| Abdomen 2 views (74019) |
$246.50 |
$425 |
2.2× |
| Acute gi blood loss imaging (78278) |
$1,682.58 |
$2,901 |
3.9× |
| Ankle 2 views (73600) |
$257.52 |
$444 |
2.8× |
| Arthrogram ankle (73615) |
$638 |
$1,100 |
1.7× |
| Arthrogram elbow (73085) |
$638 |
$1,100 |
1.7× |
| Arthrogram hip (73525) |
$638 |
$1,100 |
1.7× |
| Arthrogram knee (73580) |
$638 |
$1,100 |
1.7× |
| Arthrogram shoulder (73040) |
$638 |
$1,100 |
1.7× |
| Arthrogram wrist (73115) |
$638 |
$1,100 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$704.12 |
$1,214 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,465.66 |
$2,527 |
3.4× |
| Bone age studies (77072) |
$164.72 |
$284 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,662.28 |
$2,866 |
3.9× |
| Bone Marrow Imaging Limited Area (78102) |
$656.56 |
$1,132 |
1.5× |
| Bone survey complete (77075) |
$826.50 |
$1,425 |
7.4× |
| Bone survey infant (77076) |
$122.96 |
$212 |
1.1× |
| Bowel imaging (78290) |
$1,603.12 |
$2,764 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$345.10 |
$595 |
3.7× |
| Chest 1 view (71045) |
$164.72 |
$284 |
1.8× |
| Chest xray 3 views (71047) |
$290.58 |
$501 |
3.1× |
| Clavicle complete (73000) |
$260.42 |
$449 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$617.70 |
$1,065 |
5.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,065.22 |
$7,009 |
10.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,001 |
$3,450 |
7.9× |
| CT abdomen w contrast (74160) |
$1,760.88 |
$3,036 |
9.4× |
| CT abdomen w wo contrast (74170) |
$2,060.74 |
$3,553 |
11.0× |
| CT abdomen w/o contrast (74150) |
$1,000.50 |
$1,725 |
9.0× |
| CT angio hrt w/3d image (75574) |
$2,496.32 |
$4,304 |
6.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,129.76 |
$3,672 |
11.4× |
| CT angiography upper extremity lt (73206) |
$2,108.88 |
$3,636 |
11.3× |
| CT c-spine w/contrast (72126) |
$1,219.16 |
$2,102 |
3.3× |
| CT c-spine w/o contrast (72125) |
$1,066.62 |
$1,839 |
9.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,679.10 |
$2,895 |
9.0× |
| CT chest w contrast (71260) |
$2,314.20 |
$3,990 |
12.4× |
| CT chest w/wo contrast (71270) |
$1,785.82 |
$3,079 |
9.5× |
| CT head/brain with contrast (70460) |
$1,198.86 |
$2,067 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,306.16 |
$2,252 |
7.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$163.56 |
$282 |
1.8× |
| CT iac w contrast (70481) |
$1,654.16 |
$2,852 |
8.8× |
| CT lower ext w/o (73700) |
$1,233.66 |
$2,127 |
11.1× |
| CT lower extremity w wo contrast (73702) |
$1,562.52 |
$2,694 |
8.3× |
| CT lower extremity w/contrast material (73701) |
$1,500.17 |
$2,586.50 |
8.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,873.98 |
$3,231 |
10.0× |
| CT lumbar spine w/contrast (72132) |
$2,486.46 |
$4,287 |
6.7× |
| CT lumbar spine w/o contrast (72131) |
$1,061.40 |
$1,830 |
9.5× |
| CT maxillofacial w contrast (70487) |
$1,298.04 |
$2,238 |
6.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,707.52 |
$2,944 |
9.1× |
| CT maxillofacial wo contrast (70486) |
$1,136.80 |
$1,960 |
10.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,548.02 |
$2,669 |
8.3× |
| CT orbits w/o contrast (70480) |
$1,363.58 |
$2,351 |
12.2× |
| CT pelvis w/o contrast (72192) |
$1,012.68 |
$1,746 |
9.1× |
| CT pelvis w/wo contrast (72194) |
$1,938.36 |
$3,342 |
10.3× |
| CT scan of arm combo (73202) |
$1,625.16 |
$2,802 |
8.7× |
| CT soft tissue neck w contrast (70491) |
$1,252.22 |
$2,159 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,909.36 |
$3,292 |
10.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,008.04 |
$1,738 |
9.0× |
| CT thoracic spine w/contrast (72129) |
$1,283.54 |
$2,213 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$1,063.72 |
$1,834 |
9.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,562.52 |
$2,694 |
8.3× |
| CT thorax w/o contrast (71250) |
$1,190.74 |
$2,053 |
10.7× |
| CT upper ext wo (73200) |
$1,017.32 |
$1,754 |
9.1× |
| CT upper extremity with contrast (73201) |
$1,140.86 |
$1,967 |
3.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,293.32 |
$3,954 |
12.2× |
| CTA abdomen pelvis (74174) |
$2,093.22 |
$3,609 |
5.6× |
| CTA chest (71275) |
$2,012.60 |
$3,470 |
10.7× |
| Cta Head (70496) |
$2,649.44 |
$4,568 |
14.1× |
| Cta Neck (70498) |
$2,663.36 |
$4,592 |
14.2× |
| Cta Pelvis (72191) |
$1,863.54 |
$3,213 |
10.0× |
| Cystography minimum 3 views rs&i (74430) |
$600.88 |
$1,036 |
1.6× |
| Dilation of ureter(s) or urethra, radiological supervision and interpretation Non-Facility (74485) |
$582.32 |
$1,004 |
0.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$369.46 |
$637 |
3.3× |
| Esophagus (74220) |
$573.91 |
$989.50 |
3.1× |
| Facial bones min 3 views (70150) |
$390.63 |
$673.50 |
3.5× |
