| Abdomen 2 views (74019) |
$219.08 |
$345 |
2.0× |
| Ankle 2 views (73600) |
$169.55 |
$267 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$626.11 |
$986 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$927.10 |
$1,460 |
2.2× |
| Bone age studies (77072) |
$249.56 |
$393 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$960.12 |
$1,512 |
2.3× |
| Bone Marrow Imaging Limited Area (78102) |
$786.77 |
$1,239 |
1.9× |
| Bone survey complete (77075) |
$544.20 |
$857 |
5.0× |
| Bone survey infant (77076) |
$250.83 |
$395 |
2.3× |
| Bowel imaging (78290) |
$617.86 |
$973 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,176.66 |
$1,853 |
2.9× |
| Cervical spine 2 or 3 views (72040) |
$174.63 |
$275 |
1.9× |
| Chest 1 view (71045) |
$187.33 |
$295 |
2.1× |
| Chest xray 3 views (71047) |
$262.89 |
$414 |
2.9× |
| Clavicle complete (73000) |
$158.75 |
$250 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$480.70 |
$757 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,616.08 |
$2,545 |
4.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,365.89 |
$2,151 |
5.5× |
| CT abdomen w contrast (74160) |
$1,535.43 |
$2,418 |
8.5× |
| CT abdomen w wo contrast (74170) |
$1,800.23 |
$2,835 |
9.9× |
| CT abdomen w/o contrast (74150) |
$1,297.31 |
$2,043 |
12.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,807.21 |
$2,846 |
10.0× |
| CT c-spine w/contrast (72126) |
$1,474.47 |
$2,322 |
4.1× |
| CT c-spine w/o contrast (72125) |
$1,292.86 |
$2,036 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,391.92 |
$2,192 |
7.7× |
| CT chest w contrast (71260) |
$1,205.23 |
$1,898 |
6.7× |
| CT chest w/wo contrast (71270) |
$1,546.23 |
$2,435 |
8.5× |
| CT head/brain with contrast (70460) |
$1,191.90 |
$1,877 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,384.94 |
$2,181 |
7.7× |
| CT iac w contrast (70481) |
$1,550.67 |
$2,442 |
8.6× |
| CT lower ext w/o (73700) |
$1,036.96 |
$1,633 |
9.6× |
| CT lower extremity w wo contrast (73702) |
$1,403.35 |
$2,210 |
7.8× |
| CT lower extremity w/contrast material (73701) |
$1,336.04 |
$2,104 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,910.72 |
$3,009 |
10.6× |
| CT lumbar spine w/contrast (72132) |
$1,673.23 |
$2,635 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,193.80 |
$1,880 |
11.1× |
| CT maxillofacial w contrast (70487) |
$1,158.88 |
$1,825 |
6.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,571.63 |
$2,475 |
8.7× |
| CT maxillofacial wo contrast (70486) |
$1,156.34 |
$1,821 |
10.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,725.93 |
$2,718 |
9.5× |
| CT orbits w/o contrast (70480) |
$738.51 |
$1,163 |
6.8× |
| CT pelvis w/o contrast (72192) |
$1,028.07 |
$1,619 |
9.5× |
| CT pelvis w/wo contrast (72194) |
$1,317.63 |
$2,075 |
7.3× |
| CT scan of arm combo (73202) |
$1,781.81 |
$2,806 |
9.8× |
| CT soft tissue neck w contrast (70491) |
$1,130.30 |
$1,780 |
6.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,550.67 |
$2,442 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,242.06 |
$1,956 |
11.5× |
| CT thoracic spine w/contrast (72129) |
$1,633.22 |
$2,572 |
9.0× |
| CT thoracic spine w/o contrast (72128) |
$1,242.70 |
$1,957 |
11.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,870.71 |
$2,946 |
10.3× |
| CT thorax w/o contrast (71250) |
$988.70 |
$1,557 |
9.2× |
| CT upper ext wo (73200) |
$1,139.19 |
$1,794 |
10.6× |
| CT upper extremity with contrast (73201) |
$1,188.09 |
$1,871 |
3.3× |
| CTA abdomen pelvis (74174) |
$3,272.79 |
$5,154 |
9.1× |
| CTA chest (71275) |
$2,144.40 |
$3,377 |
11.8× |
| Cta Head (70496) |
$1,896.11 |
$2,986 |
10.5× |
| Cta Neck (70498) |
$1,882.14 |
$2,964 |
10.4× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$422.91 |
$666 |
3.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$302.90 |
$477 |
2.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$256.54 |
$404 |
2.4× |
| Esophagus (74220) |
$311.79 |
$491 |
1.7× |
| Facial bones min 3 views (70150) |
$248.29 |
$391 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$530.86 |
$836 |
4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$378.46 |
$596 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$473.71 |
$746 |
1.9× |
| Foot 2 views (73620) |
$157.48 |
$248 |
1.8× |
| Forearm 2 views (73090) |
$160.02 |
$252 |
1.8× |
| Hand 2 views (73120) |
$252.10 |
$397 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$974.73 |
$1,535 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$808.36 |
$1,273 |
2.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$231.78 |
$365 |
2.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,444.63 |
$2,275 |
2.6× |
| Knee 3 views (73562) |
$174.63 |
$275 |
