| Abdomen 2 views (74019) |
$429.19 |
$572.25 |
4.1× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,015.88 |
$1,354.50 |
2.5× |
| Ankle 2 views (73600) |
$141.75 |
$189 |
1.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,197 |
$1,596 |
3.0× |
| Bone &/joint imaging whole body (78306) |
$1,197 |
$1,596 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$1,212.75 |
$1,617 |
3.0× |
| Bone survey complete (77075) |
$476.44 |
$635.25 |
4.6× |
| Brain imaging < 4 static views (78600) |
$724.50 |
$966 |
1.8× |
| Brain imaging < 4 static views w vascular flow (78601) |
$1,334.81 |
$1,779.75 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$145.69 |
$194.25 |
1.7× |
| Chest 1 view (71045) |
$141.75 |
$189 |
1.6× |
| Chest 3 views (71047) |
$200.81 |
$267.75 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$338.63 |
$451.50 |
1.9× |
| Clavicle complete (73000) |
$157.50 |
$210 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,208.94 |
$2,945.25 |
21.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,783.94 |
$5,045.25 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,953.13 |
$3,937.50 |
12.4× |
| CT abdomen w contrast (74160) |
$1,338.75 |
$1,785 |
7.6× |
| CT abdomen w wo contrast (74170) |
$1,425.38 |
$1,900.50 |
8.1× |
| CT abdomen w/o contrast (74150) |
$1,216.69 |
$1,622.25 |
11.6× |
| CT angio hrt w/3d image (75574) |
$1,409.63 |
$1,879.50 |
4.0× |
| CT c-spine w/o contrast (72125) |
$1,216.69 |
$1,622.25 |
11.6× |
| CT cervical spine w&w/o contrast (72127) |
$2,031.75 |
$2,709 |
11.6× |
| CT cervical spine with contrast (72126) |
$1,941.19 |
$2,588.25 |
5.6× |
| CT chest w/wo contrast (71270) |
$1,846.69 |
$2,462.25 |
10.5× |
| CT chest with contrast (71260) |
$1,941.19 |
$2,588.25 |
11.0× |
| CT head/brain with contrast (70460) |
$1,941.19 |
$2,588.25 |
11.0× |
| CT head/brain without and with contrast (70470) |
$2,031.75 |
$2,709 |
11.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,409.63 |
$1,879.50 |
4.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$165.38 |
$220.50 |
1.9× |
| CT hrt w/3d image congen (75573) |
$1,409.63 |
$1,879.50 |
4.0× |
| CT lower ext w/o (73700) |
$1,515.94 |
$2,021.25 |
14.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,954.97 |
$2,606.62 |
11.1× |
| CT lumbar spine w/o contrast (72131) |
$1,362.38 |
$1,816.50 |
13.0× |
| CT lumbar spine with contrast (72132) |
$1,575 |
$2,100 |
4.5× |
| CT maxillofacial w/o contrast (70486) |
$1,295.44 |
$1,727.25 |
12.4× |
| CT neck soft tissue w contrast (70491) |
$1,941.19 |
$2,588.25 |
11.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,295.44 |
$1,727.25 |
7.4× |
| CT orbits w/o contrast (70480) |
$1,295.44 |
$1,727.25 |
12.4× |
| CT pelvis w & w/o contrast (72194) |
$2,031.75 |
$2,709 |
11.6× |
| CT pelvis w/o contrast (72192) |
$1,515.94 |
$2,021.25 |
14.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,000.25 |
$2,667 |
11.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,216.69 |
$1,622.25 |
11.6× |
| CT thoracic spine w/contrast (72129) |
$1,575 |
$2,100 |
9.0× |
| CT thoracic spine w/o contrast (72128) |
$1,953 |
$2,604 |
18.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,941.19 |
$2,588.25 |
11.0× |
| CT thorax w/o contrast (71250) |
$1,515.94 |
$2,021.25 |
14.5× |
| CT upper extremity w/o contrast rt (73200) |
$1,964.81 |
$2,619.75 |
18.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,707.03 |
$3,609.38 |
15.4× |
| Cta Abdomen (74175) |
$1,425.38 |
$1,900.50 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,854.69 |
$3,806.25 |
8.2× |
| CTA chest (71275) |
$1,752.19 |
$2,336.25 |
10.0× |
| Cta Head (70496) |
$2,031.75 |
$2,709 |
11.6× |
| Cta Neck (70498) |
$1,425.38 |
$1,900.50 |
8.1× |
| Cystography minimum 3 views rs&i (74430) |
$564 |
$752 |
1.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$275.63 |
$367.50 |
2.6× |
| Dxa bone density study axial skeleton (77085) |
$437.06 |
$582.75 |
4.2× |
| Echoencephalography real time imaging (76506) |
$204.75 |
$273 |
2.0× |
| Esophagus (74220) |
$273.75 |
$365 |
1.6× |
| Fetal biophysical profile non-stress testing (76818) |
$547.31 |
$729.75 |
5.2× |
| Fluoroscopy up to 1 hr (76000) |
$352.50 |
$470 |
1.5× |
| Foot 2 views (73620) |
$141.75 |
$189 |
1.6× |
| Forearm 2 views (73090) |
$141.75 |
$189 |
1.6× |
| Gated Heart Planar Single (78472) |
$1,027.69 |
$1,370.25 |
2.6× |
| Hand 2 views (73120) |
$228.38 |
$304.50 |
2.2× |
| Hand 3 views (73130) |
$228.38 |
$304.50 |
2.6× |
| Heart Infarct Image (78466) |
$2,999.63 |
$3,999.50 |
7.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,307.25 |
$1,743 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,039.50 |
$1,386 |
2.6× |
| Ht muscle image spect sing (78451) |
$2,001.75 |
$2,669 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$173.25 |
$231 |
2.0× |
| Hysterosalpingogram (74740) |
$352.50 |
$470 |
1.5× |
| Kidney imaging morphology (78700) |
$803.25 |
