| Abdomen 2 views (74019) |
$331.50 |
$390 |
3.1× |
| Acute gi blood loss imaging (78278) |
$1,517.25 |
$1,785 |
3.7× |
| Ankle 2 views (73600) |
$244.80 |
$288 |
2.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$997.05 |
$1,173 |
2.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,040.40 |
$1,224 |
2.5× |
| Bone &/joint imaging whole body (78306) |
$1,451.80 |
$1,708 |
3.5× |
| Bone age studies (77072) |
$195.50 |
$230 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,523.20 |
$1,792 |
3.7× |
| Bone survey complete (77075) |
$1,548.70 |
$1,822 |
14.4× |
| Bone survey infant (77076) |
$390.15 |
$459 |
3.6× |
| Bowel imaging (78290) |
$1,156.85 |
$1,361 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$323 |
$380 |
3.6× |
| Chest 1 view (71045) |
$264.35 |
$311 |
2.9× |
| Chest xray 3 views (71047) |
$229.50 |
$270 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$192.52 |
$226.50 |
1.1× |
| Clavicle complete (73000) |
$243.10 |
$286 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,293.70 |
$1,522 |
12.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,989.05 |
$4,693 |
11.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,992 |
$3,520 |
12.1× |
| CT abdomen w contrast (74160) |
$1,572.50 |
$1,850 |
8.7× |
| CT abdomen w wo contrast (74170) |
$2,244 |
$2,640 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,640.50 |
$1,930 |
15.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,119.05 |
$2,493 |
11.7× |
| CT angiography upper extremity lt (73206) |
$2,103.75 |
$2,475 |
11.6× |
| CT c-spine w/contrast (72126) |
$1,705.10 |
$2,006 |
4.7× |
| CT c-spine w/o contrast (72125) |
$1,653.25 |
$1,945 |
15.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,872.55 |
$2,203 |
10.3× |
| CT chest w contrast (71260) |
$1,725.50 |
$2,030 |
9.5× |
| CT chest w/wo contrast (71270) |
$1,872.55 |
$2,203 |
10.3× |
| CT head/brain with contrast (70460) |
$1,921 |
$2,260 |
10.6× |
| CT head/brain without and with contrast (70470) |
$1,865.75 |
$2,195 |
10.3× |
| CT iac w contrast (70481) |
$1,583.12 |
$1,862.50 |
8.7× |
| CT limited/localized follow up study (76380) |
$1,167.05 |
$1,373 |
13.0× |
| CT lower ext w/o (73700) |
$1,525.75 |
$1,795 |
14.1× |
| CT lower extremity w wo contrast (73702) |
$1,847.90 |
$2,174 |
10.2× |
| CT lower extremity w/contrast material (73701) |
$1,725.50 |
$2,030 |
9.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,913.35 |
$2,251 |
10.6× |
| CT lumbar spine w/contrast (72132) |
$1,860.65 |
$2,189 |
5.2× |
| CT lumbar spine w/o contrast (72131) |
$1,611.60 |
$1,896 |
14.9× |
| CT maxillofacial w contrast (70487) |
$2,001.75 |
$2,355 |
11.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,800.30 |
$2,118 |
9.9× |
| CT maxillofacial wo contrast (70486) |
$1,504.50 |
$1,770 |
13.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,816.45 |
$2,137 |
10.0× |
| CT orbits w/o contrast (70480) |
$1,354.05 |
$1,593 |
12.5× |
| CT pelvis w/o contrast (72192) |
$1,725.50 |
$2,030 |
16.0× |
| CT pelvis w/wo contrast (72194) |
$1,790.95 |
$2,107 |
9.9× |
| CT scan of arm combo (73202) |
$1,772.25 |
$2,085 |
9.8× |
| CT soft tissue neck w contrast (70491) |
$1,802 |
$2,120 |
10.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,737.40 |
$2,044 |
9.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,623.50 |
$1,910 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$1,602.25 |
$1,885 |
8.9× |
| CT thoracic spine w/o contrast (72128) |
$1,522.35 |
$1,791 |
14.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,718.70 |
$2,022 |
9.5× |
| CT thorax w/o contrast (71250) |
$1,525.75 |
$1,795 |
14.1× |
| CT upper ext wo (73200) |
$1,521.50 |
$1,790 |
14.1× |
| CT upper extremity with contrast (73201) |
$1,571.65 |
$1,849 |
4.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,759.10 |
$3,246 |
15.2× |
| Cta Abdomen (74175) |
$1,922.70 |
$2,262 |
10.6× |
| CTA abdomen pelvis (74174) |
$3,191.75 |
$3,755 |
8.9× |
| CTA chest (71275) |
$2,181.10 |
$2,566 |
12.0× |
| Cta Head (70496) |
$2,069.75 |
$2,435 |
11.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,265.25 |
$2,665 |
6.3× |
| Cta Neck (70498) |
$2,095.25 |
$2,465 |
11.6× |
| Cystography minimum 3 views rs&i (74430) |
$422.45 |
$497 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$510.85 |
$601 |
4.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$534.65 |
$629 |
6.0× |
| Esophagus (74220) |
$399.50 |
$470 |
2.2× |
| Facial bones min 3 views (70150) |
$369.75 |
$435 |
3.4× |
| Fetal biophysical profile non-stress testing (76818) |
$606.90 |
$714 |
5.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$516.38 |
$607.50 |
4.8× |
| Fluoroscopy up to 1 hr (76000) |
$399.50 |
$470 |
1.6× |
| Foot 2 views (73620) |
$236.30 |
$278 |
2.6× |
| Forearm 2 views (73090) |
$243.10 |
$286 |
2.7× |
| Hand 2 views (73120) |
$245.65 |
$289 |
2.3× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,534.25 |
$1,805 |
2.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,432.25 |
