| Abdomen 2 views (74019) |
$170.88 |
$267 |
1.6× |
| Acute gi blood loss imaging (78278) |
$915.84 |
$1,431 |
2.2× |
| Ankle 2 views (73600) |
$96.50 |
$150.77 |
1.1× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$3,813.12 |
$5,958 |
1.2× |
| Arthrogram hip (73525) |
$259.84 |
$406 |
0.7× |
| Arthrogram shoulder (73040) |
$403.20 |
$630 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$606.72 |
$948 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$946.56 |
$1,479 |
2.3× |
| Bone age studies (77072) |
$186.24 |
$291 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$1,153.92 |
$1,803 |
2.8× |
| Bone survey complete (77075) |
$357.76 |
$559 |
3.3× |
| Bone survey infant (77076) |
$171.52 |
$268 |
1.6× |
| Bowel imaging (78290) |
$522.88 |
$817 |
1.3× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$1,134.72 |
$1,773 |
0.8× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$860.16 |
$1,344 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$120 |
$187.50 |
1.3× |
| Chest 1 view (71045) |
$128 |
$200 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$382.08 |
$597 |
2.1× |
| Clavicle complete (73000) |
$92.16 |
$144 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$665.60 |
$1,040 |
6.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,576.96 |
$2,464 |
4.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,073.92 |
$1,678 |
4.4× |
| CT abdomen w contrast (74160) |
$846.72 |
$1,323 |
4.7× |
| CT abdomen w wo contrast (74170) |
$1,191.04 |
$1,861 |
6.6× |
| CT abdomen w/o contrast (74150) |
$655.36 |
$1,024 |
6.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$420.79 |
$657.48 |
2.3× |
| CT angiography upper extremity lt (73206) |
$420.79 |
$657.48 |
2.3× |
| CT c-spine w/contrast (72126) |
$1,057.28 |
$1,652 |
2.9× |
| CT c-spine w/o contrast (72125) |
$932.48 |
$1,457 |
8.6× |
| CT chest w contrast (71260) |
$904.96 |
$1,414 |
5.0× |
| CT chest w/wo contrast (71270) |
$1,276.16 |
$1,994 |
7.0× |
| CT head/brain with contrast (70460) |
$1,081.60 |
$1,690 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,107.84 |
$1,731 |
6.1× |
| CT iac w contrast (70481) |
$690.88 |
$1,079.50 |
3.8× |
| CT lower ext w/o (73700) |
$915.20 |
$1,430 |
8.5× |
| CT lower extremity w wo contrast (73702) |
$947.84 |
$1,481 |
5.2× |
| CT lower extremity w/contrast material (73701) |
$861.44 |
$1,346 |
4.8× |
| CT lumbar spine w/contrast (72132) |
$1,049.60 |
$1,640 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$912.64 |
$1,426 |
8.5× |
| CT maxillofacial w contrast (70487) |
$876.16 |
$1,369 |
4.8× |
| CT maxillofacial w/wo contrast (70488) |
$933.12 |
$1,458 |
5.2× |
| CT maxillofacial wo contrast (70486) |
$912.64 |
$1,426 |
8.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,061.12 |
$1,658 |
5.9× |
| CT orbits w/o contrast (70480) |
$835.20 |
$1,305 |
7.7× |
| CT pelvis w/o contrast (72192) |
$808.32 |
$1,263 |
7.5× |
| CT pelvis w/wo contrast (72194) |
$873.60 |
$1,365 |
4.8× |
| CT scan of arm combo (73202) |
$1,041.92 |
$1,628 |
5.8× |
| CT soft tissue neck w contrast (70491) |
$860.16 |
$1,344 |
4.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,248 |
$1,950 |
6.9× |
| CT soft tissue neck w/o contrast (70490) |
$702.72 |
$1,098 |
6.5× |
| CT thoracic spine w/contrast (72129) |
$1,007.36 |
$1,574 |
5.6× |
| CT thoracic spine w/o contrast (72128) |
$910.08 |
$1,422 |
8.4× |
| CT thorax w/o contrast (71250) |
$820.16 |
$1,281.50 |
7.6× |
| CT upper ext wo (73200) |
$858.24 |
$1,341 |
8.0× |
| CT upper extremity with contrast (73201) |
$1,185.28 |
$1,852 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$300.16 |
$469 |
1.7× |
| Cta Abdomen (74175) |
$224.08 |
$350.12 |
1.2× |
| CTA abdomen pelvis (74174) |
$1,588.48 |
$2,482 |
4.4× |
| CTA chest (71275) |
$894.72 |
$1,398 |
4.9× |
| Cta Head (70496) |
$1,164.80 |
$1,820 |
6.4× |
| Cta Neck (70498) |
$1,157.12 |
$1,808 |
6.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$118.40 |
$185 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$85.12 |
$133 |
0.9× |
| Echo exam of eye (76529) |
$32.88 |
$51.38 |
0.4× |
| Esophagus (74220) |
$293.12 |
$458 |
1.6× |
| Facial bones min 3 views (70150) |
$147.20 |
$230 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$251.52 |
$393 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$432.64 |
$676 |
4.0× |
| Fluoroscopy up to 1 hr (76000) |
$325.12 |
$508 |
1.3× |
| Foot 2 views (73620) |
$96 |
$150 |
1.1× |
| Forearm 2 views (73090) |
$99.20 |
$155 |
1.1× |
| Hand 2 views (73120) |
$106.24 |
$166 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,301.12 |
$2,033 |
2.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$862.08 |
$1,347 |
2.1× |