$1,071 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$750 |
$1,000 |
1.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,082.81 |
$1,443.75 |
2.0× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$750 |
$1,000 |
1.4× |
| Liver & spleen imaging static only (78215) |
$803.25 |
$1,071 |
2.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$984.38 |
$1,312.50 |
2.5× |
| Lung Ventilation Imaging (78579) |
$893.81 |
$1,191.75 |
2.2× |
| Meckels Diverticulum (78290) |
$570.94 |
$761.25 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,874.25 |
$2,499 |
5.4× |
| MRA head w/o contrast (70544) |
$1,008 |
$1,344 |
4.2× |
| MRA head with contrast (70545) |
$1,130.06 |
$1,506.75 |
3.2× |
| MRA neck w contrast (70548) |
$1,130.06 |
$1,506.75 |
3.2× |
| MRA neck w/o contrast (70547) |
$1,008 |
$1,344 |
4.2× |
| MRI abdomen w contrast (74182) |
$2,744.44 |
$3,659.25 |
7.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI abdomen w/o contrast (74181) |
$2,012.06 |
$2,682.75 |
8.4× |
| MRI any jnt lwr ext with con lt (73722) |
$2,744.44 |
$3,659.25 |
3.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,744.44 |
$3,659.25 |
3.5× |
| MRI c-spine with contrast (72142) |
$2,744.44 |
$3,659.25 |
7.9× |
| MRI cervical spine w/o contrast (72141) |
$2,476.69 |
$3,302.25 |
10.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI chest w/o contrast (71550) |
$2,476.69 |
$3,302.25 |
10.4× |
| MRI chest with contrast (71551) |
$2,744.44 |
$3,659.25 |
3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,744.44 |
$3,659.25 |
7.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,130.31 |
$4,173.75 |
13.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,476.69 |
$3,302.25 |
10.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI orbit/face/neck w/contrast (70542) |
$2,744.44 |
$3,659.25 |
7.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI pelvis w/o contrast (72195) |
$2,803.50 |
$3,738 |
11.7× |
| MRI scan of arm joint before and after contrast (73223) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI scan of leg joint before and after contrast (73723) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,744.44 |
$3,659.25 |
7.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,744.44 |
$3,659.25 |
7.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,476.69 |
$3,302.25 |
10.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,476.69 |
$3,302.25 |
10.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,130.31 |
$4,173.75 |
9.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,476.69 |
$3,302.25 |
10.4× |
| Myelogram Lumbar (72265) |
$1,563.19 |
$2,084.25 |
2.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,032.50 |
$2,710 |
1.6× |
| Nm gastric emptying study (78264) |
$976.50 |
$1,302 |
2.4× |
| Nuclear medicine of heart pumping function (78473) |
$626.06 |
$834.75 |
1.6× |
| Nuclear medicine study of digestive tracts (78299) |
$577.50 |
$770 |
1.4× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$2,001.75 |
$2,669 |
1.5× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$803.25 |
$1,071 |
2.0× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$750 |
$1,000 |
1.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$192.94 |
$257.25 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$166.50 |
$222 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,130.31 |
$4,173.75 |
9.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$893.81 |
$1,191.75 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,681.31 |
$2,241.75 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$287.44 |
$383.25 |
3.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$236.25 |
$315 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$208.69 |
$278.25 |
2.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$208.69 |
$278.25 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$232.31 |
$309.75 |
2.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$200.81 |
$267.75 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$444.94 |
$593.25 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$326.81 |
$435.75 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$196.88 |
$262.50 |
2.3× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$387.75 |
$517 |
1.7× |
| Ribs bilateral 3 views (71110) |
$252 |
$336 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$173.25 |
$231 |
1.7× |
| Scanogram (77073) |
$166.50 |
$222 |
1.6× |
| Scapula complete (73010) |
$173.25 |
$231 |
1.7× |
| Sialogram (70390) |
$352.50 |
$470 |
1.5× |
| Small bowel series (74250) |
$350.44 |
$467.25 |
2.0× |
| Spine thoracic 3 views (72072) |
$311.06 |
$414.75 |
3.0× |
| Testicular Imaging With Vascular Flow (78761) |
$960.75 |
$1,281 |
2.4× |
| Thyroid uptake measurement (78012) |
$622.13 |
$829.50 |
1.6× |
| Tmj unilateral (70328) |
$196.88 |
$262.50 |
2.3× |
| Tomogram (76100) |
$271.69 |
$362.25 |
2.6× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$1,197 |
