| Abdomen 2 views (74019) |
$283.04 |
$464 |
2.6× |
| Ankle 2 views (73600) |
$221.43 |
$363 |
2.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,236.47 |
$2,027 |
3.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,496.33 |
$2,453 |
3.6× |
| Bone &/joint imaging whole body (78306) |
$1,557.33 |
$2,553 |
3.8× |
| Bone age studies (77072) |
$202.52 |
$332 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$1,046.76 |
$1,716 |
2.5× |
| Bone survey complete (77075) |
$1,424.96 |
$2,336 |
13.2× |
| Bone survey infant (77076) |
$303.78 |
$498 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$297.68 |
$488 |
3.3× |
| Chest 1 view (71045) |
$220.82 |
$362 |
2.5× |
| Chest xray 3 views (71047) |
$220.82 |
$362 |
2.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$583.77 |
$957 |
3.2× |
| Clavicle complete (73000) |
$203.13 |
$333 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,455.46 |
$2,386 |
13.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,377.17 |
$3,897 |
6.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,978.23 |
$3,243 |
8.0× |
| CT abdomen w contrast (74160) |
$1,461.56 |
$2,396 |
8.1× |
| CT abdomen w wo contrast (74170) |
$1,674.45 |
$2,745 |
9.2× |
| CT abdomen w/o contrast (74150) |
$1,461.56 |
$2,396 |
13.5× |
| CT angio hrt w/3d image (75574) |
$1,273.68 |
$2,088 |
3.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,484.13 |
$2,433 |
8.2× |
| CT angiography upper extremity lt (73206) |
$1,345.66 |
$2,206 |
7.4× |
| CT c-spine w/contrast (72126) |
$1,715.93 |
$2,813 |
4.8× |
| CT c-spine w/o contrast (72125) |
$1,442.65 |
$2,365 |
13.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,242.36 |
$3,676 |
12.4× |
| CT chest w contrast (71260) |
$1,392.63 |
$2,283 |
7.7× |
| CT chest w/wo contrast (71270) |
$1,905.03 |
$3,123 |
10.5× |
| CT head/brain with contrast (70460) |
$1,301.74 |
$2,134 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,742.16 |
$2,856 |
9.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$711.26 |
$1,166 |
2.0× |
| CT iac w contrast (70481) |
$1,480.47 |
$2,427 |
8.2× |
| CT limited/localized follow up study (76380) |
$727.73 |
$1,193 |
8.1× |
| CT lower ext w/o (73700) |
$1,167.54 |
$1,914 |
10.8× |
| CT lower extremity w wo contrast (73702) |
$1,906.86 |
$3,126 |
10.5× |
| CT lower extremity w/contrast material (73701) |
$1,136.43 |
$1,863 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,495.72 |
$2,452 |
8.3× |
| CT lumbar spine w/contrast (72132) |
$1,462.78 |
$2,398 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$1,642.12 |
$2,692 |
15.2× |
| CT maxillofacial w contrast (70487) |
$1,127.28 |
$1,848 |
6.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,847.08 |
$3,028 |
10.2× |
| CT maxillofacial wo contrast (70486) |
$1,215.73 |
$1,993 |
11.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,839.15 |
$3,015 |
10.2× |
| CT orbits w/o contrast (70480) |
$1,298.69 |
$2,129 |
12.0× |
| CT pelvis w/o contrast (72192) |
$1,335.90 |
$2,190 |
12.4× |
| CT pelvis w/wo contrast (72194) |
$2,152.69 |
$3,529 |
11.9× |
| CT scan of arm combo (73202) |
$1,906.86 |
$3,126 |
10.5× |
| CT soft tissue neck w contrast (70491) |
$1,264.53 |
$2,073 |
7.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,396.29 |
$2,289 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,264.53 |
$2,073 |
11.7× |
| CT thoracic spine w/contrast (72129) |
$1,715.93 |
$2,813 |
9.5× |
| CT thoracic spine w/o contrast (72128) |
$1,531.10 |
$2,510 |
14.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,301.53 |
$3,773 |
12.7× |
| CT thorax w/o contrast (71250) |
$1,392.63 |
$2,283 |
12.9× |
| CT unlisted procedure (76497) |
$421.51 |
$691 |
4.7× |
| CT upper ext wo (73200) |
$1,174.86 |
$1,926 |
10.9× |
| CT upper extremity with contrast (73201) |
$1,174.86 |
$1,926 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,637.85 |
$2,685 |
9.0× |
| Cta Abdomen (74175) |
$2,907.87 |
$4,767 |
16.1× |
| CTA abdomen pelvis (74174) |
$2,373.51 |
$3,891 |
6.6× |
| CTA chest (71275) |
$1,618.33 |
$2,653 |
8.9× |
| Cta Head (70496) |
$1,523.78 |
$2,498 |
8.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$587.43 |
$963 |
1.6× |
| Cta Neck (70498) |
$2,009.95 |
$3,295 |
11.1× |
| Cta Pelvis (72191) |
$2,080.10 |
$3,410 |
11.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$350.75 |
$575 |
3.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$123.83 |
$203 |
1.4× |
| Dxa bone density study axial skeleton (77085) |
$421.51 |
$691 |
3.9× |
| Facial bones min 3 views (70150) |
$319.64 |
$524 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$1,104.71 |
