| Abdomen 2 views (74019) |
$94.30 |
$943 |
0.9× |
| Acute gastrointestinal blood loss imaging (78278) |
$334 |
$3,340 |
0.8× |
| Ankle 2 views (73600) |
$98.30 |
$983 |
1.1× |
| Arthrogram shoulder (73040) |
$169.90 |
$1,699 |
0.5× |
| Arthrography knee lt (73580) |
$360.80 |
$3,608 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$242.30 |
$2,423 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$365.70 |
$3,657 |
0.9× |
| Bone age studies (77072) |
$98.30 |
$983 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$267 |
$2,670 |
0.7× |
| Bone Marrow Imaging Limited Area (78102) |
$126.40 |
$1,264 |
0.3× |
| Bone survey complete (77075) |
$36.30 |
$363 |
0.3× |
| Cervical spine 2 or 3 views (72040) |
$127.70 |
$1,277 |
1.5× |
| Chest 1 view (71045) |
$90.60 |
$906 |
1.0× |
| Clavicle complete (73000) |
$98.30 |
$983 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$114 |
$1,140 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,533.40 |
$15,334 |
4.4× |
| CT abdomen and pelvis without contrast (74176) |
$796.30 |
$7,963 |
3.3× |
| CT abdomen w contrast (74160) |
$693.50 |
$6,935 |
3.9× |
| CT abdomen w wo contrast (74170) |
$786.40 |
$7,864 |
4.5× |
| CT abdomen w/o contrast (74150) |
$531 |
$5,310 |
5.1× |
| CT angiography upper extremity lt (73206) |
$53.40 |
$534 |
0.3× |
| CT c-spine w/o contrast (72125) |
$388.90 |
$3,889 |
3.7× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$57 |
$570 |
0.3× |
| CT cervical spine w&w/o contrast (72127) |
$576.10 |
$5,761 |
3.3× |
| CT cervical spine with contrast (72126) |
$353.80 |
$3,538 |
1.0× |
| CT chest w/wo contrast (71270) |
$786.40 |
$7,864 |
4.5× |
| CT chest with contrast (71260) |
$520.10 |
$5,201 |
3.0× |
| CT head/brain with contrast (70460) |
$508.10 |
$5,081 |
2.9× |
| CT head/brain without and with contrast (70470) |
$576.10 |
$5,761 |
3.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$10.80 |
$108 |
0.1× |
| CT iac w contrast (70481) |
$55.50 |
$555 |
0.3× |
| CT limited/localized follow up study (76380) |
$26.70 |
$267 |
0.3× |
| CT lower ext w/o (73700) |
$663.75 |
$6,637.50 |
6.3× |
| CT lower extremity w wo contrast (73702) |
$58.70 |
$587 |
0.3× |
| CT lower extremity with contrast (73701) |
$520.10 |
$5,201 |
3.0× |
| CT lumbar spine w & w/o contrast (72133) |
$605 |
$6,050 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$531 |
$5,310 |
5.1× |
| CT lumbar spine with contrast (72132) |
$490.30 |
$4,903 |
1.4× |
| CT maxillofacial w contrast (70487) |
$508.10 |
$5,081 |
2.9× |
| CT maxillofacial w/o contrast (70486) |
$388.90 |
$3,889 |
3.7× |
| CT maxillofacial w/wo contrast (70488) |
$576.10 |
$5,761 |
3.3× |
| CT neck soft tissue w contrast (70491) |
$381 |
$3,810 |
2.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$576.10 |
$5,761 |
3.3× |
| CT orbits w/o contrast (70480) |
$388.90 |
$3,889 |
3.7× |
| CT pelvis w & w/o contrast (72194) |
$576.10 |
$5,761 |
3.3× |
| CT pelvis w/o contrast (72192) |
$398.20 |
$3,982 |
3.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$576.10 |
$5,761 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$388.90 |
$3,889 |
3.7× |
| CT thoracic spine w/contrast (72129) |
$461 |
$4,610 |
2.6× |
| CT thoracic spine w/o contrast (72128) |
$531 |
$5,310 |
5.1× |
| CT thoracic spine w/wo contrast (72130) |
$605 |
$6,050 |
3.4× |
| CT thorax w/o contrast (71250) |
$531 |
$5,310 |
5.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$786.40 |
$7,864 |
4.5× |
| CT upper extremity w/o contrast rt (73200) |
$398.20 |
$3,982 |
3.8× |
| CT upper extremity with contrast (73201) |
$693.50 |
$6,935 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$600.50 |
$6,005 |
3.4× |
| Cta Abdomen (74175) |
$523 |
$5,230 |
3.0× |
| CTA abdomen pelvis (74174) |
$834.10 |
$8,341 |
2.4× |
| CTA chest (71275) |
$536.90 |
$5,369 |
3.0× |
| Cta Head (70496) |
$364 |
$3,640 |
2.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$717.80 |
$7,178 |
2.0× |
| CTA lwr ext w&w/o contrast (73706) |
$627.50 |
$6,275 |
3.6× |
| Cta Neck (70498) |
$353.80 |
$3,538 |
2.0× |
| Cta Pelvis (72191) |
$59.30 |
$593 |
0.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$86.50 |
$865 |
0.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86.50 |
$865 |
1.0× |
| Dxa bone density study axial skeleton (77085) |
$64.70 |
$647 |
0.6× |
| Echo fetal cardiovasc w/wo m-mode repeat std (76826) |
$91.60 |
$916 |
0.4× |
| Fetal biophysical profile non-stress testing (76818) |
$110.80 |
$1,108 |
1.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$147.80 |
$1,478 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$141.20 |
$1,412 |
0.6× |
| Foot 2 views (73620) |
$122.88 |
$1,228.75 |
1.4× |
| Forearm 2 views (73090) |
$73.70 |
$737 |
0.8× |
| Gated Heart Planar Single (78472) |
$346.10 |
$3,461 |
0.9× |
| Hand 2 views (73120) |
$98.30 |
$983 |
0.9× |
| Hand 3 views (73130) |
$136 |
$1,360 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$424 |
$4,240 |
0.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$394.40 |
$3,944 |
1.0× |
| Ht muscle image spect sing (78451) |