| Fetal biophysical profile non-stress testing (76818) |
$528.38 |
$911 |
4.7× |
| Foot 2 views (73620) |
$247.66 |
$427 |
2.7× |
| Forearm 2 views (73090) |
$260.42 |
$449 |
2.8× |
| Hand 2 views (73120) |
$206.19 |
$355.50 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,262 |
$3,900 |
3.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,650.68 |
$2,846 |
3.9× |
| Hysterosalpingogram (74740) |
$647.86 |
$1,117 |
2.5× |
| Kidney imaging morphology (78700) |
$811.42 |
$1,399 |
1.9× |
| Knee 3 views (73562) |
$205.32 |
$354 |
2.2× |
| Lymphoscintigraphy (78195) |
$1,769.58 |
$3,051 |
3.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,445.28 |
$4,216 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,502.41 |
$4,314.50 |
6.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$42.61 |
$73.47 |
1.4× |
| MRA head w/o contrast (70544) |
$1,264.98 |
$2,181 |
5.0× |
| MRA neck w contrast (70548) |
$2,158.76 |
$3,722 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,318.68 |
$7,446 |
11.6× |
| MRA neck w/o contrast (70547) |
$1,113.60 |
$1,920 |
4.4× |
| MRI abdomen w contrast (74182) |
$3,322.82 |
$5,729 |
8.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,563.52 |
$6,144 |
9.6× |
| MRI abdomen w/o contrast (74181) |
$2,410.48 |
$4,156 |
9.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,546.49 |
$4,390.50 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,741 |
$6,450 |
10.0× |
| MRI breast w/o contrast bilateral (77047) |
$810.84 |
$1,398 |
3.2× |
| MRI breast wo contrast unilateral (77046) |
$779.52 |
$1,344 |
3.1× |
| MRI c-spine with contrast (72142) |
$2,923.20 |
$5,040 |
7.8× |
| MRI cervical spine w/o contrast (72141) |
$2,181.96 |
$3,762 |
8.6× |
| MRI chest w/o & w/contrast material (71552) |
$4,503.12 |
$7,764 |
12.1× |
| MRI chest w/o contrast (71550) |
$1,735.07 |
$2,991.50 |
6.8× |
| MRI chest with contrast (71551) |
$2,086.26 |
$3,597 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,880.86 |
$4,967 |
7.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,543.80 |
$6,110 |
9.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,524.16 |
$4,352 |
9.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,379.74 |
$4,103 |
9.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,133.74 |
$5,403 |
8.4× |
| MRI pelvis w/contrast (72196) |
$3,056.60 |
$5,270 |
8.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,460.28 |
$5,966 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$3,026.44 |
$5,218 |
11.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,221.24 |
$7,278 |
11.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,138.38 |
$5,411 |
8.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,973.87 |
$6,851.50 |
10.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,727.16 |
$4,702 |
7.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,658.64 |
$6,308 |
9.8× |
| MRI temporomandibular joint (70336) |
$2,224.88 |
$3,836 |
8.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,540.98 |
$4,381 |
10.0× |
| MRI up ext w/o contrast (73218) |
$3,056.60 |
$5,270 |
12.0× |
| MRI upper ext joint w/o contrast (73221) |
$2,438.90 |
$4,205 |
9.6× |
| MRI, joint upper extrem combo (73223) |
$3,950.38 |
$6,811 |
10.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,288.10 |
$3,945 |
1.7× |
| Myocardial spect single study at rest or stress (78451) |
$2,767.76 |
$4,772 |
2.0× |
| Neck soft tissue (70360) |
$212.28 |
$366 |
2.3× |
| Nm bone marrow wb (78104) |
$989.48 |
$1,706 |
2.3× |
| Nm gastric emptying study (78264) |
$1,665.76 |
$2,872 |
3.9× |
| Nm kidney scan w/flow (78701) |
$1,070.10 |
$1,845 |
2.5× |
| Parathyroid Planar Imaging (78070) |
$426.88 |
$736 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$195.46 |
$337 |
1.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$875.80 |
$1,510 |
2.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,519.60 |
$2,620 |
2.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$199.52 |
$344 |
0.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$249.98 |
$431 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$381.35 |
$657.50 |
4.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$345.10 |
$595 |
3.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$325.09 |
$560.50 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$247.66 |
$427 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$369.17 |
$636.50 |
4.0× |
| Radex Hand Minimum 3 Views (73130) |
$375.26 |
$647 |
4.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$294.06 |
$507 |
2.6× |
| Radex Humerus Minimum 2 Views (73060) |
$225.62 |
$389 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$221.56 |
$382 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$245.92 |
$424 |
2.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$363.08 |
