| Abdomen 2 views (74019) |
$194.60 |
$278 |
1.9× |
| Acute gi blood loss imaging (78278) |
$842.63 |
$1,203.75 |
2.1× |
| Ankle 2 views (73600) |
$143.50 |
$205 |
1.7× |
| Arthrogram shoulder (73040) |
$517.30 |
$739 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$482.13 |
$688.75 |
1.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$494.20 |
$706 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$851.38 |
$1,216.25 |
2.2× |
| Bone age studies (77072) |
$178.33 |
$254.75 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$654.68 |
$935.25 |
1.7× |
| Bone survey complete (77075) |
$750.58 |
$1,072.25 |
7.3× |
| Bone survey infant (77076) |
$750.58 |
$1,072.25 |
7.3× |
| Bowel imaging (78290) |
$762.83 |
$1,089.75 |
1.9× |
| Brain imaging < 4 static views (78600) |
$646.45 |
$923.50 |
1.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$987 |
$1,410 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$207.03 |
$295.75 |
2.4× |
| Chest 1 view (71045) |
$208.25 |
$297.50 |
2.4× |
| Chest xray 3 views (71047) |
$257.25 |
$367.50 |
3.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$436.63 |
$623.75 |
2.5× |
| Clavicle complete (73000) |
$197.05 |
$281.50 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$552.13 |
$788.75 |
5.3× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$506.10 |
$723 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,791.83 |
$2,559.75 |
5.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,545.95 |
$2,208.50 |
6.6× |
| CT abdomen w contrast (74160) |
$1,369.38 |
$1,956.25 |
7.9× |
| CT abdomen w wo contrast (74170) |
$1,402.28 |
$2,003.25 |
8.1× |
| CT abdomen w/o contrast (74150) |
$1,220.10 |
$1,743 |
11.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,332.40 |
$3,332 |
13.5× |
| CT angiography upper extremity lt (73206) |
$2,332.40 |
$3,332 |
13.5× |
| CT c-spine w/contrast (72126) |
$1,179.85 |
$1,685.50 |
3.4× |
| CT c-spine w/o contrast (72125) |
$1,065.93 |
$1,522.75 |
10.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,442 |
$2,060 |
8.3× |
| CT chest w contrast (71260) |
$1,248.10 |
$1,783 |
7.2× |
| CT chest w/wo contrast (71270) |
$1,386 |
$1,980 |
8.0× |
| CT head/brain with contrast (70460) |
$1,357.30 |
$1,939 |
7.8× |
| CT head/brain without and with contrast (70470) |
$1,413.48 |
$2,019.25 |
8.2× |
| CT iac w contrast (70481) |
$1,179.85 |
$1,685.50 |
6.8× |
| CT limited/localized follow up study (76380) |
$650.74 |
$929.62 |
7.6× |
| CT lower ext w/o (73700) |
$1,065.93 |
$1,522.75 |
10.3× |
| CT lower extremity w wo contrast (73702) |
$1,183 |
$1,690 |
6.8× |
| CT lower extremity w/contrast material (73701) |
$1,091.13 |
$1,558.75 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,442 |
$2,060 |
8.3× |
| CT lumbar spine w/contrast (72132) |
$1,179.85 |
$1,685.50 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$1,065.93 |
$1,522.75 |
10.3× |
| CT maxillofacial w contrast (70487) |
$1,179.85 |
$1,685.50 |
6.8× |
| CT maxillofacial wo contrast (70486) |
$1,136.10 |
$1,623 |
11.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,373.40 |
$1,962 |
7.9× |
| CT orbits w/o contrast (70480) |
$1,065.93 |
$1,522.75 |
10.3× |
| CT pelvis w/o contrast (72192) |
$1,001.70 |
$1,431 |
9.7× |
| CT pelvis w/wo contrast (72194) |
$1,269.98 |
$1,814.25 |
7.3× |
| CT scan of arm combo (73202) |
$1,095.85 |
$1,565.50 |
6.3× |
| CT soft tissue neck w contrast (70491) |
$1,357.30 |
$1,939 |
7.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,265.78 |
$1,808.25 |
7.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,065.93 |
$1,522.75 |
10.3× |
| CT thoracic spine w/contrast (72129) |
$1,545.95 |
$2,208.50 |
8.9× |
| CT thoracic spine w/o contrast (72128) |
$1,357.30 |
$1,939 |
13.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,791.83 |
$2,559.75 |
10.3× |
| CT thorax w/o contrast (71250) |
$552.13 |
$788.75 |
5.3× |
| CT upper ext wo (73200) |
$1,065.93 |
$1,522.75 |
10.3× |
| CT upper extremity with contrast (73201) |
$1,091.13 |
$1,558.75 |
3.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,332.40 |
$3,332 |
13.5× |
| Cta Abdomen (74175) |
$2,332.40 |
$3,332 |
13.5× |
| CTA abdomen pelvis (74174) |
$2,332.40 |
$3,332 |
6.8× |
| CTA chest (71275) |
$2,332.40 |
$3,332 |
13.5× |
| Cta Head (70496) |
$2,332.40 |
$3,332 |
13.5× |
| Cta Neck (70498) |
$2,332.40 |
$3,332 |
13.5× |
| Cta Pelvis (72191) |
$2,332.40 |
$3,332 |
13.5× |
| Cystography minimum 3 views rs&i (74430) |
$446.34 |
$637.62 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$355.60 |
$508 |
3.4× |
| Esophagus (74220) |
$449.23 |
$641.75 |
2.6× |
| Facial bones min 3 views (70150) |
$207.03 |
$295.75 |
2.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$490.70 |
$701 |
4.8× |
| Fluoroscopy up to 1 hr (76000) |
$439.43 |
$627.75 |
1.9× |
| Foot 2 views (73620) |
$143.50 |
$205 |
1.7× |
| Forearm 2 views (73090) |
$164.33 |
$234.75 |
1.9× |
| Hand 2 views (73120) |
$136.50 |
$195 |
1.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$952.53 |
$1,360.75 |
1.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$952.53 |
$1,360.75 |
