| Abdomen 2 views (74019) |
$189.76 |
$296.50 |
1.8× |
| Ankle 2 views (73600) |
$239.36 |
$374 |
2.7× |
| Arthrogram elbow (73085) |
$654.72 |
$1,023 |
1.8× |
| Arthrogram hip (73525) |
$654.72 |
$1,023 |
1.8× |
| Arthrogram knee (73580) |
$654.72 |
$1,023 |
1.8× |
| Arthrogram shoulder (73040) |
$654.72 |
$1,023 |
1.8× |
| Arthrogram wrist (73115) |
$654.72 |
$1,023 |
1.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,039.36 |
$1,624 |
2.5× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,100.16 |
$1,719 |
2.7× |
| Bone &/joint imaging whole body (78306) |
$1,360 |
$2,125 |
3.3× |
| Bone age studies (77072) |
$198.40 |
$310 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,007.36 |
$1,574 |
2.4× |
| Bone survey complete (77075) |
$1,118.72 |
$1,748 |
10.4× |
| Bone survey infant (77076) |
$152.32 |
$238 |
1.4× |
| Bowel imaging (78290) |
$861.44 |
$1,346 |
2.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$906.88 |
$1,417 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$172 |
$268.75 |
1.9× |
| Chest 1 view (71045) |
$161.76 |
$252.75 |
1.8× |
| Chest xray 3 views (71047) |
$46.72 |
$73 |
0.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$474.88 |
$742 |
2.6× |
| Clavicle complete (73000) |
$100.96 |
$157.75 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,267.84 |
$1,981 |
11.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,927.20 |
$3,011.25 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,284.80 |
$2,007.50 |
5.2× |
| CT abdomen w contrast (74160) |
$1,626.24 |
$2,541 |
9.0× |
| CT abdomen w wo contrast (74170) |
$1,626.24 |
$2,541 |
9.0× |
| CT abdomen w/o contrast (74150) |
$972.80 |
$1,520 |
9.0× |
| CT angiography upper extremity lt (73206) |
$1,029.92 |
$1,609.25 |
5.7× |
| CT c-spine w/contrast (72126) |
$3,404.16 |
$5,319 |
9.5× |
| CT c-spine w/o contrast (72125) |
$972.80 |
$1,520 |
9.0× |
| CT chest w contrast (71260) |
$1,626.24 |
$2,541 |
9.0× |
| CT chest w/wo contrast (71270) |
$1,626.24 |
$2,541 |
9.0× |
| CT head/brain with contrast (70460) |
$1,544.32 |
$2,413 |
8.5× |
| CT head/brain without and with contrast (70470) |
$1,820.16 |
$2,844 |
10.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$221.12 |
$345.50 |
2.5× |
| CT iac w contrast (70481) |
$1,593.60 |
$2,490 |
8.8× |
| CT limited/localized follow up study (76380) |
$676.48 |
$1,057 |
7.5× |
| CT lower ext w/o (73700) |
$972.80 |
$1,520 |
9.0× |
| CT lower extremity w wo contrast (73702) |
$2,319.36 |
$3,624 |
12.8× |
| CT lower extremity w/contrast material (73701) |
$1,626.24 |
$2,541 |
9.0× |
| CT lumbar spine w/contrast (72132) |
$3,404.16 |
$5,319 |
9.5× |
| CT lumbar spine w/o contrast (72131) |
$972.80 |
$1,520 |
9.0× |
| CT maxillofacial w contrast (70487) |
$1,480.96 |
$2,314 |
8.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,599.36 |
$2,499 |
8.8× |
| CT maxillofacial wo contrast (70486) |
$1,463.68 |
$2,287 |
13.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,761.28 |
$2,752 |
9.7× |
| CT orbits w/o contrast (70480) |
$1,684.80 |
$2,632.50 |
15.6× |
| CT pelvis w/o contrast (72192) |
$972.80 |
$1,520 |
9.0× |
| CT pelvis w/wo contrast (72194) |
$1,761.28 |
$2,752 |
9.7× |
| CT soft tissue neck w contrast (70491) |
$2,122.88 |
$3,317 |
11.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,214.40 |
$3,460 |
12.2× |
| CT soft tissue neck w/o contrast (70490) |
$2,122.88 |
$3,317 |
19.7× |
| CT thoracic spine w/contrast (72129) |
$2,009.60 |
$3,140 |
11.1× |
| CT thoracic spine w/o contrast (72128) |
$972.80 |
$1,520 |
9.0× |
| CT thorax w/o contrast (71250) |
$972.80 |
$1,520 |
9.0× |
| CT upper ext wo (73200) |
$972.80 |
$1,520 |
9.0× |
| CT upper extremity with contrast (73201) |
$3,404.16 |
$5,319 |
9.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,686.40 |
$5,760 |
20.4× |
| Cta Abdomen (74175) |
$1,626.24 |
$2,541 |
9.0× |
| CTA abdomen pelvis (74174) |
$3,404.16 |
$5,319 |
9.5× |
| CTA chest (71275) |
$2,007.68 |
$3,137 |
11.1× |
| Cta Head (70496) |
$2,479.36 |
$3,874 |
13.7× |
| Cta Neck (70498) |
$2,479.36 |
$3,874 |
13.7× |
| Cta Pelvis (72191) |
$1,813.12 |
$2,833 |
10.0× |
| Cystography minimum 3 views rs&i (74430) |
$413.44 |
$646 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$113.92 |
$178 |
1.3× |
| Esophagus (74220) |
$279.04 |
$436 |
1.5× |
| Facial bones min 3 views (70150) |
$339.20 |
$530 |
3.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$855.68 |
$1,337 |
7.9× |
| Fluoroscopy up to 1 hr (76000) |
$42.56 |
$66.50 |
0.2× |
| Foot 2 views (73620) |
$30.40 |
$47.50 |
0.3× |
| Forearm 2 views (73090) |
$130.08 |
$203.25 |
1.4× |
| Hand 2 views (73120) |
$218.24 |
$341 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,176.96 |
$1,839 |
2.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,176.96 |
$1,839 |
2.9× |
| Hysterosalpingogram (74740) |
$663.68 |
$1,037 |
2.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$162.56 |