$626 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$320.74 |
$553 |
3.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$193.72 |
$334 |
1.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$348.58 |
$601 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$234.90 |
$405 |
2.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$411.22 |
$709 |
4.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$168.20 |
$290 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$157.76 |
$272 |
1.7× |
| Radiologic exam chest 2 views (71046) |
$205.32 |
$354 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$801.56 |
$1,382 |
4.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$252.88 |
$436 |
2.7× |
| Radiological examination surgical specimen (76098) |
$110.78 |
$191 |
0.2× |
| Ribs bilateral 3 views (71110) |
$390.92 |
$674 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$341.04 |
$588 |
3.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$497.64 |
$858 |
2.0× |
| Scapula (73010) |
$266.80 |
$460 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$50.17 |
$86.50 |
2.1× |
| Shoulder 1 view (73020) |
$214.02 |
$369 |
2.3× |
| Small bowel series (74250) |
$713.40 |
$1,230 |
3.8× |
| Thoracolumbar 2 views (72080) |
$67.86 |
$117 |
0.7× |
| Thyroid imaging w/blood flow (78013) |
$824.18 |
$1,421 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,215.68 |
$2,096 |
2.8× |
| Ultrasound breast complete (76641) |
$369.75 |
$637.50 |
3.3× |
| Ultrasound Exam Aaa Screen (76706) |
$319.58 |
$551 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$284.20 |
$490 |
2.5× |
| Unlisted ultrasound procedure (76999) |
$450.08 |
$776 |
4.8× |
| Urethrocystogram voiding (74455) |
$679.76 |
$1,172 |
2.7× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$825.34 |
$1,423 |
4.4× |
| Us breast unilateral limited (76642) |
$357.28 |
$616 |
3.8× |
| Us chest (76604) |
$156.89 |
$270.50 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$592.76 |
$1,022 |
5.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$84.68 |
$146 |
0.8× |
| Us ob limited (76815) |
$341.62 |
$589 |
3.1× |
| Us ob transvaginal (76817) |
$378.16 |
$652 |
3.4× |
| Us pelvic non ob complete (76856) |
$513.88 |
$886 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$278.69 |
$480.50 |
2.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$499.38 |
$861 |
4.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$379.32 |
$654 |
3.4× |
| Us retroperitoneal complete (76770) |
$470.96 |
$812 |
4.2× |
| Us retroperitoneal limited (76775) |
$413.54 |
$713 |
3.7× |
| Us scrotum and contents (76870) |
$512.72 |
$884 |
4.6× |
| Us soft tissue head/neck (76536) |
$507.50 |
$875 |
4.5× |
| Us transrectal (76872) |
$88.16 |
$152 |
0.8× |
| Wrist 2 views (73100) |
$271.44 |
$468 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$327.70 |
$565 |
3.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,680.26 |
$2,897 |
9.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$215.18 |
$371 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$205.32 |
$354 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$272.02 |
$469 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$215.76 |
$372 |
2.3× |
| X-ray eye for foreign body (70030) |
$186.18 |
$321 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$228.52 |
$394 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$287.68 |
$496 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$417.02 |
$719 |
3.7× |
| X-ray nose-rectum child f.b. (76010) |
$153.12 |
$264 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$320.74 |
$553 |
2.9× |
| X-ray retrograde pyelogram (74420) |
$2,033.48 |
$3,506 |
5.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$237.80 |
$410 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$290 |
$500 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$472.99 |
$815.50 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$341.04 |
$588 |
3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$230.26 |
$397 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$353.80 |
$610 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$412.96 |
$712 |
3.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$185.60 |
$320 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$309.14 |
$533 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$303.92 |
$524 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$249.98 |
$431 |
2.2× |
| Xr bone length studies (77073) |
$266.22 |
$459 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$405.42 |
$699 |
3.6× |
| Xr c-spine 6 or more views (72052) |
$506.92 |
$874 |
4.5× |
| Xr chest 4+ views (71048) |
$367.14 |
$633 |
3.3× |
| Xr urogram antegrade (74425) |
$418.18 |
$721 |
1.1× |