1.9× |
| Liver & spleen imaging static only (78215) |
$1,163.96 |
$1,833 |
2.8× |
| Lung perf&ventilat diferentl (78598) |
$1,397.64 |
$2,201 |
2.5× |
| Lung perfusion differential (78597) |
$1,040.13 |
$1,638 |
2.5× |
| Lung ventilation imaging (78579) |
$883.92 |
$1,392 |
2.1× |
| Lymphoscintigraphy (78195) |
$1,314.45 |
$2,070 |
2.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,248.54 |
$3,541 |
2.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,303.78 |
$3,628 |
6.4× |
| MRA head w & w/o contrast (70546) |
$1,819.28 |
$2,865 |
5.1× |
| MRA head w/o contrast (70544) |
$1,741.81 |
$2,743 |
7.1× |
| MRA head with contrast (70545) |
$2,124.71 |
$3,346 |
5.9× |
| MRA neck w contrast (70548) |
$1,565.28 |
$2,465 |
4.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,922.78 |
$3,028 |
5.3× |
| MRA neck w/o contrast (70547) |
$1,794.51 |
$2,826 |
7.3× |
| MRI abdomen w contrast (74182) |
$2,298.70 |
$3,620 |
6.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,945.01 |
$3,063 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$1,400.81 |
$2,206 |
5.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,165.99 |
$3,411 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,663.19 |
$4,194 |
7.4× |
| MRI cervical spine w/o contrast (72141) |
$1,577.34 |
$2,484 |
6.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,102.49 |
$3,311 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,930.40 |
$3,040 |
7.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,124.71 |
$3,346 |
5.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,695.45 |
$2,670 |
4.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,511.94 |
$2,381 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,430.66 |
$2,253 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,577.34 |
$2,484 |
4.4× |
| MRI pelvis w/contrast (72196) |
$1,383.03 |
$2,178 |
3.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,524.13 |
$3,975 |
7.0× |
| MRI pelvis w/o contrast (72195) |
$1,577.34 |
$2,484 |
6.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,242.19 |
$3,531 |
6.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,023.11 |
$3,186 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,983.11 |
$3,123 |
5.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,407.92 |
$3,792 |
6.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,828.17 |
$2,879 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,673.86 |
$2,636 |
6.8× |
| MRI up ext w/o contrast (73218) |
$1,570.99 |
$2,474 |
6.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,577.34 |
$2,484 |
6.4× |
| MRI, joint upper extrem combo (73223) |
$2,639.06 |
$4,156 |
7.3× |
| Myocardial Spect Multiple Studies (78452) |
$2,412.37 |
$3,799 |
1.8× |
| Neck soft tissue (70360) |
$221.62 |
$349 |
2.5× |
| Nm gastric emptying study (78264) |
$820.42 |
$1,292 |
2.0× |
| Ob us nuchal meas 1 gest (76813) |
$353.70 |
$557 |
3.3× |
| Osseous survey limited (77074) |
$376.56 |
$593 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$148.59 |
$234 |
1.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,099.19 |
$1,731 |
2.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,145.54 |
$1,804 |
2.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$147.96 |
$233 |
1.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$100.33 |
$158 |
1.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$147.96 |
$233 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$174.63 |
$275 |
1.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$312.42 |
$492 |
2.9× |
| Radex fingr minimum 2 views (73140) |
$129.54 |
$204 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$165.74 |
$261 |
1.8× |
| Radex Hand Minimum 3 Views (73130) |
$257.81 |
$406 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$140.34 |
$221 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$336.55 |
$530 |
3.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$243.84 |
$384 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$427.36 |
$673 |
4.0× |
| Radex Humerus Minimum 2 Views (73060) |
$161.93 |
$255 |
1.8× |
| Radex Kne 1/2 Views (73560) |
$146.69 |
$231 |
1.6× |
| Radex Kne Compl 4/More Views (73564) |
$294.01 |
$463 |
2.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$235.59 |
$371 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$146.69 |
$231 |
1.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$170.82 |
$269 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$99.70 |
$157 |
1.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$301.63 |
$475 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$283.85 |
$447 |
3.2× |
| Radex Toe Minimum 2 Views (73660) |
$135.89 |
