| Abdomen 2 views (74019) |
— |
$121.50 |
— |
| Acute gastrointestinal blood loss imaging (78278) |
— |
$602.60 |
— |
| Angiography Adrenal Bilateral Slctv Rs&I (75733) |
— |
$720 |
— |
| Angiography extremity bilateral rs&i (75716) |
— |
$732.30 |
— |
| Ankle 2 views (73600) |
— |
$89.60 |
— |
| Antegrade urography radiological supvj & interpj (74425) |
— |
$590.20 |
— |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
— |
$489.30 |
— |
| Aortography abdominal serialography rs&i (75625) |
— |
$545.90 |
— |
| Arthrogram elbow (73085) |
— |
$496.50 |
— |
| Arthrogram hip (73525) |
— |
$2,483.30 |
— |
| Arthrogram shoulder (73040) |
— |
$772.50 |
— |
| Arthrogram wrist (73115) |
— |
$579.90 |
— |
| Arthrography knee lt (73580) |
— |
$979.50 |
— |
| Bone &/Joint Imaging Limited Area (78300) |
— |
$879.60 |
— |
| Bone &/joint imaging whole body (78306) |
— |
$1,370.90 |
— |
| Bone age studies (77072) |
— |
$255.40 |
— |
| Bone Imaging 3 Phase (78315) |
— |
$1,917.90 |
— |
| Cervical spine 2 or 3 views (72040) |
$90 |
$121.50 |
1.0× |
| Chest 1 view (71045) |
— |
$102 |
— |
| Chest 3 views (71047) |
— |
$277.10 |
— |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
— |
$402.70 |
— |
| Clavicle complete (73000) |
— |
$90.60 |
— |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
— |
$372.90 |
— |
| CT abdomen and pelvis without and with contrast (74178) |
$690 |
$5,147.90 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$645 |
$4,142.70 |
2.7× |
| CT abdomen w contrast (74160) |
$662.50 |
$2,439 |
3.8× |
| CT abdomen w wo contrast (74170) |
$632.50 |
$2,608 |
3.6× |
| CT abdomen w/o contrast (74150) |
$695 |
$3,641.55 |
6.6× |
| CT angio hrt w/3d image (75574) |
$612.50 |
$707.60 |
1.8× |
| CT angiography upper extremity lt (73206) |
$607.50 |
$869.30 |
3.5× |
| CT c-spine w/o contrast (72125) |
$695 |
$2,356.60 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$707.50 |
$2,545.10 |
4.0× |
| CT cervical spine with contrast (72126) |
$865 |
$2,419.50 |
2.5× |
| CT chest w/wo contrast (71270) |
— |
$3,173.40 |
— |
| CT chest with contrast (71260) |
— |
$2,344.30 |
— |
| CT head/brain with contrast (70460) |
$762.50 |
$2,234.10 |
4.3× |
| CT head/brain without and with contrast (70470) |
$737.50 |
$2,582.20 |
4.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
— |
$474.80 |
— |
| CT heart no contrast quant eval coronry calcium (75571) |
— |
$51.50 |
— |
| CT iac w contrast (70481) |
$722.50 |
$2,234.10 |
4.1× |
| CT limited/localized follow up study (76380) |
— |
$807.05 |
— |
| CT lower ext w/o (73700) |
$695 |
$1,798.40 |
6.6× |
| CT lower extremity w wo contrast (73702) |
$707.50 |
$2,133.10 |
4.0× |
| CT lower extremity with contrast (73701) |
$742.50 |
$1,963.20 |
4.2× |
| CT lumbar spine w & w/o contrast (72133) |
$707.50 |
$2,730.50 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$695 |
$2,391.70 |
6.6× |
| CT lumbar spine with contrast (72132) |
$865 |
$2,606.90 |
2.5× |
| CT maxillofacial w contrast (70487) |
$757.50 |
$2,234.10 |
4.3× |
| CT maxillofacial w/o contrast (70486) |
$685 |
$2,019.30 |
6.5× |
| CT maxillofacial w/wo contrast (70488) |
$722.50 |
$2,582.20 |
4.1× |
| CT neck soft tissue w contrast (70491) |
$732.50 |
$2,158.90 |
4.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$692.50 |
$2,582.20 |
3.9× |
| CT orbits w/o contrast (70480) |
$670 |
$2,047.60 |
6.4× |
| CT pelvis w & w/o contrast (72194) |
$632.50 |
$2,541 |
3.6× |
| CT pelvis w/o contrast (72192) |
$695 |
$2,007.50 |
6.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$692.50 |
$2,243.30 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$685 |
$2,116.70 |
6.5× |
| CT thoracic spine w/contrast (72129) |
$742.50 |
$1,991 |
4.2× |
| CT thoracic spine w/o contrast (72128) |
$695 |
$1,651.10 |
6.6× |
| CT thoracic spine w/wo contrast (72130) |