$1,685 |
3.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$229.50 |
$270 |
2.1× |
| Kidney imaging morphology (78700) |
$953.70 |
$1,122 |
2.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,487.50 |
$1,750 |
2.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,547 |
$1,820 |
2.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,213.80 |
$1,428 |
2.2× |
| Knee 3 views (73562) |
$277.10 |
$326 |
3.1× |
| Liver & spleen imaging static only (78215) |
$1,040.40 |
$1,224 |
2.5× |
| Lung ventilation imaging (78579) |
$1,207 |
$1,420 |
2.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,533 |
$2,980 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,479.45 |
$2,917 |
6.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,867.90 |
$3,374 |
8.0× |
| MRA head w & w/o contrast (70546) |
$2,653.70 |
$3,122 |
7.4× |
| MRA head w/o contrast (70544) |
$2,278 |
$2,680 |
9.3× |
| MRA head with contrast (70545) |
$1,907.40 |
$2,244 |
5.3× |
| MRA neck w contrast (70548) |
$2,108.85 |
$2,481 |
5.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,677.50 |
$3,150 |
7.4× |
| MRA neck w/o contrast (70547) |
$2,123.30 |
$2,498 |
8.6× |
| MRI abdomen w contrast (74182) |
$2,524.50 |
$2,970 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,031.95 |
$3,567 |
8.4× |
| MRI abdomen w/o contrast (74181) |
$2,234.22 |
$2,628.50 |
9.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,564.45 |
$3,017 |
3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,765.90 |
$3,254 |
7.7× |
| MRI c-spine with contrast (72142) |
$2,497.30 |
$2,938 |
6.9× |
| MRI cervical spine w/o contrast (72141) |
$2,358.75 |
$2,775 |
9.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,753.15 |
$3,239 |
7.6× |
| MRI chest w/o contrast (71550) |
$2,030.65 |
$2,389 |
8.2× |
| MRI chest with contrast (71551) |
$2,329.85 |
$2,741 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,353.65 |
$2,769 |
6.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,720 |
$3,200 |
7.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,231.25 |
$2,625 |
9.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,078.25 |
$2,445 |
8.4× |
| MRI orbit face neck w contrast (70542) |
$2,266.95 |
$2,667 |
6.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,626.50 |
$3,090 |
7.3× |
| MRI pelvis w/contrast (72196) |
$2,202.35 |
$2,591 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,786.30 |
$3,278 |
7.7× |
| MRI pelvis w/o contrast (72195) |
$2,223.60 |
$2,616 |
9.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,057.45 |
$3,597 |
8.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,532.15 |
$2,979 |
7.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,238.50 |
$3,810 |
9.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,609.50 |
$3,070 |
7.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,771.85 |
$3,261 |
7.7× |
| MRI temporomandibular joint (70336) |
$1,820.70 |
$2,142 |
7.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,358.75 |
$2,775 |
9.6× |
| MRI up ext w/o contrast (73218) |
$2,195.55 |
$2,583 |
8.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,358.75 |
$2,775 |
9.6× |
| MRI, joint upper extrem combo (73223) |
$2,874.70 |
$3,382 |
8.0× |
| Myocardial Spect Multiple Studies (78452) |
$3,672 |
$4,320 |
2.7× |
| Myocardial spect single study at rest or stress (78451) |
$2,656.25 |
$3,125 |
2.0× |
| Neck soft tissue (70360) |
$254.15 |
$299 |
2.8× |
| Nm gastric emptying study (78264) |
$1,563.15 |
$1,839 |
3.8× |
| Nm kidney scan w/flow (78701) |
$1,040.40 |
$1,224 |
2.5× |
| Noncardiac Vascular Flow Imaging (78445) |
$524.45 |
$617 |
1.3× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$65.45 |
$77 |
2.2× |
| Parathyroid Planar Imaging (78070) |
$1,227.40 |
$1,444 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$272 |
$320 |
2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,040.40 |
$1,224 |
2.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,712.75 |
$2,015 |
3.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$277.10 |
$326 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$238.85 |
$281 |
2.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$277.10 |
$326 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$295.80 |
$348 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$328.95 |
$387 |
3.0× |
| Radex fingr minimum 2 views (73140) |
$224.40 |
$264 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$268.60 |
$316 |
3.0× |
| Radex Hand Minimum 3 Views (73130) |
$255 |
$300 |
2.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$249.05 |
$293 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$550.80 |
$648 |
5.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$466.65 |
$549 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$260.10 |
$306 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$260.10 |
$306 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$317.05 |
$373 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$328.10 |
