| Abdomen 2 views (74019) |
$317.90 |
$374 |
2.9× |
| Acute gi blood loss imaging (78278) |
$2,072.30 |
$2,438 |
5.0× |
| Ankle 2 views (73600) |
$288.15 |
$339 |
3.2× |
| Arthrogram hip (73525) |
$398.22 |
$468.50 |
1.1× |
| Arthrogram shoulder (73040) |
$731.85 |
$861 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,126.25 |
$1,325 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,529.15 |
$1,799 |
3.7× |
| Bone age studies (77072) |
$191.25 |
$225 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,875.10 |
$2,206 |
4.5× |
| Bone survey complete (77075) |
$111.35 |
$131 |
1.0× |
| Bone survey infant (77076) |
$258.40 |
$304 |
2.4× |
| Bowel imaging (78290) |
$1,841.10 |
$2,166 |
4.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,261.40 |
$1,484 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$300.48 |
$353.50 |
3.3× |
| Chest 1 view (71045) |
$277.95 |
$327 |
3.1× |
| Chest xray 3 views (71047) |
$357 |
$420 |
4.0× |
| Clavicle complete (73000) |
$214.20 |
$252 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$3,607.40 |
$4,244 |
33.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,886.20 |
$4,572 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,088.05 |
$3,633 |
12.5× |
| CT abdomen w contrast (74160) |
$1,928.65 |
$2,269 |
10.7× |
| CT abdomen w wo contrast (74170) |
$2,030.65 |
$2,389 |
11.2× |
| CT abdomen w/o contrast (74150) |
$1,881.90 |
$2,214 |
17.4× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,461.60 |
$2,896 |
13.6× |
| CT c-spine w/contrast (72126) |
$2,014.50 |
$2,370 |
5.6× |
| CT c-spine w/o contrast (72125) |
$1,591.20 |
$1,872 |
14.7× |
| CT chest w contrast (71260) |
$2,124.15 |
$2,499 |
11.7× |
| CT chest w/wo contrast (71270) |
$2,367.25 |
$2,785 |
13.1× |
| CT head/brain with contrast (70460) |
$2,164.10 |
$2,546 |
12.0× |
| CT head/brain without and with contrast (70470) |
$2,406.35 |
$2,831 |
13.3× |
| CT iac w contrast (70481) |
$1,815.60 |
$2,136 |
10.0× |
| CT lower ext w/o (73700) |
$1,636.25 |
$1,925 |
15.2× |
| CT lower extremity w wo contrast (73702) |
$2,186.20 |
$2,572 |
12.1× |
| CT lower extremity w/contrast material (73701) |
$1,883.60 |
$2,216 |
10.4× |
| CT lumbar spine w/contrast (72132) |
$2,049.35 |
$2,411 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$1,970.30 |
$2,318 |
18.3× |
| CT maxillofacial w contrast (70487) |
$1,669.40 |
$1,964 |
9.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,353.65 |
$2,769 |
13.0× |
| CT maxillofacial wo contrast (70486) |
$1,437.35 |
$1,691 |
13.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,470.95 |
$2,907 |
13.6× |
| CT orbits w/o contrast (70480) |
$1,581.85 |
$1,861 |
14.7× |
| CT pelvis w/o contrast (72192) |
$1,865.75 |
$2,195 |
17.3× |
| CT pelvis w/wo contrast (72194) |
$2,244 |
$2,640 |
12.4× |
| CT scan of arm combo (73202) |
$1,887 |
$2,220 |
10.4× |
| CT soft tissue neck w contrast (70491) |
$1,668.55 |
$1,963 |
9.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,339.20 |
$2,752 |
12.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,591.20 |
$1,872 |
14.7× |
| CT thoracic spine w/contrast (72129) |
$1,884.45 |
$2,217 |
10.4× |
| CT thoracic spine w/o contrast (72128) |
$1,522.35 |
$1,791 |
14.1× |
| CT thorax w/o contrast (71250) |
$1,908.25 |
$2,245 |
17.7× |
| CT upper ext wo (73200) |
$1,669.40 |
$1,964 |
15.5× |
| CT upper extremity with contrast (73201) |
$1,877.65 |
$2,209 |
5.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,739.95 |
$2,047 |
9.6× |
| Cta Abdomen (74175) |
$1,928.65 |
$2,269 |
10.7× |
| CTA abdomen pelvis (74174) |
$3,763.80 |
$4,428 |
10.5× |
| CTA chest (71275) |
$2,124.15 |
$2,499 |
11.7× |
| Cta Head (70496) |
$2,164.10 |
$2,546 |
12.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,825 |
$4,500 |
10.6× |
| Cta Neck (70498) |
$1,668.55 |
$1,963 |
9.2× |
| Cystography minimum 3 views rs&i (74430) |
$317.90 |
$374 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$550.80 |
$648 |
5.1× |
| Esophagus (74220) |
$263.08 |
$309.50 |
1.5× |
| Facial bones min 3 views (70150) |
$408.85 |
$481 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$583.95 |
$687 |
5.4× |
| Fluoroscopy up to 1 hr (76000) |
$410.55 |
$483 |
1.7× |
| Foot 2 views (73620) |
$205.28 |
$241.50 |
2.3× |
| Forearm 2 views (73090) |
$203.15 |
$239 |
2.3× |
| Hand 2 views (73120) |
$194.22 |
$228.50 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,735.70 |
$2,042 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,289.45 |
$1,517 |
3.1× |
| Hysterosalpingogram (74740) |
$589.05 |
$693 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$351.90 |
$414 |
3.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,404.20 |
$1,652 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,841.10 |
$2,166 |
3.3× |
| Knee 3 views (73562) |
$317.90 |
$374 |
3.5× |
| Lung perf&ventilat diferentl (78598) |
$1,823.25 |
$2,145 |
3.3× |
| Lung ventilation imaging (78579) |
$939.25 |
$1,105 |
2.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,294.60 |
