| Abdomen 2 views (74019) |
$396.90 |
$1,323 |
3.9× |
| Ankle 2 views (73600) |
$218.10 |
$727 |
2.6× |
| Arthrogram hip (73525) |
$320.40 |
$1,068 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$358.50 |
$1,195 |
0.9× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$453.90 |
$1,513 |
1.2× |
| Bone &/joint imaging whole body (78306) |
$1,164.90 |
$3,883 |
3.0× |
| Bone age studies (77072) |
$219.60 |
$732 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$1,155.30 |
$3,851 |
3.0× |
| Bone Marrow Imaging Limited Area (78102) |
$726.60 |
$2,422 |
1.9× |
| Bone survey complete (77075) |
$903 |
$3,010 |
8.9× |
| Bone survey infant (77076) |
$202.80 |
$676 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$225.30 |
$751 |
2.7× |
| Chest 1 view (71045) |
$150.60 |
$502 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$354 |
$1,180 |
2.1× |
| Clavicle complete (73000) |
$237 |
$790 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$123.60 |
$412 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$898.50 |
$2,995 |
2.6× |
| CT abdomen and pelvis without contrast (74176) |
$696.30 |
$2,321 |
3.0× |
| CT abdomen w contrast (74160) |
$898.50 |
$2,995 |
5.3× |
| CT abdomen w wo contrast (74170) |
$898.50 |
$2,995 |
5.3× |
| CT abdomen w/o contrast (74150) |
$422.70 |
$1,409 |
4.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$872.10 |
$2,907 |
5.1× |
| CT c-spine w/contrast (72126) |
$935.10 |
$3,117 |
2.7× |
| CT c-spine w/o contrast (72125) |
$825.60 |
$2,752 |
8.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,044.90 |
$3,483 |
6.1× |
| CT chest w contrast (71260) |
$718.80 |
$2,396 |
4.2× |
| CT chest w/wo contrast (71270) |
$898.50 |
$2,995 |
5.3× |
| CT head/brain with contrast (70460) |
$901.50 |
$3,005 |
5.3× |
| CT head/brain without and with contrast (70470) |
$898.50 |
$2,995 |
5.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$305 |
$305 |
3.6× |
| CT iac w contrast (70481) |
$863.40 |
$2,878 |
5.0× |
| CT lower ext w/o (73700) |
$422.70 |
$1,409 |
4.1× |
| CT lower extremity w wo contrast (73702) |
$1,268.40 |
$4,228 |
7.4× |
| CT lower extremity w/contrast material (73701) |
$985.20 |
$3,284 |
5.8× |
| CT lumbar spine w & w/o contrast (72133) |
$173.70 |
$579 |
1.0× |
| CT lumbar spine w/contrast (72132) |
$990.30 |
$3,301 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$422.70 |
$1,409 |
4.1× |
| CT maxillofacial w contrast (70487) |
$863.40 |
$2,878 |
5.0× |
| CT maxillofacial w/wo contrast (70488) |
$608.70 |
$2,029 |
3.6× |
| CT maxillofacial wo contrast (70486) |
$422.70 |
$1,409 |
4.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$898.50 |
$2,995 |
5.3× |
| CT orbits w/o contrast (70480) |
$422.70 |
$1,409 |
4.1× |
| CT pelvis w/o contrast (72192) |
$422.70 |
$1,409 |
4.1× |
| CT pelvis w/wo contrast (72194) |
$913.80 |
$3,046 |
5.3× |
| CT scan of arm combo (73202) |
$951.30 |
$3,171 |
5.6× |
| CT soft tissue neck w contrast (70491) |
$748.50 |
$2,495 |
4.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$898.50 |
$2,995 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$422.70 |
$1,409 |
4.1× |
| CT thoracic spine w/contrast (72129) |
$871.20 |
$2,904 |
5.1× |
| CT thoracic spine w/o contrast (72128) |
$422.70 |
$1,409 |
4.1× |
| CT thorax w/o contrast (71250) |
$422.70 |
$1,409 |
4.1× |
| CT upper ext wo (73200) |
$422.70 |
$1,409 |
4.1× |
| CT upper extremity with contrast (73201) |
$899.70 |
$2,999 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$627.30 |
$2,091 |
3.7× |
| Cta Abdomen (74175) |
$898.50 |
$2,995 |
5.3× |
| CTA abdomen pelvis (74174) |
$898.50 |
$2,995 |
2.6× |
| CTA chest (71275) |
$718.80 |
$2,396 |
4.2× |
| Cta Head (70496) |
$898.50 |
$2,995 |
5.3× |
| Cta Neck (70498) |
$898.50 |
$2,995 |
5.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$346.50 |
$1,155 |
3.4× |
| Esophagus (74220) |
$328.80 |
$1,096 |
1.9× |
| Facial bones min 3 views (70150) |
$251.10 |
$837 |
2.5× |
| Foot 2 views (73620) |
$217.80 |
$726 |
2.6× |
| Forearm 2 views (73090) |
$222.90 |
$743 |
2.6× |
| Hand 2 views (73120) |
$225 |
$750 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$883.20 |
$2,944 |
1.7× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$883.20 |
$2,944 |
2.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$404.10 |
$1,347 |
0.8× |
| Knee 3 views (73562) |
$222.60 |
$742 |