$526.10 |
$5,261 |
0.4× |
| Humerus Min 2 Views Left (73060) |
$98.30 |
$983 |
1.1× |
| Hysterosalpingogram (74740) |
$398.90 |
$3,989 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$162.20 |
$1,622 |
0.3× |
| Knee 3 views (73562) |
$136 |
$1,360 |
1.6× |
| Lung perf&ventilat diferentl (78598) |
$173.60 |
$1,736 |
0.3× |
| MRA head w & w/o contrast (70546) |
$637.70 |
$6,377 |
1.8× |
| MRA head w/o contrast (70544) |
$627.10 |
$6,271 |
2.6× |
| MRA head with contrast (70545) |
$368 |
$3,680 |
1.1× |
| MRA neck w contrast (70548) |
$746.30 |
$7,463 |
2.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$848.50 |
$8,485 |
2.4× |
| MRA neck w/o contrast (70547) |
$627.10 |
$6,271 |
2.6× |
| MRI abdomen w contrast (74182) |
$371.20 |
$3,712 |
1.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$673.70 |
$6,737 |
1.9× |
| MRI abdomen w/o contrast (74181) |
$664 |
$6,640 |
2.8× |
| MRI any jnt lwr ext with con lt (73722) |
$407.40 |
$4,074 |
0.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$408.50 |
$4,085 |
0.5× |
| MRI c-spine with contrast (72142) |
$114.40 |
$1,144 |
0.3× |
| MRI cervical spine w/o contrast (72141) |
$624 |
$6,240 |
2.6× |
| MRI chest w/o & w/contrast material (71552) |
$898.20 |
$8,982 |
2.6× |
| MRI chest w/o contrast (71550) |
$664 |
$6,640 |
2.8× |
| MRI chest with contrast (71551) |
$222 |
$2,220 |
0.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$379.80 |
$3,798 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$418.10 |
$4,181 |
1.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$664 |
$6,640 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$627.10 |
$6,271 |
2.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$848.50 |
$8,485 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$400.20 |
$4,002 |
1.1× |
| MRI pelvis w contrast (72196) |
$430.60 |
$4,306 |
1.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$898.20 |
$8,982 |
2.6× |
| MRI pelvis w/o contrast (72195) |
$664 |
$6,640 |
2.8× |
| MRI scan of arm joint before and after contrast (73223) |
$898.20 |
$8,982 |
2.6× |
| MRI scan of leg joint before and after contrast (73723) |
$898.20 |
$8,982 |
2.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$848.50 |
$8,485 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$627.10 |
$6,271 |
1.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$673.70 |
$6,737 |
1.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$114.40 |
$1,144 |
0.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$898.20 |
$8,982 |
2.6× |
| MRI thoracic spine w/o contrast (72146) |
$664 |
$6,640 |
2.8× |
| MRI upper ext joint w/o contrast (73221) |
$498 |
$4,980 |
2.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$898.20 |
$8,982 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$664 |
$6,640 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$860.60 |
$8,606 |
0.7× |
| Neck soft tissue (70360) |
$84.30 |
$843 |
1.0× |
| Nm bone marrow wb (78104) |
$204.90 |
$2,049 |
0.5× |
| Nm gastric emptying study (78264) |
$267.20 |
$2,672 |
0.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$135.80 |
$1,358 |
1.3× |
| Osseous survey infant (77076) |
$36 |
$360 |
0.3× |
| Osseous survey limited (77074) |
$272.60 |
$2,726 |
2.6× |
| Parathyrd planar w/wo subtrj (78071) |
$204.30 |
$2,043 |
0.5× |
| Parathyroid imaging (78070) |
$125 |
$1,250 |
0.3× |
| Pelvis 1 or 2 views (72170) |
$98.30 |
$983 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$898.20 |
$8,982 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$341 |
$3,410 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$477.30 |
$4,773 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$98.30 |
$983 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$200.10 |
$2,001 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$108.80 |
$1,088 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$109.30 |
$1,093 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$62 |
$620 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$64.10 |
$641 |
0.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$90.60 |
$906 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$271.30 |
$2,713 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$98.30 |
$983 |
1.1× |
| Ribs bilateral 3 views (71110) |
$42.10 |
$421 |
0.4× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$474.70 |
$4,747 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$84.90 |
$849 |
0.8× |
| Scanogram (77073) |
$43.50 |
$435 |
0.4× |
| Scapula complete (73010) |
$98.30 |
$983 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$24.10 |
$241 |
1.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$35.40 |
$354 |
0.3× |
| Spine thoracic 3 views (72072) |
$107.30 |
$1,073 |
1.0× |
| Thoracolumbar 2 views (72080) |
$98.30 |
$983 |
1.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$137.20 |
$1,372 |
0.3× |
| Tmj unilateral (70328) |
$28.40 |
$284 |
0.3× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$254.90 |
$2,549 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$272.40 |
