| Abdomen 2 views (74019) |
$324.80 |
$464 |
3.1× |
| Acute gi blood loss imaging (78278) |
$1,410.47 |
$2,014.95 |
3.6× |
| Ankle 2 views (73600) |
$223.30 |
$319 |
2.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,166.90 |
$1,667 |
3.0× |
| Bone &/joint imaging whole body (78306) |
$1,682.77 |
$2,403.96 |
4.3× |
| Bone age studies (77072) |
$225.37 |
$321.95 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$1,802.11 |
$2,574.44 |
4.6× |
| Bone survey complete (77075) |
$909.94 |
$1,299.92 |
8.8× |
| Bowel imaging (78290) |
$1,164.43 |
$1,663.47 |
2.9× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,920.80 |
$2,744 |
4.9× |
| Cervical spine 2 or 3 views (72040) |
$261.31 |
$373.30 |
3.0× |
| Chest 1 view (71045) |
$145.25 |
$207.50 |
1.7× |
| Clavicle complete (73000) |
$263.90 |
$377 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$672.70 |
$961 |
6.5× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$333.08 |
$475.83 |
3.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,844.10 |
$4,063 |
8.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,714.30 |
$2,449 |
7.3× |
| CT abdomen w contrast (74160) |
$1,494.99 |
$2,135.70 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,878.09 |
$2,682.99 |
10.8× |
| CT abdomen w/o contrast (74150) |
$1,178.80 |
$1,684 |
11.4× |
| CT angiography upper extremity lt (73206) |
$2,363.90 |
$3,377 |
13.6× |
| CT c-spine w/contrast (72126) |
$1,676.50 |
$2,395 |
4.9× |
| CT c-spine w/o contrast (72125) |
$1,411.20 |
$2,016 |
13.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,056.71 |
$1,509.59 |
6.1× |
| CT chest w contrast (71260) |
$1,419.60 |
$2,028 |
8.2× |
| CT chest w/wo contrast (71270) |
$1,675.80 |
$2,394 |
9.7× |
| CT head/brain with contrast (70460) |
$1,501.50 |
$2,145 |
8.7× |
| CT head/brain without and with contrast (70470) |
$1,647.10 |
$2,353 |
9.5× |
| CT iac w contrast (70481) |
$1,700.30 |
$2,429 |
9.8× |
| CT lower ext w/o (73700) |
$1,182.26 |
$1,688.94 |
11.4× |
| CT lower extremity w wo contrast (73702) |
$1,911 |
$2,730 |
11.0× |
| CT lower extremity w/contrast material (73701) |
$1,394.40 |
$1,992 |
8.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,218.55 |
$3,169.35 |
12.8× |
| CT lumbar spine w/contrast (72132) |
$1,826.30 |
$2,609 |
5.3× |
| CT lumbar spine w/o contrast (72131) |
$1,388.10 |
$1,983 |
13.4× |
| CT maxillofacial w contrast (70487) |
$1,544.20 |
$2,206 |
8.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,917.30 |
$2,739 |
11.1× |
| CT maxillofacial wo contrast (70486) |
$1,155.98 |
$1,651.40 |
11.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,757 |
$2,510 |
10.1× |
| CT orbits w/o contrast (70480) |
$1,061.58 |
$1,516.54 |
10.3× |
| CT pelvis w/o contrast (72192) |
$1,253.64 |
$1,790.91 |
12.1× |
| CT pelvis w/wo contrast (72194) |
$1,847.13 |
$2,638.76 |
10.7× |
| CT scan of arm combo (73202) |
$1,920.10 |
$2,743 |
11.1× |
| CT soft tissue neck w contrast (70491) |
$1,462.10 |
$2,088.71 |
8.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,645 |
$2,350 |
9.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,179.37 |
$1,684.82 |
11.4× |
| CT thoracic spine w/contrast (72129) |
$1,821.40 |
$2,602 |
10.5× |
| CT thoracic spine w/o contrast (72128) |
$1,380.40 |
$1,972 |
13.4× |
| CT thoracic spine w/wo contrast (72130) |
$2,076.58 |
$2,966.54 |
12.0× |
| CT thorax w/o contrast (71250) |
$1,229.22 |
$1,756.03 |
11.9× |
| CT upper ext wo (73200) |
$1,200.50 |
$1,715 |
11.6× |
| CT upper extremity with contrast (73201) |
$1,401.40 |
$2,002 |
4.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,874.33 |
$2,677.62 |
10.8× |
| CTA chest (71275) |
$1,882.30 |
$2,689 |
10.9× |
| Cta Head (70496) |
$1,660.40 |
$2,372 |
9.6× |
| Cta Neck (70498) |
$1,889.30 |
$2,699 |
10.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$77 |
$110 |
0.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$872.42 |
$1,246.31 |
8.4× |
| Fluoroscopy up to 1 hr (76000) |
$637.71 |
$911.02 |
2.7× |
| Foot 2 views (73620) |
$214.20 |
$306 |
2.5× |
| Forearm 2 views (73090) |
$224.26 |
$320.38 |
2.6× |
| Hand 2 views (73120) |
$213.50 |
$305 |
2.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,660.23 |
$2,371.75 |
3.1× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,737.22 |
$2,481.74 |
3.2× |
| Knee 3 views (73562) |
$296.10 |
$423 |
3.4× |
| Lung ventilation imaging (78579) |
$1,149.41 |
$1,642.01 |
2.9× |
| Lymphoscintigraphy (78195) |
$1,336.40 |
$1,909.14 |
2.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,838.15 |
$4,054.50 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,419.55 |
$3,456.50 |
7.0× |
| MRA head w & w/o contrast (70546) |
$2,615.90 |
$3,737 |
7.6× |
| MRA head w/o contrast (70544) |
$1,912.40 |
$2,732 |
8.1× |
| MRI abdomen w contrast (74182) |
$2,275 |
$3,250 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,182.20 |
$4,546 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$2,102.80 |
$3,004 |
8.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,759.05 |
$3,941.50 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,514.35 |
$5,020.50 |
10.2× |
| MRI cervical spine w/o contrast (72141) |
$1,984.21 |
$2,834.58 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,940 |
$4,200 |
8.5× |
| MRI chest with contrast (71551) |
$2,240 |
$3,200 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,752.05 |
$3,931.50 |
8.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,318 |
$4,740 |
9.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,096.85 |
$2,995.50 |
8.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,896.30 |
$2,709 |
8.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,925.30 |
$4,179 |
8.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,700.60 |
$3,858 |
7.8× |
| MRI pelvis w/o contrast (72195) |
$2,028.60 |
$2,898 |
