| Abdomen 2 views (74019) |
$263.97 |
$419 |
2.4× |
| Ankle 2 views (73600) |
$259.56 |
$412 |
2.8× |
| Bone &/joint imaging whole body (78306) |
$1,328.04 |
$2,108 |
3.1× |
| Bone age studies (77072) |
$199.08 |
$316 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$268.38 |
$426 |
2.9× |
| Chest 1 view (71045) |
$174.51 |
$277 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$626.22 |
$994 |
3.3× |
| Clavicle complete (73000) |
$253.89 |
$403 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$715.68 |
$1,136 |
6.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,183.39 |
$5,053 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,795.31 |
$4,437 |
11.0× |
| CT abdomen w contrast (74160) |
$1,665.72 |
$2,644 |
8.9× |
| CT abdomen w wo contrast (74170) |
$1,910.79 |
$3,033 |
10.2× |
| CT abdomen w/o contrast (74150) |
$1,471.68 |
$2,336 |
13.2× |
| CT c-spine w/contrast (72126) |
$1,561.14 |
$2,478 |
4.2× |
| CT c-spine w/o contrast (72125) |
$1,471.68 |
$2,336 |
13.2× |
| CT chest w contrast (71260) |
$1,665.72 |
$2,644 |
8.9× |
| CT head/brain with contrast (70460) |
$1,665.72 |
$2,644 |
8.9× |
| CT head/brain without and with contrast (70470) |
$1,859.76 |
$2,952 |
9.9× |
| CT lower ext w/o (73700) |
$1,471.68 |
$2,336 |
13.2× |
| CT lower extremity w/contrast material (73701) |
$1,665.72 |
$2,644 |
8.9× |
| CT lumbar spine w/o contrast (72131) |
$1,471.68 |
$2,336 |
13.2× |
| CT maxillofacial w contrast (70487) |
$1,665.72 |
$2,644 |
8.9× |
| CT maxillofacial wo contrast (70486) |
$1,471.68 |
$2,336 |
13.2× |
| CT orbits w/o contrast (70480) |
$1,471.68 |
$2,336 |
13.2× |
| CT pelvis w/o contrast (72192) |
$1,471.68 |
$2,336 |
13.2× |
| CT pelvis w/wo contrast (72194) |
$1,859.76 |
$2,952 |
9.9× |
| CT soft tissue neck w contrast (70491) |
$1,665.72 |
$2,644 |
8.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,471.68 |
$2,336 |
13.2× |
| CT thoracic spine w/o contrast (72128) |
$1,256.22 |
$1,994 |
11.3× |
| CT thorax w/o contrast (71250) |
$1,471.68 |
$2,336 |
13.2× |
| CT upper ext wo (73200) |
$1,471.68 |
$2,336 |
13.2× |
| CT upper extremity with contrast (73201) |
$1,665.72 |
$2,644 |
4.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,598.75 |
$4,125 |
13.9× |
| Cta Abdomen (74175) |
$2,511.81 |
$3,987 |
13.4× |
| CTA abdomen pelvis (74174) |
$2,489.76 |
$3,952 |
6.7× |
| CTA chest (71275) |
$2,374.47 |
$3,769 |
12.7× |
| Cta Head (70496) |
$2,190.51 |
$3,477 |
11.7× |
| Cta Neck (70498) |
$2,190.51 |
$3,477 |
11.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$471.24 |
$748 |
4.2× |
| Esophagus (74220) |
$399.42 |
$634 |
2.1× |
| Facial bones min 3 views (70150) |
$341.46 |
$542 |
3.1× |
| Fetal biophysical profile non-stress testing (76818) |
$465.57 |
$739 |
4.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$346.50 |
$550 |
3.1× |
| Fluoroscopy up to 1 hr (76000) |
$498.33 |
$791 |
2.0× |
| Foot 2 views (73620) |
$224.91 |
$357 |
2.4× |
| Forearm 2 views (73090) |
$245.07 |
$389 |
2.6× |
| Hand 2 views (73120) |
$242.55 |
$385 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,331.63 |
$3,701 |
4.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,282.68 |
$2,036 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,410.57 |
$2,239 |
2.4× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,318.59 |
$2,093 |
2.3× |
| Knee 3 views (73562) |
$389.34 |
$618 |
4.2× |
| Lymphoscintigraphy (78195) |
$1,764.63 |
$2,801 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,606.62 |
$4,137.50 |
3.1× |
| MRA head w & w/o contrast (70546) |
$2,885.40 |
$4,580 |
7.7× |
| MRA head w/o contrast (70544) |
$2,206.89 |
$3,503 |
8.7× |
| MRA head with contrast (70545) |
$2,574.81 |
$4,087 |
6.9× |
| MRA neck w contrast (70548) |
$2,426.13 |
$3,851 |
6.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,078.81 |
$4,887 |
8.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,858.12 |
$6,124 |
10.4× |
| MRI abdomen w/o contrast (74181) |
$2,778.93 |
$4,411 |
10.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,912.93 |
$6,211 |
10.5× |
| MRI cervical spine w/o contrast (72141) |
$2,753.73 |
$4,371 |
10.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,860.01 |
$6,127 |
10.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,343.60 |
$3,720 |
9.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,206.89 |
$3,503 |
8.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,051.09 |
$4,843 |
8.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,466.89 |
$5,503 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$2,806.02 |
$4,454 |
11.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,471.93 |
$5,511 |
9.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,703.77 |
$5,879 |
9.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,471.93 |
$5,511 |
9.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,753.73 |
$4,371 |
10.8× |
| MRI up ext w/o contrast (73218) |
$2,206.89 |
$3,503 |
8.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,206.89 |
$3,503 |