| Hysterosalpingogram (74740) |
$76.16 |
$119 |
0.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$146.56 |
$229 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$736 |
$1,150 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,042.56 |
$1,629 |
1.9× |
| Knee 3 views (73562) |
$93.76 |
$146.50 |
1.0× |
| Liver & spleen imaging static only (78215) |
$612.48 |
$957 |
1.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$465.28 |
$727 |
1.1× |
| Lung perfusion differential (78597) |
$899.84 |
$1,406 |
2.2× |
| Lymphoscintigraphy (78195) |
$726.40 |
$1,135 |
1.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,996.80 |
$3,120 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,966.72 |
$3,073 |
5.5× |
| MRA head w & w/o contrast (70546) |
$1,780.48 |
$2,782 |
4.9× |
| MRA head w/o contrast (70544) |
$1,517.44 |
$2,371 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,890.56 |
$2,954 |
5.3× |
| MRA neck w/o contrast (70547) |
$1,420.16 |
$2,219 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,163.20 |
$3,380 |
6.0× |
| MRI abdomen w/o contrast (74181) |
$1,452.80 |
$2,270 |
5.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,710.72 |
$2,673 |
2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,952 |
$3,050 |
5.4× |
| MRI cervical spine w/o contrast (72141) |
$1,336.32 |
$2,088 |
5.4× |
| MRI chest w/o & w/contrast material (71552) |
$1,900.80 |
$2,970 |
5.3× |
| MRI chest w/o contrast (71550) |
$1,179.52 |
$1,843 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,091.52 |
$3,268 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,696 |
$2,650 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,960.96 |
$3,064 |
8.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,841.28 |
$2,877 |
5.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,796.48 |
$2,807 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,551.36 |
$2,424 |
6.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,802.88 |
$2,817 |
5.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,989.76 |
$3,109 |
5.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$363.52 |
$568 |
1.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,797.76 |
$2,809 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,306.88 |
$2,042 |
5.3× |
| MRI up ext w/o contrast (73218) |
$1,830.40 |
$2,860 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,647.36 |
$2,574 |
6.7× |
| MRI, joint upper extrem combo (73223) |
$1,967.68 |
$3,074.50 |
5.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,264.96 |
$3,539 |
1.7× |
| Myocardial spect single study at rest or stress (78451) |
$1,791.36 |
$2,799 |
1.3× |
| Neck soft tissue (70360) |
$104.32 |
$163 |
1.2× |
| Nm cardiac blood pool multiple (78473) |
$1,722.24 |
$2,691 |
4.2× |
| Nm gastric emptying study (78264) |
$1,219.84 |
$1,906 |
3.0× |
| Osseous survey limited (77074) |
$366.72 |
$573 |
3.4× |
| Parathyroid Planar Imaging (78070) |
$624 |
$975 |
1.5× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$657.92 |
$1,028 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$64 |
$100 |
0.6× |
| PET image w/CT, skull-thigh (78815) |
$3,342.08 |
$5,222 |
2.3× |
| PET imaging for CT attenuation whole body (78816) |
$3,502.72 |
$5,473 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$703.36 |
$1,099 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,094.40 |
$1,710 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$83.57 |
$130.58 |
0.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$111.36 |
$174 |
1.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$86.72 |
$135.50 |
1.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$99.52 |
$155.50 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$218.88 |
$342 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$118.40 |
$185 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$108.80 |
$170 |
1.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$102.72 |
$160.50 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$109.76 |
$171.50 |
1.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$177.28 |
$277 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$132.40 |
$206.88 |
1.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$172.68 |
$269.82 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$104.32 |
$163 |
1.2× |
| Radex Kne 1/2 Views (73560) |
$134.08 |
$209.50 |
1.5× |
| Radex Kne Compl 4/More Views (73564) |
$149.63 |
$233.80 |
1.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$196.48 |
$307 |
1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$154.88 |
$242 |
1.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$165.12 |
$258 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$106.24 |
