| Abdomen 2 views (74019) |
$360.40 |
$424 |
3.3× |
| Ankle 2 views (73600) |
$328.10 |
$386 |
3.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,374.45 |
$1,617 |
3.3× |
| Bone &/joint imaging whole body (78306) |
$1,559.75 |
$1,835 |
3.8× |
| Bone Imaging 3 Phase (78315) |
$791.35 |
$931 |
1.9× |
| Bone survey complete (77075) |
$493 |
$580 |
4.6× |
| Bone survey infant (77076) |
$378.25 |
$445 |
3.5× |
| Cervical spine 2 or 3 views (72040) |
$396.10 |
$466 |
4.4× |
| Chest 1 view (71045) |
$243.10 |
$286 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$564.40 |
$664 |
3.1× |
| Clavicle complete (73000) |
$294.10 |
$346 |
3.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,102.05 |
$2,473 |
19.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,984.40 |
$5,864 |
13.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,152.65 |
$3,709 |
12.8× |
| CT abdomen w contrast (74160) |
$2,102.05 |
$2,473 |
11.6× |
| CT abdomen w wo contrast (74170) |
$3,973.75 |
$4,675 |
22.0× |
| CT abdomen w/o contrast (74150) |
$2,102.05 |
$2,473 |
19.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,785.90 |
$4,454 |
20.9× |
| CT c-spine w/contrast (72126) |
$2,102.05 |
$2,473 |
5.8× |
| CT c-spine w/o contrast (72125) |
$2,102.05 |
$2,473 |
19.5× |
| CT cervical spine w&w/o contrast (72127) |
$2,102.05 |
$2,473 |
11.6× |
| CT chest w contrast (71260) |
$2,102.05 |
$2,473 |
11.6× |
| CT chest w/wo contrast (71270) |
$2,102.05 |
$2,473 |
11.6× |
| CT head/brain with contrast (70460) |
$1,943.95 |
$2,287 |
10.7× |
| CT head/brain without and with contrast (70470) |
$2,089.30 |
$2,458 |
11.5× |
| CT iac w contrast (70481) |
$1,815.60 |
$2,136 |
10.0× |
| CT lower ext w/o (73700) |
$1,892.95 |
$2,227 |
17.5× |
| CT lower extremity w wo contrast (73702) |
$1,847.90 |
$2,174 |
10.2× |
| CT lower extremity w/contrast material (73701) |
$1,790.95 |
$2,107 |
9.9× |
| CT lumbar spine w & w/o contrast (72133) |
$2,102.05 |
$2,473 |
11.6× |
| CT lumbar spine w/contrast (72132) |
$2,102.05 |
$2,473 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$2,102.05 |
$2,473 |
19.5× |
| CT maxillofacial w contrast (70487) |
$1,841.95 |
$2,167 |
10.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,069.75 |
$2,435 |
11.4× |
| CT maxillofacial wo contrast (70486) |
$1,892.95 |
$2,227 |
17.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,069.75 |
$2,435 |
11.4× |
| CT orbits w/o contrast (70480) |
$1,496.85 |
$1,761 |
13.9× |
| CT pelvis w/o contrast (72192) |
$2,102.05 |
$2,473 |
19.5× |
| CT pelvis w/wo contrast (72194) |
$2,102.05 |
$2,473 |
11.6× |
| CT scan of arm combo (73202) |
$1,847.90 |
$2,174 |
10.2× |
| CT soft tissue neck w contrast (70491) |
$1,892.95 |
$2,227 |
10.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,102.05 |
$2,473 |
11.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,561.45 |
$1,837 |
14.5× |
| CT thoracic spine w/contrast (72129) |
$2,102.05 |
$2,473 |
11.6× |
| CT thoracic spine w/o contrast (72128) |
$2,102.05 |
$2,473 |
19.5× |
| CT thoracic spine w/wo contrast (72130) |
$2,102.05 |
$2,473 |
11.6× |
| CT thorax w/o contrast (71250) |
$2,102.05 |
$2,473 |
19.5× |
| CT upper ext wo (73200) |
$1,739.95 |
$2,047 |
16.1× |
| CT upper extremity with contrast (73201) |
$1,720.40 |
$2,024 |
4.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,399.60 |
$5,176 |
24.3× |
| Cta Abdomen (74175) |
$3,007.30 |
$3,538 |
16.6× |
| CTA abdomen pelvis (74174) |
$3,878.55 |
$4,563 |
10.8× |
| CTA chest (71275) |
$2,507.50 |
$2,950 |
13.9× |
| Cta Head (70496) |
$2,456.50 |
$2,890 |
13.6× |
| Cta Neck (70498) |
$2,352.80 |
$2,768 |
13.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$527 |
$620 |
4.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$501.50 |
$590 |
5.6× |
| Facial bones min 3 views (70150) |
$408.85 |
$481 |
3.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$438.60 |
$516 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$613.70 |
$722 |
2.5× |
| Foot 2 views (73620) |
$260.10 |
$306 |
2.9× |
| Forearm 2 views (73090) |
$312.80 |
$368 |
3.5× |
| Hand 2 views (73120) |
$260.10 |
$306 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,075.25 |
$1,265 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,075.25 |
$1,265 |
