| Abdomen 2 views (74019) |
$262.60 |
$404 |
2.4× |
| Ankle 2 views (73600) |
$213.85 |
$329 |
2.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$649.35 |
$999 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$1,326 |
$2,040 |
3.2× |
| Bone age studies (77072) |
$213.85 |
$329 |
2.0× |
| Bone Imaging 3 Phase (78315) |
$1,413.10 |
$2,174 |
3.4× |
| Bone survey complete (77075) |
$2,400.45 |
$3,693 |
22.2× |
| Bone survey infant (77076) |
$325 |
$500 |
3.0× |
| Bowel imaging (78290) |
$841.10 |
$1,294 |
2.0× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$3,917.55 |
$6,027 |
2.7× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,073.15 |
$1,651 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$249.60 |
$384 |
2.8× |
| Chest 1 view (71045) |
$210.60 |
$324 |
2.3× |
| Chest xray 3 views (71047) |
$267.15 |
$411 |
3.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$352.95 |
$543 |
1.9× |
| Clavicle complete (73000) |
$211.25 |
$325 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,200.55 |
$1,847 |
11.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,183.70 |
$4,898 |
8.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,378.35 |
$3,659 |
9.7× |
| CT abdomen w contrast (74160) |
$1,361.75 |
$2,095 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,602.90 |
$2,466 |
8.9× |
| CT abdomen w/o contrast (74150) |
$1,200.55 |
$1,847 |
11.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,668.55 |
$2,567 |
9.2× |
| CT angiography upper extremity lt (73206) |
$1,668.55 |
$2,567 |
9.2× |
| CT c-spine w/contrast (72126) |
$1,361.75 |
$2,095 |
3.8× |
| CT c-spine w/o contrast (72125) |
$1,200.55 |
$1,847 |
11.1× |
| CT chest w contrast (71260) |
$1,361.75 |
$2,095 |
7.5× |
| CT chest w/wo contrast (71270) |
$1,654.90 |
$2,546 |
9.1× |
| CT head/brain with contrast (70460) |
$1,361.75 |
$2,095 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,602.90 |
$2,466 |
8.9× |
| CT iac w contrast (70481) |
$1,361.75 |
$2,095 |
7.5× |
| CT lower ext w/o (73700) |
$1,200.55 |
$1,847 |
11.1× |
| CT lower extremity w wo contrast (73702) |
$1,602.90 |
$2,466 |
8.9× |
| CT lower extremity w/contrast material (73701) |
$1,361.75 |
$2,095 |
7.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,361.75 |
$2,095 |
7.5× |
| CT lumbar spine w/contrast (72132) |
$1,361.75 |
$2,095 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,200.55 |
$1,847 |
11.1× |
| CT maxillofacial w contrast (70487) |
$1,361.75 |
$2,095 |
7.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,602.90 |
$2,466 |
8.9× |
| CT maxillofacial wo contrast (70486) |
$1,200.55 |
$1,847 |
11.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,602.90 |
$2,466 |
8.9× |
| CT orbits w/o contrast (70480) |
$1,200.55 |
$1,847 |
11.1× |
| CT pelvis w/o contrast (72192) |
$1,200.55 |
$1,847 |
11.1× |
| CT pelvis w/wo contrast (72194) |
$1,361.75 |
$2,095 |
7.5× |
| CT scan of arm combo (73202) |
$1,602.90 |
$2,466 |
8.9× |
| CT soft tissue neck w contrast (70491) |
$1,361.75 |
$2,095 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,602.90 |
$2,466 |
8.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,200.55 |
$1,847 |
11.1× |
| CT thoracic spine w/contrast (72129) |
$1,361.75 |
$2,095 |
7.5× |
| CT thoracic spine w/o contrast (72128) |
$1,200.55 |
$1,847 |
11.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,361.75 |
$2,095 |
7.5× |
| CT thorax w/o contrast (71250) |
$1,200.55 |
$1,847 |
11.1× |
| CT upper ext wo (73200) |
$1,200.55 |
$1,847 |
11.1× |
| CT upper extremity with contrast (73201) |
$1,361.75 |
$2,095 |
3.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,183.70 |
$4,898 |
17.6× |
| Cta Abdomen (74175) |
$1,668.55 |
$2,567 |
9.2× |
| CTA abdomen pelvis (74174) |
$3,183.70 |
$4,898 |
8.8× |
| CTA chest (71275) |
$1,668.55 |
$2,567 |
9.2× |
| Cta Head (70496) |
$1,668.55 |
$2,567 |
9.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,183.70 |
$4,898 |
8.8× |
| Cta Neck (70498) |
$1,668.55 |
$2,567 |
9.2× |
| Cta Pelvis (72191) |
$1,668.55 |
$2,567 |
9.2× |
| Cystography minimum 3 views rs&i (74430) |
$283.40 |
$436 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$484.90 |
$746 |
4.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$484.90 |
$746 |
5.4× |
| Esophagus (74220) |
$339.30 |
$522 |
1.9× |
| Facial bones min 3 views (70150) |
$298.35 |
$459 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$533.65 |
$821 |
4.9× |
| Fluoroscopy up to 1 hr (76000) |
$149.50 |
$230 |
0.6× |
| Foot 2 views (73620) |
$211.25 |
$325 |
2.4× |
| Forearm 2 views (73090) |
$211.25 |
$325 |
2.4× |
| Hand 2 views (73120) |
$211.25 |
