| Abdomen 2 views (74019) |
$114.75 |
$255 |
1.1× |
| Acute gi blood loss imaging (78278) |
$877.72 |
$1,950.50 |
2.1× |
| Ankle 2 views (73600) |
$41.85 |
$93 |
0.5× |
| Arthrogram hip (73525) |
$397.80 |
$884 |
1.1× |
| Arthrogram wrist (73115) |
$274.95 |
$611 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$928.80 |
$2,064 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$926.55 |
$2,059 |
2.2× |
| Bone age studies (77072) |
$85.05 |
$189 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$1,233.90 |
$2,742 |
3.0× |
| Bone survey complete (77075) |
$293.85 |
$653 |
2.7× |
| Bone survey infant (77076) |
$254.70 |
$566 |
2.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,065.05 |
$4,589 |
4.9× |
| Cervical spine 2 or 3 views (72040) |
$41.85 |
$93 |
0.5× |
| Chest 1 view (71045) |
$41.85 |
$93 |
0.5× |
| Chest xray 3 views (71047) |
$139.95 |
$311 |
1.5× |
| Clavicle complete (73000) |
$162.90 |
$362 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$824.40 |
$1,832 |
7.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,263.95 |
$5,031 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$68.85 |
$153 |
0.3× |
| CT abdomen w contrast (74160) |
$68.85 |
$153 |
0.4× |
| CT abdomen w wo contrast (74170) |
$68.85 |
$153 |
0.4× |
| CT abdomen w/o contrast (74150) |
$68.85 |
$153 |
0.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,725.20 |
$6,056 |
14.9× |
| CT c-spine w/contrast (72126) |
$991.35 |
$2,203 |
2.7× |
| CT c-spine w/o contrast (72125) |
$68.85 |
$153 |
0.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,114.65 |
$2,477 |
6.1× |
| CT chest w contrast (71260) |
$68.85 |
$153 |
0.4× |
| CT chest w/wo contrast (71270) |
$68.85 |
$153 |
0.4× |
| CT head/brain with contrast (70460) |
$68.85 |
$153 |
0.4× |
| CT head/brain without and with contrast (70470) |
$68.85 |
$153 |
0.4× |
| CT lower ext w/o (73700) |
$68.85 |
$153 |
0.6× |
| CT lower extremity w wo contrast (73702) |
$1,683.45 |
$3,741 |
9.2× |
| CT lower extremity w/contrast material (73701) |
$68.85 |
$153 |
0.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,053 |
$2,340 |
5.7× |
| CT lumbar spine w/contrast (72132) |
$960.30 |
$2,134 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$68.85 |
$153 |
0.6× |
| CT maxillofacial w contrast (70487) |
$873.45 |
$1,941 |
4.8× |
| CT maxillofacial w/wo contrast (70488) |
$991.35 |
$2,203 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$68.85 |
$153 |
0.6× |
| CT orbits w/o contrast (70480) |
$68.85 |
$153 |
0.6× |
| CT pelvis w/o contrast (72192) |
$68.85 |
$153 |
0.6× |
| CT pelvis w/wo contrast (72194) |
$68.85 |
$153 |
0.4× |
| CT scan of arm combo (73202) |
$68.85 |
$153 |
0.4× |
| CT soft tissue neck w contrast (70491) |
$68.85 |
$153 |
0.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$68.85 |
$153 |
0.4× |
| CT soft tissue neck w/o contrast (70490) |
$68.85 |
$153 |
0.6× |
| CT thoracic spine w/o contrast (72128) |
$68.85 |
$153 |
0.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,404.90 |
$3,122 |
7.7× |
| CT thorax w/o contrast (71250) |
$68.85 |
$153 |
0.6× |
| CT upper ext wo (73200) |
$68.85 |
$153 |
0.6× |
| CT upper extremity with contrast (73201) |
$68.85 |
$153 |
0.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$68.85 |
$153 |
0.4× |
| Cta Abdomen (74175) |
$68.85 |
$153 |
0.4× |
| CTA abdomen pelvis (74174) |
$68.85 |
$153 |
0.2× |
| CTA chest (71275) |
$68.85 |
$153 |
0.4× |
| Cta Head (70496) |
$68.85 |
$153 |
0.4× |
| Cta Neck (70498) |
$68.85 |
$153 |
0.4× |
| Cystography minimum 3 views rs&i (74430) |
$256.05 |
$569 |
0.7× |
| Diskography lumbar (72295) |
$817.65 |
$1,817 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$119.70 |
$266 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$66.60 |
$148 |
0.7× |
| Dxa bone density study axial skeleton (77085) |
$119.70 |
$266 |
1.1× |
| Esophagus (74220) |
$153.90 |
$342 |
0.8× |
| Facial bones min 3 views (70150) |
$41.85 |
$93 |
0.4× |
| Fluoroscopy up to 1 hr (76000) |
$681.75 |
$1,515 |
2.7× |
| Foot 2 views (73620) |
$41.85 |
$93 |
0.5× |
| Forearm 2 views (73090) |
$41.85 |
$93 |
0.5× |
| Hand 2 views (73120) |
$41.85 |
$93 |
0.4× |
| Heart first pass single,planar (78481) |
$825.75 |
$1,835 |
1.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$743.40 |
$1,652 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$818.55 |
$1,819 |
2.0× |
| Kidney imaging morphology (78700) |
$885.15 |
$1,967 |
2.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,710.90 |
