
$1,548 |
2.5× |
| Nm gastroesophageal reflux study (78262) |
$622 |
$957 |
1.5× |
| Nuclear medicine study of endocrine organs (78099) |
$100 |
$154 |
0.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$678.50 |
$1,044 |
1.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$157 |
$242 |
1.5× |
| Osseous survey limited (77074) |
$318 |
$489 |
3.0× |
| Parathyroid imaging (78070) |
$935 |
$1,439 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$176 |
$271 |
1.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,265 |
$3,484 |
6.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$983 |
$1,513 |
2.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,106 |
$1,702 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$379 |
$583 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$282.50 |
$434.50 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$315 |
$484 |
3.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$185 |
$284.50 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$175.50 |
$269.50 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$189 |
$291 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$259 |
$399 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$207 |
$318.50 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$378 |
$581 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$451 |
$693.50 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$401.50 |
$617.50 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$167.50 |
$257.50 |
1.9× |
| Ribs bilateral 3 views (71110) |
$204 |
$314 |
1.9× |
| Scanogram (77073) |
$207 |
$318.50 |
2.0× |
| Scapula complete (73010) |
$171 |
$263.50 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$42 |
$65 |
1.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$463 |
$713 |
4.4× |
| Small bowel series (74250) |
$378 |
$581 |
2.1× |
| Spine thoracic 3 views (72072) |
$128 |
$197 |
1.2× |
| Testicular Imaging With Vascular Flow (78761) |
$980 |
$1,507 |
2.4× |
| Thyroid uptake measurement (78012) |
$767 |
$1,180 |
1.9× |
| Tmj unilateral (70328) |
$167.50 |
$257.50 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$399.50 |
$615 |
3.8× |
| Unlisted Ultrasound Procedure (76999) |
$253 |
$389 |
2.9× |
| Urethrocystography voiding (74455) |
$463 |
$713 |
1.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$647 |
$995 |
3.7× |
| Us breast unilateral complete (76641) |
$354 |
$544 |
3.4× |
| Us chest (76604) |
$314 |
$483 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$372 |
$572 |
3.5× |
| Us infant hips dynamic (76885) |
$230 |
$354 |
2.6× |
| Us ob transvaginal (76817) |
$199 |
$306 |
1.9× |
| Us pelvic non ob complete (76856) |
$411 |
$632 |
3.9× |
| Us pregnancy ltd (76815) |
$191.50 |
$294.50 |
1.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$323 |
$497 |
3.1× |
| Us retroperitoneal complete (76770) |
$411 |
$633 |
3.9× |
| Us scrotum and contents (76870) |
$465 |
$715 |
4.4× |
| Us soft tissue head/neck (76536) |
$411 |
$633 |
3.9× |
| Us spinal canal and contents (76800) |
$350 |
$539 |
3.3× |
| Us xtr non-vasc lmtd (76882) |
$306 |
$471 |
2.9× |
| Venography extremity unilateral rs&i (75820) |
$1,212 |
$1,864 |
0.8× |
| Wrist 2 views (73100) |
$153 |
$235 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$280.50 |
$432 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$596 |
$917 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$149 |
$229.50 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$167.50 |
$257.50 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183.50 |
$282.50 |
2.1× |
| X-ray eye for foreign body (70030) |
$154 |
$237 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$175.50 |
$269.50 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$163.50 |
$252 |
1.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$179.50 |
$276 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$204 |
$314 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$261 |
$402 |
3.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$149.50 |
$230 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$175.50 |
$269.50 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$167.50 |
$257.50 |
1.9× |
| X-ray of voice box or throat (70370) |
$235 |
$362 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$167.50 |
$257.50 |
1.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$683 |
$1,050 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$225 |
$346 |
2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$223 |
$342.50 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$146 |
$224 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$205 |
$315 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$147 |
$226.50 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$325 |
$500 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$179 |
$275.50 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$115 |
$177 |
1.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$175.50 |
$269.50 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$175.50 |
$269.50 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$167.50 |
$257.50 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$167.50 |
$257.50 |
1.9× |
| Xr c-spine 6 or more views (72052) |
$281.50 |
$433 |
2.7× |
| Xr finger(s) 2+ views (73140) |
$167.50 |
$257.50 |
1.9× |
| Xr shoulder 1 view (73020) |
$171.50 |
$264 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$195 |
$300 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$175.50 |
$270 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$153.50 |
$236 |
1.8× |