| Abdomen 2 views (74019) |
$108.40 |
$271 |
1.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$409.60 |
$1,024 |
1.2× |
| Angiography extremity bilateral rs&i (75716) |
$2,560.40 |
$6,401 |
0.9× |
| Angiography extremity unilateral rs&i (75710) |
$2,560.40 |
$6,401 |
0.9× |
| Ankle 2 views (73600) |
$109.60 |
$274 |
1.5× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,560.40 |
$6,401 |
0.9× |
| Arthrogram elbow (73085) |
$445.60 |
$1,114 |
1.5× |
| Arthrogram hip (73525) |
$542.80 |
$1,357 |
1.8× |
| Arthrogram shoulder (73040) |
$445.60 |
$1,114 |
1.5× |
| Arthrogram wrist (73115) |
$445.60 |
$1,114 |
1.5× |
| Arthrography knee lt (73580) |
$445.60 |
$1,114 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$419.20 |
$1,048 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$414.80 |
$1,037 |
1.2× |
| Bone age studies (77072) |
$100.40 |
$251 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$414.80 |
$1,037 |
1.2× |
| Bone survey complete (77075) |
$167.60 |
$419 |
1.9× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,098 |
$5,245 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$109.60 |
$274 |
1.5× |
| Chest 1 view (71045) |
$69.20 |
$173 |
0.9× |
| Chest 3 views (71047) |
$92 |
$230 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$144 |
$360 |
1.0× |
| Clavicle complete (73000) |
$106 |
$265 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$314 |
$785 |
3.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$671.60 |
$1,679 |
2.2× |
| CT abdomen and pelvis without contrast (74176) |
$446.40 |
$1,116 |
2.2× |
| CT abdomen w contrast (74160) |
$580.40 |
$1,451 |
3.8× |
| CT abdomen w wo contrast (74170) |
$645.20 |
$1,613 |
4.3× |
| CT abdomen w/o contrast (74150) |
$370.80 |
$927 |
4.1× |
| CT angiography upper extremity lt (73206) |
$452 |
$1,130 |
3.0× |
| CT c-spine w/o contrast (72125) |
$370.80 |
$927 |
4.1× |
| CT cervical spine with contrast (72126) |
$620.40 |
$1,551 |
2.1× |
| CT chest w/wo contrast (71270) |
$435.20 |
$1,088 |
2.9× |
| CT chest with contrast (71260) |
$435.20 |
$1,088 |
2.9× |
| CT head/brain with contrast (70460) |
$504.80 |
$1,262 |
3.3× |
| CT head/brain without and with contrast (70470) |
$645.20 |
$1,613 |
4.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$20 |
$50 |
0.3× |
| CT iac w contrast (70481) |
$622.40 |
$1,556 |
4.1× |
| CT limited/localized follow up study (76380) |
$179.20 |
$448 |
2.4× |
| CT lower ext w/o (73700) |
$370.80 |
$927 |
4.1× |
| CT lower extremity w wo contrast (73702) |
$912 |
$2,280 |
6.0× |
| CT lower extremity with contrast (73701) |
$398 |
$995 |
2.6× |
| CT lumbar spine w & w/o contrast (72133) |
$561.20 |
$1,403 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$370.80 |
$927 |
4.1× |
| CT lumbar spine with contrast (72132) |
$504.80 |
$1,262 |
1.7× |
| CT maxillofacial w contrast (70487) |
$617.20 |
$1,543 |
4.1× |
| CT maxillofacial w/o contrast (70486) |
$370.80 |
$927 |
4.1× |
| CT maxillofacial w/wo contrast (70488) |
$645.20 |
$1,613 |
4.3× |
| CT neck soft tissue w contrast (70491) |
$580.40 |
$1,451 |
3.8× |
| CT orbits w/o contrast (70480) |
$370.80 |
$927 |
4.1× |
| CT pelvis w & w/o contrast (72194) |
$561.20 |
$1,403 |
3.7× |
| CT pelvis w/o contrast (72192) |
$370.80 |
$927 |
4.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$645.20 |
$1,613 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$370.80 |
$927 |
4.1× |
| CT thoracic spine w/contrast (72129) |
$620.40 |
$1,551 |
4.1× |
| CT thoracic spine w/o contrast (72128) |
$370.80 |
$927 |
4.1× |
| CT thorax w/o contrast (71250) |
$224.40 |
$561 |
2.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$656.80 |
$1,642 |
4.3× |
| CT upper extremity w/o contrast rt (73200) |
$370.80 |
$927 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$506 |
$1,265 |
3.3× |
| Cta Abdomen (74175) |
$440 |
$1,100 |
2.9× |
| CTA abdomen pelvis (74174) |
$671.60 |
$1,679 |
2.2× |
| CTA chest (71275) |
$505.20 |
$1,263 |
3.3× |
| Cta Head (70496) |
$505.20 |
$1,263 |
3.3× |
| CTA lwr ext w&w/o contrast (73706) |
$2,015.20 |
$5,038 |
13.3× |
| Cta Neck (70498) |
$505.20 |
$1,263 |
3.3× |
| Cystography minimum 3 views rs&i (74430) |
$412 |
$1,030 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$166 |
$415 |
1.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$96 |
$240 |
1.3× |
| Echo exam of eye (76529) |
$50.40 |
$126 |
0.7× |
| Echoencephalography real time imaging (76506) |
$152.80 |
$382 |
1.7× |
| Esophagus (74220) |
$221.60 |
$554 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$241.60 |
$604 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$203.60 |
$509 |
1.0× |
| Foot 2 views (73620) |
$106 |
$265 |
1.4× |
| Forearm 2 views (73090) |
$106 |
$265 |
1.4× |
| Gated Heart Planar Single (78472) |
$945.20 |
$2,363 |
2.7× |