2.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,024.10 |
$1,463 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$914.55 |
$1,306.50 |
1.7× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$499.98 |
$714.25 |
0.9× |
| Knee 3 views (73562) |
$245.70 |
$351 |
2.9× |
| Liver & spleen imaging static only (78215) |
$952.53 |
$1,360.75 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,409.63 |
$2,013.75 |
1.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,409.63 |
$2,013.75 |
4.1× |
| MRA head w & w/o contrast (70546) |
$1,837.33 |
$2,624.75 |
5.3× |
| MRA head w/o contrast (70544) |
$1,837.33 |
$2,624.75 |
7.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,837.33 |
$2,624.75 |
5.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,845.73 |
$2,636.75 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$1,549.10 |
$2,213 |
6.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,409.63 |
$2,013.75 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,865.15 |
$2,664.50 |
5.4× |
| MRI c-spine with contrast (72142) |
$1,831.20 |
$2,616 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,691.03 |
$2,415.75 |
7.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,647.63 |
$2,353.75 |
4.8× |
| MRI chest w/o contrast (71550) |
$1,549.10 |
$2,213 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,865.15 |
$2,664.50 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,409.63 |
$2,013.75 |
6.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,781.68 |
$2,545.25 |
7.6× |
| MRI orbit face neck w contrast (70542) |
$1,933.93 |
$2,762.75 |
5.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,119.25 |
$3,027.50 |
6.1× |
| MRI pelvis w/contrast (72196) |
$1,822.45 |
$2,603.50 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,962.45 |
$2,803.50 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,549.10 |
$2,213 |
6.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,971.38 |
$2,816.25 |
5.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,691.03 |
$2,415.75 |
4.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,971.38 |
$2,816.25 |
5.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,831.20 |
$2,616 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,831.20 |
$2,616 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,691.03 |
$2,415.75 |
7.2× |
| MRI up ext w/o contrast (73218) |
$1,409.63 |
$2,013.75 |
6.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,409.63 |
$2,013.75 |
6.0× |
| MRI, joint upper extrem combo (73223) |
$1,872.59 |
$2,675.12 |
5.4× |
| Myelogram Lumbar (72265) |
$538.30 |
$769 |
0.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,259.30 |
$1,799 |
1.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,049.83 |
$1,499.75 |
0.8× |
| Neck soft tissue (70360) |
$143.50 |
$205 |
1.7× |
| Nm cisternogram (78630) |
$1,699.43 |
$2,427.75 |
3.2× |
| Nm gastric emptying study (78264) |
$610.75 |
$872.50 |
1.5× |
| Osseous survey limited (77074) |
$516.25 |
$737.50 |
5.0× |
| Parathyroid Planar Imaging (78070) |
$768.95 |
$1,098.50 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$146.48 |
$209.25 |
1.4× |
| PET imaging CT for attenuation limited area (78814) |
$3,588.38 |
$5,126.25 |
2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$733.95 |
$1,048.50 |
1.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$159.43 |
$227.75 |
0.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$164.33 |
$234.75 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$164.33 |
$234.75 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$165.20 |
$236 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$487.20 |
$696 |
4.7× |
| Radex fingr minimum 2 views (73140) |
$164.33 |
$234.75 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$164.33 |
$234.75 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$167.13 |
$238.75 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$185.50 |
$265 |
2.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$514.15 |
$734.50 |
5.0× |
| Radex Humerus Minimum 2 Views (73060) |
$197.05 |
$281.50 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$144.55 |
$206.50 |
1.7× |
| Radex Kne Compl 4/More Views (73564) |
$258.30 |
$369 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$219.63 |
$313.75 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$197.05 |
$281.50 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$211.05 |
$301.50 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$207.03 |
$295.75 |
2.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$182 |
$260 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$278.95 |
$398.50 |
3.2× |
| Radex Toe Minimum 2 Views (73660) |
$164.33 |
$234.75 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$265.48 |
$379.25 |
2.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$167.13 |
$238.75 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$143.50 |
$205 |
1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$207.55 |
$296.50 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$244.65 |
$349.50 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$1,078.88 |
$1,541.25 |
