| Abdomen 2 views (74019) |
$112.50 |
$150 |
1.2× |
| Acute gastrointestinal blood loss imaging (78278) |
$1,050 |
$1,400 |
3.0× |
| Ankle 2 views (73600) |
$157.50 |
$210 |
2.1× |
| Antegrade urography radiological supvj & interpj (74425) |
$465.75 |
$621 |
1.5× |
| Arthrogram elbow (73085) |
$206.28 |
$275.04 |
0.7× |
| Arthrogram hip (73525) |
$282.75 |
$377 |
0.9× |
| Arthrogram shoulder (73040) |
$206.25 |
$275 |
0.7× |
| Arthrogram wrist (73115) |
$150 |
$200 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$375 |
$500 |
1.1× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$375 |
$500 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$375 |
$500 |
1.1× |
| Bone age studies (77072) |
$112.50 |
$150 |
1.2× |
| Bone Imaging 3 Phase (78315) |
$562.50 |
$750 |
1.6× |
| Bone survey complete (77075) |
$300 |
$400 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$67.50 |
$90 |
0.9× |
| Chest 1 view (71045) |
$93.38 |
$124.50 |
1.2× |
| Chest 3 views (71047) |
$75 |
$100 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$187.50 |
$250 |
1.2× |
| Clavicle complete (73000) |
$157.50 |
$210 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$75 |
$100 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$375 |
$500 |
1.2× |
| CT abdomen and pelvis without contrast (74176) |
$375 |
$500 |
1.8× |
| CT abdomen w contrast (74160) |
$375 |
$500 |
2.5× |
| CT abdomen w wo contrast (74170) |
$375 |
$500 |
2.5× |
| CT abdomen w/o contrast (74150) |
$375 |
$500 |
4.2× |
| CT c-spine w/o contrast (72125) |
$225 |
$300 |
2.5× |
| CT cervical spine w&w/o contrast (72127) |
$450 |
$600 |
3.0× |
| CT cervical spine with contrast (72126) |
$450 |
$600 |
1.5× |
| CT chest w/wo contrast (71270) |
$450 |
$600 |
3.0× |
| CT chest with contrast (71260) |
$450 |
$600 |
3.0× |
| CT head/brain with contrast (70460) |
$450 |
$600 |
3.0× |
| CT head/brain without and with contrast (70470) |
$450 |
$600 |
3.0× |
| CT iac w contrast (70481) |
$450 |
$600 |
3.0× |
| CT limited/localized follow up study (76380) |
$225 |
$300 |
3.0× |
| CT lower ext w/o (73700) |
$225 |
$300 |
2.5× |
| CT lower extremity w wo contrast (73702) |
$450 |
$600 |
3.0× |
| CT lower extremity with contrast (73701) |
$262.50 |
$350 |
1.7× |
| CT lumbar spine w & w/o contrast (72133) |
$450 |
$600 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$225 |
$300 |
2.5× |
| CT lumbar spine with contrast (72132) |
$337.50 |
$450 |
1.1× |
| CT maxillofacial w contrast (70487) |
$450 |
$600 |
3.0× |
| CT maxillofacial w/o contrast (70486) |
$225 |
$300 |
2.5× |
| CT maxillofacial w/wo contrast (70488) |
$450 |
$600 |
3.0× |
| CT neck soft tissue w contrast (70491) |
$450 |
$600 |
3.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$450 |
$600 |
3.0× |
| CT orbits w/o contrast (70480) |
$225 |
$300 |
2.5× |
| CT pelvis w & w/o contrast (72194) |
$450 |
$600 |
3.0× |
| CT pelvis w/o contrast (72192) |
$375 |
$500 |
4.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$262.50 |
$350 |
1.7× |
| CT soft tissue neck w/o contrast (70490) |
$225 |
$300 |
2.5× |
| CT thoracic spine w/contrast (72129) |
$450 |
$600 |
3.0× |
| CT thoracic spine w/o contrast (72128) |
$225 |
$300 |
2.5× |
| CT thoracic spine w/wo contrast (72130) |
$450 |
$600 |
3.0× |
| CT thorax w/o contrast (71250) |
$225 |
$300 |
2.5× |
| CT unlisted procedure (76497) |
$187.50 |
$250 |
2.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$450 |
$600 |
3.0× |
| CT upper extremity w/o contrast rt (73200) |
$225 |
$300 |
2.5× |
| CT upper extremity with contrast (73201) |
$450 |
$600 |
1.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$337.50 |
$450 |
2.2× |
| Cta Abdomen (74175) |
$337.50 |
$450 |
2.2× |
| CTA abdomen pelvis (74174) |
$375 |
$500 |
1.2× |
| CTA chest (71275) |
$337.50 |
$450 |
2.2× |
| Cta Head (70496) |
$337.50 |
$450 |
2.2× |
| CTA lwr ext w&w/o contrast (73706) |
$337.50 |
$450 |
2.2× |
| Cta Neck (70498) |
$450 |
$600 |
3.0× |
| Cta Pelvis (72191) |
$450 |
$600 |
3.0× |
| Cystography minimum 3 views rs&i (74430) |
$450 |
$600 |
1.5× |
| Diskography lumbar (72295) |
$750 |
$1,000 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$105 |
$140 |
1.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$105 |
$140 |
1.4× |
| Dxa bone density study axial skeleton (77085) |