$707.50 |
$2,141.40 |
4.0× |
| CT thorax w/o contrast (71250) |
$695 |
$2,150.60 |
6.6× |
| CT upper extremity w/o contrast rt (73200) |
— |
$2,358.70 |
— |
| CT upper extremity with contrast (73201) |
$697.50 |
$2,482.30 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
— |
$1,223.60 |
— |
| Cta Abdomen (74175) |
$597.50 |
$1,897.25 |
3.4× |
| CTA abdomen pelvis (74174) |
$522.50 |
$1,173.20 |
1.5× |
| CTA chest (71275) |
— |
$2,344.30 |
— |
| Cta Head (70496) |
$667.50 |
$1,737.60 |
3.8× |
| CTA lwr ext w&w/o contrast (73706) |
$582.50 |
$1,084.60 |
3.3× |
| Cta Neck (70498) |
$632.50 |
$1,862.20 |
3.6× |
| Cystography minimum 3 views rs&i (74430) |
— |
$360.50 |
— |
| Dxa bone density study 1/> sites axial skel (77080) |
$90 |
$214.20 |
0.9× |
| Esophagus (74220) |
$210 |
$447 |
1.2× |
| Fetal biophysical profile non-stress testing (76818) |
— |
$1,723.20 |
— |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$160 |
$605.10 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
— |
$403.80 |
— |
| Foot 2 views (73620) |
— |
$98.90 |
— |
| Forearm 2 views (73090) |
— |
$83.95 |
— |
| Gated Heart Planar Single (78472) |
— |
$1,811.80 |
— |
| Hand 2 views (73120) |
— |
$46.40 |
— |
| Hand 3 views (73130) |
$110 |
$100.90 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$460 |
$1,443 |
0.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
— |
$1,799.40 |
— |
| Ht muscle image spect sing (78451) |
— |
$883.70 |
— |
| Humerus Min 2 Views Left (73060) |
— |
$95.80 |
— |
| Hysterosalpingogram (74740) |
— |
$558.30 |
— |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
— |
$49.95 |
— |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
— |
$1,691.30 |
— |
| Kidney img morphology vascular flow 1 w/rx (78708) |
— |
$2,904.60 |
— |
| Knee 3 views (73562) |
$130 |
$116.40 |
1.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
— |
$474.30 |
— |
| Liver imaging w/vascular flow (78202) |
— |
$779.70 |
— |
| Lung Ventilation Imaging (78579) |
— |
$726.20 |
— |
| Lymphoscintigraphy (78195) |
— |
$1,862.20 |
— |
| Mammary ductogram or galactogram single (77053) |
— |
$1,366.80 |
— |
| Meckels Diverticulum (78290) |
— |
$726.20 |
— |
| MRA head w/o contrast (70544) |
— |
$2,165.10 |
— |
| MRA neck w contrast (70548) |
— |
$2,331.90 |
— |
| Mra Neck W/O &W/Contrast Material (70549) |
— |
$1,731.95 |
— |
| MRA neck w/o contrast (70547) |
— |
$2,217.60 |
— |
| MRI abdomen w/o & w/contrast material (74183) |
$700 |
$3,227 |
2.0× |
| MRI abdomen w/o contrast (74181) |
$705 |
$2,324.35 |
2.9× |
| MRI any jnt lwr ext with con lt (73722) |
$875 |
$2,545.10 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$875 |
$2,248.50 |
1.1× |
| MRI breast w/o contrast bilateral (77047) |
— |
$2,234.10 |
— |
| MRI breast w/o contrast unilat (77046) |
— |
$1,737.60 |
— |
| MRI c-spine with contrast (72142) |
$760 |
$2,606.90 |
2.2× |
| MRI cervical spine w/o contrast (72141) |
$710 |
$2,606.90 |
3.0× |
| MRI chest w/o & w/contrast material (71552) |
$530 |
$2,730.50 |
1.5× |
| MRI chest w/o contrast (71550) |
$520 |
$2,390.60 |
2.2× |
| MRI chest with contrast (71551) |
$800 |
$2,482.30 |
1.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$660 |
$2,500.80 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$655 |
$2,250.60 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$695 |
$2,858.30 |
2.0× |
| MRI pelvis w contrast (72196) |
$765 |
$2,234.10 |
2.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$705 |
$2,381.40 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$660 |
$1,862.20 |
2.8× |
| MRI scan of arm joint before and after contrast (73223) |
$635 |
$2,698.60 |
1.8× |
| MRI scan of leg joint before and after contrast (73723) |
$635 |
$2,606.90 |
1.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$730 |
