| Abdomen 2 views (74019) |
$366 |
$457.50 |
3.1× |
| Ankle 2 views (73600) |
$297.60 |
$372 |
3.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$845.20 |
$1,056.50 |
1.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$768.40 |
$960.50 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$1,370 |
$1,712.50 |
3.1× |
| Bone age studies (77072) |
$284.80 |
$356 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,476 |
$1,845 |
3.3× |
| Bone survey complete (77075) |
$356.40 |
$445.50 |
3.1× |
| Bone survey infant (77076) |
$181.60 |
$227 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$366.40 |
$458 |
3.8× |
| Chest 1 view (71045) |
$299.60 |
$374.50 |
3.1× |
| Chest xray 3 views (71047) |
$408 |
$510 |
4.2× |
| Clavicle complete (73000) |
$313.20 |
$391.50 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,146 |
$1,432.50 |
9.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,596 |
$4,495 |
9.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,933.60 |
$3,667 |
11.0× |
| CT abdomen w contrast (74160) |
$1,963.60 |
$2,454.50 |
10.0× |
| CT abdomen w wo contrast (74170) |
$2,295.20 |
$2,869 |
11.7× |
| CT abdomen w/o contrast (74150) |
$1,440.40 |
$1,800.50 |
12.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$4,098.80 |
$5,123.50 |
21.0× |
| CT c-spine w/contrast (72126) |
$3,127.20 |
$3,909 |
8.0× |
| CT c-spine w/o contrast (72125) |
$2,104 |
$2,630 |
18.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,505.20 |
$3,131.50 |
12.8× |
| CT chest w contrast (71260) |
$2,039.60 |
$2,549.50 |
10.4× |
| CT chest w/wo contrast (71270) |
$2,924.80 |
$3,656 |
15.0× |
| CT head/brain with contrast (70460) |
$1,803.20 |
$2,254 |
9.2× |
| CT head/brain without and with contrast (70470) |
$3,317.60 |
$4,147 |
17.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$104 |
$130 |
1.1× |
| CT iac w contrast (70481) |
$1,992 |
$2,490 |
10.2× |
| CT limited/localized follow up study (76380) |
$1,103.20 |
$1,379 |
11.4× |
| CT lower ext w/o (73700) |
$1,529.60 |
$1,912 |
13.1× |
| CT lower extremity w wo contrast (73702) |
$1,957.60 |
$2,447 |
10.0× |
| CT lower extremity w/contrast material (73701) |
$1,735.60 |
$2,169.50 |
8.9× |
| CT lumbar spine w & w/o contrast (72133) |
$2,130.40 |
$2,663 |
10.9× |
| CT lumbar spine w/contrast (72132) |
$3,095.20 |
$3,869 |
8.0× |
| CT lumbar spine w/o contrast (72131) |
$1,814.40 |
$2,268 |
15.6× |
| CT maxillofacial w contrast (70487) |
$1,874 |
$2,342.50 |
9.6× |
| CT maxillofacial w/wo contrast (70488) |
$2,052.80 |
$2,566 |
10.5× |
| CT maxillofacial wo contrast (70486) |
$1,499.60 |
$1,874.50 |
12.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,244.80 |
$2,806 |
11.5× |
| CT orbits w/o contrast (70480) |
$1,688 |
$2,110 |
14.5× |
| CT pelvis w/o contrast (72192) |
$1,686.40 |
$2,108 |
14.5× |
| CT pelvis w/wo contrast (72194) |
$2,042.80 |
$2,553.50 |
10.5× |
| CT scan of arm combo (73202) |
$1,915.60 |
$2,394.50 |
9.8× |
| CT soft tissue neck w contrast (70491) |
$1,853.60 |
$2,317 |
9.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,400 |
$4,250 |
17.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,454.40 |
$1,818 |
12.5× |
| CT thoracic spine w/contrast (72129) |
$3,400 |
$4,250 |
17.4× |
| CT thoracic spine w/o contrast (72128) |
$1,934.40 |
$2,418 |
16.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,536.40 |
$3,170.50 |
13.0× |
| CT thorax w/o contrast (71250) |
$1,643.60 |
$2,054.50 |
14.1× |
| CT upper ext wo (73200) |
$1,487.20 |
$1,859 |
12.8× |
| CT upper extremity with contrast (73201) |
$1,693.20 |
$2,116.50 |
4.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,646 |
$2,057.50 |
8.4× |
| Cta Abdomen (74175) |
$2,867.60 |
$3,584.50 |
14.7× |
| CTA abdomen pelvis (74174) |
$3,878 |
$4,847.50 |
10.0× |
| CTA chest (71275) |
$2,840.40 |
$3,550.50 |
14.5× |
| Cta Head (70496) |
$2,874.80 |
$3,593.50 |
14.7× |
| Cta Neck (70498) |
$2,916 |
$3,645 |
14.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$339.60 |
$424.50 |
2.9× |
| Dxa bone density study axial skeleton (77085) |
$418.40 |
$523 |
3.6× |
| Esophagus (74220) |
$540 |
$675 |
2.8× |
| Facial bones min 3 views (70150) |
$439.20 |
$549 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$310.40 |
$388 |
2.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$573.60 |
$717 |
4.9× |
| Fluoroscopy up to 1 hr (76000) |
$703.60 |
$879.50 |
2.6× |
| Foot 2 views (73620) |
$284.80 |
$356 |
2.9× |
| Forearm 2 views (73090) |
$303.60 |
$379.50 |
3.1× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,238.80 |
$1,548.50 |
2.8× |
| Hand 2 views (73120) |
$305.20 |
$381.50 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,468.80 |
$1,836 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$419.60 |
