| Abdomen 2 views (74019) |
$393.70 |
$635 |
3.4× |
| Acute gi blood loss imaging (78278) |
$1,481.80 |
$2,390 |
3.3× |
| Ankle 2 views (73600) |
$335.42 |
$541 |
3.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,082.52 |
$1,746 |
2.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$982.08 |
$1,584 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$1,452.66 |
$2,343 |
3.3× |
| Bone age studies (77072) |
$246.76 |
$398 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,704.38 |
$2,749 |
3.8× |
| Bone survey complete (77075) |
$215.76 |
$348 |
1.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,111.04 |
$1,792 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$323.64 |
$522 |
3.3× |
| Chest 1 view (71045) |
$247.38 |
$399 |
2.6× |
| Chest xray 3 views (71047) |
$301.32 |
$486 |
3.1× |
| Clavicle complete (73000) |
$353.40 |
$570 |
3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$775.62 |
$1,251 |
6.7× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$207.70 |
$335 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,490.54 |
$4,017 |
6.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,129.08 |
$3,434 |
8.0× |
| CT abdomen w contrast (74160) |
$1,721.74 |
$2,777 |
8.8× |
| CT abdomen w wo contrast (74170) |
$1,906.50 |
$3,075 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,483.66 |
$2,393 |
12.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,221.46 |
$3,583 |
11.4× |
| CT c-spine w/contrast (72126) |
$1,689.50 |
$2,725 |
4.3× |
| CT c-spine w/o contrast (72125) |
$1,589.68 |
$2,564 |
13.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,858.76 |
$2,998 |
9.5× |
| CT chest w contrast (71260) |
$1,929.44 |
$3,112 |
9.9× |
| CT chest w/wo contrast (71270) |
$2,031.12 |
$3,276 |
10.4× |
| CT head/brain with contrast (70460) |
$1,459.48 |
$2,354 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,860.62 |
$3,001 |
9.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$134.54 |
$217 |
1.4× |
| CT iac w contrast (70481) |
$1,929.44 |
$3,112 |
9.9× |
| CT lower ext w/o (73700) |
$1,876.43 |
$3,026.50 |
16.1× |
| CT lower extremity w wo contrast (73702) |
$2,279.43 |
$3,676.50 |
11.7× |
| CT lower extremity w/contrast material (73701) |
$1,634.32 |
$2,636 |
8.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,928.20 |
$3,110 |
9.9× |
| CT lumbar spine w/contrast (72132) |
$1,925.10 |
$3,105 |
5.0× |
| CT lumbar spine w/o contrast (72131) |
$1,654.16 |
$2,668 |
14.2× |
| CT maxillofacial w contrast (70487) |
$1,830.24 |
$2,952 |
9.4× |
| CT maxillofacial w/wo contrast (70488) |
$2,118.54 |
$3,417 |
10.8× |
| CT maxillofacial wo contrast (70486) |
$1,423.52 |
$2,296 |
12.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,331.82 |
$3,761 |
11.9× |
| CT orbits w/o contrast (70480) |
$1,702.52 |
$2,746 |
14.6× |
| CT pelvis w/o contrast (72192) |
$1,583.48 |
$2,554 |
13.6× |
| CT pelvis w/wo contrast (72194) |
$1,967.88 |
$3,174 |
10.1× |
| CT scan of arm combo (73202) |
$2,222.70 |
$3,585 |
11.4× |
| CT soft tissue neck w contrast (70491) |
$1,692.60 |
$2,730 |
8.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,943.08 |
$3,134 |
9.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,332.38 |
$2,149 |
11.4× |
| CT thoracic spine w/contrast (72129) |
$1,865.58 |
$3,009 |
9.5× |
| CT thoracic spine w/o contrast (72128) |
$1,673.38 |
$2,699 |
14.4× |
| CT thorax w/o contrast (71250) |
$1,587.20 |
$2,560 |
13.6× |
| CT upper ext wo (73200) |
$1,926.96 |
$3,108 |
16.5× |
| CT upper extremity with contrast (73201) |
$2,074.21 |
$3,345.50 |
5.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,054.06 |
$3,313 |
10.5× |
| Cta Abdomen (74175) |
$2,680.88 |
$4,324 |
13.7× |
| CTA abdomen pelvis (74174) |
$2,287.18 |
$3,689 |
5.9× |
| CTA chest (71275) |
$2,073.28 |
$3,344 |
10.6× |
| Cta Head (70496) |
$2,083.82 |
$3,361 |
10.7× |
| Cta Neck (70498) |
$2,370.26 |
$3,823 |
12.1× |
| Cystography minimum 3 views rs&i (74430) |
$734.08 |
$1,184 |
1.9× |
| Facial bones min 3 views (70150) |
$415.40 |
$670 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$432.76 |
$698 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$235.29 |
$379.50 |
0.9× |
| Foot 2 views (73620) |
$330.15 |
$532.50 |
3.4× |
| Forearm 2 views (73090) |
$339.45 |
$547.50 |
3.5× |
| Gastric mucosa imaging (78261) |
$1,284.02 |
$2,071 |
2.9× |
| Hand 2 views (73120) |
$342.86 |
$553 |
2.9× |
| Heart first pass single,planar (78481) |
$1,512.80 |
$2,440 |
2.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,873.64 |
$3,022 |
3.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,383.22 |
$2,231 |
2.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,481.80 |
$2,390 |
2.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,037.88 |
$1,674 |
1.7× |
| Knee 3 views (73562) |
$409.51 |
