| Abdomen 2 views (74019) |
$404.80 |
$506 |
3.8× |
| Acute gi blood loss imaging (78278) |
$1,636 |
$2,045 |
4.0× |
| Ankle 2 views (73600) |
$313.60 |
$392 |
3.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,291.20 |
$1,614 |
3.1× |
| Bone &/joint imaging whole body (78306) |
$1,943.20 |
$2,429 |
4.7× |
| Bone age studies (77072) |
$354.40 |
$443 |
3.3× |
| Bone Imaging 3 Phase (78315) |
$2,184.80 |
$2,731 |
5.3× |
| Bone survey complete (77075) |
$1,276.80 |
$1,596 |
11.8× |
| Bowel imaging (78290) |
$1,508 |
$1,885 |
3.7× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$1,918.40 |
$2,398 |
3.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,935.20 |
$2,419 |
4.7× |
| Cervical spine 2 or 3 views (72040) |
$382.40 |
$478 |
4.3× |
| Chest 1 view (71045) |
$313.60 |
$392 |
3.5× |
| Chest xray 3 views (71047) |
$384 |
$480 |
4.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$698.40 |
$873 |
3.9× |
| Clavicle complete (73000) |
$329.60 |
$412 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,394.40 |
$5,493 |
12.2× |
| CT abdomen and pelvis without contrast (74176) |
$3,645.60 |
$4,557 |
14.8× |
| CT abdomen w contrast (74160) |
$2,637.60 |
$3,297 |
14.6× |
| CT abdomen w wo contrast (74170) |
$2,701.60 |
$3,377 |
14.9× |
| CT abdomen w/o contrast (74150) |
$2,130.40 |
$2,663 |
19.7× |
| CT c-spine w/o contrast (72125) |
$2,447.20 |
$3,059 |
22.7× |
| CT chest w contrast (71260) |
$2,637.60 |
$3,297 |
14.6× |
| CT chest w/wo contrast (71270) |
$2,726.40 |
$3,408 |
15.1× |
| CT head/brain with contrast (70460) |
$2,384.80 |
$2,981 |
13.2× |
| CT head/brain without and with contrast (70470) |
$2,569.60 |
$3,212 |
14.2× |
| CT iac w contrast (70481) |
$2,384.80 |
$2,981 |
13.2× |
| CT lower ext w/o (73700) |
$2,060.80 |
$2,576 |
19.1× |
| CT lower extremity w/contrast material (73701) |
$1,866.40 |
$2,333 |
10.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,624.80 |
$3,281 |
14.5× |
| CT lumbar spine w/contrast (72132) |
$2,637.60 |
$3,297 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$2,447.20 |
$3,059 |
22.7× |
| CT maxillofacial w contrast (70487) |
$2,328 |
$2,910 |
12.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,612.80 |
$3,266 |
14.4× |
| CT maxillofacial wo contrast (70486) |
$2,045.60 |
$2,557 |
19.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,569.60 |
$3,212 |
14.2× |
| CT orbits w/o contrast (70480) |
$2,116 |
$2,645 |
19.6× |
| CT pelvis w/o contrast (72192) |
$1,952.80 |
$2,441 |
18.1× |
| CT pelvis w/wo contrast (72194) |
$2,722.40 |
$3,403 |
15.0× |
| CT soft tissue neck w contrast (70491) |
$2,384.80 |
$2,981 |
13.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,637.60 |
$3,297 |
14.6× |
| CT soft tissue neck w/o contrast (70490) |
$2,055.20 |
$2,569 |
19.0× |
| CT thoracic spine w/o contrast (72128) |
$2,437.60 |
$3,047 |
22.6× |
| CT thorax w/o contrast (71250) |
$2,071.20 |
$2,589 |
19.2× |
| CT upper ext wo (73200) |
$1,944.80 |
$2,431 |
18.0× |
| CT upper extremity with contrast (73201) |
$2,221.60 |
$2,777 |
6.2× |
| CTA abdomen pelvis (74174) |
$4,181.60 |
$5,227 |
11.6× |
| CTA chest (71275) |
$2,885.60 |
$3,607 |
15.9× |
| Cta Head (70496) |
$2,860 |
$3,575 |
15.8× |
| Cta Neck (70498) |
$2,920 |
$3,650 |
16.1× |
| Cystography minimum 3 views rs&i (74430) |
$876 |
$1,095 |
2.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$580.80 |
$726 |
5.4× |
| Esophagus (74220) |
$652 |
$815 |
3.6× |
| Facial bones min 3 views (70150) |
$477.60 |
$597 |
4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$677.60 |
$847 |
6.3× |
| Fluoroscopy up to 1 hr (76000) |
$664 |
$830 |
2.7× |
| Foot 2 views (73620) |
$313.60 |
$392 |
3.5× |
| Forearm 2 views (73090) |
$329.60 |
$412 |
3.7× |
| Hand 2 views (73120) |
$329.60 |
$412 |
3.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,146.40 |
$2,683 |
3.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,938.40 |
$2,423 |
4.7× |
| Hysterosalpingogram (74740) |
$1,023.20 |
$1,279 |
4.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$344 |
$430 |
3.2× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$2,088 |
$2,610 |
5.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,356.80 |
$1,696 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,016.80 |
$2,521 |
3.6× |
| Knee 3 views (73562) |
$373.60 |
$467 |
4.2× |
| Liver & spleen imaging static only (78215) |
$1,682.40 |
$2,103 |
4.1× |
| Liver imaging static only (78201) |
$1,680.80 |
$2,101 |
3.0× |
| Lymphoscintigraphy (78195) |
$1,928.80 |
$2,411 |
3.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,709.60 |
$4,637 |
10.3× |
| MRA head w & w/o contrast (70546) |
$3,985.60 |
$4,982 |
11.1× |
| MRA head w/o contrast (70544) |
$2,936 |
$3,670 |
11.9× |
