| Abdomen 2 views (74019) |
$179.90 |
$514 |
1.8× |
| Acute gi blood loss imaging (78278) |
$92.05 |
$263 |
0.2× |
| Ankle 2 views (73600) |
$151.20 |
$432 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$161.35 |
$461 |
0.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$248.50 |
$710 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$90.65 |
$259 |
0.2× |
| Bone age studies (77072) |
$34.65 |
$99 |
0.3× |
| Bone Imaging 3 Phase (78315) |
$93.62 |
$267.50 |
0.2× |
| Bone survey complete (77075) |
$336.52 |
$961.50 |
3.3× |
| Bowel imaging (78290) |
$182.52 |
$521.50 |
0.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$87.85 |
$251 |
0.2× |
| Cervical spine 2 or 3 views (72040) |
$74.20 |
$212 |
0.9× |
| Chest 1 view (71045) |
$54.60 |
$156 |
0.6× |
| Chest xray 3 views (71047) |
$116.20 |
$332 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$108.85 |
$311 |
0.6× |
| Clavicle complete (73000) |
$165.20 |
$472 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$52.15 |
$149 |
0.5× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$212.10 |
$606 |
2.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$295.75 |
$845 |
0.9× |
| CT abdomen and pelvis without contrast (74176) |
$295.75 |
$845 |
1.3× |
| CT abdomen w contrast (74160) |
$131.95 |
$377 |
0.8× |
| CT abdomen w wo contrast (74170) |
$149.10 |
$426 |
0.9× |
| CT abdomen w/o contrast (74150) |
$127.05 |
$363 |
1.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$656.95 |
$1,877 |
3.8× |
| CT angiography upper extremity lt (73206) |
$653.98 |
$1,868.50 |
3.8× |
| CT c-spine w/o contrast (72125) |
$149.10 |
$426 |
1.5× |
| CT chest w contrast (71260) |
$149.10 |
$426 |
0.9× |
| CT chest w/wo contrast (71270) |
$149.10 |
$426 |
0.9× |
| CT head/brain with contrast (70460) |
$765.80 |
$2,188 |
4.5× |
| CT head/brain without and with contrast (70470) |
$149.10 |
$426 |
0.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$42.70 |
$122 |
0.5× |
| CT iac w contrast (70481) |
$537.95 |
$1,537 |
3.1× |
| CT limited/localized follow up study (76380) |
$54.95 |
$157 |
0.6× |
| CT lower ext w/o (73700) |
$487.02 |
$1,391.50 |
4.8× |
| CT lower extremity w wo contrast (73702) |
$957.95 |
$2,737 |
5.6× |
| CT lower extremity w/contrast material (73701) |
$880.60 |
$2,516 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$149.10 |
$426 |
1.5× |
| CT maxillofacial w contrast (70487) |
$149.10 |
$426 |
0.9× |
| CT maxillofacial w/wo contrast (70488) |
$375.02 |
$1,071.50 |
2.2× |
| CT maxillofacial wo contrast (70486) |
$101.50 |
$290 |
1.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$404.08 |
$1,154.50 |
2.4× |
| CT orbits w/o contrast (70480) |
$149.10 |
$426 |
1.5× |
| CT pelvis w/o contrast (72192) |
$149.10 |
$426 |
1.5× |
| CT pelvis w/wo contrast (72194) |
$149.10 |
$426 |
0.9× |
| CT scan of arm combo (73202) |
$957.95 |
$2,737 |
5.6× |
| CT soft tissue neck w contrast (70491) |
$149.10 |
$426 |
0.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$149.10 |
$426 |
0.9× |
| CT soft tissue neck w/o contrast (70490) |
$149.10 |
$426 |
1.5× |
| CT thoracic spine w/o contrast (72128) |
$149.10 |
$426 |
1.5× |
| CT thorax w/o contrast (71250) |
$407.40 |
$1,164 |
4.0× |
| CT upper ext wo (73200) |
$826.35 |
$2,361 |
8.1× |
| CT upper extremity with contrast (73201) |
$911.40 |
$2,604 |
2.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$175.18 |
$500.50 |
1.0× |
| Cta Abdomen (74175) |
$162.40 |
$464 |
0.9× |
| CTA abdomen pelvis (74174) |
$1,695.40 |
$4,844 |
5.0× |
| CTA chest (71275) |
$149.10 |
$426 |
0.9× |
| Cta Head (70496) |
$170.98 |
$488.50 |
1.0× |
| Cta Neck (70498) |
$156.10 |
$446 |
0.9× |
| Cta Pelvis (72191) |
$161.35 |
$461 |
0.9× |
| Cystography minimum 3 views rs&i (74430) |
$32.55 |
$93 |
0.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$72.10 |
$206 |
0.7× |
| Dxa bone density study axial skeleton (77085) |
$207.90 |
$594 |
2.0× |
| Esophagus (74220) |
$153.30 |
$438 |
0.9× |
| Facial bones min 3 views (70150) |
$107.62 |
$307.50 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$242.55 |
$693 |
1.0× |
| Foot 2 views (73620) |
$136.15 |
$389 |
1.6× |
| Forearm 2 views (73090) |
$147.35 |
$421 |
1.7× |
| Hand 2 views (73120) |
$108.15 |
$309 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$79.80 |
$228 |
0.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$90.65 |
$259 |
0.2× |
| Hysterosalpingogram (74740) |
$104.82 |
$299.50 |
0.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$90.65 |
$259 |
0.2× |
| Lung ventilation imaging (78579) |
$282.28 |
$806.50 |
