| Abdomen 2 views (74019) |
$316.20 |
$372 |
3.1× |
| Acute gi blood loss imaging (78278) |
$1,390.60 |
$1,636 |
3.5× |
| Ankle 2 views (73600) |
$168.70 |
$198.48 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$712.68 |
$838.44 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$957.97 |
$1,127.02 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,080.22 |
$1,270.85 |
2.7× |
| Bone survey complete (77075) |
$696.15 |
$819 |
6.7× |
| Bone survey infant (77076) |
$557.60 |
$656 |
5.4× |
| Bowel imaging (78290) |
$1,069.30 |
$1,258 |
2.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,492.60 |
$1,756 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$179.48 |
$211.15 |
2.1× |
| Chest 1 view (71045) |
$154.66 |
$181.95 |
1.8× |
| Chest xray 3 views (71047) |
$215.39 |
$253.40 |
2.5× |
| Cholecystography, oral contrast Non-Facility (74290) |
$690.63 |
$812.50 |
4.0× |
| Clavicle complete (73000) |
$206.52 |
$242.96 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$857.72 |
$1,009.08 |
8.3× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$205.04 |
$241.22 |
2.4× |
| Continuing medical physics consltj pr wk (77336) |
$251.18 |
$295.50 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,923.58 |
$3,439.50 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,238.03 |
$1,456.50 |
5.3× |
| CT abdomen w contrast (74160) |
$946.48 |
$1,113.50 |
5.5× |
| CT abdomen w wo contrast (74170) |
$911.35 |
$1,072.18 |
5.3× |
| CT abdomen w/o contrast (74150) |
$909.50 |
$1,070 |
8.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,674.50 |
$1,970 |
9.7× |
| CT angiography upper extremity lt (73206) |
$571.99 |
$672.93 |
3.3× |
| CT c-spine w/contrast (72126) |
$891.54 |
$1,048.86 |
2.6× |
| CT c-spine w/o contrast (72125) |
$808.74 |
$951.45 |
7.8× |
| CT chest w contrast (71260) |
$988.17 |
$1,162.55 |
5.7× |
| CT chest w/wo contrast (71270) |
$1,134.44 |
$1,334.64 |
6.5× |
| CT head/brain with contrast (70460) |
$793.60 |
$933.64 |
4.6× |
| CT head/brain without and with contrast (70470) |
$950.40 |
$1,118.12 |
5.5× |
| CT iac w contrast (70481) |
$933.52 |
$1,098.25 |
5.4× |
| CT lower ext w/o (73700) |
$697.72 |
$820.84 |
6.8× |
| CT lower extremity w/contrast material (73701) |
$751.98 |
$884.69 |
4.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,837.79 |
$2,162.10 |
10.6× |
| CT lumbar spine w/contrast (72132) |
$948.26 |
$1,115.60 |
2.8× |
| CT lumbar spine w/o contrast (72131) |
$835.74 |
$983.22 |
8.1× |
| CT maxillofacial w contrast (70487) |
$885.21 |
$1,041.42 |
5.1× |
| CT maxillofacial w/wo contrast (70488) |
$973.57 |
$1,145.38 |
5.6× |
| CT maxillofacial wo contrast (70486) |
$784.92 |
$923.44 |
7.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,057.51 |
$1,244.12 |
6.1× |
| CT orbits w/o contrast (70480) |
$1,269.90 |
$1,494 |
12.3× |
| CT pelvis w/o contrast (72192) |
$909.50 |
$1,070 |
8.8× |
| CT pelvis w/wo contrast (72194) |
$1,046.80 |
$1,231.52 |
6.0× |
| CT soft tissue neck w contrast (70491) |
$850.24 |
$1,000.29 |
4.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,038.16 |
$1,221.36 |
6.0× |
| CT soft tissue neck w/o contrast (70490) |
$806.88 |
$949.28 |
7.8× |
| CT thoracic spine w/o contrast (72128) |
$836.06 |
$983.59 |
8.1× |
| CT thorax w/o contrast (71250) |
$853.50 |
$1,004.12 |
8.3× |
| CT upper ext wo (73200) |
$639.98 |
$752.92 |
6.2× |
| CT upper extremity with contrast (73201) |
$1,182.35 |
$1,391 |
3.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,667.70 |
$1,962 |
9.6× |
| Cta Abdomen (74175) |
$1,479.85 |
$1,741 |
8.5× |
| CTA abdomen pelvis (74174) |
$2,223.18 |
$2,615.50 |
6.5× |
| CTA chest (71275) |
$1,158.16 |
$1,362.54 |
6.7× |
| Cta Head (70496) |
$990.80 |
$1,165.65 |
5.7× |
| Cta Neck (70498) |
$1,004.51 |
$1,181.78 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$493.43 |
$580.50 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$160.86 |
$189.25 |
1.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$122.40 |
$144 |
1.4× |
| Dxa bone density study axial skeleton (77085) |
$228.23 |
$268.50 |
2.2× |
| Esophagus (74220) |
$372.30 |
$437.99 |
2.1× |
| Facial bones min 3 views (70150) |
$322.15 |
$379 |
3.1× |
| Fetal biophysical profile non-stress testing (76818) |
$227.29 |
$267.40 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$419.05 |
$493 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$385.90 |
$454 |
1.6× |
| Foot 2 views (73620) |
$164.64 |
$193.69 |
1.9× |
| Forearm 2 views (73090) |
$190.22 |
$223.79 |
2.2× |
| Hand 2 views (73120) |
$165.76 |
$195 |
1.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,596.30 |
$1,878 |
3.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,506.20 |
$1,772 |
3.8× |
| Hysterosalpingogram (74740) |
$385.90 |
$454 |
1.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,383.80 |
$1,628 |
2.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,433.53 |
$1,686.50 |
2.7× |
| Knee 3 views (73562) |
$213.86 |