$166 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$128 |
$200 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$51.84 |
$81 |
0.5× |
| Radex Toe Minimum 2 Views (73660) |
$100.48 |
$157 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$187.52 |
$293 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$108.80 |
$170 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$138.88 |
$217 |
1.5× |
| Radiologic exam chest 2 views (71046) |
$73.60 |
$115 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$406.40 |
$635 |
2.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$362.56 |
$566.50 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$112.64 |
$176 |
1.3× |
| Radiological examination surgical specimen (76098) |
$146.56 |
$229 |
0.3× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$824.32 |
$1,288 |
2.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$840.32 |
$1,313 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$172.80 |
$270 |
1.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$252.80 |
$395 |
1.0× |
| Scapula (73010) |
$92.16 |
$144 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$102.40 |
$160 |
4.4× |
| Shoulder 1 view (73020) |
$119.68 |
$187 |
1.3× |
| Small bowel series (74250) |
$322.56 |
$504 |
1.8× |
| Spine thoracic 3 views (72072) |
$64 |
$100 |
0.6× |
| Thoracolumbar 2 views (72080) |
$64 |
$100 |
0.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$709.76 |
$1,109 |
1.7× |
| Ultrasound breast complete (76641) |
$348.80 |
$545 |
3.2× |
| Ultrasound Exam Aaa Screen (76706) |
$105.60 |
$165 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$253.57 |
$396.20 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$301.44 |
$471 |
2.8× |
| Urethrocystogram voiding (74455) |
$430.72 |
$673 |
1.7× |
| Us breast unilateral limited (76642) |
$303.36 |
$474 |
3.4× |
| Us chest (76604) |
$219.65 |
$343.20 |
2.0× |
| Us encephalogram (76506) |
$398.08 |
$622 |
3.7× |
| Us hips infant static (76886) |
$124.16 |
$194 |
1.4× |
| Us infant hips w manipulation (76885) |
$191.36 |
$299 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$239.49 |
$374.20 |
2.2× |
| Us ob limited (76815) |
$81.28 |
$127 |
0.8× |
| Us ob transvaginal (76817) |
$132.48 |
$207 |
1.2× |
| Us pelvic non ob complete (76856) |
$231.04 |
$361 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$221.76 |
$346.50 |
2.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$333.44 |
$521 |
3.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$372.48 |
$582 |
3.5× |
| Us retroperitoneal complete (76770) |
$428.80 |
$670 |
4.0× |
| Us retroperitoneal limited (76775) |
$323.20 |
$505 |
3.0× |
| Us scrotum and contents (76870) |
$253.76 |
$396.50 |
2.4× |
| Us soft tissue head/neck (76536) |
$373.12 |
$583 |
3.5× |
| Us spinal canal and contents (76800) |
$191.36 |
$299 |
1.8× |
| Us, eye b-scan (76512) |
$40.24 |
$62.88 |
0.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$177.92 |
$278 |
1.6× |
| Wrist 2 views (73100) |
$93.76 |
$146.50 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$284.80 |
$445 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$131.20 |
$205 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$87.68 |
$137 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$172.16 |
$269 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$184.32 |
$288 |
1.7× |
| X-ray exam of femur 2/> (73552) |
$113.60 |
$177.50 |
1.3× |
| X-ray eye for foreign body (70030) |
$186.24 |
$291 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$96 |
$150 |
1.1× |
| X-ray leg, infant (73592) |
$122.24 |
$191 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$64 |
$100 |
0.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$17.92 |
$28 |
0.2× |
| X-ray nose-rectum child f.b. (76010) |
$133.12 |
$208 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$126.40 |
$197.50 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$154.24 |
$241 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$31.04 |
$48.50 |
0.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$184.96 |
$289 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$64 |
$100 |
0.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$175.36 |
$274 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$122.88 |
$192 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$101.76 |
$159 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$182.40 |
$285 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$105.60 |
$165 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$64 |
$100 |
0.6× |
| Xr bone length studies (77073) |
$56.32 |
$88 |
0.5× |
| Xr c-spine 4 or 5 views (72050) |
$91.52 |
$143 |
0.8× |