$225 |
$300 |
2.5× |
| Echoencephalography real time imaging (76506) |
$194.25 |
$259 |
2.2× |
| Esophagus (74220) |
$192 |
$256 |
1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$150 |
$200 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$56.25 |
$75 |
0.3× |
| Foot 2 views (73620) |
$159.75 |
$213 |
2.1× |
| Forearm 2 views (73090) |
$159.75 |
$213 |
2.1× |
| Gated Heart Planar Single (78472) |
$696.75 |
$929 |
2.0× |
| Hand 2 views (73120) |
$165 |
$220 |
1.8× |
| Hand 3 views (73130) |
$165 |
$220 |
2.2× |
| Heart Infarct Image (78466) |
$369 |
$492 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$412.50 |
$550 |
0.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$412.50 |
$550 |
1.2× |
| Ht muscle image spect sing (78451) |
$1,200 |
$1,600 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$155.62 |
$207.50 |
2.1× |
| Hysterosalpingogram (74740) |
$262.50 |
$350 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$375 |
$500 |
0.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$375 |
$500 |
0.8× |
| Knee 3 views (73562) |
$176.25 |
$235 |
2.4× |
| Liver & spleen imaging static only (78215) |
$366 |
$488 |
1.1× |
| Lung Ventilation Imaging (78579) |
$412.50 |
$550 |
1.2× |
| Mammary ductogram or galactogram multiple (77054) |
$150 |
$200 |
0.7× |
| Mammary ductogram or galactogram single (77053) |
$472.50 |
$630 |
2.3× |
| Meckels Diverticulum (78290) |
$333 |
$444 |
1.0× |
| Myelogram Cervical (72240) |
$750 |
$1,000 |
1.1× |
| Myelogram Lumbar (72265) |
$562.12 |
$749.50 |
0.8× |
| Myelogram thoracic (72255) |
$750 |
$1,000 |
1.1× |
| Neck soft tissue (70360) |
$67.50 |
$90 |
0.9× |
| Nm gastric emptying study (78264) |
$412.50 |
$550 |
1.2× |
| Nuclear medicine study to assess blood clot in vein of both sides (78458) |
$533.25 |
$711 |
1.5× |
| Nuclear medicine study to assess blood clot in vein of side (78457) |
$381 |
$508 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$344.25 |
$459 |
3.8× |
| Osseous survey infant (77076) |
$180 |
$240 |
2.0× |
| Osseous survey limited (77074) |
$105 |
$140 |
1.2× |
| Parathyroid imaging (78070) |
$1,050 |
$1,400 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$105 |
$140 |
1.2× |
| Peritoneogram rs&i (74190) |
$375 |
$500 |
0.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,050 |
$1,400 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,050 |
$1,400 |
2.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$375 |
$500 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$67.50 |
$90 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$105 |
$140 |
1.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$172.50 |
$230 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$105 |
$140 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$112.50 |
$150 |
1.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$151.50 |
$202 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$187.50 |
$250 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$187.50 |
$250 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$187.50 |
$250 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$67.50 |
$90 |
0.9× |
| Radiological examination surgical specimen (76098) |
$487.50 |
$650 |
1.0× |
| Ribs bilateral 3 views (71110) |
$187.50 |
$250 |
2.1× |
| Scapula complete (73010) |
$159.75 |
$213 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$150 |
$200 |
6.4× |
| Sella turcica (70240) |
$126 |
$168 |
1.7× |
| Small bowel series (74250) |
$187.50 |
$250 |
1.2× |
| Speech evaluation complex (70371) |
$300 |
$400 |
1.5× |
| Spine thoracic 3 views (72072) |
$105 |
$140 |
1.2× |
| Testicular Imaging With Vascular Flow (78761) |
$487.50 |
$650 |
1.4× |
| Thoracolumbar 2 views (72080) |
$146.25 |
$195 |
2.0× |
| Thyroid Imaging With Vascular Flow (78013) |
$412.50 |
$550 |
1.2× |
| Tumor Imaging, Limited Area - Nm Tumor Localization Limited (78800) |
$300 |
$400 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$225 |
$300 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$157.50 |
$210 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$489 |
$652 |
2.4× |
| Urethrocystography voiding (74455) |
$262.50 |
$350 |
1.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$450 |
$600 |
3.0× |
| Us abdl aorta screen aaa (76706) |