0.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$769.65 |
$2,199 |
1.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,390.20 |
$3,972 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,720.25 |
$4,915 |
5.1× |
| MRA head w & w/o contrast (70546) |
$775.78 |
$2,216.50 |
2.3× |
| MRA head w/o contrast (70544) |
$149.10 |
$426 |
0.6× |
| MRA head with contrast (70545) |
$628.95 |
$1,797 |
1.8× |
| MRA neck w contrast (70548) |
$601.82 |
$1,719.50 |
1.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$678.82 |
$1,939.50 |
2.0× |
| MRA neck w/o contrast (70547) |
$149.10 |
$426 |
0.6× |
| MRI abdomen w contrast (74182) |
$692.48 |
$1,978.50 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$163.10 |
$466 |
0.5× |
| MRI abdomen w/o contrast (74181) |
$552.48 |
$1,578.50 |
2.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$696.68 |
$1,990.50 |
0.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,841.35 |
$5,261 |
5.4× |
| MRI c-spine with contrast (72142) |
$176.05 |
$503 |
0.5× |
| MRI cervical spine w/o contrast (72141) |
$148.92 |
$425.50 |
0.6× |
| MRI chest w/o & w/contrast material (71552) |
$863.45 |
$2,467 |
2.5× |
| MRI chest w/o contrast (71550) |
$584.68 |
$1,670.50 |
2.5× |
| MRI chest with contrast (71551) |
$809.38 |
$2,312.50 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,409.45 |
$4,027 |
4.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,720.25 |
$4,915 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,355.55 |
$3,873 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$149.10 |
$426 |
0.6× |
| MRI orbit face neck w contrast (70542) |
$149.10 |
$426 |
0.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$154.35 |
$441 |
0.5× |
| MRI pelvis w/contrast (72196) |
$149.10 |
$426 |
0.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$151.20 |
$432 |
0.4× |
| MRI pelvis w/o contrast (72195) |
$149.10 |
$426 |
0.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$214.90 |
$614 |
0.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$167.65 |
$479 |
0.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$207.20 |
$592 |
0.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$183.05 |
$523 |
0.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$223.30 |
$638 |
0.7× |
| MRI temporomandibular joint (70336) |
$615.30 |
$1,758 |
2.6× |
| MRI thoracic spine w/o contrast (72146) |
$149.10 |
$426 |
0.6× |
| MRI up ext w/o contrast (73218) |
$1,219.05 |
$3,483 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$993.65 |
$2,839 |
4.3× |
| MRI, joint upper extrem combo (73223) |
$1,720.25 |
$4,915 |
5.1× |
| Myocardial Spect Multiple Studies (78452) |
$1,271.90 |
$1,903 |
1.0× |
| Myocardial spect single study at rest or stress (78451) |
$710.32 |
$2,029.50 |
0.6× |
| Neck soft tissue (70360) |
$75.60 |
$216 |
0.9× |
| Nm gastric emptying study (78264) |
$275.62 |
$787.50 |
0.7× |
| Parathyroid Planar Imaging (78070) |
$208.95 |
$597 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$66.50 |
$190 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$343.88 |
$982.50 |
0.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$90.65 |
$259 |
0.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$113.58 |
$324.50 |
0.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$156.45 |
$447 |
1.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$137.90 |
$394 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$129.85 |
$371 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$32.55 |
$93 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$88.55 |
$253 |
0.9× |
| Radex fingr minimum 2 views (73140) |
$121.45 |
$347 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$129.50 |
$370 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$143.50 |
$410 |
1.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$93.45 |
$267 |
1.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$148.05 |
$423 |
1.5× |
| Radex Humerus Minimum 2 Views (73060) |
$124.95 |
$357 |
1.5× |
| Radex Kne 1/2 Views (73560) |
$53.20 |
$152 |
0.6× |
| Radex Kne Compl 4/More Views (73564) |
$161.70 |
$462 |
1.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$101.15 |
$289 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$71.22 |
$203.50 |
0.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$153.30 |
$438 |
1.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$51.98 |
$148.50 |
0.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$104.82 |
$299.50 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$101.85 |
$291 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$153.65 |