2.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$709.75 |
$835 |
1.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,001.30 |
$1,178 |
1.8× |
| Knee 3 views (73562) |
$331.50 |
$390 |
3.7× |
| Lung perfusion differential (78597) |
$567.80 |
$668 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,782.90 |
$3,274 |
3.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,782.90 |
$3,274 |
7.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,729.80 |
$4,388 |
10.4× |
| MRA head w & w/o contrast (70546) |
$2,782.90 |
$3,274 |
7.7× |
| MRA head w/o contrast (70544) |
$2,782.90 |
$3,274 |
11.3× |
| MRA neck w contrast (70548) |
$2,782.90 |
$3,274 |
7.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,782.90 |
$3,274 |
7.7× |
| MRA neck w/o contrast (70547) |
$2,782.90 |
$3,274 |
11.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,501.58 |
$4,119.50 |
9.7× |
| MRI abdomen w/o contrast (74181) |
$2,782.90 |
$3,274 |
11.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,782.90 |
$3,274 |
3.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,782.90 |
$3,274 |
7.7× |
| MRI c-spine with contrast (72142) |
$2,782.90 |
$3,274 |
7.7× |
| MRI cervical spine w/o contrast (72141) |
$2,782.90 |
$3,274 |
11.3× |
| MRI chest w/o contrast (71550) |
$2,782.90 |
$3,274 |
11.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,782.90 |
$3,274 |
7.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,782.90 |
$3,274 |
7.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,782.90 |
$3,274 |
11.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,782.90 |
$3,274 |
11.3× |
| MRI orbit face neck w contrast (70542) |
$2,782.90 |
$3,274 |
7.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,782.90 |
$3,274 |
7.7× |
| MRI pelvis w/contrast (72196) |
$2,782.90 |
$3,274 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,782.90 |
$3,274 |
7.7× |
| MRI pelvis w/o contrast (72195) |
$2,782.90 |
$3,274 |
11.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,782.90 |
$3,274 |
7.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,782.90 |
$3,274 |
7.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,683.05 |
$4,333 |
10.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,782.90 |
$3,274 |
7.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,782.90 |
$3,274 |
7.7× |
| MRI temporomandibular joint (70336) |
$2,782.90 |
$3,274 |
11.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,782.90 |
$3,274 |
11.3× |
| MRI up ext w/o contrast (73218) |
$2,782.90 |
$3,274 |
11.3× |
| MRI upper ext joint w/o contrast (73221) |
$2,782.90 |
$3,274 |
11.3× |
| MRI, joint upper extrem combo (73223) |
$2,782.90 |
$3,274 |
7.7× |
| Myocardial Spect Multiple Studies (78452) |
$4,005.20 |
$4,712 |
3.0× |
| Myocardial spect single study at rest or stress (78451) |
$1,505.35 |
$1,771 |
1.1× |
| Neck soft tissue (70360) |
$124.95 |
$147 |
1.4× |
| Nm gastric emptying study (78264) |
$931.60 |
$1,096 |
2.3× |
| Osseous survey limited (77074) |
$378.25 |
$445 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$312.80 |
$368 |
2.9× |
| PET image w/CT, skull-thigh (78815) |
$4,305.25 |
$5,065 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$4,305.25 |
$5,065 |
2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$567.80 |
$668 |
1.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,093.10 |
$1,286 |
2.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$317.05 |
$373 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$279.65 |
$329 |
3.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$338.30 |
$398 |
3.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$218.45 |
$257 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$306.85 |
$361 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$306 |
$360 |
3.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$285.60 |
$336 |
3.2× |
| Radex Hand Minimum 3 Views (73130) |
$306 |
$360 |
3.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$515.95 |
$607 |
4.8× |
| Radex Humerus Minimum 2 Views (73060) |
$272.85 |
$321 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$285.60 |
$336 |
3.2× |
| Radex Kne Compl 4/More Views (73564) |
$378.25 |
$445 |
3.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$354.45 |
