| Abdomen 2 views (74019) |
$310.10 |
$443 |
2.7× |
| Acute gi blood loss imaging (78278) |
$1,925 |
$2,750 |
4.3× |
| Ankle 2 views (73600) |
$224.70 |
$321 |
2.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,267 |
$1,810 |
2.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,267 |
$1,810 |
2.8× |
| Bone &/joint imaging whole body (78306) |
$2,203.60 |
$3,148 |
4.9× |
| Bone age studies (77072) |
$225.40 |
$322 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$2,481.50 |
$3,545 |
5.6× |
| Bone survey complete (77075) |
$629.30 |
$899 |
5.4× |
| Bone survey infant (77076) |
$501.90 |
$717 |
4.3× |
| Bowel imaging (78290) |
$1,131.20 |
$1,616 |
2.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$2,609.60 |
$3,728 |
5.9× |
| Cervical spine 2 or 3 views (72040) |
$312.20 |
$446 |
3.2× |
| Chest 1 view (71045) |
$227.50 |
$325 |
2.3× |
| Chest xray 3 views (71047) |
$337.40 |
$482 |
3.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$447.30 |
$639 |
2.3× |
| Clavicle complete (73000) |
$245 |
$350 |
2.5× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$285.60 |
$408 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,311 |
$4,730 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,627.10 |
$3,753 |
9.9× |
| CT abdomen w contrast (74160) |
$1,770.65 |
$2,529.50 |
9.1× |
| CT abdomen w wo contrast (74170) |
$2,038.40 |
$2,912 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,478.40 |
$2,112 |
12.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,723.40 |
$2,462 |
8.8× |
| CT angiography upper extremity lt (73206) |
$2,127.30 |
$3,039 |
10.9× |
| CT c-spine w/contrast (72126) |
$1,743 |
$2,490 |
4.5× |
| CT c-spine w/o contrast (72125) |
$1,661.80 |
$2,374 |
14.3× |
| CT cervical spine w&w/o contrast (72127) |
$2,220.40 |
$3,172 |
11.4× |
| CT chest w contrast (71260) |
$1,809.50 |
$2,585 |
9.3× |
| CT chest w/wo contrast (71270) |
$1,988.70 |
$2,841 |
10.2× |
| CT head/brain with contrast (70460) |
$1,629.60 |
$2,328 |
8.3× |
| CT head/brain without and with contrast (70470) |
$1,946.70 |
$2,781 |
10.0× |
| CT iac w contrast (70481) |
$1,675.80 |
$2,394 |
8.6× |
| CT limited/localized follow up study (76380) |
$674.80 |
$964 |
7.0× |
| CT lower ext w/o (73700) |
$1,339.10 |
$1,913 |
11.5× |
| CT lower extremity w wo contrast (73702) |
$2,076.90 |
$2,967 |
10.6× |
| CT lower extremity w/contrast material (73701) |
$1,527.40 |
$2,182 |
7.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,026.50 |
$2,895 |
10.4× |
| CT lumbar spine w/contrast (72132) |
$1,864.10 |
$2,663 |
4.8× |
| CT lumbar spine w/o contrast (72131) |
$1,592.50 |
$2,275 |
13.7× |
| CT maxillofacial w contrast (70487) |
$1,591.10 |
$2,273 |
8.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,764.70 |
$2,521 |
9.0× |
| CT maxillofacial wo contrast (70486) |
$1,373.05 |
$1,961.50 |
11.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,926.40 |
$2,752 |
9.9× |
| CT orbits w/o contrast (70480) |
$1,469.30 |
$2,099 |
12.6× |
| CT pelvis w/o contrast (72192) |
$1,404.20 |
$2,006 |
12.1× |
| CT pelvis w/wo contrast (72194) |
$1,970.50 |
$2,815 |
10.1× |
| CT scan of arm combo (73202) |
$1,879.50 |
$2,685 |
9.6× |
| CT soft tissue neck w contrast (70491) |
$1,643.25 |
$2,347.50 |
8.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,908.20 |
$2,726 |
9.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,461.60 |
$2,088 |
12.5× |
| CT thoracic spine w/contrast (72129) |
$1,892.80 |
$2,704 |
9.7× |
| CT thoracic spine w/o contrast (72128) |
$1,556.80 |
$2,224 |
13.4× |
| CT thoracic spine w/wo contrast (72130) |
$2,144.80 |
$3,064 |
11.0× |
| CT thorax w/o contrast (71250) |
$1,393.70 |
$1,991 |
12.0× |
| CT upper ext wo (73200) |
$1,461.60 |
$2,088 |
12.5× |
| CT upper extremity with contrast (73201) |
$1,644.30 |
$2,349 |
4.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,647 |
$5,210 |
18.7× |
| Cta Abdomen (74175) |
$3,039.40 |
$4,342 |
15.5× |
| CTA abdomen pelvis (74174) |
$2,791.60 |
$3,988 |
7.2× |
| CTA chest (71275) |
$2,986.55 |
$4,266.50 |
15.3× |
| Cta Head (70496) |
$2,614.50 |
$3,735 |
13.4× |
| Cta Neck (70498) |
$2,573.90 |
$3,677 |
13.2× |
| Cta Pelvis (72191) |
$2,127.30 |
$3,039 |
10.9× |
| Cystography minimum 3 views rs&i (74430) |
$496.30 |
$709 |
1.3× |
| Esophagus (74220) |
$441.70 |
$631 |
2.3× |
| Facial bones min 3 views (70150) |
$390.60 |
$558 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$490 |
$700 |
4.2× |
| Foot 2 views (73620) |
$219.10 |
$313 |
2.3× |
| Forearm 2 views (73090) |
$235.90 |
$337 |
2.4× |
| Hand 2 views (73120) |
$214.20 |
