| Abdomen 2 views (74019) |
$406.45 |
$739 |
3.8× |
| Acute gi blood loss imaging (78278) |
$782.10 |
$1,422 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$871.20 |
$1,584 |
2.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,106.60 |
$2,012 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,177.55 |
$2,141 |
2.9× |
| Bone Imaging 3 Phase (78315) |
$1,071.40 |
$1,948 |
2.6× |
| Bone survey complete (77075) |
$179.30 |
$326 |
1.7× |
| Bone survey infant (77076) |
$93.50 |
$170 |
0.9× |
| Bowel imaging (78290) |
$841.50 |
$1,530 |
2.0× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,074.70 |
$1,954 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$281.60 |
$512 |
3.1× |
| Chest 1 view (71045) |
$177.65 |
$323 |
2.0× |
| Chest xray 3 views (71047) |
$177.65 |
$323 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$194.70 |
$354 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$403.98 |
$734.50 |
3.7× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$249.70 |
$454 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,134.82 |
$3,881.50 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,601.32 |
$2,911.50 |
6.5× |
| CT abdomen w contrast (74160) |
$1,549.90 |
$2,818 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,788.05 |
$3,251 |
9.9× |
| CT abdomen w/o contrast (74150) |
$1,549.90 |
$2,818 |
14.4× |
| CT c-spine w/contrast (72126) |
$1,450.35 |
$2,637 |
4.0× |
| CT c-spine w/o contrast (72125) |
$1,450.35 |
$2,637 |
13.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,595.55 |
$2,901 |
8.8× |
| CT chest w contrast (71260) |
$1,495.45 |
$2,719 |
8.3× |
| CT chest w/wo contrast (71270) |
$1,645.05 |
$2,991 |
9.1× |
| CT head/brain with contrast (70460) |
$1,423.95 |
$2,589 |
7.9× |
| CT head/brain without and with contrast (70470) |
$1,566.40 |
$2,848 |
8.7× |
| CT iac w contrast (70481) |
$1,423.95 |
$2,589 |
7.9× |
| CT limited/localized follow up study (76380) |
$627 |
$1,140 |
7.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,550.45 |
$2,819 |
8.6× |
| CT lumbar spine w/contrast (72132) |
$1,409.65 |
$2,563 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$1,409.65 |
$2,563 |
13.1× |
| CT maxillofacial w contrast (70487) |
$1,331.55 |
$2,421 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,464.65 |
$2,663 |
8.1× |
| CT maxillofacial wo contrast (70486) |
$1,331.55 |
$2,421 |
12.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,566.40 |
$2,848 |
8.7× |
| CT orbits w/o contrast (70480) |
$1,423.95 |
$2,589 |
13.2× |
| CT pelvis w/o contrast (72192) |
$1,474 |
$2,680 |
13.7× |
| CT pelvis w/wo contrast (72194) |
$1,621.40 |
$2,948 |
9.0× |
| CT soft tissue neck w contrast (70491) |
$1,504.80 |
$2,736 |
8.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,655.50 |
$3,010 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,504.80 |
$2,736 |
13.9× |
| CT thoracic spine w/contrast (72129) |
$1,443.20 |
$2,624 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,443.20 |
$2,624 |
13.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,587.30 |
$2,886 |
8.8× |
| CT thorax w/o contrast (71250) |
$1,495.45 |
$2,719 |
13.9× |
| CT unlisted procedure (76497) |
$4,430.25 |
$8,055 |
49.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,011.35 |
$3,657 |
11.1× |
| Cta Abdomen (74175) |
$1,646.70 |
$2,994 |
9.1× |
| CTA abdomen pelvis (74174) |
$1,849.65 |
$3,363 |
5.1× |
| CTA chest (71275) |
$1,645.05 |
$2,991 |
9.1× |
| Cta Head (70496) |
$1,566.40 |
$2,848 |
8.7× |
| Cta Neck (70498) |
$1,566.40 |
$2,848 |
8.7× |
| Cta Pelvis (72191) |
$1,675.85 |
$3,047 |
9.3× |
| Cystography minimum 3 views rs&i (74430) |
$431.75 |
$785 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$282.70 |
$514 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$144.65 |
$263 |
1.6× |
| Dxa bone density study axial skeleton (77085) |
$255.20 |
$464 |
2.4× |
| Esophagus (74220) |
$522.22 |
$949.50 |
2.9× |
| Facial bones min 3 views (70150) |
$278.85 |
$507 |
2.6× |
| Fetal biophysical profile non-stress testing (76818) |
$409.48 |
$744.50 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$409.48 |
$744.50 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$279.95 |
$509 |
1.1× |
| Heart first pass single,planar (78481) |
$807.95 |
$1,469 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,108.25 |
