| Abdomen 2 views (74019) |
$370 |
$436 |
3.4× |
| Acute gi blood loss imaging (78278) |
$2,331 |
$2,743 |
5.5× |
| Ankle 2 views (73600) |
$478 |
$563 |
5.2× |
| Arthrogram shoulder (73040) |
$1,492 |
$1,756 |
4.1× |
| Bone &/joint imaging whole body (78306) |
$2,772 |
$3,261 |
6.6× |
| Bone Imaging 3 Phase (78315) |
$2,096 |
$2,465 |
5.0× |
| Bowel imaging (78290) |
$1,833 |
$2,157 |
4.3× |
| Cervical spine 2 or 3 views (72040) |
$267 |
$314 |
2.9× |
| Chest 1 view (71045) |
$478 |
$563 |
5.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,036 |
$1,219 |
5.6× |
| Clavicle complete (73000) |
$478 |
$563 |
5.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,973 |
$4,674 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,772 |
$3,261 |
11.0× |
| CT abdomen w contrast (74160) |
$3,711 |
$4,366 |
20.0× |
| CT abdomen w wo contrast (74170) |
$4,122 |
$4,849 |
22.3× |
| CT abdomen w/o contrast (74150) |
$2,171 |
$2,554 |
19.7× |
| CT c-spine w/contrast (72126) |
$3,106 |
$3,654 |
8.4× |
| CT c-spine w/o contrast (72125) |
$2,171 |
$2,554 |
19.7× |
| CT cervical spine w&w/o contrast (72127) |
$3,236 |
$3,807 |
17.5× |
| CT chest w contrast (71260) |
$2,931.50 |
$3,449 |
15.8× |
| CT chest w/wo contrast (71270) |
$4,023.50 |
$4,733.50 |
21.7× |
| CT head/brain with contrast (70460) |
$3,711 |
$4,366 |
20.0× |
| CT head/brain without and with contrast (70470) |
$4,122 |
$4,849 |
22.3× |
| CT iac w contrast (70481) |
$2,345 |
$2,758 |
12.7× |
| CT limited/localized follow up study (76380) |
$811 |
$954 |
8.8× |
| CT lower ext w/o (73700) |
$1,839 |
$2,164 |
16.7× |
| CT lower extremity w wo contrast (73702) |
$3,159 |
$3,717 |
17.1× |
| CT lower extremity w/contrast material (73701) |
$2,034 |
$2,393 |
11.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,676 |
$3,148 |
14.5× |
| CT lumbar spine w/contrast (72132) |
$3,711 |
$4,366 |
10.1× |
| CT lumbar spine w/o contrast (72131) |
$2,171 |
$2,554 |
19.7× |
| CT maxillofacial w contrast (70487) |
$2,856 |
$3,360 |
15.4× |
| CT maxillofacial w/wo contrast (70488) |
$4,122 |
$4,849 |
22.3× |
| CT maxillofacial wo contrast (70486) |
$2,171 |
$2,554 |
19.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,499 |
$4,116 |
18.9× |
| CT orbits w/o contrast (70480) |
$2,171 |
$2,554 |
19.7× |
| CT pelvis w/o contrast (72192) |
$2,171 |
$2,554 |
19.7× |
| CT pelvis w/wo contrast (72194) |
$4,122 |
$4,849 |
22.3× |
| CT scan of arm combo (73202) |
$2,885 |
$3,394 |
15.6× |
| CT soft tissue neck w contrast (70491) |
$3,616 |
$4,255 |
19.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$4,122 |
$4,849 |
22.3× |
| CT soft tissue neck w/o contrast (70490) |
$2,171 |
$2,554 |
19.7× |
| CT thoracic spine w/o contrast (72128) |
$2,171 |
$2,554 |
19.7× |
| CT thoracic spine w/wo contrast (72130) |
$3,302.50 |
$3,885 |
17.8× |
| CT thorax w/o contrast (71250) |
$2,119 |
$2,493 |
19.2× |
| CT upper ext wo (73200) |
$2,171 |
$2,554 |
19.7× |
| CT upper extremity with contrast (73201) |
$3,021 |
$3,554 |
8.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,316 |
$5,078 |
23.3× |
| Cta Abdomen (74175) |
$3,641 |
$4,283 |
19.7× |
| CTA abdomen pelvis (74174) |
$4,865 |
$5,724 |
13.2× |
| CTA chest (71275) |
$3,711 |
$4,366 |
20.0× |
| Cta Head (70496) |
$3,944 |
$4,639.50 |
21.3× |
| Cta Neck (70498) |
$3,641 |
$4,283 |
19.7× |
| Esophagus (74220) |
$602 |
$709 |
3.3× |
| Facial bones min 3 views (70150) |
$762 |
$897 |
6.9× |
| Fluoroscopy up to 1 hr (76000) |
$859 |
$1,011 |
3.4× |
| Foot 2 views (73620) |
$478 |
$563 |
5.2× |
| Forearm 2 views (73090) |
$518 |
$609 |
5.6× |
| Hand 2 views (73120) |
$478 |
$563 |
4.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,218 |
$2,609 |
3.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,856 |
$3,360 |
5.0× |
| Liver & spleen imaging static only (78215) |