2.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,542.20 |
$8,474 |
3.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,699.80 |
$5,666 |
5.0× |
| Mr safety determination physician/other qhp (76016) |
$83.10 |
$277 |
1.0× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$23.10 |
$77 |
0.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$86.70 |
$289 |
0.9× |
| Mr safety implt pos&/immoblj (76019) |
$56.10 |
$187 |
1.0× |
| Mr safety med physics xm customization plng&mntr (76017) |
$228.30 |
$761 |
1.0× |
| MRA head w/o contrast (70544) |
$913.50 |
$3,045 |
3.9× |
| MRA head with contrast (70545) |
$943.50 |
$3,145 |
2.8× |
| MRA neck w contrast (70548) |
$943.50 |
$3,145 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,699.80 |
$5,666 |
5.0× |
| MRA neck w/o contrast (70547) |
$913.50 |
$3,045 |
3.9× |
| MRI abdomen w contrast (74182) |
$2,124.60 |
$7,082 |
6.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,699.80 |
$5,666 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$913.50 |
$3,045 |
3.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,542.20 |
$8,474 |
3.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,699.80 |
$5,666 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$913.50 |
$3,045 |
3.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,952.10 |
$6,507 |
5.7× |
| MRI chest w/o contrast (71550) |
$1,470.30 |
$4,901 |
6.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,699.80 |
$5,666 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$913.50 |
$3,045 |
3.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,058.70 |
$3,529 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,699.80 |
$5,666 |
5.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,699.80 |
$5,666 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$913.50 |
$3,045 |
3.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,699.80 |
$5,666 |
5.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,699.80 |
$5,666 |
5.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,699.80 |
$5,666 |
5.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,699.80 |
$5,666 |
5.0× |
| MRI temporomandibular joint (70336) |
$2,306.70 |
$7,689 |
9.9× |
| MRI thoracic spine w/o contrast (72146) |
$913.50 |
$3,045 |
3.9× |
| MRI up ext w/o contrast (73218) |
$913.50 |
$3,045 |
3.9× |
| MRI upper ext joint w/o contrast (73221) |
$913.50 |
$3,045 |
3.9× |
| MRI, joint upper extrem combo (73223) |
$1,699.80 |
$5,666 |
5.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,632.20 |
$8,774 |
2.1× |
| Myocardial spect single study at rest or stress (78451) |
$2,366.40 |
$7,888 |
1.9× |
| Neck soft tissue (70360) |
$213.90 |
$713 |
2.5× |
| Nm gastric emptying study (78264) |
$866.40 |
$2,888 |
2.2× |
| Nonvascular shunt X-ray (75809) |
$143.10 |
$477 |
1.4× |
| Parathyroid Planar Imaging (78070) |
$533.40 |
$1,778 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$210.60 |
$702 |
2.1× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$997.20 |
$3,324 |
2.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,380.30 |
$4,601 |
2.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$225.90 |
$753 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$218.40 |
$728 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$225.30 |
$751 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$224.40 |
$748 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$224.40 |
$748 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$217.50 |
$725 |
2.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$225.90 |
$753 |
2.7× |
| Radex Hand Minimum 3 Views (73130) |
$225.30 |
$751 |
2.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$123.30 |
$411 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$121.80 |
$406 |
1.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$381.30 |
$1,271 |
3.7× |
| Radex Humerus Minimum 2 Views (73060) |
$238.20 |
$794 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$232.20 |
$774 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$257.40 |
$858 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$213.90 |
$713 |
2.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$214.20 |
$714 |
2.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$225.30 |
$751 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$183 |
$610 |
2.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$297.30 |