$2,855.20 |
2.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$765 |
$2,855.20 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$730 |
$3,103.40 |
2.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$760 |
$2,667.70 |
2.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$730 |
$2,855.20 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$710 |
$2,482.30 |
3.0× |
| MRI tmj (70336) |
— |
$1,562.50 |
— |
| MRI upper ext joint w/o contrast (73221) |
$690 |
$2,423.60 |
2.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$605 |
$2,606.90 |
1.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$555 |
$2,358.70 |
2.3× |
| Myelogram Cervical (72240) |
— |
$151.40 |
— |
| Myocardial Spect Multiple Studies (78452) |
— |
$4,028.30 |
— |
| Neck soft tissue (70360) |
— |
$248.20 |
— |
| Nm gastric emptying study (78264) |
— |
$1,605.80 |
— |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
— |
$340.90 |
— |
| Osseous survey infant (77076) |
— |
$372.90 |
— |
| Osseous survey limited (77074) |
— |
$473.80 |
— |
| Parathyroid imaging (78070) |
— |
$1,284.40 |
— |
| Pelvis 1 or 2 views (72170) |
$210 |
$104 |
2.0× |
| PET image w/CT, skull-thigh (78815) |
— |
$3,351.65 |
— |
| PET imaging for CT attenuation whole body (78816) |
— |
$3,072 |
— |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$700 |
$2,698.60 |
2.0× |
| Pulmonary Perfusion Imaging Particulate (78580) |
— |
$726.20 |
— |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
— |
$2,297.90 |
— |
| Radex abscess/fistula/sinus tract rs&i (76080) |
— |
$1,060.90 |
— |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$110 |
$320.30 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$200 |
$402.70 |
1.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
— |
$311.10 |
— |
| Radiolog exam mandible compl minimum 4 views (70110) |
— |
$124.60 |
— |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$105 |
$313.10 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$115 |
$90.60 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
— |
$621.10 |
— |
| Radiologic exam upr gi trc double contrast study (74246) |
— |
$784.85 |
— |
| Radiologic exam upr gi trc single contrast study (74240) |
— |
$748.80 |
— |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
— |
$221.50 |
— |
| Radiological examination surgical specimen (76098) |
— |
$226.60 |
— |
| Rp loclzj tum spect 1 area single day imaging (78803) |
— |
$1,647 |
— |
| Sacroiliac Joints < 3 Views (72200) |
— |
$322.40 |
— |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
— |
$558.30 |
— |
| Scanogram (77073) |
— |
$167.90 |
— |
| Scapula complete (73010) |
— |
$99.90 |
— |
| Screening digital breast tomosynthesis (77063) |
— |
$98.35 |
— |
| Sialogram (70390) |
— |
$313.10 |
— |
| Small bowel series (74250) |
— |
$682.90 |
— |
| Spine thoracic 3 views (72072) |
— |
$115.40 |
— |
| Spleen imaging only (78185) |
— |
$713.80 |
— |
| Thyroid Imaging With Vascular Flow (78013) |
— |
$899.20 |
— |
| Thyroid uptake measurement (78012) |
— |
$728.20 |
— |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
— |
$2,242.30 |
— |
| Tomogram (76100) |
— |
$217.30 |
— |
| Ultrasound, abdomen limited (76705) |
$225 |
$304.90 |
2.1× |
| Unlisted Ultrasound Procedure (76999) |
— |
$500.60 |
— |
| Upper Extremity Infant (73092) |
— |
$95.80 |
— |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
— |
$474.85 |
— |
| Urethrocystography retrograde rs&i (74450) |
— |
$466.60 |
— |
| Urethrocystography voiding (74455) |
— |
$558.30 |
— |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$682.90 |
— |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
— |
$881.70 |
— |
| Us abdl aorta screen aaa (76706) |
— |
$918.80 |
— |
| Us breast unilateral complete (76641) |
$220 |
$692.20 |
2.1× |
| Us breast unilateral limited (76642) |