$325 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,396.85 |
$2,149 |
2.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,396.85 |
$2,149 |
3.4× |
| Hysterosalpingogram (74740) |
$253.50 |
$390 |
1.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$119.92 |
$184.50 |
1.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,454.70 |
$2,238 |
2.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,411.15 |
$2,171 |
2.5× |
| Knee 3 views (73562) |
$247 |
$380 |
2.7× |
| Lymphoscintigraphy (78195) |
$845 |
$1,300 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,833.65 |
$2,821 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,833.65 |
$2,821 |
5.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,388.10 |
$3,674 |
6.6× |
| MRA head w & w/o contrast (70546) |
$2,388.10 |
$3,674 |
6.6× |
| MRA head w/o contrast (70544) |
$1,833.65 |
$2,821 |
7.4× |
| MRA head with contrast (70545) |
$1,833.65 |
$2,821 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,388.10 |
$3,674 |
6.6× |
| MRA neck w/o contrast (70547) |
$1,833.65 |
$2,821 |
7.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,388.10 |
$3,674 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,833.65 |
$2,821 |
7.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,833.65 |
$2,821 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,388.10 |
$3,674 |
6.6× |
| MRI c-spine with contrast (72142) |
$1,833.65 |
$2,821 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,833.65 |
$2,821 |
7.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,388.10 |
$3,674 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,833.65 |
$2,821 |
7.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,833.65 |
$2,821 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,388.10 |
$3,674 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,833.65 |
$2,821 |
7.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,833.65 |
$2,821 |
7.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,388.10 |
$3,674 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,388.10 |
$3,674 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,833.65 |
$2,821 |
7.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,388.10 |
$3,674 |
6.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,833.65 |
$2,821 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,388.10 |
$3,674 |
6.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,388.10 |
$3,674 |
6.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,833.65 |
$2,821 |
7.4× |
| MRI up ext w/o contrast (73218) |
$1,833.65 |
$2,821 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,833.65 |
$2,821 |
7.4× |
| MRI, joint upper extrem combo (73223) |
$2,388.10 |
$3,674 |
6.6× |
| Myocardial Spect Multiple Studies (78452) |
$3,131.70 |
$4,818 |
2.3× |
| Myocardial spect single study at rest or stress (78451) |
$3,004.95 |
$4,623 |
2.2× |
| Neck soft tissue (70360) |
$211.25 |
$325 |
2.4× |
| Nm gastric emptying study (78264) |
$1,296.10 |
$1,994 |
3.1× |
| Parathyroid Planar Imaging (78070) |
$968.50 |
$1,490 |
2.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$968.50 |
$1,490 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$227.50 |
$350 |
2.1× |
| PET image w/CT, skull-thigh (78815) |
$3,878.88 |
$5,967.50 |
2.6× |
| PET imaging for CT attenuation whole body (78816) |
$4,460.95 |
$6,863 |
3.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,599 |
$2,460 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$230.10 |
$354 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$211.25 |
$325 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$268.45 |
$413 |
3.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$185.90 |
$286 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$298.35 |
$459 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$212.55 |
$327 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$227.50 |
$350 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$211.25 |
$325 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$211.25 |
$325 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$453.05 |
$697 |
4.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$475.15 |
$731 |
4.4× |
| Radex Humerus Minimum 2 Views (73060) |
$213.85 |
$329 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$227.50 |
$350 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$268.45 |
$413 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$306.15 |
$471 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$227.50 |
$350 |
2.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$230.10 |
$354 |
2.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$230.10 |