$150 |
$200 |
1.7× |
| Us breast unilateral complete (76641) |
$225 |
$300 |
2.5× |
| Us breast unilateral limited (76642) |
$225 |
$300 |
3.0× |
| Us chest (76604) |
$225 |
$300 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$225 |
$300 |
2.5× |
| Us elastography parenchyma (76981) |
$187.50 |
$250 |
2.1× |
| Us guided compression repair (76936) |
$516 |
$688 |
2.8× |
| Us kidney transplant (76776) |
$354 |
$472 |
3.9× |
| Us ob transvaginal (76817) |
$150 |
$200 |
1.7× |
| Us pelvic non ob complete (76856) |
$225 |
$300 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$225 |
$300 |
2.5× |
| Us pregnancy ltd (76815) |
$420 |
$560 |
4.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$150 |
$200 |
1.7× |
| Us retroperitoneal complete (76770) |
$254.25 |
$339 |
2.8× |
| Us retroperitoneal limited (76775) |
$225 |
$300 |
2.5× |
| Us scrotum and contents (76870) |
$225 |
$300 |
2.5× |
| Us soft tissue head/neck (76536) |
$346.39 |
$461.85 |
3.8× |
| Us transrectal (76872) |
$225 |
$300 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$225 |
$300 |
2.5× |
| Venogram extremity bilateral (75822) |
$187.50 |
$250 |
0.1× |
| Venography caval inferior serialography rs&i (75825) |
$1,519.94 |
$2,026.59 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$187.50 |
$250 |
0.1× |
| Vertebral fracture assessment via dxa (77086) |
$135 |
$180 |
1.8× |
| Wrist 2 views (73100) |
$159.75 |
$213 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$105 |
$140 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$138.75 |
$185 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$165 |
$220 |
2.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$150 |
$200 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$159.75 |
$213 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$67.50 |
$90 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$67.50 |
$90 |
0.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$222 |
$296 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$105 |
$140 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$159.75 |
$213 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$165 |
$220 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$67.50 |
$90 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$78 |
$104 |
0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$67.50 |
$90 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$57 |
$76 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$105 |
$140 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$67.50 |
$90 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$67.50 |
$90 |
0.9× |
| X-ray of voice box or throat (70370) |
$232.50 |
$310 |
3.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$246.75 |
$329 |
2.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$317.25 |
$423 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$67.50 |
$90 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$258.75 |
$345 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$105 |
$140 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$67.50 |
$90 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$163.50 |
$218 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$67.50 |
$90 |
0.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$67.50 |
$90 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$105 |
$140 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$105 |
$140 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$120.75 |
$161 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$72 |
$96 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$67.50 |
$90 |
0.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$105 |
$140 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$67.50 |
$90 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$150.52 |
$200.70 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$358.50 |
$478 |
4.0× |
| Xr chest 4+ views (71048) |
$169.12 |
$225.50 |
1.9× |
| Xr finger(s) 2+ views (73140) |
$135 |
$180 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$105 |
$140 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$163.50 |
$218 |
2.2× |
| Xr tmj bilateral (70330) |
$220.50 |
$294 |
2.9× |
| Xray knee 1 or 2 views rt (73560) |
$161.25 |
$215 |
2.2× |