| Abdomen 2 views (74019) |
$201.84 |
$348 |
1.9× |
| Acute gi blood loss imaging (78278) |
$652.50 |
$1,125 |
1.6× |
| Arthrogram ankle (73615) |
$527.22 |
$909 |
1.5× |
| Arthrogram elbow (73085) |
$527.22 |
$909 |
1.5× |
| Arthrogram hip (73525) |
$527.22 |
$909 |
1.5× |
| Arthrogram knee (73580) |
$527.22 |
$909 |
1.5× |
| Arthrogram shoulder (73040) |
$527.22 |
$909 |
1.5× |
| Arthrogram wrist (73115) |
$495.90 |
$855 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$895.52 |
$1,544 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$895.52 |
$1,544 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$1,030.08 |
$1,776 |
2.5× |
| Bone age studies (77072) |
$234.90 |
$405 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$895.52 |
$1,544 |
2.2× |
| Bone survey complete (77075) |
$237.80 |
$410 |
2.2× |
| Bone survey infant (77076) |
$381.06 |
$657 |
3.5× |
| Bowel imaging (78290) |
$652.50 |
$1,125 |
1.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,679.10 |
$2,895 |
4.1× |
| Cervical spine 2 or 3 views (72040) |
$165.30 |
$285 |
1.8× |
| Chest 1 view (71045) |
$100.34 |
$173 |
1.1× |
| Chest xray 3 views (71047) |
$285.36 |
$492 |
3.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$424.56 |
$732 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$481.40 |
$830 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,504.36 |
$6,042 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,336.24 |
$4,028 |
9.5× |
| CT abdomen w contrast (74160) |
$1,354.30 |
$2,335 |
7.5× |
| CT abdomen w wo contrast (74170) |
$2,020.72 |
$3,484 |
11.2× |
| CT abdomen w/o contrast (74150) |
$1,354.30 |
$2,335 |
12.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,577.02 |
$2,719 |
8.7× |
| CT c-spine w/contrast (72126) |
$1,445.94 |
$2,493 |
4.0× |
| CT c-spine w/o contrast (72125) |
$1,445.94 |
$2,493 |
13.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,169.20 |
$3,740 |
12.0× |
| CT chest w contrast (71260) |
$1,301.52 |
$2,244 |
7.2× |
| CT chest w/wo contrast (71270) |
$1,952.28 |
$3,366 |
10.8× |
| CT head/brain with contrast (70460) |
$1,219.16 |
$2,102 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,828.74 |
$3,153 |
10.1× |
| CT iac w contrast (70481) |
$1,139.12 |
$1,964 |
6.3× |
| CT lower ext w/o (73700) |
$1,333.42 |
$2,299 |
12.4× |
| CT lower extremity w wo contrast (73702) |
$1,999.84 |
$3,448 |
11.0× |
| CT lower extremity w/contrast material (73701) |
$1,333.42 |
$2,299 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,154.70 |
$3,715 |
11.9× |
| CT lumbar spine w/contrast (72132) |
$1,436.66 |
$2,477 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,436.66 |
$2,477 |
13.3× |
| CT maxillofacial w contrast (70487) |
$1,210.46 |
$2,087 |
6.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,815.98 |
$3,131 |
10.0× |
| CT maxillofacial wo contrast (70486) |
$1,210.46 |
$2,087 |
11.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,708.68 |
$2,946 |
9.4× |
| CT orbits w/o contrast (70480) |
$1,139.12 |
$1,964 |
10.6× |
| CT pelvis w/o contrast (72192) |
$1,317.76 |
$2,272 |
12.2× |
| CT pelvis w/wo contrast (72194) |
$1,976.64 |
$3,408 |
10.9× |
| CT scan of arm combo (73202) |
$1,827 |
$3,150 |
10.1× |
| CT soft tissue neck w contrast (70491) |
$1,244.10 |
$2,145 |
6.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,866.44 |
$3,218 |
10.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,244.10 |
$2,145 |
11.5× |
| CT thoracic spine w/contrast (72129) |
$1,405.92 |
$2,424 |
7.8× |
| CT thoracic spine w/o contrast (72128) |
$1,405.92 |
$2,424 |
13.0× |
| CT thoracic spine w/wo contrast (72130) |
$2,108.88 |
$3,636 |
11.6× |
| CT thorax w/o contrast (71250) |
$1,301.52 |
$2,244 |
12.1× |
| CT upper ext wo (73200) |
$1,218 |
$2,100 |
11.3× |
| CT upper extremity with contrast (73201) |
$1,218 |
$2,100 |
3.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,930.82 |
$3,329 |
10.7× |
| Cta Abdomen (74175) |
$1,800.32 |
$3,104 |
9.9× |
| CTA abdomen pelvis (74174) |
$2,902.90 |
$5,005 |
8.1× |
| CTA chest (71275) |
$1,634.44 |
$2,818 |
9.0× |
| Cta Head (70496) |
$1,639.66 |
$2,827 |
9.1× |
| Cta Neck (70498) |
$1,484.22 |
$2,559 |
8.2× |
| Cta Pelvis (72191) |
$1,829.90 |
$3,155 |
10.1× |
| Cystography minimum 3 views rs&i (74430) |
$636.26 |
$1,097 |
1.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$205.32 |
$354 |
1.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$230.26 |
$397 |
2.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$149.64 |
$258 |
1.7× |
| Echo exam of eye (76529) |
$89.61 |
$154.50 |
1.0× |
| Esophagus (74220) |
$352.06 |
$607 |
1.9× |
| Facial bones min 3 views (70150) |
$209.38 |
$361 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$429.20 |
$740 |
4.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$211.70 |
