| Abdomen 2 views (74019) |
$244.92 |
$390 |
2.3× |
| Acute gi blood loss imaging (78278) |
$1,398.56 |
$2,227 |
3.4× |
| Ankle 2 views (73600) |
$195.31 |
$311 |
2.2× |
| Arthrogram shoulder (73040) |
$501.77 |
$799 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$670.08 |
$1,067 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,056.30 |
$1,682 |
2.6× |
| Bone age studies (77072) |
$189.03 |
$301 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,232.14 |
$1,962 |
3.0× |
| Bone survey complete (77075) |
$619.84 |
$987 |
5.7× |
| Bone survey infant (77076) |
$244.92 |
$390 |
2.3× |
| Bowel imaging (78290) |
$953.93 |
$1,519 |
2.3× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,096.49 |
$1,746 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$228.59 |
$364 |
2.5× |
| Chest 1 view (71045) |
$192.17 |
$306 |
2.1× |
| Chest xray 3 views (71047) |
$175.84 |
$280 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$393.76 |
$627 |
2.2× |
| Clavicle complete (73000) |
$185.89 |
$296 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$798.19 |
$1,271 |
7.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,535.24 |
$4,037 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,867.04 |
$2,973 |
7.6× |
| CT abdomen w contrast (74160) |
$1,284.89 |
$2,046 |
7.1× |
| CT abdomen w wo contrast (74170) |
$1,563.72 |
$2,490 |
8.6× |
| CT abdomen w/o contrast (74150) |
$1,040.60 |
$1,657 |
9.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,580.68 |
$2,517 |
8.7× |
| CT angiography upper extremity lt (73206) |
$1,401.07 |
$2,231 |
7.7× |
| CT c-spine w/contrast (72126) |
$1,453.82 |
$2,315 |
4.0× |
| CT c-spine w/o contrast (72125) |
$1,441.26 |
$2,295 |
13.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,491.50 |
$2,375 |
8.2× |
| CT chest w contrast (71260) |
$1,342.04 |
$2,137 |
7.4× |
| CT chest w/wo contrast (71270) |
$1,421.79 |
$2,264 |
7.9× |
| CT head/brain with contrast (70460) |
$1,154.26 |
$1,838 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,389.14 |
$2,212 |
7.7× |
| CT iac w contrast (70481) |
$1,266.05 |
$2,016 |
7.0× |
| CT lower ext w/o (73700) |
$1,258.51 |
$2,004 |
11.7× |
| CT lower extremity w/contrast material (73701) |
$1,309.38 |
$2,085 |
7.2× |
| CT lumbar spine w/contrast (72132) |
$1,314.40 |
$2,093 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$1,268.56 |
$2,020 |
11.8× |
| CT maxillofacial w contrast (70487) |
$1,229 |
$1,957 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,318.80 |
$2,100 |
7.3× |
| CT maxillofacial wo contrast (70486) |
$1,196.97 |
$1,906 |
11.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,170.59 |
$1,864 |
6.5× |
| CT orbits w/o contrast (70480) |
$1,102.14 |
$1,755 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,185.04 |
$1,887 |
11.0× |
| CT pelvis w/wo contrast (72194) |
$1,440 |
$2,293 |
8.0× |
| CT scan of arm combo (73202) |
$1,296.82 |
$2,065 |
7.2× |
| CT soft tissue neck w contrast (70491) |
$1,250.98 |
$1,992 |
6.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,331.36 |
$2,120 |
7.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,027.41 |
$1,636 |
9.5× |
| CT thoracic spine w/contrast (72129) |
$1,223.97 |
$1,949 |
6.8× |
| CT thoracic spine w/o contrast (72128) |
$1,218.95 |
$1,941 |
11.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,414.88 |
$2,253 |
7.8× |
| CT thorax w/o contrast (71250) |
$1,184.41 |
$1,886 |
11.0× |
| CT upper ext wo (73200) |
$1,097.12 |
$1,747 |
10.2× |
| CT upper extremity with contrast (73201) |
$1,291.80 |
$2,057 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,948.68 |
$3,103 |
10.8× |
| Cta Abdomen (74175) |
$1,726.37 |
$2,749 |
9.5× |
| CTA abdomen pelvis (74174) |
$2,411.52 |
$3,840 |
6.7× |
| CTA chest (71275) |
$1,718.21 |
$2,736 |
9.5× |
| Cta Head (70496) |
$1,674.25 |
$2,666 |
9.2× |
| Cta Neck (70498) |
$1,672.36 |
$2,663 |
9.2× |
| Cta Pelvis (72191) |
$1,277.98 |
$2,035 |
7.1× |
| Cystography minimum 3 views rs&i (74430) |
$477.91 |
$761 |
1.3× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$1,153.01 |
$1,836 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$594.09 |
$946 |
5.5× |
| Esophagus (74220) |
$391.24 |
$623 |
2.2× |
| Facial bones min 3 views (70150) |
$243.04 |
$387 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$421.39 |
$671 |
3.9× |
| Fluoroscopy up to 1 hr (76000) |
$397.52 |
$633 |
1.6× |
| Foot 2 views (73620) |
$182.12 |
$290 |
2.0× |
| Forearm 2 views (73090) |
$188.40 |
$300 |
2.1× |
| Hand 2 views (73120) |
$185.26 |
$295 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,313.15 |
$2,091 |
2.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,161.80 |
$1,850 |
2.8× |
| Hysterosalpingogram (74740) |
$503.66 |
$802 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,011.71 |
$1,611 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,112.82 |
$1,772 |
2.0× |
| Knee 3 views (73562) |
$212.89 |
$339 |
2.4× |