$1,596 |
3.0× |
| Ultrasound scan to determine eye length and lens power (76519) |
$166.50 |
$222 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$307.13 |
$409.50 |
2.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$123.75 |
$165 |
1.4× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$775.69 |
$1,034.25 |
1.9× |
| Unlisted respiratory procedure, diagnostic nuclear medicine UNSCHEDULED (78599) |
$577.50 |
$770 |
1.4× |
| Unlisted Ultrasound Procedure (76999) |
$123.75 |
$165 |
1.4× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$952.88 |
$1,270.50 |
2.4× |
| Urethrocystography retrograde rs&i (74450) |
$346.50 |
$462 |
1.4× |
| Urethrocystography voiding (74455) |
$393.75 |
$525 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$370.13 |
$493.50 |
2.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$531.56 |
$708.75 |
3.0× |
| Us breast unilateral limited (76642) |
$307.13 |
$409.50 |
3.5× |
| Us chest (76604) |
$166.50 |
$222 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$236.82 |
$315.75 |
2.3× |
| Us ob transvaginal (76817) |
$547.31 |
$729.75 |
5.2× |
| Us pelvic non ob complete (76856) |
$712.69 |
$950.25 |
6.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$173.25 |
$231 |
1.7× |
| Us pregnancy ltd (76815) |
$378 |
$504 |
3.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$547.31 |
$729.75 |
5.2× |
| Us retroperitoneal complete (76770) |
$326.81 |
$435.75 |
3.1× |
| Us scrotum and contents (76870) |
$326.81 |
$435.75 |
3.1× |
| Us soft tissue head/neck (76536) |
$360.84 |
$481.12 |
3.4× |
| Us xtr non-vasc lmtd (76882) |
$307.13 |
$409.50 |
2.9× |
| Vascular flow imaging (78445) |
$577.50 |
$770 |
1.4× |
| Venogram extremity bilateral (75822) |
$1,875 |
$2,500 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$1,125 |
$1,500 |
0.7× |
| Vertebral fracture assessment via dxa (77086) |
$165.38 |
$220.50 |
1.9× |
| Wrist 2 views (73100) |
$141.75 |
$189 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$271.69 |
$362.25 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$216.56 |
$288.75 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$228.38 |
$304.50 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$590.63 |
$787.50 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$141.75 |
$189 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$181.13 |
$241.50 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$157.50 |
$210 |
1.8× |
| X-ray eye for foreign body (70030) |
$123.75 |
$165 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$204.75 |
$273 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$232.31 |
$309.75 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$141.75 |
$189 |
1.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$366.18 |
$488.25 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$189 |
$252 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$230.90 |
$307.88 |
2.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$244.13 |
$325.50 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$145.69 |
$194.25 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$204.75 |
$273 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$236.25 |
$315 |
2.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$564 |
$752 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$200.81 |
$267.75 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$270.75 |
$361 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$240 |
$320 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$236.25 |
$315 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$236.25 |
$315 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$252 |
$336 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$220.50 |
$294 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$220.50 |
$294 |
2.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$166.50 |
$222 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$123.75 |
$165 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$200.81 |
$267.75 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$137.81 |
$183.75 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$226.50 |
$302 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$232.31 |
$309.75 |
2.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$141.75 |
$189 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$141.75 |
$189 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$259.88 |
$346.50 |
2.5× |
| Xr chest 4+ views (71048) |
$220.50 |
$294 |
2.1× |
| Xr Cholecystography Oral Contrast (74290) |
$273.75 |
$365 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$141.75 |
$189 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$421.31 |
$561.75 |
4.0× |
| Xr tibia/fibula 2 views (73590) |
$173.25 |
$231 |
2.0× |
| Xr tmj bilateral (70330) |
$248.06 |
$330.75 |
2.8× |
| Xray knee 1 or 2 views rt (73560) |
$141.75 |
$189 |
1.6× |