$386 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$289 |
$340 |
3.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$335.75 |
$395 |
3.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$280.50 |
$330 |
3.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$229.50 |
$270 |
2.6× |
| Radex Toe Minimum 2 Views (73660) |
$241.40 |
$284 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$258.40 |
$304 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$257.55 |
$303 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$255 |
$300 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$216.75 |
$255 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$310.25 |
$365 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$212.50 |
$250 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$273.70 |
$322 |
3.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$260.10 |
$306 |
2.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$216.75 |
$255 |
2.0× |
| Ribs bilateral 3 views (71110) |
$342.55 |
$403 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$252.45 |
$297 |
2.3× |
| Scapula (73010) |
$249.90 |
$294 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$107.10 |
$126 |
4.6× |
| Shoulder 1 view (73020) |
$212.50 |
$250 |
2.4× |
| Small bowel series (74250) |
$430.10 |
$506 |
2.4× |
| Spine thoracic 3 views (72072) |
$378.25 |
$445 |
3.5× |
| Thoracolumbar 2 views (72080) |
$235.45 |
$277 |
2.6× |
| Thyroid imaging w/blood flow (78013) |
$1,040.40 |
$1,224 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,167.90 |
$1,374 |
2.8× |
| Tmj unilateral (70328) |
$241.40 |
$284 |
2.7× |
| Ultrasound breast complete (76641) |
$524.45 |
$617 |
4.9× |
| Ultrasound Exam Aaa Screen (76706) |
$623.05 |
$733 |
5.8× |
| Ultrasound, abdomen limited (76705) |
$632.40 |
$744 |
5.9× |
| Umbilical-artery Doppler (OB) (76820) |
$344.25 |
$405 |
3.2× |
| Unlisted ultrasound procedure (76999) |
$405.45 |
$477 |
4.5× |
| Us breast unilateral limited (76642) |
$441.58 |
$519.50 |
4.9× |
| Us chest (76604) |
$511.70 |
$602 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$381.65 |
$449 |
3.5× |
| Us encephalogram (76506) |
$498.10 |
$586 |
4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$491.30 |
$578 |
4.6× |
| Us ob limited (76815) |
$417.35 |
$491 |
3.9× |
| Us ob transvaginal (76817) |
$524.45 |
$617 |
4.9× |
| Us pelvic non ob complete (76856) |
$600.10 |
$706 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$382.50 |
$450 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$579.70 |
$682 |
5.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$498.10 |
$586 |
4.6× |
| Us retroperitoneal complete (76770) |
$752.68 |
$885.50 |
7.0× |
| Us retroperitoneal limited (76775) |
$611.15 |
$719 |
5.7× |
| Us scrotum and contents (76870) |
$589.05 |
$693 |
5.5× |
| Us soft tissue head/neck (76536) |
$616.25 |
$725 |
5.7× |
| Wrist 2 views (73100) |
$241.40 |
$284 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$355.30 |
$418 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$250.75 |
$295 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$242.25 |
$285 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$301.75 |
$355 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$391 |
$460 |
3.6× |
| X-ray exam of femur 2/> (73552) |
$285.60 |
$336 |
3.2× |
| X-ray eye for foreign body (70030) |
$227.80 |
$268 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$233.75 |
$275 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$216.75 |
$255 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$254.15 |
$299 |
2.8× |
| X-ray leg, infant (73592) |
$249.90 |
$294 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$374 |
$440 |
3.5× |
| X-ray nose-rectum child f.b. (76010) |
$238.85 |
$281 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$277.10 |
$326 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$536.35 |
$631 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$323 |
$380 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$399.50 |
$470 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$476 |
$560 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$306.85 |
$361 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$272 |
$320 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$354.45 |
$417 |
3.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$298.35 |
$351 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$291.55 |
$343 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$241.40 |
$284 |
2.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$283.90 |
$334 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$272.85 |
$321 |
3.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$288.15 |
$339 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$305.15 |
$359 |
2.8× |
| Xr c-spine 4 or 5 views (72050) |
$364.65 |
$429 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$357 |
$420 |
3.3× |
| Xr chest 4+ views (71048) |
$238.85 |
$281 |
2.2× |