$3,876 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,157.75 |
$3,715 |
8.8× |
| MRA head w & w/o contrast (70546) |
$3,895.55 |
$4,583 |
10.8× |
| MRA head w/o contrast (70544) |
$2,864.50 |
$3,370 |
11.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,157.75 |
$3,715 |
8.8× |
| MRA neck w/o contrast (70547) |
$2,792.25 |
$3,285 |
11.3× |
| MRI abdomen w contrast (74182) |
$3,224.05 |
$3,793 |
9.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,870.05 |
$4,553 |
10.7× |
| MRI abdomen w/o contrast (74181) |
$2,997.95 |
$3,527 |
12.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,156.90 |
$3,714 |
3.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,156.90 |
$3,714 |
8.8× |
| MRI c-spine with contrast (72142) |
$2,838.15 |
$3,339 |
7.9× |
| MRI cervical spine w/o contrast (72141) |
$3,194.30 |
$3,758 |
13.0× |
| MRI chest w/o & w/contrast material (71552) |
$3,864.95 |
$4,547 |
10.7× |
| MRI chest w/o contrast (71550) |
$3,291.20 |
$3,872 |
13.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,005.60 |
$3,536 |
8.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,194.30 |
$3,758 |
8.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,194.30 |
$3,758 |
13.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,875.55 |
$3,383 |
11.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,646.50 |
$4,290 |
10.1× |
| MRI pelvis w/contrast (72196) |
$2,875.55 |
$3,383 |
8.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,530.50 |
$5,330 |
12.6× |
| MRI pelvis w/o contrast (72195) |
$3,257.20 |
$3,832 |
13.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,556 |
$5,360 |
12.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,291.20 |
$3,872 |
9.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,676.70 |
$5,502 |
13.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,963.95 |
$3,487 |
8.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,560.25 |
$5,365 |
12.7× |
| MRI temporomandibular joint (70336) |
$2,877.25 |
$3,385 |
11.7× |
| MRI thoracic spine w/o contrast (72146) |
$3,353.25 |
$3,945 |
13.6× |
| MRI up ext w/o contrast (73218) |
$2,686 |
$3,160 |
10.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,689.40 |
$3,164 |
10.9× |
| MRI, joint upper extrem combo (73223) |
$3,881.10 |
$4,566 |
10.8× |
| Myocardial Spect Multiple Studies (78452) |
$3,400.85 |
$4,001 |
2.5× |
| Myocardial spect single study at rest or stress (78451) |
$1,817.30 |
$2,138 |
1.4× |
| Neck soft tissue (70360) |
$191.25 |
$225 |
2.1× |
| Nm gastric emptying study (78264) |
$1,921.85 |
$2,261 |
4.7× |
| Noncardiac Vascular Flow Imaging (78445) |
$877.20 |
$1,032 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$1,014.90 |
$1,194 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$268.60 |
$316 |
2.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,405.90 |
$1,654 |
3.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,181.95 |
$2,567 |
3.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$234.60 |
$276 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$211.65 |
$249 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$248.62 |
$292.50 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$306 |
$360 |
3.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$482.80 |
$568 |
4.5× |
| Radex fingr minimum 2 views (73140) |
$197.20 |
$232 |
2.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$234.18 |
$275.50 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$233.75 |
$275 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$301.75 |
$355 |
3.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$464.10 |
$546 |
4.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$467.50 |
$550 |
4.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$639.20 |
$752 |
5.9× |
| Radex Humerus Minimum 2 Views (73060) |
$255 |
$300 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$247.78 |
$291.50 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$380.80 |
$448 |
3.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$338.72 |
$398.50 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$176.80 |
$208 |
2.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$445.40 |
$524 |
4.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$257.55 |
$303 |
2.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$236.30 |
$278 |
2.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$328.10 |
$386 |
3.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$341.70 |
$402 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$186.15 |
$219 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$260.10 |
$306 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$264.78 |
$311.50 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$245.65 |
$289 |
2.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$317.90 |
$374 |
2.9× |
| Radiologic exam chest 2 views (71046) |
$312.80 |
$368 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$681.70 |
$802 |