$100 |
$607.15 |
1.1× |
| Us chest (76604) |
— |
$430.50 |
— |
| Us compl joint r-t w/image documentation (76881) |
— |
$412 |
— |
| Us ob transvaginal (76817) |
— |
$378.50 |
— |
| Us pelvic non ob complete (76856) |
$100 |
$365.70 |
1.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
— |
$356.90 |
— |
| Us pregnancy ltd (76815) |
$160 |
$177 |
1.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$160 |
$395.95 |
1.5× |
| Us retroperitoneal complete (76770) |
$255 |
$1,391 |
2.4× |
| Us retroperitoneal limited (76775) |
$300 |
$1,080 |
2.9× |
| Us scrotum and contents (76870) |
— |
$731.30 |
— |
| Us soft tissue head/neck (76536) |
$240 |
$682.90 |
2.3× |
| Us spinal canal and contents (76800) |
— |
$434.70 |
— |
| Us transrectal (76872) |
— |
$196.20 |
— |
| Us xtr non-vasc lmtd (76882) |
— |
$44.30 |
— |
| Wrist 2 views (73100) |
— |
$95.80 |
— |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
— |
$144.20 |
— |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$113.30 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$110 |
$98.90 |
1.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$762.20 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
— |
$89.60 |
— |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
— |
$102 |
— |
| X-ray exam hip uni 1 view (73501) |
— |
$124.60 |
— |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$100 |
$99.90 |
1.1× |
| X-ray exam hip uni 4/> views (73503) |
— |
$58.70 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$100 |
$434.70 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
— |
$280.20 |
— |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$115 |
$95.80 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
— |
$89.60 |
— |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$205 |
$129.80 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
— |
$74.20 |
— |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$167.90 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$160 |
$115.40 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
— |
$775.60 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
— |
$107.10 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
— |
$143.20 |
— |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
— |
$527.40 |
— |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$115 |
$109.20 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
— |
$120.50 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$103 |
— |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
— |
$93.70 |
— |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$115 |
$95.80 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
— |
$124.60 |
— |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
— |
$191.60 |
— |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
— |
$447 |
— |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
— |
$311.10 |
— |
| X-Ray Spine One View - Xr Spine (72020) |
— |
$74.20 |
— |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
— |
$118.50 |
— |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$115 |
$98.90 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$145 |
$111.20 |
1.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$639.60 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
— |
$92.70 |
— |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$105 |
$115.40 |
1.2× |
| Xr c-spine 6 or more views (72052) |
— |
$187.50 |
— |
| Xr chest 4+ views (71048) |
— |
$405.80 |
— |
| Xr finger(s) 2+ views (73140) |
— |
$103 |
— |
| Xr shoulder 1 view (73020) |
— |
$75.20 |
— |
| Xr spine cervical 4 or 5 views (72050) |
$135 |
$120 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
— |
$94.80 |
— |
| Xr tmj bilateral (70330) |
— |
$328.60 |
— |
| Xray knee 1 or 2 views rt (73560) |
$115 |
$102 |
1.3× |