$365 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$440.22 |
$759 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$972.08 |
$1,676 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$826.50 |
$1,425 |
2.0× |
| Hysterosalpingogram (74740) |
$502.28 |
$866 |
2.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$211.70 |
$365 |
2.0× |
| Kidney imaging morphology (78700) |
$899.58 |
$1,551 |
2.2× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$754 |
$1,300 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$900.16 |
$1,552 |
1.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$900.16 |
$1,552 |
1.6× |
| Liver & spleen imaging static only (78215) |
$766.76 |
$1,322 |
1.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$969.18 |
$1,671 |
2.3× |
| Liver imaging w/vascular flow (78202) |
$1,024.28 |
$1,766 |
1.8× |
| Lung perf&ventilat diferentl (78598) |
$1,269.04 |
$2,188 |
2.3× |
| Lung ventilation imaging (78579) |
$827.66 |
$1,427 |
2.0× |
| Lymphoscintigraphy (78195) |
$1,161.74 |
$2,003 |
2.1× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$110.78 |
$191 |
1.2× |
| MRA head w & w/o contrast (70546) |
$2,351.90 |
$4,055 |
6.5× |
| MRA head w/o contrast (70544) |
$1,912.26 |
$3,297 |
7.8× |
| MRA neck w contrast (70548) |
$2,134.40 |
$3,680 |
5.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,185.94 |
$5,493 |
8.8× |
| MRA neck w/o contrast (70547) |
$2,134.40 |
$3,680 |
8.7× |
| MRI abdomen w contrast (74182) |
$2,134.40 |
$3,680 |
5.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,185.94 |
$5,493 |
8.8× |
| MRI abdomen w/o contrast (74181) |
$2,134.40 |
$3,680 |
8.7× |
| MRI c-spine with contrast (72142) |
$1,926.18 |
$3,321 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,926.18 |
$3,321 |
7.8× |
| MRI chest w/o & w/contrast material (71552) |
$3,260.76 |
$5,622 |
9.1× |
| MRI chest w/o contrast (71550) |
$2,173.84 |
$3,748 |
8.8× |
| MRI chest with contrast (71551) |
$2,173.84 |
$3,748 |
2.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,383.80 |
$4,110 |
9.7× |
| MRI orbit face neck w contrast (70542) |
$2,383.80 |
$4,110 |
6.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,575.70 |
$6,165 |
9.9× |
| MRI pelvis w/contrast (72196) |
$1,921.54 |
$3,313 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,863.46 |
$4,937 |
8.0× |
| MRI pelvis w/o contrast (72195) |
$1,921.54 |
$3,313 |
7.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,888.98 |
$4,981 |
8.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,123.38 |
$3,661 |
5.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,185.36 |
$5,492 |
8.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,123.38 |
$3,661 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,185.36 |
$5,492 |
8.8× |
| MRI temporomandibular joint (70336) |
$2,173.84 |
$3,748 |
8.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,123.38 |
$3,661 |
8.6× |
| Myelogram Lumbar (72265) |
$839.84 |
$1,448 |
1.0× |
| Myelogram thoracic (72255) |
$907.12 |
$1,564 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$2,855.34 |
$4,923 |
2.1× |
| Myocardial spect single study at rest or stress (78451) |
$1,356.33 |
$2,338.50 |
1.0× |
| Neck soft tissue (70360) |
$84.10 |
$145 |
0.9× |
| Nm gastric emptying study (78264) |
$1,048.64 |
$1,808 |
2.5× |
| Nm gastroesophageal reflux study (78262) |
$1,059.66 |
$1,827 |
2.6× |
| Nm kidney scan w/flow (78701) |
$1,017.32 |
$1,754 |
2.5× |
| Osseous survey limited (77074) |
$423.40 |
$730 |
3.9× |
| Parathyroid Planar Imaging (78070) |
$1,141.44 |
$1,968 |
2.8× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,095.62 |
$1,889 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$144.42 |
$249 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$734.86 |
$1,267 |
1.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,505.10 |
$2,595 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$381.06 |
$657 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$238.38 |
$411 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$366.56 |
$632 |
3.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$22.62 |
$39 |
0.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$93.96 |
$162 |
0.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$303.34 |
$523 |
2.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$95.12 |
$164 |
0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$142.68 |
$246 |
1.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$206.48 |
$356 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$140.94 |
$243 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$254.62 |
$439 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$116 |
$200 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$104.98 |
$181 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$298.12 |
$514 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$193.14 |