$251.60 |
2.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,033.60 |
$1,216 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,351.95 |
$2,767 |
3.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,347.85 |
$1,585.70 |
3.9× |
| Mammary ductogram or galactogram single (77053) |
$549.95 |
$647 |
2.3× |
| MRA head w & w/o contrast (70546) |
$2,241.45 |
$2,637 |
6.5× |
| MRA head w/o contrast (70544) |
$1,577.60 |
$1,856 |
6.7× |
| MRA neck w contrast (70548) |
$2,139.03 |
$2,516.50 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,011.36 |
$1,189.82 |
2.9× |
| MRA neck w/o contrast (70547) |
$1,406.12 |
$1,654.25 |
6.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,381.28 |
$2,801.50 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,601.83 |
$1,884.50 |
6.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,136.48 |
$2,513.50 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,198.10 |
$2,586 |
6.4× |
| MRI breast w/o contrast bilateral (77047) |
$1,807.95 |
$2,127 |
7.7× |
| MRI c-spine with contrast (72142) |
$1,348.46 |
$1,586.42 |
3.9× |
| MRI cervical spine w/o contrast (72141) |
$1,197.71 |
$1,409.06 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,423.41 |
$1,674.60 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,813.90 |
$2,134 |
7.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,645.18 |
$1,935.50 |
7.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,371.08 |
$2,789.50 |
6.9× |
| MRI pelvis w/contrast (72196) |
$1,180.78 |
$1,389.15 |
3.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,192.15 |
$2,579 |
6.4× |
| MRI pelvis w/o contrast (72195) |
$1,844.08 |
$2,169.50 |
7.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,490.02 |
$1,752.96 |
4.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,348.04 |
$1,585.92 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,603.72 |
$1,886.72 |
4.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,443.93 |
$1,698.74 |
4.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,604.98 |
$1,888.20 |
4.7× |
| MRI temporomandibular joint (70336) |
$2,365.55 |
$2,783 |
10.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,198.02 |
$1,409.44 |
5.1× |
| MRI up ext w/o contrast (73218) |
$1,633.28 |
$1,921.50 |
6.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,266.30 |
$1,489.76 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$2,147.95 |
$2,527 |
6.2× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$966.45 |
$1,137 |
0.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,832.42 |
$3,332.25 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$1,534.68 |
$1,805.50 |
1.2× |
| Neck soft tissue (70360) |
$142.86 |
$168.06 |
1.7× |
| Nm gastric emptying study (78264) |
$928.90 |
$1,092.82 |
2.4× |
| Nm red cell sequestration (78140) |
$424.15 |
$499 |
1.1× |
| Nonvascular shunt X-ray (75809) |
$525.30 |
$618 |
5.1× |
| Osseous survey limited (77074) |
$2,843.68 |
$3,345.50 |
27.5× |
| Parathyroid Planar Imaging (78070) |
$1,183.63 |
$1,392.50 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$193.05 |
$227.12 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$5,408.55 |
$6,363 |
3.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,070.58 |
$1,259.50 |
2.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$177.47 |
$208.79 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$190.99 |
$224.69 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$188.92 |
$222.25 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$323 |
$380 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$168.59 |
$198.34 |
2.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$210.35 |
$247.46 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$222.40 |
$261.64 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$298.35 |
$351 |
3.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$265.24 |
$312.05 |
2.6× |
| Radex Humerus Minimum 2 Views (73060) |
$200.80 |
$236.22 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$182.26 |
$214.42 |
2.1× |
| Radex Kne Compl 4/More Views (73564) |
$223.84 |
$263.34 |
2.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$234.32 |
$275.66 |
2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$193.60 |
$227.76 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$229.14 |
$269.58 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$220.36 |
$259.24 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$158.22 |
$186.14 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$157.73 |
$185.56 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$194.86 |
$229.25 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$217.22 |
$255.55 |
2.5× |
| Radiation treatment delivery level 3 (77412) |
$275.40 |
$324 |
0.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$170.47 |
$200.55 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$189.80 |
$223.29 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$438.53 |