8.7× |
| MRI, joint upper extrem combo (73223) |
$3,217.41 |
$5,107 |
8.6× |
| Myocardial Spect Multiple Studies (78452) |
$3,226.86 |
$5,122 |
2.3× |
| Neck soft tissue (70360) |
$242.55 |
$385 |
2.6× |
| Nm gastric emptying study (78264) |
$1,469.16 |
$2,332 |
3.4× |
| Pelvis 1 or 2 views (72170) |
$281.61 |
$447 |
2.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$277.83 |
$441 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$245.07 |
$389 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$277.83 |
$441 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$339.57 |
$539 |
3.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$380.52 |
$604 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$233.10 |
$370 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$315 |
$500 |
3.4× |
| Radex Hand Minimum 3 Views (73130) |
$281.61 |
$447 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$251.37 |
$399 |
2.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$377.37 |
$599 |
3.4× |
| Radex Humerus Minimum 2 Views (73060) |
$251.37 |
$399 |
2.7× |
| Radex Kne 1/2 Views (73560) |
$277.83 |
$441 |
3.0× |
| Radex Kne Compl 4/More Views (73564) |
$347.13 |
$551 |
3.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$307.44 |
$488 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$294.21 |
$467 |
3.2× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$328.86 |
$522 |
2.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$260.19 |
$413 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$397.53 |
$631 |
4.3× |
| Radex Toe Minimum 2 Views (73660) |
$263.97 |
$419 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$251.37 |
$399 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$221.13 |
$351 |
2.4× |
| Radiologic exam chest 2 views (71046) |
$238.14 |
$378 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$614.88 |
$976 |
3.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$540.54 |
$858 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$247.59 |
$393 |
2.7× |
| Radiological examination surgical specimen (76098) |
$233.10 |
$370 |
0.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$523.53 |
$831 |
2.1× |
| Scapula (73010) |
$259.56 |
$412 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$48.51 |
$77 |
2.1× |
| Small bowel series (74250) |
$612.36 |
$972 |
3.3× |
| Spine thoracic 3 views (72072) |
$290.43 |
$461 |
2.6× |
| Thoracolumbar 2 views (72080) |
$272.79 |
$433 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$566.37 |
$899 |
5.1× |
| Ultrasound, abdomen limited (76705) |
$477.54 |
$758 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$385.56 |
$612 |
3.5× |
| Us breast unilateral limited (76642) |
$364.14 |
$578 |
3.9× |
| Us chest (76604) |
$449.82 |
$714 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$593.46 |
$942 |
5.3× |
| Us infant hips w manipulation (76885) |
$507.15 |
$805 |
5.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$299.25 |
$475 |
2.7× |
| Us ob detailed single fetus (76811) |
$950.04 |
$1,508 |
3.7× |
| Us ob limited (76815) |
$398.79 |
$633 |
3.6× |
| Us ob transvaginal (76817) |
$454.86 |
$722 |
4.1× |
| Us pelvic non ob complete (76856) |
$510.93 |
$811 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$358.47 |
$569 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$497.07 |
$789 |
4.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$485.10 |
$770 |
4.3× |
| Us retroperitoneal complete (76770) |
$515.97 |
$819 |
4.6× |
| Us retroperitoneal limited (76775) |
$463.05 |
$735 |
4.1× |
| Us scrotum and contents (76870) |
$463.05 |
$735 |
4.1× |
| Us soft tissue head/neck (76536) |
$539.91 |
$857 |
4.8× |
| Wrist 2 views (73100) |
$254.52 |
$404 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$347.13 |
$551 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$307.44 |
$488 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$245.07 |
$389 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$367.92 |
$584 |
4.0× |
| X-ray exam of femur 2/> (73552) |
$285.39 |
$453 |
3.1× |
| X-ray eye for foreign body (70030) |
$238.14 |
$378 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$272.16 |
$432 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$290.43 |
$461 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$549.36 |
$872 |
4.9× |
| X-ray retrograde pyelogram (74420) |
$1,926.54 |
$3,058 |
5.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$268.38 |
$426 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$390.60 |
$620 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$285.39 |
$453 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$238.14 |
$378 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$290.43 |
$461 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$238.14 |
$378 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$277.83 |
$441 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$359.10 |
$570 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$458.01 |
$727 |
4.1× |