$417 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$271.15 |
$319 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$380.80 |
$448 |
3.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$321.30 |
$378 |
3.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$373.15 |
$439 |
4.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$132.60 |
$156 |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$226.95 |
$267 |
2.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$198.90 |
$234 |
1.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$301.75 |
$355 |
3.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$258.40 |
$304 |
2.9× |
| Radiologic exam chest 2 views (71046) |
$312.80 |
$368 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$295.80 |
$348 |
3.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$306 |
$360 |
3.4× |
| Ribs bilateral 3 views (71110) |
$374 |
$440 |
3.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,892.10 |
$2,226 |
3.4× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,892.10 |
$2,226 |
1.4× |
| Scapula (73010) |
$334.90 |
$394 |
3.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$51.85 |
$61 |
2.2× |
| Shoulder 1 view (73020) |
$255.85 |
$301 |
2.8× |
| Small bowel series (74250) |
$449.65 |
$529 |
2.5× |
| Spine thoracic 3 views (72072) |
$469.20 |
$552 |
4.3× |
| Thyroid imaging w/blood flow (78013) |
$567.80 |
$668 |
1.4× |
| Ultrasound breast complete (76641) |
$505.75 |
$595 |
4.7× |
| Ultrasound Exam Aaa Screen (76706) |
$688.50 |
$810 |
6.4× |
| Ultrasound, abdomen limited (76705) |
$799 |
$940 |
7.4× |
| Umbilical-artery Doppler (OB) (76820) |
$138.55 |
$163 |
1.3× |
| Us breast unilateral limited (76642) |
$521.05 |
$613 |
5.8× |
| Us chest (76604) |
$491.30 |
$578 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$212.50 |
$250 |
2.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$542.30 |
$638 |
5.0× |
| Us ob limited (76815) |
$602.65 |
$709 |
5.6× |
| Us ob transvaginal (76817) |
$553.35 |
$651 |
5.1× |
| Us pelvic non ob complete (76856) |
$675.75 |
$795 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$199.75 |
$235 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$537.20 |
$632 |
5.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$563.55 |
$663 |
5.2× |
| Us retroperitoneal complete (76770) |
$847.45 |
$997 |
7.9× |
| Us retroperitoneal limited (76775) |
$691.05 |
$813 |
6.4× |
| Us scrotum and contents (76870) |
$539.75 |
$635 |
5.0× |
| Us soft tissue head/neck (76536) |
$695.30 |
$818 |
6.4× |
| Wrist 2 views (73100) |
$276.25 |
$325 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$255.85 |
$301 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$285.60 |
$336 |
3.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$371.45 |
$437 |
4.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$449.65 |
$529 |
4.2× |
| X-ray exam of femur 2/> (73552) |
$301.32 |
$354.50 |
3.4× |
| X-ray eye for foreign body (70030) |
$171.70 |
$202 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$331.50 |
$390 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$338.30 |
$398 |
3.8× |
| X-ray leg, infant (73592) |
$265.20 |
$312 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$469.20 |
$552 |
4.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$396.10 |
$466 |
3.7× |
| X-ray retrograde pyelogram (74420) |
$497.25 |
$585 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$306.85 |
$361 |
3.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$413.52 |
$486.50 |
3.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$396.10 |
$466 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$355.30 |
$418 |
3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$286.45 |
$337 |
3.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$355.30 |
$418 |
4.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$519.35 |
$611 |
4.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$504.90 |
$594 |
4.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$297.50 |
$350 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$305.15 |
$359 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$369.75 |
$435 |
3.4× |
| Xr c-spine 4 or 5 views (72050) |
$452.20 |
$532 |
4.2× |
| Xr c-spine 6 or more views (72052) |
$355.30 |
$418 |
3.3× |