$333 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$502.28 |
$866 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$699.48 |
$1,206 |
3.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$513.88 |
$886 |
2.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$362.50 |
$625 |
3.4× |
| Radiological examination surgical specimen (76098) |
$343.36 |
$592 |
0.6× |
| Ribs bilateral 3 views (71110) |
$128.18 |
$221 |
1.2× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,535.84 |
$2,648 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$249.40 |
$430 |
2.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$328.28 |
$566 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$81.20 |
$140 |
3.5× |
| Small bowel series (74250) |
$577.10 |
$995 |
3.2× |
| Spine thoracic 3 views (72072) |
$135.14 |
$233 |
1.3× |
| Spleen imaging only (78185) |
$538.24 |
$928 |
1.3× |
| Thoracolumbar 2 views (72080) |
$64.96 |
$112 |
0.7× |
| Thyroid imaging w/blood flow (78013) |
$475.60 |
$820 |
1.2× |
| Tmj unilateral (70328) |
$316.68 |
$546 |
3.5× |
| Ultrasound breast complete (76641) |
$396.72 |
$684 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$407.16 |
$702 |
3.8× |
| Ultrasound, abdomen limited (76705) |
$413.54 |
$713 |
3.8× |
| Umbilical-artery Doppler (OB) (76820) |
$205.32 |
$354 |
1.9× |
| Ureteral reflux study (78740) |
$845.64 |
$1,458 |
2.0× |
| Urethrocystogram voiding (74455) |
$729.64 |
$1,258 |
3.0× |
| Urethrocystography retrograde rs&i (74450) |
$729.64 |
$1,258 |
3.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$822.44 |
$1,418 |
4.5× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$853.76 |
$1,472 |
4.7× |
| Us breast unilateral limited (76642) |
$262.74 |
$453 |
2.9× |
| Us chest (76604) |
$313.20 |
$540 |
2.9× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$430.65 |
$742.50 |
1.9× |
| Us encephalogram (76506) |
$199.23 |
$343.50 |
1.8× |
| Us infant hips w manipulation (76885) |
$265.06 |
$457 |
3.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$56.84 |
$98 |
0.5× |
| Us ob limited (76815) |
$320.74 |
$553 |
3.0× |
| Us ob transvaginal (76817) |
$302.76 |
$522 |
2.8× |
| Us pelvic non ob complete (76856) |
$391.50 |
$675 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$305.08 |
$526 |
2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$295.22 |
$509 |
2.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$218.08 |
$376 |
2.0× |
| Us retroperitoneal complete (76770) |
$551 |
$950 |
5.1× |
| Us retroperitoneal limited (76775) |
$402.52 |
$694 |
3.7× |
| Us scrotum and contents (76870) |
$508.08 |
$876 |
4.7× |
| Us soft tissue head/neck (76536) |
$605.52 |
$1,044 |
5.6× |
| Us spinal canal and contents (76800) |
$241.86 |
$417 |
2.2× |
| Us, eye b-scan (76512) |
$82.94 |
$143 |
0.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$413.54 |
$713 |
3.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$106.72 |
$184 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$147.32 |
$254 |
1.6× |
| X-ray b.e. reductn intuss (74283) |
$580 |
$1,000 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$735.44 |
$1,268 |
4.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$269.99 |
$465.50 |
2.5× |
| X-ray eye for foreign body (70030) |
$151.96 |
$262 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$80.62 |
$139 |
0.9× |
| X-ray IV pyelogram (ivp) (74400) |
$792.28 |
$1,366 |
4.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$218.66 |
$377 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$169.36 |
$292 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$133.98 |
$231 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$510.98 |
$881 |
4.7× |
| X-ray nose-rectum child f.b. (76010) |
$173.42 |
$299 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$184.44 |
$318 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$597.98 |
$1,031 |
5.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$107.30 |
$185 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$107.30 |
$185 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$101.50 |
$175 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$316.68 |
$546 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$223.88 |
$386 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$188.50 |
$325 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$94.54 |
$163 |
1.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$176.90 |
$305 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$135.14 |
$233 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$579.42 |
$999 |
5.4× |
| Xr c-spine 4 or 5 views (72050) |
$122.38 |
$211 |
1.1× |
| Xr c-spine 6 or more views (72052) |
$165.30 |
$285 |
1.5× |
| Xr chest 4+ views (71048) |
$380.48 |
$656 |
3.5× |
| Xr urogram antegrade (74425) |
$754 |
$1,300 |
2.1× |