$2,015 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$443.30 |
$806 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$849.20 |
$1,544 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,502.60 |
$2,732 |
2.7× |
| Lung ventilation imaging (78579) |
$740.30 |
$1,346 |
1.8× |
| Lymphoscintigraphy (78195) |
$1,246.30 |
$2,266 |
2.2× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$178.20 |
$324 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,589.40 |
$4,708 |
7.2× |
| MRA head w/o contrast (70544) |
$2,087.80 |
$3,796 |
8.5× |
| MRA head with contrast (70545) |
$2,067.45 |
$3,759 |
5.7× |
| MRA neck w contrast (70548) |
$1,885.40 |
$3,428 |
5.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,424.95 |
$4,409 |
6.7× |
| MRA neck w/o contrast (70547) |
$1,691.80 |
$3,076 |
6.9× |
| MRI abdomen w contrast (74182) |
$1,998.70 |
$3,634 |
5.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,562.45 |
$4,659 |
7.1× |
| MRI abdomen w/o contrast (74181) |
$1,345.30 |
$2,446 |
5.5× |
| MRI c-spine with contrast (72142) |
$1,924.45 |
$3,499 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,924.45 |
$3,499 |
7.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,424.95 |
$4,409 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,725.90 |
$3,138 |
7.0× |
| MRI chest with contrast (71551) |
$1,919.50 |
$3,490 |
2.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,742.95 |
$3,169 |
7.1× |
| MRI orbit face neck w contrast (70542) |
$1,867.80 |
$3,396 |
5.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,621.30 |
$4,766 |
7.3× |
| MRI pelvis w/contrast (72196) |
$1,703.90 |
$3,098 |
4.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,333.38 |
$4,242.50 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,833.42 |
$3,333.50 |
7.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,617.45 |
$4,759 |
7.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,826 |
$3,320 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,579.50 |
$4,690 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,828.20 |
$3,324 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,648.80 |
$4,816 |
7.4× |
| MRI temporomandibular joint (70336) |
$3,144.35 |
$5,717 |
12.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,865.60 |
$3,392 |
7.6× |
| Myelogram Cervical (72240) |
$837.65 |
$1,523 |
1.0× |
| Myelogram Lumbar (72265) |
$521.95 |
$949 |
0.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,115.85 |
$3,847 |
1.6× |
| Myocardial spect single study at rest or stress (78451) |
$1,777.60 |
$3,232 |
1.3× |
| Neck soft tissue (70360) |
$154.55 |
$281 |
1.7× |
| Nm gastric emptying study (78264) |
$607.20 |
$1,104 |
1.5× |
| Nonvascular shunt X-ray (75809) |
$254.65 |
$463 |
2.4× |
| Ob us nuchal meas 1 gest (76813) |
$508.20 |
$924 |
4.7× |
| Osseous survey limited (77074) |
$130.90 |
$238 |
1.2× |
| Parathyroid Planar Imaging (78070) |
$1,034.55 |
$1,881 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$233.20 |
$424 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$960.85 |
$1,747 |
2.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$755.15 |
$1,373 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$353.10 |
$642 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$120.45 |
$219 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$200.20 |
$364 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$380.60 |
$692 |
3.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$497.20 |
$904 |
4.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$765.88 |
$1,392.50 |
7.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$278.85 |
$507 |
2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$244.20 |
$444 |
2.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$298.10 |
$542 |
2.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$315.15 |
$573 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$271.15 |
$493 |
3.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$380.60 |
$692 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$240.08 |
$436.50 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$463.38 |
$842.50 |
4.3× |
| Radiologic exam chest 2 views (71046) |
$216.42 |
$393.50 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$556.05 |
$1,011 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$557.70 |
