| Abdomen 2 views (74019) |
$406.40 |
$508 |
3.8× |
| Acute gi blood loss imaging (78278) |
$1,652.80 |
$2,066 |
4.0× |
| Ankle 2 views (73600) |
$346.40 |
$433 |
3.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,346.40 |
$1,683 |
3.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,668 |
$2,085 |
4.0× |
| Bone &/joint imaging whole body (78306) |
$2,033.60 |
$2,542 |
4.9× |
| Bone age studies (77072) |
$369.60 |
$462 |
3.4× |
| Bone Imaging 3 Phase (78315) |
$2,329.60 |
$2,912 |
5.6× |
| Bone survey complete (77075) |
$1,088 |
$1,360 |
10.1× |
| Bone survey infant (77076) |
$570.40 |
$713 |
5.3× |
| Bowel imaging (78290) |
$1,608 |
$2,010 |
3.9× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$2,025.60 |
$2,532 |
3.6× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,113.60 |
$2,642 |
5.1× |
| Cervical spine 2 or 3 views (72040) |
$496 |
$620 |
5.5× |
| Chest 1 view (71045) |
$314.40 |
$393 |
3.5× |
| Chest xray 3 views (71047) |
$410.40 |
$513 |
4.6× |
| Clavicle complete (73000) |
$422.40 |
$528 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,261.60 |
$6,577 |
14.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,885.60 |
$4,857 |
15.8× |
| CT abdomen w contrast (74160) |
$2,932 |
$3,665 |
16.2× |
| CT abdomen w wo contrast (74170) |
$2,976.80 |
$3,721 |
16.4× |
| CT abdomen w/o contrast (74150) |
$2,240 |
$2,800 |
20.8× |
| CT c-spine w/o contrast (72125) |
$2,440 |
$3,050 |
22.6× |
| CT chest w contrast (71260) |
$2,840 |
$3,550 |
15.7× |
| CT chest w/wo contrast (71270) |
$3,167.20 |
$3,959 |
17.5× |
| CT head/brain with contrast (70460) |
$2,716.80 |
$3,396 |
15.0× |
| CT head/brain without and with contrast (70470) |
$2,852 |
$3,565 |
15.8× |
| CT iac w contrast (70481) |
$2,661.60 |
$3,327 |
14.7× |
| CT lower ext w/o (73700) |
$2,307.20 |
$2,884 |
21.4× |
| CT lower extremity w wo contrast (73702) |
$2,359.20 |
$2,949 |
13.0× |
| CT lower extremity w/contrast material (73701) |
$2,652.80 |
$3,316 |
14.7× |
| CT lumbar spine w/contrast (72132) |
$2,769.60 |
$3,462 |
7.7× |
| CT lumbar spine w/o contrast (72131) |
$2,592 |
$3,240 |
24.0× |
| CT maxillofacial w contrast (70487) |
$2,519.20 |
$3,149 |
13.9× |
| CT maxillofacial w/wo contrast (70488) |
$3,016 |
$3,770 |
16.7× |
| CT maxillofacial wo contrast (70486) |
$2,075.20 |
$2,594 |
19.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,952.80 |
$3,691 |
16.3× |
| CT orbits w/o contrast (70480) |
$2,284.80 |
$2,856 |
21.2× |
| CT pelvis w/o contrast (72192) |
$1,978.40 |
$2,473 |
18.3× |
| CT pelvis w/wo contrast (72194) |
$2,675.20 |
$3,344 |
14.8× |
| CT scan of arm combo (73202) |
$2,369.60 |
$2,962 |
13.1× |
| CT soft tissue neck w contrast (70491) |
$2,497.60 |
$3,122 |
13.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$4,096 |
$5,120 |
22.6× |
| CT soft tissue neck w/o contrast (70490) |
$2,089.60 |
$2,612 |
19.4× |
| CT thoracic spine w/o contrast (72128) |
$2,564 |
$3,205 |
23.8× |
| CT thorax w/o contrast (71250) |
$2,176.80 |
$2,721 |
20.2× |
| CT upper ext wo (73200) |
$2,307.20 |
$2,884 |
21.4× |
| CT upper extremity with contrast (73201) |
$2,288 |
$2,860 |
6.4× |
| Cta Abdomen (74175) |
$3,599.20 |
$4,499 |
19.9× |
| CTA abdomen pelvis (74174) |
$4,780 |
$5,975 |
13.3× |
| CTA chest (71275) |
$2,927.20 |
$3,659 |
16.2× |
| Cta Head (70496) |
$2,976 |
$3,720 |
16.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,008 |
$3,760 |
8.4× |
| Cta Neck (70498) |
$2,976 |
$3,720 |
16.4× |
| Cta Pelvis (72191) |
$2,888.80 |
$3,611 |
16.0× |
| Cystography minimum 3 views rs&i (74430) |
$856 |
$1,070 |
2.4× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$748.80 |
$936 |
6.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$819.20 |
$1,024 |
7.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$425.60 |
$532 |
4.7× |
