| Abdomen 2 views (74019) |
$346.80 |
$578 |
3.2× |
| Acute gi blood loss imaging (78278) |
$1,488 |
$2,480 |
3.6× |
| Bone &/Joint Imaging Limited Area (78300) |
$972.60 |
$1,621 |
2.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,171.20 |
$1,952 |
2.8× |
| Bone &/joint imaging whole body (78306) |
$1,336.20 |
$2,227 |
3.2× |
| Bone age studies (77072) |
$66.60 |
$111 |
0.6× |
| Bone Imaging 3 Phase (78315) |
$1,474.80 |
$2,458 |
3.6× |
| Bone survey complete (77075) |
$310.80 |
$518 |
2.9× |
| Bone survey infant (77076) |
$310.80 |
$518 |
2.9× |
| Bowel imaging (78290) |
$1,474.80 |
$2,458 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$250.20 |
$417 |
2.8× |
| Chest 1 view (71045) |
$128.63 |
$214.38 |
1.4× |
| Chest xray 3 views (71047) |
$301.20 |
$502 |
3.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$712.20 |
$1,187 |
3.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$669 |
$1,115 |
6.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$415.20 |
$692 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,860.20 |
$4,767 |
7.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,762.20 |
$2,937 |
7.2× |
| CT abdomen w contrast (74160) |
$1,515.60 |
$2,526 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,891.20 |
$3,152 |
10.4× |
| CT abdomen w/o contrast (74150) |
$988.80 |
$1,648 |
9.2× |
| CT c-spine w/contrast (72126) |
$1,522.20 |
$2,537 |
4.2× |
| CT c-spine w/o contrast (72125) |
$1,449.60 |
$2,416 |
13.4× |
| CT chest w contrast (71260) |
$1,533.60 |
$2,556 |
8.5× |
| CT chest w/wo contrast (71270) |
$1,770.60 |
$2,951 |
9.8× |
| CT head/brain with contrast (70460) |
$1,203 |
$2,005 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,441.80 |
$2,403 |
8.0× |
| CT iac w contrast (70481) |
$1,713.60 |
$2,856 |
9.5× |
| CT limited/localized follow up study (76380) |
$658.80 |
$1,098 |
7.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,667.40 |
$2,779 |
9.2× |
| CT lumbar spine w/contrast (72132) |
$1,667.40 |
$2,779 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,449.60 |
$2,416 |
13.4× |
| CT maxillofacial w contrast (70487) |
$1,246.20 |
$2,077 |
6.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,744.80 |
$2,908 |
9.6× |
| CT maxillofacial wo contrast (70486) |
$1,186.80 |
$1,978 |
11.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,911 |
$3,185 |
10.6× |
| CT orbits w/o contrast (70480) |
$1,449.60 |
$2,416 |
13.4× |
| CT pelvis w/o contrast (72192) |
$1,186.20 |
$1,977 |
11.0× |
| CT pelvis w/wo contrast (72194) |
$1,839 |
$3,065 |
10.2× |
| CT soft tissue neck w contrast (70491) |
$1,314.60 |
$2,191 |
7.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,591.20 |
$2,652 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,038.60 |
$1,731 |
9.6× |
| CT thoracic spine w/contrast (72129) |
$1,596.60 |
$2,661 |
8.8× |
| CT thoracic spine w/o contrast (72128) |
$867.60 |
$1,446 |
8.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,752.60 |
$2,921 |
9.7× |
| CT thorax w/o contrast (71250) |
$1,393.80 |
$2,323 |
12.9× |
| CT unlisted procedure (76497) |
$4,477.20 |
$7,462 |
49.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,306.40 |
$3,844 |
12.7× |
| Cta Abdomen (74175) |
$1,879.20 |
$3,132 |
10.4× |
| CTA abdomen pelvis (74174) |
$2,319.60 |
$3,866 |
6.4× |
| CTA chest (71275) |
$2,076 |
$3,460 |
11.5× |
| Cta Head (70496) |
$1,730.40 |
$2,884 |
9.6× |
| Cta Neck (70498) |
$1,578 |
$2,630 |
8.7× |
| Cystography minimum 3 views rs&i (74430) |
$145.80 |
$243 |
0.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$337.80 |
$563 |
3.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$131.40 |
$219 |
1.5× |
| Esophagus (74220) |
$467.40 |
$779 |
2.6× |
| Facial bones min 3 views (70150) |
$330 |
$550 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$273 |
$455 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$363 |
$605 |
1.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,633.80 |
$2,723 |
2.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,314.20 |
$3,857 |
5.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$576 |
$960 |
1.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$93.23 |
$155.37 |
1.0× |
| MRA head w/o contrast (70544) |
$2,146.20 |
$3,577 |
8.7× |
| MRA head with contrast (70545) |
$2,197.20 |
$3,662 |
6.1× |
| MRA neck w contrast (70548) |
$2,262 |
$3,770 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,126.60 |
$5,211 |
8.7× |
| MRA neck w/o contrast (70547) |
$2,159.40 |
$3,599 |
8.8× |
| MRI abdomen w contrast (74182) |
$2,431.80 |
$4,053 |
6.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,827.20 |
$4,712 |
7.9× |
| MRI abdomen w/o contrast (74181) |
$1,823.70 |
$3,039.50 |
7.4× |
| MRI c-spine with contrast (72142) |
$2,485.20 |
$4,142 |
6.9× |
| MRI cervical spine w/o contrast (72141) |
$2,180.40 |
$3,634 |
8.9× |
| MRI chest w/o contrast (71550) |
$2,997 |
$4,995 |
12.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,085 |
$3,475 |
8.5× |
| MRI orbit face neck w contrast (70542) |
$2,238 |
$3,730 |
6.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,065.40 |
$5,109 |
8.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,501.60 |
$5,836 |
9.7× |
| MRI pelvis w/o contrast (72195) |
$2,101.20 |
$3,502 |
8.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,532.80 |
$5,888 |
9.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,591.40 |
$4,319 |
7.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,515.40 |
$5,859 |
9.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,367 |