$254 |
1.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,050.24 |
$1,641 |
1.9× |
| Knee 3 views (73562) |
$225.92 |
$353 |
2.5× |
| Liver & spleen imaging static only (78215) |
$1,466.24 |
$2,291 |
3.6× |
| Lung perf&ventilat diferentl (78598) |
$711.04 |
$1,111 |
1.3× |
| Lymphoscintigraphy (78195) |
$1,057.92 |
$1,653 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,520 |
$5,500 |
4.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,477.76 |
$2,309 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,404.16 |
$5,319 |
9.5× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$172.16 |
$269 |
1.9× |
| MRA head w & w/o contrast (70546) |
$1,776.32 |
$2,775.50 |
4.9× |
| MRA head w/o contrast (70544) |
$2,170.24 |
$3,391 |
8.8× |
| MRA head with contrast (70545) |
$2,664.96 |
$4,164 |
7.4× |
| MRA neck w contrast (70548) |
$2,664.96 |
$4,164 |
7.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,404.16 |
$5,319 |
9.5× |
| MRA neck w/o contrast (70547) |
$2,170.24 |
$3,391 |
8.8× |
| MRI abdomen w contrast (74182) |
$3,404.16 |
$5,319 |
9.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,404.16 |
$5,319 |
9.5× |
| MRI abdomen w/o contrast (74181) |
$2,170.24 |
$3,391 |
8.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,473.44 |
$2,302.25 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,404.16 |
$5,319 |
9.5× |
| MRI c-spine with contrast (72142) |
$3,404.16 |
$5,319 |
9.5× |
| MRI cervical spine w/o contrast (72141) |
$2,170.24 |
$3,391 |
8.8× |
| MRI chest w/o & w/contrast material (71552) |
$3,203.84 |
$5,006 |
8.9× |
| MRI chest w/o contrast (71550) |
$2,664.96 |
$4,164 |
10.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,473.44 |
$2,302.25 |
4.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,404.16 |
$5,319 |
9.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,170.24 |
$3,391 |
8.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,664.96 |
$4,164 |
10.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,742.72 |
$5,848 |
10.4× |
| MRI pelvis w/contrast (72196) |
$3,404.16 |
$5,319 |
9.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,908.64 |
$2,982.25 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$2,170.24 |
$3,391 |
8.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,404.16 |
$5,319 |
9.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,404.16 |
$5,319 |
9.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,404.16 |
$5,319 |
9.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,404.16 |
$5,319 |
9.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,404.16 |
$5,319 |
9.5× |
| MRI temporomandibular joint (70336) |
$2,664.96 |
$4,164 |
10.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,170.24 |
$3,391 |
8.8× |
| MRI up ext w/o contrast (73218) |
$2,170.24 |
$3,391 |
8.8× |
| MRI upper ext joint w/o contrast (73221) |
$2,170.24 |
$3,391 |
8.8× |
| MRI, joint upper extrem combo (73223) |
$3,404.16 |
$5,319 |
9.5× |
| Myelogram Lumbar (72265) |
$404.16 |
$631.50 |
0.5× |
| Neck soft tissue (70360) |
$32.32 |
$50.50 |
0.4× |
| Nm gastric emptying study (78264) |
$1,176.96 |
$1,839 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$111.36 |
$174 |
1.0× |
| Osseous survey limited (77074) |
$330.88 |
$517 |
3.1× |
| Parathyroid Planar Imaging (78070) |
$897.92 |
$1,403 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$32.32 |
$50.50 |
0.3× |
| PET image w/CT, skull-thigh (78815) |
$2,280.64 |
$3,563.50 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$2,292.16 |
$3,581.50 |
1.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,021.44 |
$1,596 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$490.88 |
$767 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$185.76 |
$290.25 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$134.88 |
$210.75 |
1.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$32 |
$50 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$228.16 |
$356.50 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$118.40 |
$185 |
1.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$174.24 |
$272.25 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$140.96 |
$220.25 |
1.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$146.72 |
$229.25 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$298.88 |
$467 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$267.84 |
$418.50 |
2.5× |
| Radex Humerus Minimum 2 Views (73060) |
$149.28 |
$233.25 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$172.16 |
$269 |
1.9× |
| Radex Kne Compl 4/More Views (73564) |
$394.24 |
$616 |
3.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$487.04 |
$761 |
4.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$304 |
$475 |
3.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$158.24 |
$247.25 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$176.48 |
$275.75 |
