| Abdomen 2 views (74019) |
$208.50 |
$278 |
2.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$902.81 |
$1,203.75 |
2.5× |
| Ankle 2 views (73600) |
$153.75 |
$205 |
1.9× |
| Arthrogram shoulder (73040) |
$554.25 |
$739 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$516.56 |
$688.75 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$529.50 |
$706 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$912.19 |
$1,216.25 |
2.5× |
| Bone age studies (77072) |
$191.06 |
$254.75 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$701.44 |
$935.25 |
1.9× |
| Bone survey complete (77075) |
$804.19 |
$1,072.25 |
8.4× |
| Brain imaging < 4 static views (78600) |
$692.63 |
$923.50 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$221.81 |
$295.75 |
2.8× |
| Chest 1 view (71045) |
$223.13 |
$297.50 |
2.8× |
| Chest 3 views (71047) |
$275.63 |
$367.50 |
3.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$467.81 |
$623.75 |
2.9× |
| Clavicle complete (73000) |
$211.13 |
$281.50 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$591.56 |
$788.75 |
6.2× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$542.25 |
$723 |
3.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,919.81 |
$2,559.75 |
6.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,656.38 |
$2,208.50 |
7.5× |
| CT abdomen w contrast (74160) |
$1,467.19 |
$1,956.25 |
9.1× |
| CT abdomen w wo contrast (74170) |
$1,502.44 |
$2,003.25 |
9.3× |
| CT abdomen w/o contrast (74150) |
$1,307.25 |
$1,743 |
13.6× |
| CT angiography upper extremity lt (73206) |
$2,499 |
$3,332 |
15.5× |
| CT c-spine w/o contrast (72125) |
$1,142.06 |
$1,522.75 |
11.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,545 |
$2,060 |
9.6× |
| CT cervical spine with contrast (72126) |
$1,264.13 |
$1,685.50 |
3.9× |
| CT chest w/wo contrast (71270) |
$1,485 |
$1,980 |
9.2× |
| CT chest with contrast (71260) |
$1,337.25 |
$1,783 |
8.3× |
| CT head/brain with contrast (70460) |
$1,454.25 |
$1,939 |
9.0× |
| CT head/brain without and with contrast (70470) |
$1,514.44 |
$2,019.25 |
9.4× |
| CT iac w contrast (70481) |
$1,264.13 |
$1,685.50 |
7.8× |
| CT limited/localized follow up study (76380) |
$697.22 |
$929.62 |
8.7× |
| CT lower ext w/o (73700) |
$1,142.06 |
$1,522.75 |
11.9× |
| CT lower extremity w wo contrast (73702) |
$1,267.50 |
$1,690 |
7.9× |
| CT lower extremity with contrast (73701) |
$1,169.06 |
$1,558.75 |
7.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,545 |
$2,060 |
9.6× |
| CT lumbar spine w/o contrast (72131) |
$1,142.06 |
$1,522.75 |
11.9× |
| CT lumbar spine with contrast (72132) |
$1,264.13 |
$1,685.50 |
3.9× |
| CT maxillofacial w contrast (70487) |
$1,264.13 |
$1,685.50 |
7.8× |
| CT maxillofacial w/o contrast (70486) |
$1,217.25 |
$1,623 |
12.7× |
| CT neck soft tissue w contrast (70491) |
$1,454.25 |
$1,939 |
9.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,471.50 |
$1,962 |
9.1× |
| CT orbits w/o contrast (70480) |
$1,142.06 |
$1,522.75 |
11.9× |
| CT pelvis w & w/o contrast (72194) |
$1,360.69 |
$1,814.25 |
8.4× |
| CT pelvis w/o contrast (72192) |
$1,073.25 |
$1,431 |
11.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,356.19 |
$1,808.25 |
8.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,142.06 |
$1,522.75 |
11.9× |
| CT thoracic spine w/contrast (72129) |
$1,656.38 |
$2,208.50 |
10.3× |
| CT thoracic spine w/o contrast (72128) |
$1,454.25 |
$1,939 |
15.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,919.81 |
$2,559.75 |
11.9× |
| CT thorax w/o contrast (71250) |
$591.56 |
$788.75 |
6.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,174.13 |
$1,565.50 |
7.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,142.06 |
$1,522.75 |
11.9× |
| CT upper extremity with contrast (73201) |
$1,169.06 |
$1,558.75 |
3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,499 |
$3,332 |
15.5× |
| Cta Abdomen (74175) |
$2,499 |
$3,332 |
15.5× |
| CTA abdomen pelvis (74174) |
$2,499 |
$3,332 |
7.8× |
| CTA chest (71275) |
$2,499 |
$3,332 |
15.5× |
| Cta Head (70496) |
$2,499 |
$3,332 |
15.5× |
| CTA lwr ext w&w/o contrast (73706) |
$2,499 |
$3,332 |
15.5× |
| Cta Neck (70498) |
$2,499 |
$3,332 |
15.5× |
| Cta Pelvis (72191) |
$2,499 |
$3,332 |
15.5× |
| Cystography minimum 3 views rs&i (74430) |
$478.22 |
$637.62 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$381 |
$508 |
4.0× |
| Echoencephalography real time imaging (76506) |
$566.25 |
$755 |
5.9× |
| Esophagus (74220) |
$481.31 |
$641.75 |
3.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$525.75 |
$701 |
5.5× |
| Fluoroscopy up to 1 hr (76000) |
$470.81 |
$627.75 |
2.1× |
| Foot 2 views (73620) |
$153.75 |
$205 |
1.9× |
| Forearm 2 views (73090) |
$176.06 |
$234.75 |
2.2× |
| Gated Heart Planar Single (78472) |
$1,057.50 |
$1,410 |
2.9× |
| Hand 2 views (73120) |
$146.25 |
$195 |
1.5× |
| Hand 3 views (73130) |
$179.06 |
$238.75 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,020.56 |
$1,360.75 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,020.56 |
$1,360.75 |
2.8× |
| Ht muscle image spect sing (78451) |
$1,124.81 |