8.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,054.80 |
$4,364 |
8.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,055.90 |
$2,937 |
6.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,051.30 |
$4,359 |
8.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,042.20 |
$4,346 |
8.8× |
| MRI temporomandibular joint (70336) |
$1,559.60 |
$2,228 |
6.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,978.60 |
$2,826.57 |
8.4× |
| MRI up ext w/o contrast (73218) |
$2,064.30 |
$2,949 |
8.8× |
| MRI upper ext joint w/o contrast (73221) |
$2,159.15 |
$3,084.50 |
9.2× |
| MRI, joint upper extrem combo (73223) |
$3,323.95 |
$4,748.50 |
9.6× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$1,413.31 |
$2,019.01 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,794.72 |
$5,421.03 |
3.0× |
| Myocardial spect single study at rest or stress (78451) |
$3,794.72 |
$5,421.03 |
3.0× |
| Neck soft tissue (70360) |
$237.30 |
$339 |
2.8× |
| Nm gastric emptying study (78264) |
$1,196.30 |
$1,709 |
3.0× |
| Parathyroid Planar Imaging (78070) |
$1,211.34 |
$1,730.48 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$227.80 |
$325.42 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,200.12 |
$1,714.46 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,724.07 |
$2,462.96 |
3.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$246.61 |
$352.30 |
2.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$216.92 |
$309.88 |
2.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$254.33 |
$363.32 |
3.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$291.14 |
$415.92 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$196.24 |
$280.35 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$240.06 |
$342.95 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$250.83 |
$358.32 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$249.20 |
$356 |
2.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$398.65 |
$569.50 |
3.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$280 |
$400 |
2.7× |
| Radex Humerus Minimum 2 Views (73060) |
$241.54 |
$345.05 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$203.37 |
$290.52 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$326.60 |
$466.57 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$240.66 |
$343.80 |
2.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$328.30 |
$469 |
3.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$257.02 |
$367.18 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$184.82 |
$264.02 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$249.44 |
$356.35 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$236.60 |
$338 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$242.84 |
$346.90 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$233.34 |
$333.35 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,969.10 |
$2,813 |
3.7× |
| Scapula (73010) |
$317.80 |
$454 |
3.1× |
| Shoulder 1 view (73020) |
$248.50 |
$355 |
2.9× |
| Spine thoracic 3 views (72072) |
$303.80 |
$434 |
2.9× |
| Thyroid imaging w/blood flow (78013) |
$898.10 |
$1,283 |
2.3× |
| Thyroid uptake measurement (78012) |
$637.71 |
$911.02 |
1.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,313.90 |
$1,877 |
3.3× |
| Ultrasound breast complete (76641) |
$688.80 |
$984 |
6.7× |
| Ultrasound Exam Aaa Screen (76706) |
$331.80 |
$474 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$485.10 |
$693 |
4.7× |
| Umbilical-artery Doppler (OB) (76820) |
$410.35 |
$586.22 |
4.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$52.50 |
$75 |
0.6× |
| Us chest (76604) |
$547.51 |
$782.16 |
5.3× |
| Us compl joint r-t w/image documentation (76881) |
$379.58 |
$542.25 |
3.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$257.60 |
$368 |
2.5× |
| Us ob limited (76815) |
$497.68 |
$710.97 |
4.8× |
| Us ob transvaginal (76817) |
$362.52 |
$517.89 |
3.5× |
| Us pelvic non ob complete (76856) |
$522.90 |
$747 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$368.90 |
$527 |
3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$518.70 |
$741 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$338.80 |
$484 |
3.3× |
| Us retroperitoneal complete (76770) |
$562.10 |
$803 |
5.4× |
| Us retroperitoneal limited (76775) |
$732.49 |
$1,046.42 |
7.1× |
| Us scrotum and contents (76870) |
$488.34 |
$697.63 |
4.7× |
| Us soft tissue head/neck (76536) |
$465.50 |
$665 |
4.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$578.90 |
$827 |
5.6× |
| Wrist 2 views (73100) |
$195.06 |
$278.65 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$366.24 |
$523.20 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$255.99 |
$365.70 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$205.80 |
$294 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$268.17 |
$383.10 |
3.1× |
| X-ray exam of femur 2/> (73552) |
$228.34 |
$326.21 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$198.10 |
$283 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$294.84 |
$421.20 |
2.9× |
| X-ray retrograde pyelogram (74420) |
$67.20 |
$96 |
0.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$300.16 |
$428.80 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$465.50 |
$665 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$322.70 |
$461 |
3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$326.20 |
$466 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$280 |
$400 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$241.50 |
$345 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$258.30 |
$369 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$238 |
$340 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$301 |
$430 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$359.80 |
$514 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$522.90 |
$747 |
5.1× |