| Abdomen 2 views (74019) |
$285.99 |
$387 |
2.7× |
| Acute gi blood loss imaging (78278) |
$1,306.55 |
$1,768 |
3.2× |
| Ankle 2 views (73600) |
$222.44 |
$301 |
2.5× |
| Arthrogram hip (73525) |
$362.11 |
$490 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$974.74 |
$1,319 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$1,224.52 |
$1,657 |
3.0× |
| Bone age studies (77072) |
$222.44 |
$301 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$1,379.71 |
$1,867 |
3.3× |
| Bone survey complete (77075) |
$586.77 |
$794 |
5.4× |
| Bowel imaging (78290) |
$1,041.99 |
$1,410 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$248.30 |
$336 |
2.8× |
| Chest 1 view (71045) |
$226.13 |
$306 |
2.5× |
| Chest xray 3 views (71047) |
$199.53 |
$270 |
2.2× |
| Clavicle complete (73000) |
$204.70 |
$277 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$850.59 |
$1,151 |
7.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,955.26 |
$3,999 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,197.05 |
$2,973 |
8.9× |
| CT abdomen w contrast (74160) |
$1,511.99 |
$2,046 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,742.56 |
$2,358 |
9.6× |
| CT abdomen w/o contrast (74150) |
$1,178.70 |
$1,595 |
10.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,885.93 |
$2,552 |
10.4× |
| CT angiography upper extremity lt (73206) |
$1,648.71 |
$2,231 |
9.1× |
| CT c-spine w/contrast (72126) |
$1,524.56 |
$2,063 |
4.2× |
| CT c-spine w/o contrast (72125) |
$1,435.14 |
$1,942 |
13.3× |
| CT chest w contrast (71260) |
$1,559.29 |
$2,110 |
8.6× |
| CT chest w/wo contrast (71270) |
$1,590.33 |
$2,152 |
8.8× |
| CT head/brain with contrast (70460) |
$1,297.68 |
$1,756 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,589.59 |
$2,151 |
8.8× |
| CT iac w contrast (70481) |
$1,312.46 |
$1,776 |
7.2× |
| CT limited/localized follow up study (76380) |
$444.14 |
$601 |
4.9× |
| CT lower ext w/o (73700) |
$1,314.68 |
$1,779 |
12.2× |
| CT lower extremity w wo contrast (73702) |
$1,547.47 |
$2,094 |
8.5× |
| CT lower extremity w/contrast material (73701) |
$1,539.34 |
$2,083 |
8.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,618.41 |
$2,190 |
8.9× |
| CT lumbar spine w/contrast (72132) |
$1,553.38 |
$2,102 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$1,457.31 |
$1,972 |
13.5× |
| CT maxillofacial w contrast (70487) |
$1,415.18 |
$1,915 |
7.8× |
| CT maxillofacial wo contrast (70486) |
$1,391.54 |
$1,883 |
12.9× |
| CT orbits w/o contrast (70480) |
$1,196.44 |
$1,619 |
11.1× |
| CT pelvis w/o contrast (72192) |
$1,334.63 |
$1,806 |
12.4× |
| CT scan of arm combo (73202) |
$1,607.32 |
$2,175 |
8.9× |
| CT soft tissue neck w contrast (70491) |
$1,415.18 |
$1,915 |
7.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,484.65 |
$2,009 |
8.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,141.02 |
$1,544 |
10.6× |
| CT thoracic spine w/contrast (72129) |
$1,439.57 |
$1,948 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,423.31 |
$1,926 |
13.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,574.07 |
$2,130 |
8.7× |
| CT thorax w/o contrast (71250) |
$1,339.07 |
$1,812 |
12.4× |
| CT unlisted procedure (76497) |
$4,856.71 |
$6,572 |
54.1× |
| CT upper ext wo (73200) |
$1,264.43 |
$1,711 |
11.7× |
| CT upper extremity with contrast (73201) |
$1,520.12 |
$2,057 |
4.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,205.92 |
$2,985 |
12.2× |
| Cta Abdomen (74175) |
$1,966.48 |
$2,661 |
10.9× |
| CTA abdomen pelvis (74174) |
$2,844.41 |
$3,849 |
7.9× |
| CTA chest (71275) |
$1,933.22 |
$2,616 |
10.7× |
| Cta Head (70496) |
$1,916.97 |
$2,594 |
10.6× |
| Cta Neck (70498) |
$1,894.80 |
$2,564 |
10.5× |
| Cta Pelvis (72191) |
$1,503.86 |
$2,035 |
8.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,356.80 |
$1,836 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$398.32 |
$539 |
3.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$192.88 |
$261 |
2.1× |
| Facial bones min 3 views (70150) |
$254.96 |
$345 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$495.13 |
$670 |
4.6× |
| Fluoroscopy up to 1 hr (76000) |
$459.66 |
$622 |
1.9× |
| Foot 2 views (73620) |
$202.49 |
$274 |
2.3× |
| Forearm 2 views (73090) |
$206.92 |
$280 |
2.3× |
| Hand 2 views (73120) |
$219.48 |
$297 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,545.25 |
$2,091 |
2.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,370.11 |
$1,854 |
3.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,304.34 |
$1,765 |
2.3× |