$1,014 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$492.52 |
$895.50 |
2.7× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$69.30 |
$126 |
0.8× |
| Radiological examination surgical specimen (76098) |
$111.10 |
$202 |
0.2× |
| Ribs bilateral 3 views (71110) |
$391.32 |
$711.50 |
3.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$942.42 |
$1,713.50 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$249.15 |
$453 |
2.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$509.30 |
$926 |
2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$53.35 |
$97 |
2.3× |
| Sella turcica (70240) |
$137.50 |
$250 |
1.5× |
| Small bowel series (74250) |
$520.30 |
$946 |
2.9× |
| Spine thoracic 3 views (72072) |
$318.45 |
$579 |
3.0× |
| Spleen imaging only (78185) |
$789.25 |
$1,435 |
1.9× |
| Testicular Imaging With Vascular Flow (78761) |
$906.95 |
$1,649 |
2.2× |
| Thoracolumbar 2 views (72080) |
$234.85 |
$427 |
2.6× |
| Thyroid imaging w/blood flow (78013) |
$310.75 |
$565 |
0.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$628.10 |
$1,142 |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$429 |
$780 |
4.0× |
| Ultrasound, abdomen limited (76705) |
$549.45 |
$999 |
5.1× |
| Umbilical-artery Doppler (OB) (76820) |
$413.05 |
$751 |
3.8× |
| Urethrocystogram voiding (74455) |
$431.75 |
$785 |
1.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$816.75 |
$1,485 |
4.5× |
| Us chest (76604) |
$519.75 |
$945 |
4.8× |
| Us hips infant static (76886) |
$508.20 |
$924 |
5.7× |
| Us infant hips w manipulation (76885) |
$257.95 |
$469 |
2.9× |
| Us ob limited (76815) |
$543.95 |
$989 |
5.0× |
| Us ob transvaginal (76817) |
$549.45 |
$999 |
5.1× |
| Us pelvic non ob complete (76856) |
$539 |
$980 |
5.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$539 |
$980 |
5.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$630.85 |
$1,147 |
5.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$280.50 |
$510 |
2.6× |
| Us retroperitoneal complete (76770) |
$530.75 |
$965 |
4.9× |
| Us retroperitoneal limited (76775) |
$429 |
$780 |
4.0× |
| Us scrotum and contents (76870) |
$539 |
$980 |
5.0× |
| Us soft tissue head/neck (76536) |
$176 |
$320 |
1.6× |
| Us spinal canal and contents (76800) |
$509.30 |
$926 |
4.7× |
| Us transrectal (76872) |
$359.70 |
$654 |
3.3× |
| Us transrectal prostate volume (76873) |
$509.30 |
$926 |
4.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$508.20 |
$924 |
4.7× |
| Vertebral fracture assessment via dxa (77086) |
$166.65 |
$303 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$512.05 |
$931 |
4.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$189.20 |
$344 |
2.1× |
| X-ray b.e. reductn intuss (74283) |
$614.35 |
$1,117 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$784.30 |
$1,426 |
4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$607.20 |
$1,104 |
5.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$180.40 |
$328 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$238.70 |
$434 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$699.60 |
$1,272 |
7.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$135.85 |
$247 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$532.95 |
$969 |
4.9× |
| X-ray nose-rectum child f.b. (76010) |
$295.90 |
$538 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$470.25 |
$855 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$394.90 |
$718 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$298.10 |
$542 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$244.75 |
$445 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$432.30 |
$786 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$315.70 |
$574 |
2.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$191.95 |
$349 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$283.80 |
$516 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$240.90 |
$438 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$315.70 |
$574 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$432.30 |
$786 |
4.0× |
| Xr bone length studies (77073) |
$160.60 |
$292 |
1.5× |
| Xr c-spine 4 or 5 views (72050) |
$433.68 |
$788.50 |
4.0× |
| Xr c-spine 6 or more views (72052) |
$546.15 |
$993 |
5.1× |
| Xr chest 4+ views (71048) |
$236.22 |
$429.50 |
2.2× |