$306 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,986.60 |
$2,838 |
3.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$2,228.80 |
$3,184 |
3.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,317.70 |
$3,311 |
3.8× |
| Knee 3 views (73562) |
$290.15 |
$414.50 |
3.0× |
| Liver & spleen imaging static only (78215) |
$1,108.10 |
$1,583 |
2.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,096.50 |
$2,995 |
2.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,589.30 |
$3,699 |
6.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,601.20 |
$3,716 |
6.7× |
| MRA head w & w/o contrast (70546) |
$2,570.40 |
$3,672 |
6.6× |
| MRA head w/o contrast (70544) |
$1,953 |
$2,790 |
7.3× |
| MRA head with contrast (70545) |
$1,664.60 |
$2,378 |
4.3× |
| MRA neck w contrast (70548) |
$2,503.20 |
$3,576 |
6.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,679.60 |
$3,828 |
6.9× |
| MRA neck w/o contrast (70547) |
$1,936.20 |
$2,766 |
7.3× |
| MRI abdomen w contrast (74182) |
$2,544.50 |
$3,635 |
6.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,903.95 |
$4,148.50 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$2,044 |
$2,920 |
7.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,314.20 |
$3,306 |
2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,754.50 |
$3,935 |
7.1× |
| MRI c-spine with contrast (72142) |
$1,981.70 |
$2,831 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$2,100.35 |
$3,000.50 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,964.50 |
$4,235 |
7.6× |
| MRI chest w/o contrast (71550) |
$1,931.30 |
$2,759 |
7.3× |
| MRI chest with contrast (71551) |
$2,490.60 |
$3,558 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,043.30 |
$2,919 |
5.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,634.10 |
$3,763 |
6.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,985.20 |
$2,836 |
7.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,043.30 |
$2,919 |
7.7× |
| MRI orbit face neck w contrast (70542) |
$2,729.30 |
$3,899 |
7.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,784.60 |
$3,978 |
7.2× |
| MRI pelvis w/contrast (72196) |
$2,424.10 |
$3,463 |
6.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,872.80 |
$4,104 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$1,950.20 |
$2,786 |
7.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,975 |
$4,250 |
7.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,431.10 |
$3,473 |
6.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,904.30 |
$4,149 |
7.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,880.20 |
$2,686 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,042.90 |
$4,347 |
7.8× |
| MRI temporomandibular joint (70336) |
$1,929.90 |
$2,757 |
7.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,048.20 |
$2,926 |
7.7× |
| MRI up ext w/o contrast (73218) |
$1,974.35 |
$2,820.50 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,016.70 |
$2,881 |
7.6× |
| MRI, joint upper extrem combo (73223) |
$2,531.90 |
$3,617 |
6.5× |
| Myocardial Spect Multiple Studies (78452) |
$4,090.10 |
$5,843 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,718.10 |
$3,883 |
1.9× |
| Neck soft tissue (70360) |
$245.70 |
$351 |
2.5× |
| Nm gastric emptying study (78264) |
$1,773.10 |
$2,533 |
4.0× |
| Nm gastroesophageal reflux study (78262) |
$1,071.70 |
$1,531 |
2.4× |
| Nm kidney scan w/flow (78701) |
$1,515.50 |
$2,165 |
3.4× |
| Osseous survey limited (77074) |
$385 |
$550 |
3.3× |
| Parathyroid Planar Imaging (78070) |
$952 |
$1,360 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$235.20 |
$336 |
2.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,432.20 |
$2,046 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$399.70 |
$571 |
0.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$271.60 |
$388 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$231.70 |
$331 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$250.60 |
$358 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$335.30 |
$479 |
2.9× |
| Radex fingr minimum 2 views (73140) |
$166.60 |
$238 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$263.20 |
$376 |
2.7× |
| Radex Hand Minimum 3 Views (73130) |
$251.65 |
$359.50 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$181.30 |
$259 |
1.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$375.55 |
$536.50 |
3.2× |
| Radex Humerus Minimum 2 Views (73060) |
$251.30 |
$359 |
2.6× |
| Radex Kne 1/2 Views (73560) |
$213.50 |
$305 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$363.65 |
$519.50 |
3.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$397.60 |