| Knee 3 views (73562) |
$247.56 |
$335 |
2.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,313.07 |
$3,130 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,389.93 |
$3,234 |
6.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,597.58 |
$3,515 |
7.2× |
| MRA head w & w/o contrast (70546) |
$2,564.33 |
$3,470 |
7.1× |
| MRA head w/o contrast (70544) |
$2,189.66 |
$2,963 |
8.9× |
| MRA neck w contrast (70548) |
$2,021.16 |
$2,735 |
5.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,764.60 |
$3,741 |
7.7× |
| MRA neck w/o contrast (70547) |
$1,822.37 |
$2,466 |
7.4× |
| MRI abdomen w contrast (74182) |
$2,402.49 |
$3,251 |
6.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,948.61 |
$3,990 |
8.2× |
| MRI abdomen w/o contrast (74181) |
$2,179.31 |
$2,949 |
8.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,568.76 |
$3,476 |
7.1× |
| MRI cervical spine w/o contrast (72141) |
$2,116.50 |
$2,864 |
8.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,398.79 |
$3,246 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,809.07 |
$2,448 |
7.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,225.87 |
$3,012 |
6.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,617.54 |
$3,542 |
7.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,114.28 |
$2,861 |
8.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,591.07 |
$2,153 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,757.95 |
$3,732 |
7.7× |
| MRI pelvis w/contrast (72196) |
$1,869.67 |
$2,530 |
5.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,827.41 |
$3,826 |
7.9× |
| MRI pelvis w/o contrast (72195) |
$2,115.76 |
$2,863 |
8.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,785.29 |
$3,769 |
7.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,917.57 |
$3,948 |
8.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,766.08 |
$3,743 |
7.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,126.84 |
$2,878 |
8.6× |
| MRI up ext w/o contrast (73218) |
$2,134.97 |
$2,889 |
8.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,143.84 |
$2,901 |
8.7× |
| MRI, joint upper extrem combo (73223) |
$2,610.89 |
$3,533 |
7.3× |
| Myocardial Spect Multiple Studies (78452) |
$2,837.02 |
$3,839 |
2.1× |
| Myocardial spect single study at rest or stress (78451) |
$1,629.50 |
$2,205 |
1.2× |
| Neck soft tissue (70360) |
$206.92 |
$280 |
2.3× |
| Nm gastric emptying study (78264) |
$1,361.24 |
$1,842 |
3.3× |
| Osseous survey limited (77074) |
$285.25 |
$386 |
2.6× |
| Parathyroid Planar Imaging (78070) |
$1,351.63 |
$1,829 |
3.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$691.70 |
$936 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$227.61 |
$308 |
2.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$702.79 |
$951 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,246.69 |
$1,687 |
2.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$235 |
$318 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$192.14 |
$260 |
2.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$238.70 |
$323 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$239.44 |
$324 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$348.81 |
$472 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$194.36 |
$263 |
2.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$221.70 |
$300 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$220.22 |
$298 |
2.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$240.18 |
$325 |
2.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$317.77 |
$430 |
2.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$410.88 |
$556 |
3.8× |
| Radex Humerus Minimum 2 Views (73060) |
$227.61 |
$308 |
2.5× |
| Radex Kne 1/2 Views (73560) |
$230.57 |
$312 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$281.56 |
$381 |
2.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$263.82 |
$357 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$218.74 |
$296 |
2.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$282.30 |
$382 |
2.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$239.44 |
$324 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$182.53 |
$247 |
2.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$245.35 |
$332 |
2.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$247.56 |
$335 |
2.8× |
| Radex Toe Minimum 2 Views (73660) |
$185.49 |
$251 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$153.71 |
$208 |
1.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$233.52 |
$316 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$210.62 |