$660.50 |
4.2× |
| Liver & spleen imaging static only (78215) |
$720.13 |
$1,161.50 |
1.6× |
| Lung ventilation imaging (78579) |
$1,111.04 |
$1,792 |
2.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,971.60 |
$3,180 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,971.60 |
$3,180 |
5.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,334.30 |
$3,765 |
6.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$135.78 |
$219 |
1.4× |
| MRA head w & w/o contrast (70546) |
$2,037.94 |
$3,287 |
5.2× |
| MRA head w/o contrast (70544) |
$1,759.56 |
$2,838 |
6.6× |
| MRA neck w contrast (70548) |
$1,804.20 |
$2,910 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,037.94 |
$3,287 |
5.2× |
| MRA neck w/o contrast (70547) |
$1,686.40 |
$2,720 |
6.3× |
| MRI abdomen w contrast (74182) |
$1,884.80 |
$3,040 |
4.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,049.72 |
$3,306 |
5.3× |
| MRI abdomen w/o contrast (74181) |
$1,660.36 |
$2,678 |
6.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,971.91 |
$3,180.50 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,334.61 |
$3,765.50 |
6.0× |
| MRI c-spine with contrast (72142) |
$2,049.72 |
$3,306 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,319.36 |
$2,128 |
5.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,813.50 |
$2,925 |
4.7× |
| MRI chest w/o contrast (71550) |
$1,294.56 |
$2,088 |
4.9× |
| MRI chest with contrast (71551) |
$1,439.02 |
$2,321 |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,971.60 |
$3,180 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,334.61 |
$3,765.50 |
6.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,539.15 |
$2,482.50 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,689.50 |
$2,725 |
6.4× |
| MRI orbit face neck w contrast (70542) |
$1,813.50 |
$2,925 |
4.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,972.84 |
$3,182 |
5.1× |
| MRI pelvis w/contrast (72196) |
$1,729.18 |
$2,789 |
4.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,049.72 |
$3,306 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,577.28 |
$2,544 |
5.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,037.94 |
$3,287 |
5.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,888.52 |
$3,046 |
4.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,669.10 |
$4,305 |
6.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,804.20 |
$2,910 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,288.42 |
$3,691 |
5.9× |
| MRI temporomandibular joint (70336) |
$1,297.04 |
$2,092 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,466.92 |
$2,366 |
5.5× |
| MRI up ext w/o contrast (73218) |
$1,539.15 |
$2,482.50 |
5.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,539.15 |
$2,482.50 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$2,334.61 |
$3,765.50 |
6.0× |
| Myocardial infarct spect (78469) |
$1,601.46 |
$2,583 |
2.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$735.32 |
$1,186 |
0.5× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$2,884.86 |
$4,653 |
2.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,028.14 |
$6,497 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$1,439.02 |
$2,321 |
1.0× |
| Neck soft tissue (70360) |
$241.18 |
$389 |
2.5× |
| Nm gastric emptying study (78264) |
$1,525.20 |
$2,460 |
3.4× |
| Nm gastroesophageal reflux study (78262) |
$830.18 |
$1,339 |
1.9× |
| Nm kidney scan w/flow (78701) |
$1,291.46 |
$2,083 |
2.9× |
| Parathyroid Planar Imaging (78070) |
$1,006.88 |
$1,624 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$364.56 |
$588 |
3.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$935.58 |
$1,509 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,481.80 |
$2,390 |
2.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$386.88 |
$624 |
4.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$323.33 |
$521.50 |
3.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$266.91 |
$430.50 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$335.42 |
$541 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$137.64 |
$222 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$383.47 |
$618.50 |
4.0× |
| Radex Hand Minimum 3 Views (73130) |
$550.25 |
$887.50 |
5.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$291.40 |
$470 |
3.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$391.22 |
$631 |
3.4× |
| Radex Humerus Minimum 2 Views (73060) |
$369.52 |
$596 |
3.8× |
| Radex Kne 1/2 Views (73560) |
$372 |
$600 |
3.8× |
| Radex Kne Compl 4/More Views (73564) |
$473.06 |
$763 |
4.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$290.16 |
$468 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$252.34 |
$407 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$488.56 |
$788 |
4.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$420.98 |