| Hand 2 views (73120) |
$115.60 |
$289 |
1.3× |
| Hand 3 views (73130) |
$106 |
$265 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$493.60 |
$1,234 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$493.60 |
$1,234 |
1.4× |
| Ht muscle image spect sing (78451) |
$1,140.40 |
$2,851 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$106 |
$265 |
1.4× |
| Hysterosalpingogram (74740) |
$397.60 |
$994 |
1.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$535.60 |
$1,339 |
1.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$535.60 |
$1,339 |
1.1× |
| Knee 3 views (73562) |
$109.60 |
$274 |
1.5× |
| Lymphoscintigraphy (78195) |
$369.60 |
$924 |
0.8× |
| MRA head w/o contrast (70544) |
$597.20 |
$1,493 |
2.9× |
| MRA neck w contrast (70548) |
$871.60 |
$2,179 |
2.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$926 |
$2,315 |
3.1× |
| MRA neck w/o contrast (70547) |
$830 |
$2,075 |
4.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,173.20 |
$2,933 |
3.9× |
| MRI abdomen w/o contrast (74181) |
$568.80 |
$1,422 |
2.8× |
| MRI any jnt lwr ext with con lt (73722) |
$607.20 |
$1,518 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$926 |
$2,315 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$597.20 |
$1,493 |
2.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$926 |
$2,315 |
3.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$597.20 |
$1,493 |
2.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$568.80 |
$1,422 |
2.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$869.60 |
$2,174 |
2.9× |
| MRI pelvis w contrast (72196) |
$954.40 |
$2,386 |
3.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,021.60 |
$2,554 |
3.4× |
| MRI pelvis w/o contrast (72195) |
$862.40 |
$2,156 |
4.2× |
| MRI scan of arm joint before and after contrast (73223) |
$991.20 |
$2,478 |
3.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,123.60 |
$2,809 |
3.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$897.20 |
$2,243 |
3.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$968.40 |
$2,421 |
3.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$942 |
$2,355 |
3.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$986.80 |
$2,467 |
3.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$942 |
$2,355 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$743.60 |
$1,859 |
3.6× |
| MRI upper ext joint w/o contrast (73221) |
$913.20 |
$2,283 |
4.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$954.40 |
$2,386 |
3.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$869.60 |
$2,174 |
4.2× |
| Myelogram Cervical (72240) |
$747.20 |
$1,868 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,311.60 |
$3,279 |
1.2× |
| Neck soft tissue (70360) |
$92 |
$230 |
1.2× |
| Nm gastric emptying study (78264) |
$409.60 |
$1,024 |
1.2× |
| Nuclear Rx Oral Admin (79005) |
$386.80 |
$967 |
1.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$144 |
$360 |
1.6× |
| Osseous survey infant (77076) |
$145.60 |
$364 |
1.6× |
| Osseous survey limited (77074) |
$396.40 |
$991 |
4.4× |
| Parathyrd planar w/wo subtrj (78071) |
$515.20 |
$1,288 |
1.5× |
| Parathyroid imaging (78070) |
$371.20 |
$928 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$115.60 |
$289 |
1.3× |
| PET image w/CT, skull-thigh (78815) |
$2,202.80 |
$5,507 |
1.8× |
| PET imaging for CT attenuation whole body (78816) |
$2,202.80 |
$5,507 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$897.20 |
$2,243 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$535.60 |
$1,339 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$129.60 |
$324 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$167.60 |
$419 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$145.60 |
$364 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$69.20 |
$173 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$108.40 |
$271 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$80.80 |
$202 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$235.20 |
$588 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$162.80 |
$407 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$221.60 |
$554 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$106 |
$265 |
1.4× |
| Radiological examination surgical specimen (76098) |
$714 |
$1,785 |
1.5× |
| Ribs bilateral 3 views (71110) |
$167.60 |
$419 |
1.9× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$827.60 |
$2,069 |
0.7× |
| Rp loclzj tum spect CT 2area 1d img/1 ar img>2+d (78832) |
$1,052 |
$2,630 |
0.9× |
| Scapula complete (73010) |
$106 |
$265 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$44.80 |
$112 |
1.9× |
| Small bowel series (74250) |
$158 |
$395 |
1.0× |
| Spine thoracic 3 views (72072) |
$115.60 |
$289 |
1.3× |
| Testicular Imaging With Vascular Flow (78761) |
$333.20 |