| MRA head with contrast (70545) |
$3,021.60 |
$3,777 |
8.4× |
| MRA neck w contrast (70548) |
$2,920 |
$3,650 |
8.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,812.80 |
$4,766 |
10.6× |
| MRA neck w/o contrast (70547) |
$2,936 |
$3,670 |
11.9× |
| MRI abdomen w contrast (74182) |
$3,392 |
$4,240 |
9.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,098.40 |
$5,123 |
11.4× |
| MRI abdomen w/o contrast (74181) |
$3,083.20 |
$3,854 |
12.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,895.20 |
$4,869 |
10.8× |
| MRI c-spine with contrast (72142) |
$3,399.20 |
$4,249 |
9.4× |
| MRI cervical spine w/o contrast (72141) |
$3,237.60 |
$4,047 |
13.1× |
| MRI chest w/o contrast (71550) |
$3,237.60 |
$4,047 |
13.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,913.60 |
$4,892 |
10.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,237.60 |
$4,047 |
13.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,376 |
$4,220 |
13.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,304 |
$5,380 |
12.0× |
| MRI pelvis w/contrast (72196) |
$4,099.20 |
$5,124 |
11.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,303.20 |
$5,379 |
12.0× |
| MRI pelvis w/o contrast (72195) |
$3,237.60 |
$4,047 |
13.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,304 |
$5,380 |
12.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,407.20 |
$4,259 |
9.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,217.60 |
$5,272 |
11.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,461.60 |
$4,327 |
9.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,144 |
$5,180 |
11.5× |
| MRI temporomandibular joint (70336) |
$3,237.60 |
$4,047 |
13.1× |
| MRI thoracic spine w/o contrast (72146) |
$3,237.60 |
$4,047 |
13.1× |
| MRI up ext w/o contrast (73218) |
$3,144.80 |
$3,931 |
12.8× |
| MRI upper ext joint w/o contrast (73221) |
$3,237.60 |
$4,047 |
13.1× |
| MRI, joint upper extrem combo (73223) |
$3,992 |
$4,990 |
11.1× |
| Myocardial Spect Multiple Studies (78452) |
$4,744.80 |
$5,931 |
3.6× |
| Myocardial spect single study at rest or stress (78451) |
$2,516.80 |
$3,146 |
1.9× |
| Neck soft tissue (70360) |
$329.60 |
$412 |
3.7× |
| Nm gastric emptying study (78264) |
$1,829.60 |
$2,287 |
4.4× |
| Nm gastroesophageal reflux study (78262) |
$1,692 |
$2,115 |
4.1× |
| Parathyrd planar w/spect&CT (78072) |
$1,171.20 |
$1,464 |
2.1× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,384 |
$2,980 |
5.8× |
| Pelvis 1 or 2 views (72170) |
$376.80 |
$471 |
3.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,398.40 |
$1,748 |
3.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,020 |
$2,525 |
3.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$974.40 |
$1,218 |
1.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$368.80 |
$461 |
4.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$329.60 |
$412 |
3.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$368.80 |
$461 |
4.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$313.60 |
$392 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$440.80 |
$551 |
4.1× |
| Radex fingr minimum 2 views (73140) |
$315.20 |
$394 |
3.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$368.80 |
$461 |
4.1× |
| Radex Hand Minimum 3 Views (73130) |
$368.80 |
$461 |
4.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$296 |
$370 |
3.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$436 |
$545 |
4.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$440.80 |
$551 |
4.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$550.40 |
$688 |
5.1× |
| Radex Humerus Minimum 2 Views (73060) |
$338.40 |
$423 |
3.8× |
| Radex Kne 1/2 Views (73560) |
$329.60 |
$412 |
3.7× |
| Radex Kne Compl 4/More Views (73564) |
$468.80 |
$586 |
4.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$492.80 |
$616 |
4.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$368.80 |
$461 |
4.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$438.40 |
$548 |
4.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$384 |
$480 |
4.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$282.40 |
$353 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$307.20 |
$384 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$425.60 |
$532 |
4.7× |
| Radex Toe Minimum 2 Views (73660) |
$305.60 |
$382 |
3.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$298.40 |
$373 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$368.80 |
$461 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$329.60 |
$412 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$443.20 |
$554 |
4.1× |
| Radiologic exam chest 2 views (71046) |
$374.40 |
$468 |
4.2× |
| Radiologic exam colon single contrast study (74270) |
$880.80 |
$1,101 |