| Lung ventilation imaging (78579) |
$336.61 |
$536 |
0.8× |
| Lymphoscintigraphy (78195) |
$1,386.62 |
$2,208 |
2.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,965.64 |
$3,130 |
2.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,208.05 |
$3,516 |
6.1× |
| Mammary ductogram or galactogram single (77053) |
$268.16 |
$427 |
1.1× |
| MRA head w & w/o contrast (70546) |
$2,179.79 |
$3,471 |
6.1× |
| MRA head w/o contrast (70544) |
$1,861.39 |
$2,964 |
7.6× |
| MRA head with contrast (70545) |
$1,548.02 |
$2,465 |
4.3× |
| MRA neck w contrast (70548) |
$1,717.58 |
$2,735 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,349.98 |
$3,742 |
6.5× |
| MRI abdomen w contrast (74182) |
$1,563.09 |
$2,489 |
4.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,505.72 |
$3,990 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$1,852.60 |
$2,950 |
7.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,047.28 |
$3,260 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,182.30 |
$3,475 |
6.1× |
| MRI breast w/o contrast bilateral (77047) |
$2,370.07 |
$3,774 |
9.6× |
| MRI c-spine with contrast (72142) |
$1,688.69 |
$2,689 |
4.7× |
| MRI cervical spine w/o contrast (72141) |
$1,846.32 |
$2,940 |
7.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,032.84 |
$3,237 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,537.34 |
$2,448 |
6.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,416.77 |
$2,256 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,292.20 |
$3,650 |
6.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,797.34 |
$2,862 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,635.94 |
$2,605 |
6.6× |
| MRI orbit face neck w contrast (70542) |
$461.58 |
$735 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,344.32 |
$3,733 |
6.5× |
| MRI pelvis w/contrast (72196) |
$1,911 |
$3,043 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,402.73 |
$3,826 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,820.57 |
$2,899 |
7.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,367.56 |
$3,770 |
6.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,656.66 |
$2,638 |
4.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,479.34 |
$3,948 |
6.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,841.30 |
$2,932 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,350.60 |
$3,743 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,808.01 |
$2,879 |
7.3× |
| MRI up ext w/o contrast (73218) |
$1,814.92 |
$2,890 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,825.60 |
$2,907 |
7.4× |
| MRI, joint upper extrem combo (73223) |
$2,218.72 |
$3,533 |
6.2× |
| Myocardial Spect Multiple Studies (78452) |
$2,449.20 |
$3,900 |
1.8× |
| Myocardial spect single study at rest or stress (78451) |
$1,454.45 |
$2,316 |
1.1× |
| Neck soft tissue (70360) |
$175.84 |
$280 |
2.0× |
| Nm gastric emptying study (78264) |
$1,141.08 |
$1,817 |
2.8× |
| Osseous survey limited (77074) |
$307.72 |
$490 |
2.9× |
| Parathyroid Planar Imaging (78070) |
$1,099 |
$1,750 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$199.70 |
$318 |
1.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$867.90 |
$1,382 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$898.67 |
$1,431 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$525.64 |
$837 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$205.98 |
$328 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$170.19 |
$271 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$215.40 |
$343 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$290.76 |
$463 |
3.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$351.68 |
$560 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$199.70 |
$318 |
2.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$203.47 |
$324 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$210.38 |
$335 |
2.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$242.41 |
$386 |
2.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$203.47 |
$324 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$322.16 |
$513 |
3.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$365.50 |
$582 |
3.4× |
| Radex Humerus Minimum 2 Views (73060) |
$202.84 |
$323 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$205.98 |
$328 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$253.08 |
$403 |
2.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$224.82 |
$358 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$195.94 |
$312 |
2.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$239.90 |
$382 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$210.38 |
$335 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$140.67 |
$224 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$208.50 |
$332 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$171.44 |
$273 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$144.44 |