$524.50 |
3.6× |
| Knee 3 views (73562) |
$356 |
$445 |
3.7× |
| Liver & spleen imaging static only (78215) |
$707.60 |
$884.50 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,589.20 |
$4,486.50 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,198.80 |
$3,998.50 |
8.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,978.80 |
$4,973.50 |
10.2× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$347.20 |
$434 |
3.6× |
| MRA head w & w/o contrast (70546) |
$4,564 |
$5,705 |
11.7× |
| MRA head w/o contrast (70544) |
$3,239.60 |
$4,049.50 |
12.2× |
| MRA head with contrast (70545) |
$3,806.40 |
$4,758 |
9.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,564 |
$5,705 |
11.7× |
| MRA neck w/o contrast (70547) |
$3,239.60 |
$4,049.50 |
12.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,228.80 |
$6,536 |
13.4× |
| MRI abdomen w/o contrast (74181) |
$3,790.80 |
$4,738.50 |
14.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,134.40 |
$3,918 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,260 |
$5,325 |
11.0× |
| MRI c-spine with contrast (72142) |
$3,983.20 |
$4,979 |
10.2× |
| MRI cervical spine w/o contrast (72141) |
$3,428.40 |
$4,285.50 |
12.9× |
| MRI chest w/o & w/contrast material (71552) |
$6,102 |
$7,627.50 |
15.7× |
| MRI chest w/o contrast (71550) |
$4,424.40 |
$5,530.50 |
16.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,439.60 |
$4,299.50 |
8.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,370.80 |
$5,463.50 |
11.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,992 |
$3,740 |
11.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,998.80 |
$4,998.50 |
15.0× |
| MRI orbit face neck w contrast (70542) |
$4,598.80 |
$5,748.50 |
11.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,287.60 |
$6,609.50 |
13.6× |
| MRI pelvis w/contrast (72196) |
$4,031.60 |
$5,039.50 |
10.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,841.20 |
$6,051.50 |
12.5× |
| MRI pelvis w/o contrast (72195) |
$3,507.20 |
$4,384 |
13.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,732.40 |
$5,915.50 |
12.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,164.40 |
$5,205.50 |
10.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,899.20 |
$6,124 |
12.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$4,296 |
$5,370 |
11.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,155.20 |
$6,444 |
13.3× |
| MRI temporomandibular joint (70336) |
$3,715.20 |
$4,644 |
14.0× |
| MRI thoracic spine w/o contrast (72146) |
$3,740 |
$4,675 |
14.1× |
| MRI up ext w/o contrast (73218) |
$2,756.40 |
$3,445.50 |
10.4× |
| MRI upper ext joint w/o contrast (73221) |
$3,120.40 |
$3,900.50 |
11.7× |
| MRI, joint upper extrem combo (73223) |
$4,676.40 |
$5,845.50 |
12.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,164 |
$3,955 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$3,775.20 |
$4,719 |
2.6× |
| Neck soft tissue (70360) |
$294 |
$367.50 |
3.0× |
| Nm gastric emptying study (78264) |
$2,798 |
$3,497.50 |
6.3× |
| Osseous survey limited (77074) |
$183.60 |
$229.50 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$365.20 |
$456.50 |
3.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$902.40 |
$1,128 |
1.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$324.80 |
$406 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$268.40 |
$335.50 |
2.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$326 |
$407.50 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$259.20 |
$324 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$315.60 |
$394.50 |
3.3× |
| Radex Hand Minimum 3 Views (73130) |
$325.20 |
$406.50 |
3.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$283.60 |
$354.50 |
2.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$469.20 |
$586.50 |
4.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$435.20 |
$544 |
3.7× |
| Radex Humerus Minimum 2 Views (73060) |
$326 |
$407.50 |
3.4× |
| Radex Kne 1/2 Views (73560) |
$320 |
$400 |
3.3× |
| Radex Kne Compl 4/More Views (73564) |
$406.40 |
$508 |
3.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$434.80 |
$543.50 |
3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$311.20 |
$389 |
3.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$427.60 |
$534.50 |
3.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$352.40 |
$440.50 |
3.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$325.60 |
$407 |
3.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$401.60 |
$502 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$534.80 |
$668.50 |
5.5× |
| Radex Toe Minimum 2 Views (73660) |
$257.20 |
$321.50 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$266.80 |