| Facial bones min 3 views (70150) |
$597.60 |
$747 |
5.5× |
| Fetal biophysical profile non-stress testing (76818) |
$756.80 |
$946 |
7.0× |
| Fetal Echo (76825) |
$1,704 |
$2,130 |
3.0× |
| Foot 2 views (73620) |
$340.80 |
$426 |
3.8× |
| Forearm 2 views (73090) |
$412.80 |
$516 |
4.6× |
| Hand 2 views (73120) |
$368 |
$460 |
3.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,131.20 |
$2,664 |
3.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,925.60 |
$2,407 |
4.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$332.80 |
$416 |
3.1× |
| Kidney function study, non-imaging radioisotopic study Non-Facility (78725) |
$1,944.80 |
$2,431 |
4.7× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,041.60 |
$2,552 |
3.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,428 |
$3,035 |
4.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$2,884.80 |
$3,606 |
5.1× |
| Knee 3 views (73562) |
$415.20 |
$519 |
4.6× |
| Liver & spleen imaging static only (78215) |
$1,676 |
$2,095 |
4.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,992.80 |
$2,491 |
4.8× |
| Liver imaging static only (78201) |
$1,852.80 |
$2,316 |
3.3× |
| Liver imaging w/vascular flow (78202) |
$1,864.80 |
$2,331 |
3.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,704.80 |
$4,631 |
4.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,493.60 |
$4,367 |
9.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,062.40 |
$5,078 |
11.3× |
| MRA head w & w/o contrast (70546) |
$4,066.40 |
$5,083 |
11.3× |
| MRA head w/o contrast (70544) |
$2,952.80 |
$3,691 |
12.0× |
| MRA head with contrast (70545) |
$3,313.60 |
$4,142 |
9.2× |
| MRA neck w contrast (70548) |
$3,052.80 |
$3,816 |
8.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,887.20 |
$4,859 |
10.8× |
| MRA neck w/o contrast (70547) |
$2,807.20 |
$3,509 |
11.4× |
| MRI abdomen w contrast (74182) |
$3,473.60 |
$4,342 |
9.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,335.20 |
$5,419 |
12.0× |
| MRI abdomen w/o contrast (74181) |
$3,044 |
$3,805 |
12.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,437.60 |
$4,297 |
4.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,088 |
$5,110 |
11.4× |
| MRI c-spine with contrast (72142) |
$3,486.40 |
$4,358 |
9.7× |
| MRI cervical spine w/o contrast (72141) |
$3,321.60 |
$4,152 |
13.5× |
| MRI chest w/o contrast (71550) |
$2,977.60 |
$3,722 |
12.1× |
| MRI chest with contrast (71551) |
$3,609.60 |
$4,512 |
4.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,582.40 |
$4,478 |
9.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,112.80 |
$5,141 |
11.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,955.20 |
$3,694 |
12.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,392 |
$4,240 |
13.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,758.40 |
$5,948 |
13.2× |
| MRI pelvis w/contrast (72196) |
$4,008 |
$5,010 |
11.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,391.20 |
$5,489 |
12.2× |
| MRI pelvis w/o contrast (72195) |
$3,156 |
$3,945 |
12.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,720.80 |
$5,901 |
13.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,508 |
$4,385 |
9.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,399.20 |
$5,499 |
12.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,496.80 |
$4,371 |
9.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,322.40 |
$5,403 |
12.0× |
| MRI temporomandibular joint (70336) |
$2,997.60 |
$3,747 |
12.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,370.40 |
$4,213 |
13.7× |
| MRI up ext w/o contrast (73218) |
$2,828 |
$3,535 |
11.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,952.80 |
$3,691 |
12.0× |
| MRI, joint upper extrem combo (73223) |
$4,205.60 |
$5,257 |
11.7× |
| Myocardial Spect Multiple Studies (78452) |
$4,920.80 |