$2,724 |
2.6× |
| Umbilical-artery Doppler (OB) (76820) |
$93.80 |
$938 |
0.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$115.10 |
$1,151 |
1.3× |
| Upper Extremity Infant (73092) |
$43.50 |
$435 |
0.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$422.10 |
$4,221 |
2.4× |
| Us abdl aorta screen aaa (76706) |
$119.60 |
$1,196 |
1.1× |
| Us breast unilateral complete (76641) |
$66 |
$660 |
0.6× |
| Us breast unilateral limited (76642) |
$55.90 |
$559 |
0.6× |
| Us chest (76604) |
$116.90 |
$1,169 |
1.1× |
| Us compl joint r-t w/image documentation (76881) |
$90.20 |
$902 |
0.9× |
| Us guided compression repair (76936) |
$109.60 |
$1,096 |
0.5× |
| Us infant hips dynamic (76885) |
$32.30 |
$323 |
0.4× |
| Us infant hips limited static (76886) |
$29.30 |
$293 |
0.3× |
| Us kidney transplant (76776) |
$152.20 |
$1,522 |
1.4× |
| Us ob detailed single fetus (76811) |
$94.10 |
$941 |
0.4× |
| Us ob transvaginal (76817) |
$229.50 |
$2,295 |
2.2× |
| Us pelvic non ob complete (76856) |
$295.10 |
$2,951 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$132.50 |
$1,325 |
1.3× |
| Us pregnancy ltd (76815) |
$170.70 |
$1,707 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$204.70 |
$2,047 |
1.9× |
| Us retroperitoneal complete (76770) |
$220.20 |
$2,202 |
2.1× |
| Us retroperitoneal limited (76775) |
$280.20 |
$2,802 |
2.7× |
| Us scrotum and contents (76870) |
$168.90 |
$1,689 |
1.6× |
| Us soft tissue head/neck (76536) |
$213.50 |
$2,135 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$63.60 |
$636 |
0.6× |
| Wrist 2 views (73100) |
$98.30 |
$983 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$155.90 |
$1,559 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$108.80 |
$1,088 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$108.80 |
$1,088 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$98.30 |
$983 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$108.80 |
$1,088 |
1.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$42.10 |
$421 |
0.4× |
| X-ray exam hip uni 1 view (73501) |
$86.10 |
$861 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$98.30 |
$983 |
1.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133.20 |
$1,332 |
1.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$38.40 |
$384 |
0.4× |
| X-ray exam of femur 1 (73551) |
$98.30 |
$983 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$108.80 |
$1,088 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$98.30 |
$983 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$136 |
$1,360 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$98.30 |
$983 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$26.90 |
$269 |
0.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$147.25 |
$1,472.50 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$108.80 |
$1,088 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$31.30 |
$313 |
0.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$98.30 |
$983 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$316.40 |
$3,164 |
3.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$112.70 |
$1,127 |
1.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$109.30 |
$1,093 |
1.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$114.60 |
$1,146 |
1.3× |
| X-ray of voice box or throat (70370) |
$130.60 |
$1,306 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$109.30 |
$1,093 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$43.50 |
$435 |
0.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$47.50 |
$475 |
0.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$108.80 |
$1,088 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$124.60 |
$1,246 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$97.30 |
$973 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$98.30 |
$983 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$92.12 |
$921.25 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$109.30 |
$1,093 |
1.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$64.80 |
$648 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$131.70 |
$1,317 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$109.30 |
$1,093 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$31.30 |
$313 |
0.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$98.30 |
$983 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$64.10 |
$641 |
0.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$91.20 |
$912 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$98.30 |
$983 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$136 |
$1,360 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$141.30 |
$1,413 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$98.30 |
$983 |
1.1× |
| Xr shoulder 1 view (73020) |
$86.10 |
$861 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$132.70 |
$1,327 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$92.12 |
$921.25 |
1.1× |
| Xr tmj bilateral (70330) |
$117.80 |
$1,178 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$136.12 |
$1,361.25 |
1.6× |