$833 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$549.20 |
$1,373 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$241.60 |
$604 |
2.7× |
| Upper Extremity Infant (73092) |
$145.60 |
$364 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$265.20 |
$663 |
1.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$328 |
$820 |
2.2× |
| Us abdl aorta screen aaa (76706) |
$100 |
$250 |
1.1× |
| Us breast unilateral complete (76641) |
$192 |
$480 |
2.1× |
| Us breast unilateral limited (76642) |
$192 |
$480 |
2.6× |
| Us chest (76604) |
$134.80 |
$337 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$152 |
$380 |
1.7× |
| Us infant hips dynamic (76885) |
$144 |
$360 |
1.9× |
| Us infant hips limited static (76886) |
$230 |
$575 |
3.1× |
| Us kidney transplant (76776) |
$288 |
$720 |
3.2× |
| Us ob transvaginal (76817) |
$241.60 |
$604 |
2.7× |
| Us pelvic non ob complete (76856) |
$241.60 |
$604 |
2.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$114 |
$285 |
1.3× |
| Us pregnancy ltd (76815) |
$241.60 |
$604 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$241.60 |
$604 |
2.7× |
| Us retroperitoneal complete (76770) |
$186 |
$465 |
2.1× |
| Us retroperitoneal limited (76775) |
$161.60 |
$404 |
1.8× |
| Us scrotum and contents (76870) |
$161.60 |
$404 |
1.8× |
| Us soft tissue head/neck (76536) |
$186 |
$465 |
2.1× |
| Us spinal canal and contents (76800) |
$144 |
$360 |
1.6× |
| Us xtr non-vasc lmtd (76882) |
$108 |
$270 |
1.2× |
| Wrist 2 views (73100) |
$106 |
$265 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$145.60 |
$364 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$95.20 |
$238 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$109.60 |
$274 |
1.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$238.80 |
$597 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$106 |
$265 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$106 |
$265 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$68.40 |
$171 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$106 |
$265 |
1.4× |
| X-ray exam hip uni 4/> views (73503) |
$266.80 |
$667 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$129.60 |
$324 |
1.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$260 |
$650 |
2.9× |
| X-ray exam of femur 1 (73551) |
$68.40 |
$171 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$167.60 |
$419 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$92 |
$230 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$106 |
$265 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$106 |
$265 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$166.40 |
$416 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$120.40 |
$301 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$106 |
$265 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$95.20 |
$238 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$115.60 |
$289 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$167.60 |
$419 |
1.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$167.60 |
$419 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$106 |
$265 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$95.20 |
$238 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$129.60 |
$324 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$106 |
$265 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$170.40 |
$426 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$145.60 |
$364 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$115.60 |
$289 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$106 |
$265 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$109.60 |
$274 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$109.60 |
$274 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$82 |
$205 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$167.60 |
$419 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$100.40 |
$251 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$92 |
$230 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$139.60 |
$349 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$106 |
$265 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$115.60 |
$289 |
1.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$261.60 |
$654 |
2.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$106 |
$265 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$106 |
$265 |
1.4× |
| Xr arthrogram ankle (73615) |
$450 |
$1,125 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$167.60 |
$419 |
1.9× |
| Xr finger(s) 2+ views (73140) |
$106 |
$265 |
1.4× |
| Xr shoulder 1 view (73020) |
$59.60 |
$149 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$164 |
$410 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$106 |
$265 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$106 |
$265 |
1.4× |