6.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$453.43 |
$647.75 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$464.10 |
$663 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$197.05 |
$281.50 |
2.3× |
| Ribs bilateral 3 views (71110) |
$228.03 |
$325.75 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$179.20 |
$256 |
1.7× |
| Scapula (73010) |
$143.50 |
$205 |
1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$96.95 |
$138.50 |
4.1× |
| Shoulder 1 view (73020) |
$143.50 |
$205 |
1.7× |
| Small bowel series (74250) |
$389.38 |
$556.25 |
2.2× |
| Speech evaluation complex (70371) |
$302.05 |
$431.50 |
1.3× |
| Spine thoracic 3 views (72072) |
$237.13 |
$338.75 |
2.3× |
| Thyroid imaging w/blood flow (78013) |
$1,036.88 |
$1,481.25 |
2.6× |
| Thyroid uptake measurement (78012) |
$664.65 |
$949.50 |
1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,351.88 |
$1,931.25 |
3.4× |
| Tmj unilateral (70328) |
$186.03 |
$265.75 |
2.2× |
| Tomogram (76100) |
$1,014.30 |
$1,449 |
9.8× |
| Ultrasound breast complete (76641) |
$490.70 |
$701 |
4.8× |
| Ultrasound elastography first target lesion (76982) |
$245.53 |
$350.75 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$490.70 |
$701 |
4.8× |
| Ultrasound, abdomen limited (76705) |
$490.70 |
$701 |
4.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$914.73 |
$1,306.75 |
10.6× |
| Unlisted ultrasound procedure (76999) |
$199.15 |
$284.50 |
2.3× |
| Us breast unilateral limited (76642) |
$440.48 |
$629.25 |
5.1× |
| Us chest (76604) |
$490.70 |
$701 |
4.8× |
| Us compl joint r-t w/image documentation (76881) |
$490.70 |
$701 |
4.8× |
| Us elastography parenchyma (76981) |
$245.53 |
$350.75 |
2.4× |
| Us encephalogram (76506) |
$528.50 |
$755 |
5.1× |
| Us hips infant static (76886) |
$137.20 |
$196 |
1.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$481.08 |
$687.25 |
4.7× |
| Us ob limited (76815) |
$490.70 |
$701 |
4.8× |
| Us ob transvaginal (76817) |
$476.70 |
$681 |
4.6× |
| Us pelvic non ob complete (76856) |
$490.70 |
$701 |
4.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$473.03 |
$675.75 |
4.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$259 |
$370 |
2.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$517.30 |
$739 |
5.0× |
| Us retroperitoneal complete (76770) |
$490.70 |
$701 |
4.8× |
| Us retroperitoneal limited (76775) |
$490.70 |
$701 |
4.8× |
| Us scrotum and contents (76870) |
$490.70 |
$701 |
4.8× |
| Us soft tissue head/neck (76536) |
$564.03 |
$805.75 |
5.5× |
| Us spinal canal and contents (76800) |
$375.38 |
$536.25 |
3.6× |
| Venogram Extremity Unilateral (75820) |
$528.15 |
$754.50 |
0.3× |
| Venography caval inferior serialography rs&i (75825) |
$1,933.75 |
$2,762.50 |
0.6× |
| Venous thrombosis imaging, venogram; unilateral Non-Facility (78457) |
$447.30 |
$639 |
0.8× |
| Wrist 2 views (73100) |
$157.15 |
$224.50 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$287.70 |
$411 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$245.70 |
$351 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,078.88 |
$1,541.25 |
6.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$143.50 |
$205 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$418.08 |
$597.25 |
4.9× |
| X-ray exam of femur 2/> (73552) |
$197.05 |
$281.50 |
2.3× |
| X-ray eye for foreign body (70030) |
$143.50 |
$205 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$184.45 |
$263.50 |
2.1× |
| X-ray IV pyelogram (ivp) (74400) |
$639.45 |
$913.50 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$171.68 |
$245.25 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$164.33 |
$234.75 |
1.9× |
| X-ray leg, infant (73592) |
$288.05 |
$411.50 |
3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$211.05 |
$301.50 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$326.20 |
$466 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$236.78 |
$338.25 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$198.98 |
$284.25 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$214.38 |
$306.25 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$249.90 |
$357 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$267.40 |
$382 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$207.03 |
$295.75 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$211.93 |
$302.75 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$230.30 |
$329 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$200.03 |
$285.75 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$186.73 |
$266.75 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$207.03 |
$295.75 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$158.38 |
$226.25 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$207.03 |
$295.75 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$253.23 |
$361.75 |
2.5× |
| Xr bone length studies (77073) |
$262.50 |
$375 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$271.25 |
$387.50 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$295.75 |
$422.50 |
2.9× |
| Xr chest 4+ views (71048) |
$273.88 |
$391.25 |
2.7× |