$515.92 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$527 |
$620 |
3.0× |
| Radiologic examination femur 1 view (73551) |
$349.35 |
$411 |
4.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$204.52 |
$240.62 |
2.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$72.29 |
$85.05 |
0.7× |
| Ribs bilateral 3 views (71110) |
$245.28 |
$288.56 |
2.4× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,147.93 |
$1,350.50 |
2.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,479.43 |
$1,740.50 |
3.7× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,210.85 |
$2,601 |
4.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,572.50 |
$1,850 |
2.9× |
| Sacroiliac Joints < 3 Views (72200) |
$288.72 |
$339.68 |
2.8× |
| Scapula (73010) |
$226.48 |
$266.45 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$49.73 |
$58.50 |
2.1× |
| Shoulder 1 view (73020) |
$142.22 |
$167.32 |
1.7× |
| Spine thoracic 3 views (72072) |
$265.04 |
$311.82 |
2.6× |
| Ther rad simulaj-aided field setting simple (77280) |
$450.50 |
$530 |
3.4× |
| Thyroid imaging w/blood flow (78013) |
$818.98 |
$963.50 |
2.1× |
| Thyroid uptake measurement (78012) |
$379.53 |
$446.50 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,272.88 |
$1,497.50 |
3.2× |
| Ultrasound breast complete (76641) |
$539.75 |
$635 |
5.2× |
| Ultrasound, abdomen limited (76705) |
$670.65 |
$789 |
6.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$63.75 |
$75 |
0.7× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$152.58 |
$179.50 |
13.8× |
| Urethrocystogram voiding (74455) |
$383.76 |
$451.48 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$527 |
$620 |
2.2× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$538.18 |
$633.15 |
3.1× |
| Us breast unilateral limited (76642) |
$539.75 |
$635 |
6.3× |
| Us chest (76604) |
$153.72 |
$180.85 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$361.25 |
$425 |
3.5× |
| Us ob detailed single fetus (76811) |
$481.32 |
$566.25 |
2.0× |
| Us ob transvaginal (76817) |
$459.85 |
$541 |
4.5× |
| Us pelvic non ob complete (76856) |
$417.30 |
$490.94 |
4.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$232.38 |
$273.39 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$157.04 |
$184.75 |
1.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$327.84 |
$385.69 |
3.2× |
| Us retroperitoneal complete (76770) |
$467.29 |
$549.75 |
4.5× |
| Us retroperitoneal limited (76775) |
$490.45 |
$577 |
4.7× |
| Us scrotum and contents (76870) |
$384.42 |
$452.25 |
3.7× |
| Us soft tissue head/neck (76536) |
$477.15 |
$561.35 |
4.6× |
| Venogram extremity bilateral (75822) |
$1,353.63 |
$1,592.50 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$901.85 |
$1,061 |
0.6× |
| Vertebral fracture assessment via dxa (77086) |
$133.03 |
$156.50 |
1.5× |
| Wrist 2 views (73100) |
$165.17 |
$194.32 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$250.30 |
$294.46 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$231.20 |
$272 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$767.55 |
$903 |
4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$148.15 |
$174.29 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$323 |
$380 |
3.8× |
| X-ray exam of femur 2/> (73552) |
$283.48 |
$333.50 |
3.3× |
| X-ray eye for foreign body (70030) |
$62.31 |
$73.30 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$205.78 |
$242.09 |
2.4× |
| X-ray IV pyelogram (ivp) (74400) |
$509.66 |
$599.60 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$161.84 |
$190.40 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$75.29 |
$88.58 |
0.9× |
| X-ray leg, infant (73592) |
$158.32 |
$186.25 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$209.02 |
$245.90 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$457.73 |
$538.50 |
4.4× |
| X-ray nose-rectum child f.b. (76010) |
$105.40 |
$124 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300.48 |
$353.50 |
3.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$253.22 |
$297.90 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$423.30 |
$498 |
4.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$61.63 |
$72.50 |
0.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$228.60 |
$268.94 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$320.34 |
$376.88 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$209.50 |
$246.46 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$167.48 |
$197.04 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$444.55 |
$523 |
5.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$173.48 |
$204.10 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$230.12 |
$270.72 |
2.2× |
| Xr bone length studies (77073) |
$354.88 |
$417.50 |
3.4× |
| Xr c-spine 4 or 5 views (72050) |
$279.12 |
$328.36 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$339.68 |
$399.62 |
3.3× |
| Xr chest 4+ views (71048) |
$218.95 |
$257.59 |
2.1× |
| Xr urogram antegrade (74425) |
$456.03 |
$536.50 |
1.3× |