$439 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$67.38 |
$192.50 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$250.95 |
$717 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$37.80 |
$108 |
0.4× |
| Radiologic exam colon single contrast study (74270) |
$48.30 |
$138 |
0.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$105 |
$300 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$107.98 |
$308.50 |
0.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$195.65 |
$559 |
2.3× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$85.22 |
$243.50 |
0.8× |
| Radiological examination surgical specimen (76098) |
$136.32 |
$389.50 |
0.3× |
| Ribs bilateral 3 views (71110) |
$87.85 |
$251 |
0.9× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$192.50 |
$550 |
0.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$285.25 |
$815 |
0.5× |
| Scapula (73010) |
$74.90 |
$214 |
0.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$44.45 |
$127 |
1.9× |
| Sella turcica (70240) |
$41.48 |
$118.50 |
0.5× |
| Shoulder 1 view (73020) |
$83.65 |
$239 |
1.0× |
| Small bowel series (74250) |
$51.80 |
$148 |
0.3× |
| Spine thoracic 3 views (72072) |
$22.75 |
$65 |
0.2× |
| Thoracolumbar 2 views (72080) |
$86.62 |
$247.50 |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$138.60 |
$396 |
0.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$264.95 |
$757 |
0.7× |
| Tomogram (76100) |
$54.25 |
$155 |
0.5× |
| Ultrasound breast complete (76641) |
$306.60 |
$876 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$304.85 |
$871 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$90.65 |
$259 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$119.88 |
$342.50 |
0.5× |
| Us breast unilateral limited (76642) |
$178.15 |
$509 |
2.1× |
| Us chest (76604) |
$124.78 |
$356.50 |
1.2× |
| Us compl joint r-t w/image documentation (76881) |
$195.65 |
$559 |
1.9× |
| Us hips infant static (76886) |
$51.80 |
$148 |
0.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$52.15 |
$149 |
0.5× |
| Us ob limited (76815) |
$90.65 |
$259 |
0.9× |
| Us pelvic non ob complete (76856) |
$90.65 |
$259 |
0.9× |
| Us retroperitoneal complete (76770) |
$103.95 |
$297 |
1.0× |
| Us retroperitoneal limited (76775) |
$90.65 |
$259 |
0.9× |
| Us scrotum and contents (76870) |
$90.65 |
$259 |
0.9× |
| Us soft tissue head/neck (76536) |
$98.88 |
$282.50 |
1.0× |
| Us transrectal (76872) |
$182.35 |
$521 |
1.8× |
| Venogram extremity bilateral (75822) |
$240.28 |
$686.50 |
0.2× |
| Venogram Extremity Unilateral (75820) |
$289.10 |
$826 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$208.60 |
$596 |
2.5× |
| Wrist 2 views (73100) |
$150.50 |
$430 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$140.88 |
$402.50 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$59.50 |
$170 |
0.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$71.40 |
$204 |
0.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$120.05 |
$343 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$28 |
$80 |
0.3× |
| X-ray exam of femur 2/> (73552) |
$204.05 |
$583 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$90.30 |
$258 |
1.1× |
| X-ray IV pyelogram (ivp) (74400) |
$47.25 |
$135 |
0.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$55.82 |
$159.50 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$93.62 |
$267.50 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$180.95 |
$517 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$136.50 |
$390 |
1.3× |
| X-ray retrograde pyelogram (74420) |
$214.90 |
$614 |
0.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$145.60 |
$416 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$150.85 |
$431 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$104.30 |
$298 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$52.85 |
$151 |
0.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$70 |
$200 |
0.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$180.95 |
$517 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$30.45 |
$87 |
0.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$64.92 |
$185.50 |
0.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$49.35 |
$141 |
0.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$63.52 |
$181.50 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$89.08 |
$254.50 |
1.0× |
| Xr bone length studies (77073) |
$141.40 |
$404 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$102.38 |
$292.50 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$191.62 |
$547.50 |
1.9× |
| Xr chest 4+ views (71048) |
$298.90 |
$854 |
2.9× |