$1,499.75 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$211.13 |
$281.50 |
2.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,097.25 |
$1,463 |
2.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$979.88 |
$1,306.50 |
2.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$535.69 |
$714.25 |
1.1× |
| Knee 3 views (73562) |
$263.25 |
$351 |
3.3× |
| Liver & spleen imaging static only (78215) |
$1,020.56 |
$1,360.75 |
2.8× |
| Meckels Diverticulum (78290) |
$817.31 |
$1,089.75 |
2.2× |
| MRA head w & w/o contrast (70546) |
$1,968.56 |
$2,624.75 |
6.1× |
| MRA head w/o contrast (70544) |
$1,968.56 |
$2,624.75 |
9.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,968.56 |
$2,624.75 |
6.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,977.56 |
$2,636.75 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,659.75 |
$2,213 |
7.6× |
| MRI any jnt lwr ext with con lt (73722) |
$1,510.31 |
$2,013.75 |
2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,510.31 |
$2,013.75 |
2.1× |
| MRI c-spine with contrast (72142) |
$1,962 |
$2,616 |
6.1× |
| MRI cervical spine w/o contrast (72141) |
$1,811.81 |
$2,415.75 |
8.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,765.31 |
$2,353.75 |
5.5× |
| MRI chest w/o contrast (71550) |
$1,659.75 |
$2,213 |
7.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,510.31 |
$2,013.75 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,908.94 |
$2,545.25 |
8.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,270.63 |
$3,027.50 |
7.1× |
| MRI orbit/face/neck w/contrast (70542) |
$2,072.06 |
$2,762.75 |
6.5× |
| MRI pelvis w contrast (72196) |
$1,952.63 |
$2,603.50 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,102.63 |
$2,803.50 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,659.75 |
$2,213 |
7.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,006.34 |
$2,675.12 |
6.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,998.38 |
$2,664.50 |
6.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,112.19 |
$2,816.25 |
6.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,811.81 |
$2,415.75 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,112.19 |
$2,816.25 |
6.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,962 |
$2,616 |
6.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,962 |
$2,616 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,811.81 |
$2,415.75 |
8.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,510.31 |
$2,013.75 |
6.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,510.31 |
$2,013.75 |
4.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,510.31 |
$2,013.75 |
6.9× |
| Myelogram Lumbar (72265) |
$576.75 |
$769 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,349.25 |
$1,799 |
1.1× |
| Neck soft tissue (70360) |
$153.75 |
$205 |
1.9× |
| Nm cisternogram (78630) |
$1,820.81 |
$2,427.75 |
3.6× |
| Nm gastric emptying study (78264) |
$654.38 |
$872.50 |
1.8× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$479.25 |
$639 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$554.25 |
$739 |
5.8× |
| Osseous survey infant (77076) |
$804.19 |
$1,072.25 |
8.4× |
| Osseous survey limited (77074) |
$553.13 |
$737.50 |
5.8× |
| Parathyroid imaging (78070) |
$823.88 |
$1,098.50 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$156.94 |
$209.25 |
1.6× |
| PET imaging CT for attenuation limited area (78814) |
$3,844.69 |
$5,126.25 |
2.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,998.38 |
$2,664.50 |
6.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$786.38 |
$1,048.50 |
2.1× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$170.81 |
$227.75 |
0.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$522 |
$696 |
5.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$235.31 |
$313.75 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$153.75 |
$205 |
1.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$222.38 |
$296.50 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$262.13 |
$349.50 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$1,155.94 |
$1,541.25 |
7.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$485.81 |
$647.75 |
3.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$497.25 |
$663 |
3.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$211.13 |
$281.50 |
2.6× |
| Ribs bilateral 3 views (71110) |
$244.31 |
$325.75 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$192 |
$256 |
2.0× |
| Scanogram (77073) |
$281.25 |
$375 |
2.9× |
| Scapula complete (73010) |
$153.75 |
$205 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$103.88 |
$138.50 |
4.4× |
| Small bowel series (74250) |
$417.19 |
$556.25 |
2.6× |
| Speech evaluation complex (70371) |
$323.63 |
$431.50 |
1.5× |
| Spine thoracic 3 views (72072) |
$254.06 |
$338.75 |
2.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$1,110.94 |
$1,481.25 |
3.0× |
| Thyroid uptake measurement (78012) |
$712.13 |
$949.50 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,448.44 |
$1,931.25 |
3.9× |
| Tmj unilateral (70328) |
$199.31 |
$265.75 |
2.5× |
| Tomogram (76100) |
$1,086.75 |
$1,449 |
11.3× |