3.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$456.45 |
$537 |
2.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$94.35 |
$111 |
0.5× |
| Radiologic examination femur 1 view (73551) |
$306 |
$360 |
3.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$234.60 |
$276 |
2.6× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$372.30 |
$438 |
3.5× |
| Radiological examination surgical specimen (76098) |
$129.20 |
$152 |
0.2× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,484.10 |
$1,746 |
3.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$374.64 |
$440.75 |
1.5× |
| Scapula (73010) |
$249.90 |
$294 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$80.75 |
$95 |
3.5× |
| Shoulder 1 view (73020) |
$193.80 |
$228 |
2.2× |
| Small bowel series (74250) |
$669.80 |
$788 |
3.7× |
| Spine thoracic 3 views (72072) |
$373.15 |
$439 |
3.5× |
| Thoracolumbar 2 views (72080) |
$296.54 |
$348.87 |
3.3× |
| Thyroid imaging w/blood flow (78013) |
$742.05 |
$873 |
1.8× |
| Thyroid uptake measurement (78012) |
$409.70 |
$482 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$921.40 |
$1,084 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$804.10 |
$946 |
7.5× |
| Ultrasound, abdomen limited (76705) |
$433.50 |
$510 |
4.0× |
| Umbilical-artery Doppler (OB) (76820) |
$411.40 |
$484 |
3.8× |
| Unlisted fluoroscopic procedure (76496) |
$505.75 |
$595 |
5.6× |
| Urethrocystogram voiding (74455) |
$67.15 |
$79 |
0.3× |
| Urethrocystography retrograde rs&i (74450) |
$472.18 |
$555.50 |
1.9× |
| Us breast unilateral limited (76642) |
$414.80 |
$488 |
4.6× |
| Us chest (76604) |
$463.25 |
$545 |
4.3× |
| Us compl joint r-t w/image documentation (76881) |
$576.30 |
$678 |
5.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$291.98 |
$343.50 |
2.7× |
| Us ob detailed single fetus (76811) |
$1,073.55 |
$1,263 |
4.4× |
| Us ob limited (76815) |
$565.68 |
$665.50 |
5.2× |
| Us ob transvaginal (76817) |
$640.90 |
$754 |
5.9× |
| Us pelvic non ob complete (76856) |
$577.58 |
$679.50 |
5.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$299.20 |
$352 |
2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$650.25 |
$765 |
6.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$811.75 |
$955 |
7.5× |
| Us retroperitoneal complete (76770) |
$804.10 |
$946 |
7.5× |
| Us retroperitoneal limited (76775) |
$464.95 |
$547 |
4.3× |
| Us scrotum and contents (76870) |
$802.40 |
$944 |
7.4× |
| Us soft tissue head/neck (76536) |
$456.45 |
$537 |
4.2× |
| Us spinal canal and contents (76800) |
$646 |
$760 |
6.0× |
| Us transrectal (76872) |
$285.60 |
$336 |
2.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$776.05 |
$913 |
7.2× |
| Wrist 2 views (73100) |
$208.68 |
$245.50 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$385.05 |
$453 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$285.60 |
$336 |
3.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,229.10 |
$1,446 |
6.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$211.65 |
$249 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$362.10 |
$426 |
4.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$481.95 |
$567 |
4.5× |
| X-ray exam of femur 2/> (73552) |
$294.10 |
$346 |
3.3× |
| X-ray eye for foreign body (70030) |
$263.50 |
$310 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$264.35 |
$311 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$328.10 |
$386 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$219.30 |
$258 |
2.4× |
| X-ray leg, infant (73592) |
$311.95 |
$367 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$391.42 |
$460.50 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$505.75 |
$595 |
4.7× |
| X-ray nose-rectum child f.b. (76010) |
$325.55 |
$383 |
3.6× |
| X-ray optic foramen (70190) |
$116.45 |
$137 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$285.60 |
$336 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$555.90 |
$654 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$330.65 |
$389 |
3.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$277.52 |
$326.50 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$422.02 |
$496.50 |
3.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$322.15 |
$379 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$291.55 |
$343 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$277.95 |
$327 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$342.55 |
$403 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$228.65 |
$269 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$413.10 |
$486 |
4.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$327.25 |
$385 |
3.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$294.95 |
$347 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$280.50 |
$330 |
2.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$527.85 |
$621 |
4.9× |
| Xr c-spine 4 or 5 views (72050) |
$323.85 |
$381 |
3.0× |
| Xr c-spine 6 or more views (72052) |
$459 |
$540 |
4.3× |