| Abdomen 2 views (74019) |
$236 |
$591 |
2.1× |
| Ankle 2 views (73600) |
$96 |
$239 |
1.0× |
| Arthrogram hip (73525) |
$358 |
$895 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$678 |
$1,694 |
1.6× |
| Bone age studies (77072) |
$83 |
$208 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$824 |
$2,060 |
2.0× |
| Bone survey complete (77075) |
$152 |
$379 |
1.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$974 |
$2,435 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$172.50 |
$431.50 |
1.9× |
| Chest 1 view (71045) |
$86 |
$215 |
0.9× |
| Chest xray 3 views (71047) |
$126 |
$314 |
1.4× |
| Clavicle complete (73000) |
$96 |
$240 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,157.50 |
$5,393 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,942 |
$4,855 |
7.7× |
| CT abdomen w contrast (74160) |
$1,163 |
$2,907 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,324 |
$3,310 |
7.2× |
| CT abdomen w/o contrast (74150) |
$756 |
$1,889 |
6.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,366 |
$3,414 |
7.4× |
| CT angiography upper extremity lt (73206) |
$596 |
$1,490 |
3.2× |
| CT c-spine w/contrast (72126) |
$1,163 |
$2,907 |
3.2× |
| CT c-spine w/o contrast (72125) |
$1,163 |
$2,907 |
10.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,326 |
$3,315 |
7.2× |
| CT chest w contrast (71260) |
$1,163 |
$2,907 |
6.3× |
| CT chest w/wo contrast (71270) |
$1,326 |
$3,315 |
7.2× |
| CT head/brain with contrast (70460) |
$1,163 |
$2,907 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,288 |
$3,219 |
7.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$222 |
$554 |
2.4× |
| CT iac w contrast (70481) |
$1,135 |
$2,838 |
6.1× |
| CT lower ext w/o (73700) |
$755 |
$1,887 |
6.8× |
| CT lower extremity w wo contrast (73702) |
$1,325 |
$3,312 |
7.2× |
| CT lower extremity w/contrast material (73701) |
$274 |
$685 |
1.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,326 |
$3,315 |
7.2× |
| CT lumbar spine w/contrast (72132) |
$1,163 |
$2,907 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$756 |
$1,889 |
6.9× |
| CT maxillofacial w contrast (70487) |
$1,163 |
$2,907 |
6.3× |
| CT maxillofacial w/wo contrast (70488) |
$595 |
$1,488 |
3.2× |
| CT maxillofacial wo contrast (70486) |
$755 |
$1,887 |
6.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,678 |
$4,194 |
9.1× |
| CT orbits w/o contrast (70480) |
$755 |
$1,887 |
6.8× |
| CT pelvis w/o contrast (72192) |
$756 |
$1,889 |
6.9× |
| CT pelvis w/wo contrast (72194) |
$1,326 |
$3,315 |
7.2× |
| CT scan of arm combo (73202) |
$1,491 |
$3,727 |
8.1× |
| CT soft tissue neck w contrast (70491) |
$1,163 |
$2,907 |
6.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,288 |
$3,219 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$755 |
$1,887 |
6.8× |
| CT thoracic spine w/contrast (72129) |
$1,163 |
$2,907 |
6.3× |
| CT thoracic spine w/o contrast (72128) |
$756 |
$1,889 |
6.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,326 |
$3,315 |
7.2× |
| CT thorax w/o contrast (71250) |
$756 |
$1,889 |
6.9× |
| CT upper ext wo (73200) |
$755 |
$1,887 |
6.8× |
| CT upper extremity with contrast (73201) |
$200 |
$500 |
0.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$660 |
$1,650 |
3.6× |
| Cta Abdomen (74175) |
$1,366 |
$3,416 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,067 |
$2,668 |
2.9× |
| CTA chest (71275) |
$1,575 |
$3,937 |
8.5× |
| Cta Head (70496) |
$1,366 |
$3,416 |
7.4× |
| Cta Neck (70498) |
$1,366 |
$3,416 |
7.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$210 |
$525 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$189 |
$473 |
2.1× |
| Esophagus (74220) |
$205 |
$512 |
1.1× |
| Facial bones min 3 views (70150) |
$136 |
$341 |
1.2× |
| Fetal biophysical profile non-stress testing (76818) |
$267 |
$667 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$369 |
$923 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$536 |
$1,341 |
2.1× |
| Foot 2 views (73620) |
$94 |
$234 |
1.0× |
| Forearm 2 views (73090) |
$96 |
$240 |
1.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$844 |
$2,110 |
2.0× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$471 |
$1,178 |
1.9× |
| Hand 2 views (73120) |
$136 |
$341 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,204 |
$3,011 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$742 |
$1,855 |
1.8× |
| Hysterosalpingogram (74740) |
$413 |
$1,033 |