$2,218 |
$2,609 |
5.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,790 |
$4,458 |
4.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,790 |
$4,458 |
10.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,091 |
$4,813 |
11.1× |
| MRA head w & w/o contrast (70546) |
$3,823 |
$4,497 |
10.4× |
| MRA head w/o contrast (70544) |
$3,344 |
$3,934 |
13.3× |
| MRA head with contrast (70545) |
$3,574 |
$4,205 |
9.7× |
| MRA neck w contrast (70548) |
$3,564 |
$4,193 |
9.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,587 |
$5,397 |
12.5× |
| MRA neck w/o contrast (70547) |
$3,272 |
$3,849 |
13.0× |
| MRI abdomen w contrast (74182) |
$4,126 |
$4,854 |
11.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,060 |
$5,954 |
13.7× |
| MRI abdomen w/o contrast (74181) |
$3,755 |
$4,417 |
14.9× |
| MRI c-spine with contrast (72142) |
$4,179 |
$4,916 |
11.3× |
| MRI cervical spine w/o contrast (72141) |
$3,823 |
$4,497 |
15.2× |
| MRI chest w/o & w/contrast material (71552) |
$4,184 |
$4,922 |
11.4× |
| MRI chest w/o contrast (71550) |
$3,694 |
$4,346 |
14.7× |
| MRI chest with contrast (71551) |
$4,250 |
$5,000 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,759 |
$4,423 |
10.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,384 |
$5,158 |
11.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,257 |
$3,831 |
12.9× |
| MRI orbit face neck w contrast (70542) |
$4,038 |
$4,750 |
11.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$6,862 |
$8,073 |
18.6× |
| MRI pelvis w/contrast (72196) |
$4,002 |
$4,708 |
10.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,977 |
$5,855 |
13.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,341 |
$6,283 |
14.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,116 |
$4,843 |
11.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,342 |
$6,284 |
14.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$4,123 |
$4,851 |
11.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,322 |
$6,261 |
14.5× |
| MRI thoracic spine w/o contrast (72146) |
$3,108 |
$3,656 |
12.3× |
| MRI up ext w/o contrast (73218) |
$3,108 |
$3,656 |
12.3× |
| MRI upper ext joint w/o contrast (73221) |
$3,108 |
$3,656 |
12.3× |
| MRI, joint upper extrem combo (73223) |
$4,091 |
$4,813 |
11.1× |
| Myelogram Cervical (72240) |
$2,702 |
$3,179 |
3.3× |
| Myelogram Lumbar (72265) |
$2,367 |
$2,785 |
2.9× |
| Myelogram thoracic (72255) |
$2,702 |
$3,179 |
3.3× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$4,064 |
$4,782 |
3.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,064 |
$4,782 |
3.0× |
| Neck soft tissue (70360) |
$497 |
$585 |
5.4× |
| Nm gastric emptying study (78264) |
$2,404 |
$2,829 |
5.7× |
| Osseous survey limited (77074) |
$585 |
$688 |
5.3× |
| Parathyroid Planar Imaging (78070) |
$1,405 |
$1,653 |
3.3× |
| Pelvis 1 or 2 views (72170) |
$478 |
$563 |
4.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,479 |
$1,740 |
3.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,598 |
$3,057 |
4.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$574 |
$675 |
6.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$478 |
$563 |
5.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$574 |
$675 |
6.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$413 |
$486 |
3.7× |
| Radex fingr minimum 2 views (73140) |
$428 |
$504 |
4.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$475 |
$559 |
5.2× |
| Radex Hand Minimum 3 Views (73130) |
$574 |
$675 |
6.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$708 |
$833 |
7.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$1,196 |
$1,407 |
10.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$578 |
$680 |
5.2× |
| Radex Humerus Minimum 2 Views (73060) |
$536 |
$630 |
5.8× |
| Radex Kne 1/2 Views (73560) |
$397 |
$467 |
4.3× |