$3,945 |
6.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,363.60 |
$5,606 |
9.3× |
| MRI temporomandibular joint (70336) |
$2,152.80 |
$3,588 |
8.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,076 |
$3,460 |
8.4× |
| Myelogram Lumbar (72265) |
$270.60 |
$451 |
0.3× |
| Neck soft tissue (70360) |
$188.40 |
$314 |
2.1× |
| Nonvascular shunt X-ray (75809) |
$395.40 |
$659 |
3.7× |
| Osseous survey limited (77074) |
$211.20 |
$352 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$168 |
$280 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$109.20 |
$182 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$250.80 |
$418 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$461.40 |
$769 |
4.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$553.80 |
$923 |
5.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$252 |
$420 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$394.80 |
$658 |
3.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$330 |
$550 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$330 |
$550 |
3.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$210 |
$350 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$121.80 |
$203 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$319.80 |
$533 |
3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$346.80 |
$578 |
3.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$646.20 |
$1,077 |
6.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$194.40 |
$324 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$415.80 |
$693 |
3.9× |
| Radiologic exam chest 2 views (71046) |
$282.60 |
$471 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$780 |
$1,300 |
4.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$786 |
$1,310 |
4.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$655.20 |
$1,092 |
3.6× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$39.60 |
$66 |
0.4× |
| Radiological examination surgical specimen (76098) |
$39.60 |
$66 |
0.1× |
| Ribs bilateral 3 views (71110) |
$268.80 |
$448 |
2.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$787.20 |
$1,312 |
1.9× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,014.97 |
$1,691.61 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$211.20 |
$352 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$141 |
$235 |
6.0× |
| Sella turcica (70240) |
$105.60 |
$176 |
1.2× |
| Small bowel series (74250) |
$633 |
$1,055 |
3.5× |
| Spine thoracic 3 views (72072) |
$250.20 |
$417 |
2.3× |
| Thoracolumbar 2 views (72080) |
$211.20 |
$352 |
2.4× |
| Tomogram (76100) |
$303.60 |
$506 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$460.20 |
$767 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$324.60 |
$541 |
3.0× |
| Umbilical-artery Doppler (OB) (76820) |
$136.80 |
$228 |
1.3× |
| Urethrocystogram voiding (74455) |
$454.80 |
$758 |
1.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$752.40 |
$1,254 |
4.2× |
| Us chest (76604) |
$306.60 |
$511 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$171 |
$285 |
1.6× |
| Us ob limited (76815) |
$256.20 |
$427 |
2.4× |
| Us ob transvaginal (76817) |
$334.20 |
$557 |
3.1× |
| Us pelvic non ob complete (76856) |
$517.20 |
$862 |
4.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$165.60 |
$276 |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$399.60 |
$666 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$415.80 |
$693 |
3.9× |
| Us retroperitoneal complete (76770) |
$527.40 |
$879 |
4.9× |
| Us retroperitoneal limited (76775) |
$469.20 |
$782 |
4.3× |
| Us scrotum and contents (76870) |
$436.80 |
$728 |
4.0× |
| Us soft tissue head/neck (76536) |
$421.20 |
$702 |
3.9× |
| Us transrectal (76872) |
$464.40 |
$774 |
4.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$486 |
$810 |
4.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$250.80 |
$418 |
2.8× |
| X-ray b.e. reductn intuss (74283) |
$805.20 |
$1,342 |
4.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,096.80 |
$1,828 |
6.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$331.20 |
$552 |
3.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$198 |
$330 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$330 |
$550 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$277.80 |
$463 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$250.20 |
$417 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$415.80 |
$693 |
3.9× |
| X-ray nose-rectum child f.b. (76010) |
$66 |
$110 |
0.7× |
| X-ray retrograde pyelogram (74420) |
$283.20 |
$472 |
0.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$364.80 |
$608 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$237.60 |
$396 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$211.20 |
$352 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$142.80 |
$238 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$330 |
$550 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$330 |
$550 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$145.20 |
$242 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$225 |
$375 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$198 |
$330 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$222.60 |
$371 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$289.80 |
$483 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$347.40 |
$579 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$415.80 |
$693 |
3.9× |
| Xr chest 4+ views (71048) |
$320.40 |
$534 |
3.0× |