$6,151 |
3.7× |
| Myocardial spect single study at rest or stress (78451) |
$3,461.60 |
$4,327 |
2.6× |
| Neck soft tissue (70360) |
$393.60 |
$492 |
4.4× |
| Nm gastric emptying study (78264) |
$1,900 |
$2,375 |
4.6× |
| Osseous survey limited (77074) |
$621.60 |
$777 |
5.8× |
| Parathyroid Planar Imaging (78070) |
$1,532 |
$1,915 |
3.7× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$2,100.80 |
$2,626 |
5.1× |
| Pelvis 1 or 2 views (72170) |
$399.20 |
$499 |
3.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,500.80 |
$1,876 |
3.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,146.40 |
$2,683 |
3.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$420 |
$525 |
4.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$401.60 |
$502 |
4.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$446.40 |
$558 |
5.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$443.20 |
$554 |
4.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$520.80 |
$651 |
4.8× |
| Radex fingr minimum 2 views (73140) |
$345.60 |
$432 |
3.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$452 |
$565 |
5.0× |
| Radex Hand Minimum 3 Views (73130) |
$429.60 |
$537 |
4.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$295.20 |
$369 |
3.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$464.80 |
$581 |
4.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$548 |
$685 |
5.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$742.40 |
$928 |
6.9× |
| Radex Humerus Minimum 2 Views (73060) |
$403.20 |
$504 |
4.5× |
| Radex Kne 1/2 Views (73560) |
$372.80 |
$466 |
4.2× |
| Radex Kne Compl 4/More Views (73564) |
$540 |
$675 |
5.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$540 |
$675 |
5.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$442.40 |
$553 |
4.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$444 |
$555 |
4.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$441.60 |
$552 |
4.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$356 |
$445 |
4.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$484 |
$605 |
4.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$486.40 |
$608 |
5.4× |
| Radex Toe Minimum 2 Views (73660) |
$351.20 |
$439 |
3.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$340.80 |
$426 |
3.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$446.40 |
$558 |
5.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$815.20 |
$1,019 |
7.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$400.80 |
$501 |
4.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$464 |
$580 |
4.3× |
| Radiologic exam chest 2 views (71046) |
$392.80 |
$491 |
4.4× |
| Radiologic examination femur 1 view (73551) |
$378.40 |
$473 |
4.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$456 |
$570 |
5.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$420 |
$525 |
3.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$287.20 |
$359 |
2.7× |
| Ribs bilateral 3 views (71110) |
$636 |
$795 |
5.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,836.80 |
$3,546 |
5.1× |
| Scapula (73010) |
$416 |
$520 |
3.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$90.40 |
$113 |
3.9× |
| Shoulder 1 view (73020) |
$369.60 |
$462 |
4.1× |
| Small bowel series (74250) |
$865.60 |
$1,082 |
4.8× |
| Spine thoracic 3 views (72072) |
$580.80 |
$726 |
5.4× |
| Spleen imaging only (78185) |
$759.20 |
$949 |
1.8× |
| Thoracolumbar 2 views (72080) |
$442.40 |
$553 |
4.9× |
| Thyroid imaging w/blood flow (78013) |
$1,136 |
$1,420 |
2.8× |
| Thyroid uptake measurement (78012) |
$1,538.40 |
$1,923 |
3.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,467.20 |
$1,834 |
3.6× |
| Tmj unilateral (70328) |
$375.20 |
$469 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$612 |
$765 |
5.7× |
| Ultrasound, abdomen limited (76705) |