1.6× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$28 |
$69 |
0.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$664 |
$1,659 |
1.2× |
| Knee 3 views (73562) |
$109 |
$273 |
1.2× |
| Liver & spleen imaging static only (78215) |
$574 |
$1,436 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$345 |
$863 |
0.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,660 |
$4,150 |
4.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,092 |
$5,231 |
5.7× |
| MRA head w & w/o contrast (70546) |
$2,089 |
$5,223 |
5.7× |
| MRA head w/o contrast (70544) |
$1,459 |
$3,648 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,089 |
$5,223 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,459 |
$3,648 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,092 |
$5,231 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,459 |
$3,648 |
5.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,660 |
$4,149 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,091 |
$5,228 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$289 |
$722 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$274 |
$685 |
0.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,092 |
$5,231 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,458 |
$3,646 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,458 |
$3,646 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,092 |
$5,231 |
5.7× |
| MRI pelvis w/contrast (72196) |
$1,660 |
$4,149 |
4.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,092 |
$5,231 |
5.7× |
| MRI pelvis w/o contrast (72195) |
$1,459 |
$3,648 |
5.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,096 |
$5,240 |
5.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,660 |
$4,150 |
4.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,096 |
$5,240 |
5.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,662 |
$4,154 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,096 |
$5,240 |
5.7× |
| MRI thoracic spine w/o contrast (72146) |
$289 |
$722 |
1.1× |
| MRI up ext w/o contrast (73218) |
$578 |
$1,446 |
2.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,458 |
$3,646 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$2,092 |
$5,231 |
5.7× |
| Myelogram Cervical (72240) |
$642 |
$1,606 |
0.8× |
| Myelogram Lumbar (72265) |
$642 |
$1,606 |
0.8× |
| Myelogram thoracic (72255) |
$642 |
$1,606 |
0.8× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$840 |
$2,101 |
0.6× |
| Myocardial Perfusion Planar Multiple Studies (78454) |
$840 |
$2,101 |
0.6× |
| Myocardial Spect Multiple Studies (78452) |
$808 |
$2,021 |
0.6× |
| Myocardial spect single study at rest or stress (78451) |
$558 |
$1,396 |
0.4× |
| Neck soft tissue (70360) |
$94 |
$236 |
1.0× |
| Nm gastric emptying study (78264) |
$656 |
$1,640 |
1.6× |
| Nonvascular shunt X-ray (75809) |
$184 |
$459 |
1.7× |
| Ob us nuchal meas 1 gest (76813) |
$274 |
$685 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$136 |
$341 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$886 |
$2,216 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$104 |
$259 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$94 |
$236 |
1.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$112 |
$280 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$64 |
$161 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$60 |
$150 |
0.5× |
| Radex fingr minimum 2 views (73140) |
$103 |
$257 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$103 |
$257 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$104 |
$259 |
1.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$92 |
$231 |
1.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$71 |
$177 |
0.6× |
| Radex Humerus Minimum 2 Views (73060) |
$99 |
$248 |
1.1× |
| Radex Kne 1/2 Views (73560) |
$97 |
$243 |
1.1× |
| Radex Kne Compl 4/More Views (73564) |
$136 |
$341 |
1.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$136 |
$341 |
1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$106 |
$264 |
1.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$120 |
$299 |
1.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$99 |
$248 |
1.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$101 |
$253 |
1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$135 |
$338 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$99 |
$248 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$98 |
$245 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$110 |
$274 |