$3,802 |
3.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$3,067.65 |
$6,817 |
5.4× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,500.30 |
$3,334 |
2.6× |
| Knee 3 views (73562) |
$41.85 |
$93 |
0.5× |
| Liver imaging static only (78201) |
$1,297.80 |
$2,884 |
2.3× |
| Lung ventilation imaging (78579) |
$1,533.60 |
$3,408 |
3.7× |
| MRA head w & w/o contrast (70546) |
$1,202.85 |
$2,673 |
3.3× |
| MRA head w/o contrast (70544) |
$977.40 |
$2,172 |
3.9× |
| MRA neck w/o contrast (70547) |
$977.40 |
$2,172 |
3.9× |
| MRI abdomen w contrast (74182) |
$1,155.60 |
$2,568 |
3.2× |
| MRI abdomen w/o contrast (74181) |
$977.40 |
$2,172 |
3.9× |
| MRI c-spine with contrast (72142) |
$1,155.60 |
$2,568 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$977.40 |
$2,172 |
3.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,124.10 |
$2,498 |
3.1× |
| MRI chest w/o contrast (71550) |
$913.05 |
$2,029 |
3.7× |
| MRI chest with contrast (71551) |
$1,080.45 |
$2,401 |
1.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,201.40 |
$4,892 |
6.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$977.40 |
$2,172 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$977.40 |
$2,172 |
3.9× |
| MRI orbit face neck w contrast (70542) |
$1,155.60 |
$2,568 |
3.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,202.85 |
$2,673 |
3.3× |
| MRI pelvis w/contrast (72196) |
$1,155.60 |
$2,568 |
3.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,150.10 |
$4,778 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$977.40 |
$2,172 |
3.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,202.85 |
$2,673 |
3.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,155.60 |
$2,568 |
3.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,202.85 |
$2,673 |
3.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,155.60 |
$2,568 |
3.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,202.85 |
$2,673 |
3.3× |
| MRI temporomandibular joint (70336) |
$977.40 |
$2,172 |
3.9× |
| MRI thoracic spine w/o contrast (72146) |
$977.40 |
$2,172 |
3.9× |
| MRI up ext w/o contrast (73218) |
$977.40 |
$2,172 |
3.9× |
| MRI upper ext joint w/o contrast (73221) |
$977.40 |
$2,172 |
3.9× |
| Myocardial Spect Multiple Studies (78452) |
$2,537.10 |
$5,638 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,710.90 |
$3,802 |
1.3× |
| Neck soft tissue (70360) |
$41.85 |
$93 |
0.5× |
| Nm gastric emptying study (78264) |
$2,147.40 |
$4,772 |
5.1× |
| Noncardiac Vascular Flow Imaging (78445) |
$791.55 |
$1,759 |
1.9× |
| Osseous survey limited (77074) |
$254.70 |
$566 |
2.3× |
| Parathyroid Planar Imaging (78070) |
$1,339.65 |
$2,977 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$41.85 |
$93 |
0.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$818.55 |
$1,819 |
2.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$41.85 |
$93 |
0.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$41.85 |
$93 |
0.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$41.85 |
$93 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$101.70 |
$226 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$126.90 |
$282 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$41.85 |
$93 |
0.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$41.85 |
$93 |
0.5× |
| Radex Hand Minimum 3 Views (73130) |
$41.85 |
$93 |
0.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$41.85 |
$93 |
0.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$100.80 |
$224 |
0.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$113.18 |
$251.50 |
1.0× |
| Radex Humerus Minimum 2 Views (73060) |
$126.45 |
$281 |
1.4× |
| Radex Kne 1/2 Views (73560) |
$41.85 |
$93 |
0.5× |
| Radex Kne Compl 4/More Views (73564) |
$41.85 |
$93 |
0.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$129.15 |
$287 |
1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$41.85 |
$93 |
0.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$41.85 |
$93 |
0.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$41.85 |
$93 |
0.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$131.40 |
$292 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$106.20 |
$236 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$41.85 |
$93 |
0.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$41.85 |
$93 |
0.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$41.85 |
$93 |
0.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$155.70 |
$346 |
1.4× |
| Radiologic exam chest 2 views (71046) |
$41.85 |