| Radex Kne Compl 4/More Views (73564) |
$475 |
$559 |
4.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$762 |
$897 |
6.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$578 |
$680 |
6.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$574 |
$675 |
6.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$607 |
$714 |
5.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$578 |
$680 |
6.3× |
| Radex Toe Minimum 2 Views (73660) |
$428 |
$504 |
4.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$1,135 |
$1,336 |
10.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$475 |
$559 |
5.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$370 |
$436 |
4.0× |
| Radiologic exam chest 2 views (71046) |
$370 |
$436 |
4.0× |
| Radiologic exam colon single contrast study (74270) |
$1,535 |
$1,806 |
8.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,025 |
$1,206 |
5.5× |
| Radiologic examination femur 1 view (73551) |
$723 |
$851 |
7.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$545 |
$642 |
5.9× |
| Ribs bilateral 3 views (71110) |
$536 |
$630 |
4.9× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$6,327 |
$7,443 |
11.0× |
| Scapula (73010) |
$574 |
$675 |
5.2× |
| Shoulder 1 view (73020) |
$449 |
$528 |
4.9× |
| Small bowel series (74250) |
$1,036 |
$1,219 |
5.6× |
| Spine thoracic 3 views (72072) |
$716 |
$842 |
6.5× |
| Thoracolumbar 2 views (72080) |
$578 |
$680 |
6.3× |
| Thyroid uptake measurement (78012) |
$1,082 |
$1,273 |
2.6× |
| Ultrasound breast complete (76641) |
$612 |
$720 |
5.5× |
| Ultrasound, abdomen limited (76705) |
$1,243 |
$1,463 |
11.3× |
| Unlisted miscellaneous px dx nuclear medicine (78999) |
$1,239 |
$1,457 |
2.9× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$954 |
$1,122 |
5.2× |
| Us breast unilateral limited (76642) |
$462 |
$544 |
5.0× |
| Us chest (76604) |
$746 |
$878 |
6.8× |
| Us compl joint r-t w/image documentation (76881) |
$730 |
$859 |
6.6× |
| Us pelvic non ob complete (76856) |
$1,243 |
$1,463 |
11.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$810 |
$953 |
7.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$550 |
$647.50 |
5.0× |
| Us retroperitoneal limited (76775) |
$1,049 |
$1,234 |
9.5× |
| Us scrotum and contents (76870) |
$1,144 |
$1,346 |
10.4× |
| Us soft tissue head/neck (76536) |
$1,092 |
$1,285 |
9.9× |
| Wrist 2 views (73100) |
$478 |
$563 |
5.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$889 |
$1,046 |
8.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$574 |
$675 |
6.2× |
| X-ray b.e. reductn intuss (74283) |
$495 |
$583 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,191 |
$1,402 |
6.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$245 |
$289 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$650.50 |
$765.50 |
7.1× |
| X-ray exam of femur 2/> (73552) |
$723 |
$851 |
7.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$574 |
$675 |
6.2× |
| X-ray leg, infant (73592) |
$717 |
$843 |
7.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$324 |
$381 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$889 |
$1,046 |
8.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$716 |
$842 |
6.5× |
| X-ray retrograde pyelogram (74420) |
$954 |
$1,122 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$578 |
$680 |
6.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$295 |
$348 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$574 |
$675 |
6.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$762 |
$897 |
8.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$446 |
$525 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$578 |
$680 |
5.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$317 |
$373 |
3.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$578 |
$680 |
6.3× |
| Xr c-spine 4 or 5 views (72050) |
$889 |
$1,046 |
8.1× |