1.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$273 |
$683 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90 |
$224 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$281 |
$702 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$100 |
$251 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$210 |
$525 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$227 |
$567 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$94 |
$236 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$141 |
$353 |
1.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$109 |
$273 |
1.0× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$1,725 |
$4,313 |
3.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$968 |
$2,420 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$98 |
$245 |
0.9× |
| Scapula (73010) |
$97 |
$243 |
0.9× |
| Shoulder 1 view (73020) |
$87 |
$218 |
0.9× |
| Small bowel series (74250) |
$210 |
$525 |
1.1× |
| Spine thoracic 3 views (72072) |
$136 |
$341 |
1.2× |
| Thoracolumbar 2 views (72080) |
$109 |
$273 |
1.2× |
| Thyroid imaging w/blood flow (78013) |
$368 |
$919 |
0.9× |
| Thyroid uptake measurement (78012) |
$368 |
$919 |
0.9× |
| Tmj unilateral (70328) |
$99 |
$248 |
1.1× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) |
$184 |
$461 |
1.7× |
| Ultrasound breast complete (76641) |
$182 |
$455 |
1.6× |
| Ultrasound Exam Aaa Screen (76706) |
$98 |
$245 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$369 |
$923 |
3.3× |
| Us breast unilateral limited (76642) |
$139 |
$348 |
1.5× |
| Us chest (76604) |
$236 |
$590 |
2.1× |
| Us encephalogram (76506) |
$243 |
$607 |
2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$72 |
$181 |
0.7× |
| Us ob detailed single fetus (76811) |
$580 |
$1,449 |
2.3× |
| Us ob limited (76815) |
$236 |
$590 |
2.1× |
| Us ob transvaginal (76817) |
$243 |
$607 |
2.2× |
| Us pelvic non ob complete (76856) |
$369 |
$923 |
3.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$244 |
$611 |
2.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$369 |
$923 |
3.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$243 |
$607 |
2.2× |
| Us retroperitoneal complete (76770) |
$369 |
$923 |
3.3× |
| Us retroperitoneal limited (76775) |
$369 |
$923 |
3.3× |
| Us scrotum and contents (76870) |
$369 |
$923 |
3.3× |
| Us soft tissue head/neck (76536) |
$382.50 |
$956.50 |
3.5× |
| Us spinal canal and contents (76800) |
$369 |
$923 |
3.3× |
| Us transrectal (76872) |
$380 |
$950 |
3.4× |
| Us transrectal prostate volume (76873) |
$381 |
$952 |
3.5× |
| Wrist 2 views (73100) |
$98 |
$245 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$136 |
$341 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$111 |
$277 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$210 |
$525 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$96 |
$240 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$112 |
$280 |
1.2× |
| X-ray exam of femur 2/> (73552) |
$98 |
$245 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$99 |
$248 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$101 |
$253 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$100 |
$251 |
1.1× |
| X-ray leg, infant (73592) |
$98 |
$245 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$136 |
$341 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$177 |
$442 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$136 |
$341 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$103 |
$257 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$136 |
$341 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$138 |
$345 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$136 |
$341 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$100 |
$251 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$116 |
$290 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$136 |
$341 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$136 |
$341 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$87 |
$218 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$114 |
$286 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$104 |
$261 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$136 |
$341 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$136 |
$341 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$139 |
$347 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$164 |
$410 |
1.5× |
| Xr chest 4+ views (71048) |
$126 |
$315 |
1.1× |