$568 |
3.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$249.20 |
$356 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$291.20 |
$416 |
2.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$301 |
$430 |
3.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$265.30 |
$379 |
2.7× |
| Radex Toe Minimum 2 Views (73660) |
$177.45 |
$253.50 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$217 |
$310 |
1.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$233.45 |
$333.50 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$496.30 |
$709 |
4.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$224.70 |
$321 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$317.10 |
$453 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$520.10 |
$743 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$269.50 |
$385 |
2.8× |
| Scapula (73010) |
$276.50 |
$395 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$192.50 |
$275 |
8.2× |
| Shoulder 1 view (73020) |
$200.20 |
$286 |
2.1× |
| Small bowel series (74250) |
$463.40 |
$662 |
2.4× |
| Spine thoracic 3 views (72072) |
$380.45 |
$543.50 |
3.3× |
| Thoracolumbar 2 views (72080) |
$306.60 |
$438 |
3.2× |
| Thyroid imaging w/blood flow (78013) |
$538.30 |
$769 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$714 |
$1,020 |
1.6× |
| Ultrasound breast complete (76641) |
$501.20 |
$716 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$725.90 |
$1,037 |
6.2× |
| Unlisted ultrasound procedure (76999) |
$548.10 |
$783 |
5.7× |
| Urethrocystogram voiding (74455) |
$459.90 |
$657 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$616.70 |
$881 |
2.3× |
| Us breast unilateral limited (76642) |
$294.70 |
$421 |
3.0× |
| Us chest (76604) |
$505.40 |
$722 |
4.3× |
| Us compl joint r-t w/image documentation (76881) |
$669.20 |
$956 |
5.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$207.55 |
$296.50 |
1.8× |
| Us ob limited (76815) |
$499.10 |
$713 |
4.3× |
| Us pelvic non ob complete (76856) |
$725.90 |
$1,037 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$564.55 |
$806.50 |
4.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$720.30 |
$1,029 |
6.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$399.70 |
$571 |
3.4× |
| Us retroperitoneal complete (76770) |
$710.85 |
$1,015.50 |
6.1× |
| Us retroperitoneal limited (76775) |
$511 |
$730 |
4.4× |
| Us scrotum and contents (76870) |
$557.90 |
$797 |
4.8× |
| Us soft tissue head/neck (76536) |
$638.75 |
$912.50 |
5.5× |
| Wrist 2 views (73100) |
$210 |
$300 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$406.35 |
$580.50 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$252 |
$360 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$809.20 |
$1,156 |
4.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$231.70 |
$331 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$307.30 |
$439 |
3.2× |
| X-ray exam of femur 2/> (73552) |
$256.20 |
$366 |
2.6× |
| X-ray eye for foreign body (70030) |
$276.50 |
$395 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$217 |
$310 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$683.90 |
$977 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$256.20 |
$366 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$143.50 |
$205 |
1.5× |
| X-ray leg, infant (73592) |
$191.10 |
$273 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$391.30 |
$559 |
3.4× |
| X-ray nose-rectum child f.b. (76010) |
$214.20 |
$306 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$307.30 |
$439 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$416.50 |
$595 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$341.60 |
$488 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$428.40 |
$612 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$301 |
$430 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$294 |
$420 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$363.30 |
$519 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$356.30 |
$509 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$231.70 |
$331 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$196.70 |
$281 |
2.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$218.40 |
$312 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$261.10 |
$373 |
2.7× |
| Xr bone length studies (77073) |
$232.40 |
$332 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$409.50 |
$585 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$455.70 |
$651 |
3.9× |
| Xr chest 4+ views (71048) |
$378 |
$540 |
3.2× |
| Xr urogram antegrade (74425) |
$542.50 |
$775 |
1.4× |