$771.20 |
$964 |
7.1× |
| Unlisted ultrasound procedure (76999) |
$669.60 |
$837 |
7.5× |
| Us breast unilateral limited (76642) |
$480 |
$600 |
5.3× |
| Us chest (76604) |
$588.80 |
$736 |
5.5× |
| Us compl joint r-t w/image documentation (76881) |
$729.60 |
$912 |
6.8× |
| Us hips infant static (76886) |
$391.20 |
$489 |
4.4× |
| Us infant hips w manipulation (76885) |
$645.60 |
$807 |
7.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$592 |
$740 |
5.5× |
| Us ob detailed single fetus (76811) |
$1,044.80 |
$1,306 |
4.2× |
| Us ob limited (76815) |
$604.80 |
$756 |
5.6× |
| Us ob transvaginal (76817) |
$896.80 |
$1,121 |
8.3× |
| Us pelvic non ob complete (76856) |
$1,014.40 |
$1,268 |
9.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$714.40 |
$893 |
6.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$955.20 |
$1,194 |
8.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$580.80 |
$726 |
5.4× |
| Us retroperitoneal complete (76770) |
$996.80 |
$1,246 |
9.2× |
| Us retroperitoneal limited (76775) |
$728.80 |
$911 |
6.8× |
| Us scrotum and contents (76870) |
$820.80 |
$1,026 |
7.6× |
| Us soft tissue head/neck (76536) |
$902.40 |
$1,128 |
8.4× |
| Us spinal canal and contents (76800) |
$641.60 |
$802 |
5.9× |
| Us transrectal (76872) |
$812 |
$1,015 |
7.5× |
| Us,transplanted kidney, real time/ doppler (76776) |
$905.60 |
$1,132 |
8.4× |
| Wrist 2 views (73100) |
$318.40 |
$398 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$636.80 |
$796 |
5.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$470.40 |
$588 |
5.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$372 |
$465 |
4.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$412.80 |
$516 |
4.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$603.20 |
$754 |
5.6× |
| X-ray exam of femur 2/> (73552) |
$468.80 |
$586 |
5.2× |
| X-ray eye for foreign body (70030) |
$347.20 |
$434 |
3.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$365.60 |
$457 |
4.1× |
| X-ray IV pyelogram (ivp) (74400) |
$1,248.80 |
$1,561 |
6.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$356 |
$445 |
4.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$407.20 |
$509 |
4.5× |
| X-ray leg, infant (73592) |
$314.40 |
$393 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$501.60 |
$627 |
4.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$756 |
$945 |
7.0× |
| X-ray nose-rectum child f.b. (76010) |
$270.40 |
$338 |
3.0× |
| X-ray optic foramen (70190) |
$409.60 |
$512 |
4.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$520.80 |
$651 |
4.8× |
| X-ray retrograde pyelogram (74420) |
$1,110.40 |
$1,388 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$442.40 |
$553 |
4.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$532.80 |
$666 |
4.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$672.80 |
$841 |
6.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$468.80 |
$586 |
4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$442.40 |
$553 |
4.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$539.20 |
$674 |
6.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$639.20 |
$799 |
5.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$433.60 |
$542 |
4.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$393.60 |
$492 |
4.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$395.20 |
$494 |
4.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$416 |
$520 |
4.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$463.20 |
$579 |
4.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$616.80 |
$771 |
5.7× |
| Xr bone length studies (77073) |
$540.80 |
$676 |
5.0× |
| Xr c-spine 4 or 5 views (72050) |
$662.40 |
$828 |
6.1× |
| Xr c-spine 6 or more views (72052) |
$832 |
$1,040 |
7.7× |
| Xr chest 4+ views (71048) |
$556 |
$695 |
5.2× |