$285 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$274.91 |
$372 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$231.31 |
$313 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$243.87 |
$330 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$227.61 |
$308 |
2.5× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$253.48 |
$343 |
2.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$253.48 |
$343 |
2.3× |
| Ribs bilateral 3 views (71110) |
$251.26 |
$340 |
2.3× |
| Sacroiliac Joints < 3 Views (72200) |
$242.39 |
$328 |
2.2× |
| Scapula (73010) |
$240.91 |
$326 |
2.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$65.03 |
$88 |
2.8× |
| Shoulder 1 view (73020) |
$206.18 |
$279 |
2.3× |
| Spine thoracic 3 views (72072) |
$306.68 |
$415 |
2.8× |
| Thoracolumbar 2 views (72080) |
$239.44 |
$324 |
2.7× |
| Thyroid uptake measurement (78012) |
$528.38 |
$715 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$667.32 |
$903 |
1.6× |
| Ultrasound breast complete (76641) |
$447.83 |
$606 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$413.84 |
$560 |
3.8× |
| Ultrasound, abdomen limited (76705) |
$467.79 |
$633 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$318.51 |
$431 |
3.0× |
| Us breast unilateral limited (76642) |
$351.02 |
$475 |
3.9× |
| Us chest (76604) |
$378.37 |
$512 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$438.97 |
$594 |
4.1× |
| Us encephalogram (76506) |
$307.42 |
$416 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$374.67 |
$507 |
3.5× |
| Us ob limited (76815) |
$401.28 |
$543 |
3.7× |
| Us ob transvaginal (76817) |
$408.67 |
$553 |
3.8× |
| Us pelvic non ob complete (76856) |
$489.22 |
$662 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$339.20 |
$459 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$453.01 |
$613 |
4.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$458.92 |
$621 |
4.3× |
| Us retroperitoneal complete (76770) |
$526.17 |
$712 |
4.9× |
| Us retroperitoneal limited (76775) |
$418.27 |
$566 |
3.9× |
| Us scrotum and contents (76870) |
$481.09 |
$651 |
4.5× |
| Us soft tissue head/neck (76536) |
$474.44 |
$642 |
4.4× |
| Us spinal canal and contents (76800) |
$394.63 |
$534 |
3.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$419.75 |
$568 |
3.9× |
| Venogram Extremity Unilateral (75820) |
$931.14 |
$1,260 |
0.6× |
| Venography caval superior serialography rs&i (75827) |
$1,441.05 |
$1,950 |
0.9× |
| Wrist 2 views (73100) |
$213.57 |
$289 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$346.59 |
$469 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$185.49 |
$251 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$203.96 |
$276 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$276.39 |
$374 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$320.73 |
$434 |
3.0× |
| X-ray exam of femur 2/> (73552) |
$245.35 |
$332 |
2.7× |
| X-ray eye for foreign body (70030) |
$248.30 |
$336 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$250.52 |
$339 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$226.13 |
$306 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$230.57 |
$312 |
2.6× |
| X-ray leg, infant (73592) |
$149.28 |
$202 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$266.04 |
$360 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$393.15 |
$532 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$161.10 |
$218 |
1.8× |
| X-ray optic foramen (70190) |
$79.81 |
$108 |
0.9× |
| X-ray retrograde pyelogram (74420) |
$775.21 |
$1,049 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$214.31 |
$290 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$298.56 |
$404 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$357.68 |
$484 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$227.61 |
$308 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$226.87 |
$307 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$232.78 |
$315 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$235 |
$318 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$225.40 |
$305 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$181.79 |
$246 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$255.69 |
$346 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$260.87 |
$353 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$113.81 |
$154 |
1.1× |
| Xr c-spine 4 or 5 views (72050) |
$321.46 |
$435 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$359.89 |
$487 |
3.3× |