$1,811 |
10.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$650.26 |
$1,066 |
6.0× |
| Fluoroscopy up to 1 hr (76000) |
$365.39 |
$599 |
1.5× |
| Foot 2 views (73620) |
$214.72 |
$352 |
2.4× |
| Forearm 2 views (73090) |
$203.13 |
$333 |
2.3× |
| Hand 2 views (73120) |
$202.52 |
$332 |
1.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,816.58 |
$2,978 |
3.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,816.58 |
$2,978 |
4.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$213.50 |
$350 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$900.97 |
$1,477 |
1.6× |
| Knee 3 views (73562) |
$243.39 |
$399 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,179.53 |
$3,573 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,615.68 |
$4,288 |
7.3× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$215.33 |
$353 |
2.4× |
| MRA head w & w/o contrast (70546) |
$2,288.72 |
$3,752 |
6.4× |
| MRA head w/o contrast (70544) |
$2,168.55 |
$3,555 |
8.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,346.67 |
$3,847 |
6.5× |
| MRA neck w/o contrast (70547) |
$1,770.83 |
$2,903 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,411.33 |
$3,953 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$2,179.53 |
$3,573 |
8.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,411.33 |
$3,953 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,411.33 |
$3,953 |
6.7× |
| MRI c-spine with contrast (72142) |
$2,203.32 |
$3,612 |
6.1× |
| MRI cervical spine w/o contrast (72141) |
$2,179.53 |
$3,573 |
8.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,346.67 |
$3,847 |
6.5× |
| MRI chest w/o contrast (71550) |
$2,179.53 |
$3,573 |
8.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,411.33 |
$3,953 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,121.58 |
$3,478 |
8.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,820.24 |
$2,984 |
7.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,566.27 |
$4,207 |
7.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,612.02 |
$4,282 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$2,179.53 |
$3,573 |
8.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,426.58 |
$3,978 |
6.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,221.01 |
$3,641 |
6.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,549.19 |
$4,179 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,121.58 |
$3,478 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,426.58 |
$3,978 |
6.7× |
| MRI temporomandibular joint (70336) |
$2,020.32 |
$3,312 |
8.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,179.53 |
$3,573 |
8.9× |
| MRI up ext w/o contrast (73218) |
$2,179.53 |
$3,573 |
8.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,121.58 |
$3,478 |
8.6× |
| MRI, joint upper extrem combo (73223) |
$2,411.33 |
$3,953 |
6.7× |
| Myocardial Spect Multiple Studies (78452) |
$2,528.45 |
$4,145 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,476.81 |
$2,421 |
1.1× |
| Neck soft tissue (70360) |
$179.95 |
$295 |
2.0× |
| Nm gastric emptying study (78264) |
$1,310.28 |
$2,148 |
3.2× |
| Osseous survey limited (77074) |
$125.05 |
$205 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,790.35 |
$2,935 |
4.3× |
| Pelvis 1 or 2 views (72170) |
$256.20 |
$420 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$2,515.03 |
$4,123 |
1.7× |
| PET imaging for CT attenuation whole body (78816) |
$2,521.74 |
$4,134 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,959.32 |
$3,212 |
3.5× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$742.98 |
$1,218 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$245.52 |
$402.50 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$193.37 |
$317 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$220.21 |
$361 |
2.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$270.23 |
$443 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$328.79 |
$539 |
3.0× |
| Radex fingr minimum 2 views (73140) |
$171.41 |
$281 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$149.45 |
$245 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$243.39 |
$399 |
2.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$180.56 |
$296 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$406.26 |
$666 |
3.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$107.36 |
$176 |
1.0× |
| Radex Humerus Minimum 2 Views (73060) |
$221.43 |
$363 |
2.5× |
| Radex Kne 1/2 Views (73560) |
$208.62 |
$342 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$269.62 |