$230 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$206.61 |
$329 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$189.66 |
$302 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$282.60 |
$450 |
2.6× |
| Radiologic exam chest 2 views (71046) |
$205.36 |
$327 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$513.08 |
$817 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$339.12 |
$540 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$201.59 |
$321 |
1.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$416.99 |
$664 |
2.3× |
| Radiologic examination femur 1 view (73551) |
$157 |
$250 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$200.33 |
$319 |
2.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$203.47 |
$324 |
1.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$203.47 |
$324 |
1.9× |
| Radiological examination surgical specimen (76098) |
$361.73 |
$576 |
0.6× |
| Ribs bilateral 3 views (71110) |
$226.08 |
$360 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$169.56 |
$270 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$465.35 |
$741 |
1.9× |
| Scapula (73010) |
$214.78 |
$342 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$74.73 |
$119 |
3.2× |
| Sella turcica (70240) |
$180.24 |
$287 |
2.0× |
| Shoulder 1 view (73020) |
$190.91 |
$304 |
2.1× |
| Small bowel series (74250) |
$624.86 |
$995 |
3.5× |
| Spine thoracic 3 views (72072) |
$263.76 |
$420 |
2.4× |
| Thoracolumbar 2 views (72080) |
$203.47 |
$324 |
2.3× |
| Ultrasound breast complete (76641) |
$251.83 |
$401 |
2.3× |
| Ultrasound Exam Aaa Screen (76706) |
$351.68 |
$560 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$456.56 |
$727 |
4.2× |
| Urethrocystogram voiding (74455) |
$499.26 |
$795 |
2.0× |
| Us breast unilateral limited (76642) |
$298.93 |
$476 |
3.3× |
| Us chest (76604) |
$322.16 |
$513 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$164.54 |
$262 |
1.5× |
| Us encephalogram (76506) |
$261.25 |
$416 |
2.4× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$124.34 |
$198 |
1.2× |
| Us ob limited (76815) |
$366.12 |
$583 |
3.4× |
| Us ob transvaginal (76817) |
$347.91 |
$554 |
3.2× |
| Us pelvic non ob complete (76856) |
$478.54 |
$762 |
4.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$321.54 |
$512 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$444 |
$707 |
4.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$396.90 |
$632 |
3.7× |
| Us retroperitoneal complete (76770) |
$457.81 |
$729 |
4.2× |
| Us retroperitoneal limited (76775) |
$403.18 |
$642 |
3.7× |
| Us scrotum and contents (76870) |
$419.50 |
$668 |
3.9× |
| Us soft tissue head/neck (76536) |
$396.90 |
$632 |
3.7× |
| Us spinal canal and contents (76800) |
$335.35 |
$534 |
3.1× |
| Us, eye b-scan (76512) |
$268.16 |
$427 |
2.5× |
| Wrist 2 views (73100) |
$187.77 |
$299 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$308.98 |
$492 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$167.68 |
$267 |
1.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$639.93 |
$1,019 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$178.35 |
$284 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$234.87 |
$374 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$287 |
$457 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$216.03 |
$344 |
2.4× |
| X-ray eye for foreign body (70030) |
$211.64 |
$337 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$177.10 |
$282 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$192.80 |
$307 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$171.44 |
$273 |
1.9× |
| X-ray leg, infant (73592) |
$137.53 |
$219 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$236.76 |
$377 |
2.2× |
| X-ray nose-rectum child f.b. (76010) |
$153.86 |
$245 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$175.21 |
$279 |
1.6× |
| X-ray retrograde pyelogram (74420) |
$609.79 |
$971 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$190.28 |
$303 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$276.95 |
$441 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$329.70 |
$525 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$89.80 |
$143 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$207.24 |
$330 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$195.94 |
$312 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$229.22 |
$365 |
2.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$212.26 |
$338 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$191.54 |
$305 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$108.02 |
$172 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$206.61 |
$329 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$221.68 |
$353 |
2.1× |
| Xr bone length studies (77073) |
$253.71 |
$404 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$295.79 |
$471 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$306.46 |
$488 |
2.8× |