$991 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$176.70 |
$589 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$207 |
$690 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$123 |
$410 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$225.90 |
$753 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$224.40 |
$748 |
2.6× |
| Radiologic exam chest 2 views (71046) |
$187.20 |
$624 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$435.60 |
$1,452 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$187.80 |
$626 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$634.20 |
$2,114 |
3.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$544.50 |
$1,815 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$171.60 |
$572 |
2.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$225.90 |
$753 |
2.7× |
| Ribs bilateral 3 views (71110) |
$319.50 |
$1,065 |
3.1× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$345 |
$1,150 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$278.10 |
$927 |
2.7× |
| Scapula (73010) |
$260.40 |
$868 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$64.50 |
$215 |
2.8× |
| Shoulder 1 view (73020) |
$169.50 |
$565 |
2.0× |
| Small bowel series (74250) |
$284.10 |
$947 |
1.7× |
| Spine thoracic 3 views (72072) |
$306.90 |
$1,023 |
3.0× |
| Thoracolumbar 2 views (72080) |
$225.30 |
$751 |
2.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$323.40 |
$1,078 |
0.8× |
| Ultrasound breast complete (76641) |
$442.20 |
$1,474 |
4.3× |
| Ultrasound Exam Aaa Screen (76706) |
$422.70 |
$1,409 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$453.30 |
$1,511 |
4.4× |
| Us breast unilateral limited (76642) |
$232.20 |
$774 |
2.7× |
| Us chest (76604) |
$264 |
$880 |
2.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$214.20 |
$714 |
2.1× |
| Us ob limited (76815) |
$135.90 |
$453 |
1.3× |
| Us ob transvaginal (76817) |
$422.70 |
$1,409 |
4.1× |
| Us pelvic non ob complete (76856) |
$457.50 |
$1,525 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$354 |
$1,180 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$423.90 |
$1,413 |
4.2× |
| Us retroperitoneal complete (76770) |
$422.70 |
$1,409 |
4.1× |
| Us retroperitoneal limited (76775) |
$422.70 |
$1,409 |
4.1× |
| Us scrotum and contents (76870) |
$425.70 |
$1,419 |
4.2× |
| Us soft tissue head/neck (76536) |
$402.90 |
$1,343 |
4.0× |
| Wrist 2 views (73100) |
$231.60 |
$772 |
2.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$370.80 |
$1,236 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$90.60 |
$302 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$217.80 |
$726 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$192.30 |
$641 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$293.10 |
$977 |
2.9× |
| X-ray exam of femur 2/> (73552) |
$226.20 |
$754 |
2.7× |
| X-ray eye for foreign body (70030) |
$219 |
$730 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$191.10 |
$637 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$127.20 |
$424 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$126.30 |
$421 |
1.5× |
| X-ray leg, infant (73592) |
$320.40 |
$1,068 |
3.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$287.10 |
$957 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$410.40 |
$1,368 |
4.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$318.90 |
$1,063 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$234 |
$780 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$327 |
$1,090 |
3.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$358.80 |
$1,196 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$223.80 |
$746 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$223.80 |
$746 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$225.30 |
$751 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$396.90 |
$1,323 |
3.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$287.40 |
$958 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$204 |
$680 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$192.90 |
$643 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$279 |
$930 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$387.60 |
$1,292 |
3.8× |
| Xr bone length studies (77073) |
$217.80 |
$726 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$395.10 |
$1,317 |
3.9× |
| Xr c-spine 6 or more views (72052) |
$448.80 |
$1,496 |
4.4× |