$93 |
0.5× |
| Radiologic exam colon single contrast study (74270) |
$254.70 |
$566 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$254.70 |
$566 |
1.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$337.50 |
$750 |
1.8× |
| Radiologic examination femur 1 view (73551) |
$41.85 |
$93 |
0.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$41.85 |
$93 |
0.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$155.70 |
$346 |
1.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$107.55 |
$239 |
1.0× |
| Scapula (73010) |
$41.85 |
$93 |
0.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$217.80 |
$484 |
9.3× |
| Shoulder 1 view (73020) |
$41.85 |
$93 |
0.5× |
| Small bowel series (74250) |
$219.60 |
$488 |
1.2× |
| Thyroid imaging w/blood flow (78013) |
$943.65 |
$2,097 |
2.3× |
| Thyroid uptake measurement (78012) |
$1,744.65 |
$3,877 |
4.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,050.75 |
$2,335 |
2.5× |
| Ultrasound breast complete (76641) |
$274.50 |
$610 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$257.40 |
$572 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$201.15 |
$447 |
1.8× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$31.50 |
$70 |
0.3× |
| Us breast unilateral limited (76642) |
$247.95 |
$551 |
2.7× |
| Us chest (76604) |
$207.45 |
$461 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$41.85 |
$93 |
0.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$41.85 |
$93 |
0.4× |
| Us ob detailed single fetus (76811) |
$292.95 |
$651 |
1.2× |
| Us ob limited (76815) |
$41.85 |
$93 |
0.4× |
| Us ob transvaginal (76817) |
$259.65 |
$577 |
2.4× |
| Us pelvic non ob complete (76856) |
$318.15 |
$707 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$192.60 |
$428 |
1.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$219.15 |
$487 |
2.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$94.50 |
$210 |
0.9× |
| Us retroperitoneal complete (76770) |
$265.95 |
$591 |
2.4× |
| Us scrotum and contents (76870) |
$266.85 |
$593 |
2.4× |
| Us soft tissue head/neck (76536) |
$198.90 |
$442 |
1.8× |
| Us spinal canal and contents (76800) |
$495.45 |
$1,101 |
4.5× |
| Venogram Extremity Unilateral (75820) |
$310.95 |
$691 |
0.2× |
| Vertebral fracture assessment via dxa (77086) |
$66.60 |
$148 |
0.7× |
| Wrist 2 views (73100) |
$41.85 |
$93 |
0.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$96.75 |
$215 |
1.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$307.35 |
$683 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$41.85 |
$93 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$41.85 |
$93 |
0.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$129.60 |
$288 |
1.2× |
| X-ray exam of femur 2/> (73552) |
$102.38 |
$227.50 |
1.1× |
| X-ray eye for foreign body (70030) |
$64.35 |
$143 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$41.85 |
$93 |
0.5× |
| X-ray IV pyelogram (ivp) (74400) |
$289.35 |
$643 |
1.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$106.20 |
$236 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$211.05 |
$469 |
2.3× |
| X-ray leg, infant (73592) |
$41.85 |
$93 |
0.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$41.85 |
$93 |
0.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$159.75 |
$355 |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$232.20 |
$516 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$143.10 |
$318 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$41.85 |
$93 |
0.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$41.85 |
$93 |
0.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$41.85 |
$93 |
0.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$41.85 |
$93 |
0.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$41.85 |
$93 |
0.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$41.85 |
$93 |
0.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$41.85 |
$93 |
0.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$131.85 |
$293 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$41.85 |
$93 |
0.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$80.10 |
$178 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$41.85 |
$93 |
0.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$41.85 |
$93 |
0.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$41.85 |
$93 |
0.4× |
| Xr c-spine 4 or 5 views (72050) |
$41.85 |
$93 |
0.4× |
| Xr c-spine 6 or more views (72052) |
$212.40 |
$472 |
1.9× |
| Xr chest 4+ views (71048) |
$93.60 |
$208 |
0.9× |