$679 |
4.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$220.10 |
$355 |
2.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$233.74 |
$377 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$483.60 |
$780 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$251.10 |
$405 |
2.6× |
| Radex upper extremity infant minimum 2 views (73092) |
$138.88 |
$224 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$397.11 |
$640.50 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$185.69 |
$299.50 |
1.9× |
| Radiologic exam chest 2 views (71046) |
$287.68 |
$464 |
3.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$170.50 |
$275 |
1.8× |
| Ribs bilateral 3 views (71110) |
$445.78 |
$719 |
3.8× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$788.64 |
$1,272 |
1.8× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,305.41 |
$2,105.50 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$172.05 |
$277.50 |
1.5× |
| Scapula (73010) |
$424.70 |
$685 |
3.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$77.50 |
$125 |
3.3× |
| Shoulder 1 view (73020) |
$341.93 |
$551.50 |
3.5× |
| Spine thoracic 3 views (72072) |
$410.44 |
$662 |
3.5× |
| Thoracolumbar 2 views (72080) |
$351.54 |
$567 |
3.6× |
| Thyroid imaging w/blood flow (78013) |
$679.52 |
$1,096 |
1.5× |
| Thyroid uptake measurement (78012) |
$450.12 |
$726 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$830.18 |
$1,339 |
1.9× |
| Tmj unilateral (70328) |
$185.38 |
$299 |
1.9× |
| Ultrasound breast complete (76641) |
$477.71 |
$770.50 |
4.1× |
| Ultrasound Exam Aaa Screen (76706) |
$467.48 |
$754 |
4.0× |
| Ultrasound, abdomen limited (76705) |
$578.46 |
$933 |
5.0× |
| Us breast unilateral limited (76642) |
$304.42 |
$491 |
3.1× |
| Us chest (76604) |
$569.16 |
$918 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$531.96 |
$858 |
4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$483.60 |
$780 |
4.2× |
| Us ob limited (76815) |
$397.42 |
$641 |
3.4× |
| Us ob transvaginal (76817) |
$426.56 |
$688 |
3.7× |
| Us pelvic non ob complete (76856) |
$544.36 |
$878 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$298.22 |
$481 |
2.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$394.01 |
$635.50 |
3.4× |
| Us retroperitoneal complete (76770) |
$689.44 |
$1,112 |
5.9× |
| Us retroperitoneal limited (76775) |
$478.64 |
$772 |
4.1× |
| Us scrotum and contents (76870) |
$623.10 |
$1,005 |
5.3× |
| Us soft tissue head/neck (76536) |
$608.84 |
$982 |
5.2× |
| Us, eye b-scan (76512) |
$163.06 |
$263 |
1.4× |
| Wrist 2 views (73100) |
$334.80 |
$540 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$460.04 |
$742 |
3.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$335.42 |
$541 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$360.53 |
$581.50 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$324.26 |
$523 |
3.3× |
| X-ray exam of femur 2/> (73552) |
$395.25 |
$637.50 |
4.1× |
| X-ray eye for foreign body (70030) |
$259.78 |
$419 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$150.35 |
$242.50 |
1.6× |
| X-ray IV pyelogram (ivp) (74400) |
$644.80 |
$1,040 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$235.60 |
$380 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$259.78 |
$419 |
2.7× |
| X-ray leg, infant (73592) |
$128.03 |
$206.50 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$373.24 |
$602 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$688.82 |
$1,111 |
5.9× |
| X-ray nose-rectum child f.b. (76010) |
$123.38 |
$199 |
1.3× |
| X-ray optic foramen (70190) |
$299.46 |
$483 |
3.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$347.20 |
$560 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$314.34 |
$507 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$381.30 |
$615 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$427.80 |
$690 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$370.14 |
$597 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$314.34 |
$507 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$324.26 |
$523 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$322.40 |
$520 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$343.48 |
$554 |
2.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$287.06 |
$463 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$275.28 |
$444 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$226.30 |
$365 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$383.16 |
$618 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$394.94 |
$637 |
3.4× |
| Xr bone length studies (77073) |
$171.74 |
$277 |
1.5× |
| Xr c-spine 4 or 5 views (72050) |
$503.44 |
$812 |
4.3× |
| Xr c-spine 6 or more views (72052) |
$570.40 |
$920 |
4.9× |
| Xr chest 4+ views (71048) |
$453.84 |
$732 |
3.9× |