$214 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$374.02 |
$589 |
3.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$164.47 |
$259 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$151.77 |
$239 |
1.7× |
| Radiologic exam chest 2 views (71046) |
$145.42 |
$229 |
1.6× |
| Radiologic examination femur 1 view (73551) |
$94.62 |
$149 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$164.47 |
$259 |
1.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$251.46 |
$396 |
2.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$198.12 |
$312 |
1.8× |
| Ribs bilateral 3 views (71110) |
$222.89 |
$351 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,031.37 |
$3,199 |
3.6× |
| Sacroiliac Joints < 3 Views (72200) |
$187.33 |
$295 |
1.7× |
| Scapula (73010) |
$113.67 |
$179 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$66.68 |
$105 |
2.9× |
| Shoulder 1 view (73020) |
$140.34 |
$221 |
1.6× |
| Spine thoracic 3 views (72072) |
$262.89 |
$414 |
2.4× |
| Spleen imaging only (78185) |
$812.80 |
$1,280 |
2.0× |
| Thoracolumbar 2 views (72080) |
$82.55 |
$130 |
0.9× |
| Thyroid imaging w/blood flow (78013) |
$599.44 |
$944 |
1.5× |
| Thyroid uptake measurement (78012) |
$574.68 |
$905 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$899.16 |
$1,416 |
2.2× |
| Tmj unilateral (70328) |
$203.84 |
$321 |
2.3× |
| Ultrasound breast complete (76641) |
$393.07 |
$619 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$376.56 |
$593 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$329.57 |
$519 |
3.1× |
| Umbilical-artery Doppler (OB) (76820) |
$452.12 |
$712 |
4.2× |
| Us breast unilateral limited (76642) |
$227.97 |
$359 |
2.5× |
| Us chest (76604) |
$281.31 |
$443 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$301.63 |
$475 |
2.8× |
| Us elastography parenchyma (76981) |
$318.14 |
$501 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$234.32 |
$369 |
2.2× |
| Us ob limited (76815) |
$250.19 |
$394 |
2.3× |
| Us ob transvaginal (76817) |
$461.65 |
$727 |
4.3× |
| Us pelvic non ob complete (76856) |
$391.16 |
$616 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$327.66 |
$516 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$539.75 |
$850 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$267.97 |
$422 |
2.5× |
| Us retroperitoneal complete (76770) |
$376.56 |
$593 |
3.5× |
| Us retroperitoneal limited (76775) |
$428.63 |
$675 |
4.0× |
| Us scrotum and contents (76870) |
$381 |
$600 |
3.5× |
| Us soft tissue head/neck (76536) |
$337.19 |
$531 |
3.1× |
| Us transrectal (76872) |
$481.97 |
$759 |
4.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$406.40 |
$640 |
3.8× |
| Wrist 2 views (73100) |
$87.63 |
$138 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$240.03 |
$378 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$195.58 |
$308 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$147.96 |
$233 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$179.71 |
$283 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$345.44 |
$544 |
3.2× |
| X-ray exam of femur 2/> (73552) |
$176.53 |
$278 |
2.0× |
| X-ray eye for foreign body (70030) |
$142.24 |
$224 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$149.86 |
$236 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$144.15 |
$227 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$141.61 |
$223 |
1.6× |
| X-ray leg, infant (73592) |
$227.33 |
$358 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$215.27 |
$339 |
2.0× |
| X-ray nose-rectum child f.b. (76010) |
$245.75 |
$387 |
2.7× |
| X-ray optic foramen (70190) |
$196.22 |
$309 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$307.34 |
$484 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$167.01 |
$263 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$239.40 |
$377 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$240.67 |
$379 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$180.98 |
$285 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$148.59 |
$234 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$75.57 |
$119 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$306.71 |
$483 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$196.22 |
$309 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$124.46 |
$196 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$229.24 |
$361 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$189.23 |
$298 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$184.79 |
$291 |
1.7× |
| Xr bone length studies (77073) |
$285.75 |
$450 |
2.6× |
| Xr c-spine 4 or 5 views (72050) |
$269.88 |
$425 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$432.44 |
$681 |
4.0× |