| Ultrasound elastography first target lesion (76982) |
$263.06 |
$350.75 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$525.75 |
$701 |
5.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$980.06 |
$1,306.75 |
12.2× |
| Unlisted Ultrasound Procedure (76999) |
$213.38 |
$284.50 |
2.7× |
| Upper Extremity Infant (73092) |
$284.44 |
$379.25 |
3.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$685.13 |
$913.50 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$525.75 |
$701 |
5.5× |
| Us breast unilateral complete (76641) |
$525.75 |
$701 |
5.5× |
| Us breast unilateral limited (76642) |
$471.94 |
$629.25 |
5.9× |
| Us chest (76604) |
$525.75 |
$701 |
5.5× |
| Us compl joint r-t w/image documentation (76881) |
$525.75 |
$701 |
5.5× |
| Us elastography parenchyma (76981) |
$263.06 |
$350.75 |
2.7× |
| Us infant hips limited static (76886) |
$147 |
$196 |
1.8× |
| Us ob transvaginal (76817) |
$510.75 |
$681 |
5.3× |
| Us pelvic non ob complete (76856) |
$525.75 |
$701 |
5.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$506.81 |
$675.75 |
5.3× |
| Us pregnancy ltd (76815) |
$525.75 |
$701 |
5.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$277.50 |
$370 |
2.9× |
| Us retroperitoneal complete (76770) |
$525.75 |
$701 |
5.5× |
| Us retroperitoneal limited (76775) |
$525.75 |
$701 |
5.5× |
| Us scrotum and contents (76870) |
$525.75 |
$701 |
5.5× |
| Us soft tissue head/neck (76536) |
$604.31 |
$805.75 |
6.3× |
| Us spinal canal and contents (76800) |
$402.19 |
$536.25 |
4.2× |
| Us xtr non-vasc lmtd (76882) |
$515.44 |
$687.25 |
5.4× |
| Venography caval inferior serialography rs&i (75825) |
$2,071.88 |
$2,762.50 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$565.88 |
$754.50 |
0.4× |
| Wrist 2 views (73100) |
$168.38 |
$224.50 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$308.25 |
$411 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$263.25 |
$351 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$176.06 |
$234.75 |
2.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,155.94 |
$1,541.25 |
7.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$153.75 |
$205 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$177 |
$236 |
2.2× |
| X-ray exam hip uni 1 view (73501) |
$198.75 |
$265 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$447.94 |
$597.25 |
5.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$550.88 |
$734.50 |
5.7× |
| X-ray eye for foreign body (70030) |
$153.75 |
$205 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$221.81 |
$295.75 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$197.63 |
$263.50 |
2.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$176.06 |
$234.75 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$176.06 |
$234.75 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$183.94 |
$245.25 |
2.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$276.75 |
$369 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$176.06 |
$234.75 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$308.63 |
$411.50 |
3.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$226.13 |
$301.50 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$349.50 |
$466 |
3.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$211.13 |
$281.50 |
2.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$253.69 |
$338.25 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$213.19 |
$284.25 |
2.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$226.13 |
$301.50 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$229.69 |
$306.25 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$267.75 |
$357 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$286.50 |
$382 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$221.81 |
$295.75 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$221.81 |
$295.75 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$227.06 |
$302.75 |
2.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$195 |
$260 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$246.75 |
$329 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$214.31 |
$285.75 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$200.06 |
$266.75 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$221.81 |
$295.75 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$169.69 |
$226.25 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$221.81 |
$295.75 |
2.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$271.31 |
$361.75 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$176.06 |
$234.75 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$179.06 |
$238.75 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$316.88 |
$422.50 |
3.3× |
| Xr chest 4+ views (71048) |
$293.44 |
$391.25 |
3.1× |
| Xr finger(s) 2+ views (73140) |
$176.06 |
$234.75 |
2.2× |
| Xr shoulder 1 view (73020) |
$153.75 |
$205 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$290.63 |
$387.50 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$211.13 |
$281.50 |
2.6× |
| Xr tmj bilateral (70330) |
$298.88 |
$398.50 |
3.7× |
| Xray knee 1 or 2 views rt (73560) |
$154.88 |
$206.50 |
1.9× |