4.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$910.40 |
$1,138 |
5.0× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$439.20 |
$549 |
4.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$338.40 |
$423 |
3.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$475.20 |
$594 |
0.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$301.60 |
$377 |
2.8× |
| Radiological examination surgical specimen (76098) |
$715.20 |
$894 |
1.3× |
| Ribs bilateral 3 views (71110) |
$491.20 |
$614 |
4.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,764 |
$3,455 |
4.9× |
| Scapula (73010) |
$359.20 |
$449 |
3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$137.60 |
$172 |
5.9× |
| Shoulder 1 view (73020) |
$308.80 |
$386 |
3.4× |
| Small bowel series (74250) |
$760.80 |
$951 |
4.2× |
| Spine thoracic 3 views (72072) |
$474.40 |
$593 |
4.4× |
| Testicular Imaging With Vascular Flow (78761) |
$1,339.20 |
$1,674 |
3.2× |
| Thoracolumbar 2 views (72080) |
$383.20 |
$479 |
4.3× |
| Thyroid imaging w/blood flow (78013) |
$853.60 |
$1,067 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,574.40 |
$1,968 |
3.8× |
| Ultrasound Exam Aaa Screen (76706) |
$627.20 |
$784 |
5.8× |
| Ultrasound, abdomen limited (76705) |
$772 |
$965 |
7.2× |
| Umbilical-artery Doppler (OB) (76820) |
$428.80 |
$536 |
4.0× |
| Ureteral reflux study (78740) |
$1,383.20 |
$1,729 |
3.4× |
| Urethrocystogram voiding (74455) |
$1,009.60 |
$1,262 |
4.1× |
| Urethrocystography retrograde rs&i (74450) |
$856.80 |
$1,071 |
3.5× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,040 |
$1,300 |
5.7× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$1,202.40 |
$1,503 |
6.6× |
| Us chest (76604) |
$735.20 |
$919 |
6.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$586.40 |
$733 |
5.4× |
| Us ob limited (76815) |
$587.20 |
$734 |
5.4× |
| Us ob transvaginal (76817) |
$656.80 |
$821 |
6.1× |
| Us pelvic non ob complete (76856) |
$819.20 |
$1,024 |
7.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$586.40 |
$733 |
5.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$792.80 |
$991 |
7.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$522.40 |
$653 |
4.8× |
| Us retroperitoneal complete (76770) |
$1,017.60 |
$1,272 |
9.4× |
| Us retroperitoneal limited (76775) |
$700 |
$875 |
6.5× |
| Us scrotum and contents (76870) |
$779.20 |
$974 |
7.2× |
| Us soft tissue head/neck (76536) |
$772 |
$965 |
7.2× |
| Venogram Extremity Unilateral (75820) |
$2,020 |
$2,525 |
1.2× |
| Wrist 2 views (73100) |
$294.40 |
$368 |
3.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$531.20 |
$664 |
4.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$368.80 |
$461 |
4.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,071.20 |
$1,339 |
5.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$329.60 |
$412 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$362.40 |
$453 |
4.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$504 |
$630 |
4.7× |
| X-ray exam of femur 2/> (73552) |
$329.60 |
$412 |
3.7× |
| X-ray eye for foreign body (70030) |
$322.40 |
$403 |
3.6× |
| X-ray IV pyelogram (ivp) (74400) |
$1,087.20 |
$1,359 |
6.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$372 |
$465 |
4.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$324.80 |
$406 |
3.6× |
| X-ray leg, infant (73592) |
$316.80 |
$396 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$425.60 |
$532 |
3.9× |
| X-ray nose-rectum child f.b. (76010) |
$366.40 |
$458 |
4.1× |
| X-ray optic foramen (70190) |
$300.80 |
$376 |
3.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$472 |
$590 |
4.4× |
| X-ray retrograde pyelogram (74420) |
$1,036 |
$1,295 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$368.80 |
$461 |
4.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$511.20 |
$639 |
4.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$384 |
$480 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$359.20 |
$449 |
4.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$433.60 |
$542 |
4.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$551.20 |
$689 |
5.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$410.40 |
$513 |
3.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$359.20 |
$449 |
4.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$338.40 |
$423 |
3.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$359.20 |
$449 |
4.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$382.40 |
$478 |
3.5× |
| Xr bone length studies (77073) |
$443.20 |
$554 |
4.1× |
| Xr c-spine 4 or 5 views (72050) |
$536 |
$670 |
5.0× |
| Xr c-spine 6 or more views (72052) |
$618.40 |
$773 |
5.7× |
| Xr chest 4+ views (71048) |
$500.80 |
$626 |
4.6× |
| Xr urogram antegrade (74425) |
$684.80 |
$856 |
1.9× |