$442 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$269.62 |
$442 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$234.24 |
$384 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$297.98 |
$488.50 |
2.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$143.35 |
$235 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$215.33 |
$353 |
2.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$299.51 |
$491 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$220.21 |
$361 |
2.5× |
| Radex Toe Minimum 2 Views (73660) |
$171.41 |
$281 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$202.52 |
$332 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$250.71 |
$411 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$238.51 |
$391 |
2.7× |
| Radiologic exam chest 2 views (71046) |
$251.93 |
$413 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$214.72 |
$352 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$220.82 |
$362 |
2.5× |
| Ribs bilateral 3 views (71110) |
$74.42 |
$122 |
0.7× |
| Sacroiliac Joints < 3 Views (72200) |
$201.91 |
$331 |
1.9× |
| Scapula (73010) |
$215.33 |
$353 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$112.85 |
$185 |
4.8× |
| Shoulder 1 view (73020) |
$188.49 |
$309 |
2.1× |
| Spine thoracic 3 views (72072) |
$278.77 |
$457 |
2.6× |
| Thoracolumbar 2 views (72080) |
$179.95 |
$295 |
2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,021.14 |
$1,674 |
2.5× |
| Ultrasound breast complete (76641) |
$507.52 |
$832 |
4.7× |
| Ultrasound Exam Aaa Screen (76706) |
$359.90 |
$590 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$140.30 |
$230 |
1.3× |
| Umbilical-artery Doppler (OB) (76820) |
$335.50 |
$550 |
3.1× |
| Unlisted ultrasound procedure (76999) |
$335.50 |
$550 |
3.7× |
| Us breast unilateral limited (76642) |
$449.57 |
$737 |
5.0× |
| Us chest (76604) |
$140.30 |
$230 |
1.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$335.50 |
$550 |
3.1× |
| Us ob limited (76815) |
$434.32 |
$712 |
4.0× |
| Us ob transvaginal (76817) |
$477.63 |
$783 |
4.4× |
| Us pelvic non ob complete (76856) |
$600.24 |
$984 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$341.60 |
$560 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$786.90 |
$1,290 |
7.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$477.63 |
$783 |
4.4× |
| Us retroperitoneal complete (76770) |
$696.62 |
$1,142 |
6.5× |
| Us retroperitoneal limited (76775) |
$359.90 |
$590 |
3.3× |
| Us scrotum and contents (76870) |
$599.02 |
$982 |
5.6× |
| Us soft tissue head/neck (76536) |
$528.87 |
$867 |
4.9× |
| Us spinal canal and contents (76800) |
$615.49 |
$1,009 |
5.7× |
| Wrist 2 views (73100) |
$214.72 |
$352 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$263.52 |
$432 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$196.42 |
$322 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$294.02 |
$482 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$301.95 |
$495 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$237.90 |
$390 |
2.6× |
| X-ray eye for foreign body (70030) |
$191.54 |
$314 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$68.93 |
$113 |
0.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$245.22 |
$402 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$208.62 |
$342 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$308.05 |
$505 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$356.85 |
$585 |
3.3× |
| X-ray nose-rectum child f.b. (76010) |
$238.51 |
$391 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$220.21 |
$361 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$83.57 |
$137 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$395.28 |
$648 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$558.76 |
$916 |
5.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$224.48 |
$368 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$224.48 |
$368 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$214.72 |
$352 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$363.56 |
$596 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$238.51 |
$391 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$171.41 |
$281 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$269.62 |
$442 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$257.42 |
$422 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$263.52 |
$432 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$305.61 |
$501 |
2.8× |
| Xr c-spine 4 or 5 views (72050) |
$380.64 |
$624 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$466.65 |
$765 |
4.3× |