$354 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$247 |
$380 |
2.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$295.75 |
$455 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$99.45 |
$153 |
1.1× |
| Radex Toe Minimum 2 Views (73660) |
$212.55 |
$327 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$220.35 |
$339 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$213.85 |
$329 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$228.80 |
$352 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$297.05 |
$457 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$274.30 |
$422 |
3.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$249.60 |
$384 |
2.8× |
| Radiological examination surgical specimen (76098) |
$101.40 |
$156 |
0.2× |
| Ribs bilateral 3 views (71110) |
$266.50 |
$410 |
2.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$115.70 |
$178 |
0.3× |
| Scapula (73010) |
$230.10 |
$354 |
2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$42.58 |
$65.50 |
1.8× |
| Shoulder 1 view (73020) |
$105.95 |
$163 |
1.2× |
| Small bowel series (74250) |
$323.05 |
$497 |
1.8× |
| Spine thoracic 3 views (72072) |
$298.35 |
$459 |
2.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,134.90 |
$1,746 |
2.8× |
| Ultrasound breast complete (76641) |
$453.70 |
$698 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$730.60 |
$1,124 |
6.8× |
| Ultrasound, abdomen limited (76705) |
$653.90 |
$1,006 |
6.1× |
| Umbilical-artery Doppler (OB) (76820) |
$299.65 |
$461 |
2.8× |
| Urethrocystography retrograde rs&i (74450) |
$53.95 |
$83 |
0.2× |
| Us breast unilateral limited (76642) |
$449.80 |
$692 |
5.0× |
| Us chest (76604) |
$537.55 |
$827 |
5.0× |
| Us compl joint r-t w/image documentation (76881) |
$533.65 |
$821 |
4.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$288.60 |
$444 |
2.7× |
| Us ob limited (76815) |
$472.55 |
$727 |
4.4× |
| Us ob transvaginal (76817) |
$547.30 |
$842 |
5.1× |
| Us pelvic non ob complete (76856) |
$599.95 |
$923 |
5.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$471.58 |
$725.50 |
4.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$605.80 |
$932 |
5.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$472.55 |
$727 |
4.4× |
| Us retroperitoneal complete (76770) |
$730.60 |
$1,124 |
6.8× |
| Us retroperitoneal limited (76775) |
$639.60 |
$984 |
5.9× |
| Us scrotum and contents (76870) |
$592.80 |
$912 |
5.5× |
| Us soft tissue head/neck (76536) |
$562.90 |
$866 |
5.2× |
| Us transrectal (76872) |
$394.55 |
$607 |
3.7× |
| Us,transplanted kidney, real time/ doppler (76776) |
$481 |
$740 |
4.5× |
| Wrist 2 views (73100) |
$211.25 |
$325 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$227.50 |
$350 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$211.25 |
$325 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$249.60 |
$384 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$475.15 |
$731 |
4.4× |
| X-ray exam of femur 2/> (73552) |
$230.10 |
$354 |
2.6× |
| X-ray eye for foreign body (70030) |
$105.95 |
$163 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$240.50 |
$370 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$247 |
$380 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$186.55 |
$287 |
2.1× |
| X-ray leg, infant (73592) |
$230.10 |
$354 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$295.75 |
$455 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$418.60 |
$644 |
3.9× |
| X-ray nose-rectum child f.b. (76010) |
$172.90 |
$266 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$268.45 |
$413 |
2.5× |
| X-ray retrograde pyelogram (74420) |
$369.20 |
$568 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$239.85 |
$369 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$270.40 |
$416 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$319.80 |
$492 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$294.45 |
$453 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$230.10 |
$354 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$284.70 |
$438 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$287.30 |
$442 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$284.70 |
$438 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$184.60 |
$284 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$230.10 |
$354 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$230.10 |
$354 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$213.85 |
$329 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$287.30 |
$442 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$287.30 |
$442 |
2.7× |