$333.50 |
2.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$336.40 |
$420.50 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$301.60 |
$377 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$420 |
$525 |
3.6× |
| Radiologic exam chest 2 views (71046) |
$345.20 |
$431.50 |
3.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,011.60 |
$1,264.50 |
5.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$880.80 |
$1,101 |
4.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$796.40 |
$995.50 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$240.40 |
$300.50 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$197.20 |
$246.50 |
2.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$312 |
$390 |
2.7× |
| Ribs bilateral 3 views (71110) |
$432 |
$540 |
3.7× |
| Sacroiliac Joints < 3 Views (72200) |
$316 |
$395 |
2.7× |
| Scapula (73010) |
$326 |
$407.50 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$303.60 |
$379.50 |
13.0× |
| Shoulder 1 view (73020) |
$292.80 |
$366 |
3.0× |
| Small bowel series (74250) |
$676.80 |
$846 |
3.5× |
| Spine thoracic 3 views (72072) |
$449.60 |
$562 |
3.9× |
| Thoracolumbar 2 views (72080) |
$372 |
$465 |
3.8× |
| Ultrasound breast complete (76641) |
$673.20 |
$841.50 |
5.8× |
| Ultrasound Exam Aaa Screen (76706) |
$630.40 |
$788 |
5.4× |
| Ultrasound, abdomen limited (76705) |
$399.20 |
$499 |
3.4× |
| Umbilical-artery Doppler (OB) (76820) |
$264.80 |
$331 |
2.3× |
| Urea Breath Test C-14 Isotopic Acquisj Analysis (78267) |
$651.20 |
$814 |
58.9× |
| Us breast unilateral limited (76642) |
$461.60 |
$577 |
4.8× |
| Us chest (76604) |
$418.40 |
$523 |
3.6× |
| Us elastography parenchyma (76981) |
$918 |
$1,147.50 |
7.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$793.60 |
$992 |
6.8× |
| Us ob limited (76815) |
$532 |
$665 |
4.6× |
| Us ob transvaginal (76817) |
$459.20 |
$574 |
3.9× |
| Us pelvic non ob complete (76856) |
$1,172 |
$1,465 |
10.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$623.60 |
$779.50 |
5.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$543.20 |
$679 |
4.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$608 |
$760 |
5.2× |
| Us retroperitoneal complete (76770) |
$940.80 |
$1,176 |
8.1× |
| Us retroperitoneal limited (76775) |
$462.40 |
$578 |
4.0× |
| Us scrotum and contents (76870) |
$815.20 |
$1,019 |
7.0× |
| Us soft tissue head/neck (76536) |
$752.80 |
$941 |
6.5× |
| Us transrectal (76872) |
$341.60 |
$427 |
2.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$516.80 |
$646 |
4.4× |
| Wrist 2 views (73100) |
$296.40 |
$370.50 |
3.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$502.80 |
$628.50 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$416.40 |
$520.50 |
4.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$972 |
$1,215 |
5.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$316 |
$395 |
3.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$352 |
$440 |
3.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$643.20 |
$804 |
5.5× |
| X-ray exam of femur 2/> (73552) |
$376 |
$470 |
3.9× |
| X-ray eye for foreign body (70030) |
$231.20 |
$289 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$337.60 |
$422 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$335.60 |
$419.50 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$150.80 |
$188.50 |
1.6× |
| X-ray leg, infant (73592) |
$268.80 |
$336 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$369.60 |
$462 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$286 |
$357.50 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$439.20 |
$549 |
3.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$371.60 |
$464.50 |
3.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$429.20 |
$536.50 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$481.20 |
$601.50 |
4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$392.80 |
$491 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$332 |
$415 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$448.40 |
$560.50 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$421.20 |
$526.50 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$381.20 |
$476.50 |
3.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$236.40 |
$295.50 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$460 |
$575 |
4.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$353.60 |
$442 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$379.60 |
$474.50 |
3.3× |
| Xr bone length studies (77073) |
$237.60 |
$297 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$555.20 |
$694 |
4.8× |
| Xr c-spine 6 or more views (72052) |
$663.60 |
$829.50 |
5.7× |
| Xr chest 4+ views (71048) |
$458 |
$572.50 |
3.9× |