2.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$158.72 |
$248 |
1.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$371.20 |
$580 |
3.4× |
| Radex Toe Minimum 2 Views (73660) |
$98.56 |
$154 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$239.36 |
$374 |
2.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$249.60 |
$390 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$147.68 |
$230.75 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$57.60 |
$90 |
0.5× |
| Radiologic exam chest 2 views (71046) |
$175.52 |
$274.25 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$712.32 |
$1,113 |
3.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$727.04 |
$1,136 |
4.0× |
| Radiologic examination femur 1 view (73551) |
$162.56 |
$254 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$158.08 |
$247 |
1.8× |
| Ribs bilateral 3 views (71110) |
$35.20 |
$55 |
0.3× |
| Scapula (73010) |
$32.32 |
$50.50 |
0.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$134.27 |
$209.80 |
5.7× |
| Shoulder 1 view (73020) |
$100.16 |
$156.50 |
1.1× |
| Small bowel series (74250) |
$673.92 |
$1,053 |
3.7× |
| Spine thoracic 3 views (72072) |
$488.32 |
$763 |
4.5× |
| Thoracolumbar 2 views (72080) |
$395.52 |
$618 |
4.4× |
| Thyroid imaging w/blood flow (78013) |
$812.80 |
$1,270 |
2.0× |
| Tomogram (76100) |
$369.92 |
$578 |
3.4× |
| Ultrasound breast complete (76641) |
$753.28 |
$1,177 |
7.0× |
| Ultrasound Exam Aaa Screen (76706) |
$654.08 |
$1,022 |
6.1× |
| Ultrasound, abdomen limited (76705) |
$654.08 |
$1,022 |
6.1× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$217.60 |
$340 |
2.4× |
| Unlisted ultrasound procedure (76999) |
$654.08 |
$1,022 |
7.3× |
| Urethrocystogram voiding (74455) |
$558.08 |
$872 |
2.3× |
| Urethrocystography retrograde rs&i (74450) |
$347.52 |
$543 |
1.4× |
| Us chest (76604) |
$611.20 |
$955 |
5.7× |
| Us compl joint r-t w/image documentation (76881) |
$68.80 |
$107.50 |
0.6× |
| Us encephalogram (76506) |
$654.08 |
$1,022 |
6.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$292.48 |
$457 |
2.7× |
| Us ob limited (76815) |
$530.24 |
$828.50 |
4.9× |
| Us ob transvaginal (76817) |
$396.16 |
$619 |
3.7× |
| Us pelvic non ob complete (76856) |
$855.68 |
$1,337 |
7.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$736 |
$1,150 |
6.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$516 |
$806.25 |
4.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$504.80 |
$788.75 |
4.7× |
| Us retroperitoneal complete (76770) |
$654.08 |
$1,022 |
6.1× |
| Us scrotum and contents (76870) |
$654.08 |
$1,022 |
6.1× |
| Us soft tissue head/neck (76536) |
$654.08 |
$1,022 |
6.1× |
| Wrist 2 views (73100) |
$135.84 |
$212.25 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$212.48 |
$332 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,001.60 |
$1,565 |
5.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$129.28 |
$202 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$380.16 |
$594 |
4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$521.60 |
$815 |
4.8× |
| X-ray exam of femur 2/> (73552) |
$193.92 |
$303 |
2.2× |
| X-ray eye for foreign body (70030) |
$254.08 |
$397 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$279.04 |
$436 |
3.1× |
| X-ray IV pyelogram (ivp) (74400) |
$667.20 |
$1,042.50 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$463.36 |
$724 |
5.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$39.04 |
$61 |
0.4× |
| X-ray leg, infant (73592) |
$267.52 |
$418 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$251.68 |
$393.25 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$508.16 |
$794 |
4.7× |
| X-ray nose-rectum child f.b. (76010) |
$61.76 |
$96.50 |
0.7× |
| X-ray retrograde pyelogram (74420) |
$558.08 |
$872 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$40 |
$62.50 |
0.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$371.84 |
$581 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$249.28 |
$389.50 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$380.16 |
$594 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$380.16 |
$594 |
4.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$362.24 |
$566 |
4.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$542.72 |
$848 |
5.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$173.76 |
$271.50 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$143.04 |
$223.50 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$319.36 |
$499 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$25.60 |
$40 |
0.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$574.72 |
$898 |
5.3× |
| Xr bone length studies (77073) |
$321.28 |
$502 |
3.0× |
| Xr c-spine 4 or 5 views (72050) |
$56.96 |
$89 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$531.20 |
$830 |
4.9× |
| Xr chest 4+ views (71048) |
$80 |
$125 |
0.7× |
| Xr urogram antegrade (74425) |
$490.24 |
$766 |
1.4× |