| Abdomen 2 views (74019) |
$242 |
$302.50 |
2.4× |
| Acute gi blood loss imaging (78278) |
$810.40 |
$1,013 |
2.1× |
| Ankle 2 views (73600) |
$196.80 |
$246 |
2.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$810.40 |
$1,013 |
2.1× |
| Bone &/joint imaging whole body (78306) |
$810.40 |
$1,013 |
2.1× |
| Bone age studies (77072) |
$210.80 |
$263.50 |
2.1× |
| Bone Imaging 3 Phase (78315) |
$810.40 |
$1,013 |
2.1× |
| Bone survey complete (77075) |
$242 |
$302.50 |
2.4× |
| Bone survey infant (77076) |
$440 |
$550 |
4.4× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,164.80 |
$1,456 |
3.0× |
| Cervical spine 2 or 3 views (72040) |
$196.80 |
$246 |
2.4× |
| Chest 1 view (71045) |
$201.60 |
$252 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$406.80 |
$508.50 |
2.4× |
| Clavicle complete (73000) |
$201.60 |
$252 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$192 |
$240 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,566.40 |
$1,958 |
4.7× |
| CT abdomen and pelvis without contrast (74176) |
$956.40 |
$1,195.50 |
4.2× |
| CT abdomen w contrast (74160) |
$748 |
$935 |
4.4× |
| CT abdomen w wo contrast (74170) |
$748 |
$935 |
4.4× |
| CT abdomen w/o contrast (74150) |
$460.40 |
$575.50 |
4.6× |
| CT angio hrt w/3d image (75574) |
$402.40 |
$503 |
1.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$897.60 |
$1,122 |
5.3× |
| CT angiography upper extremity lt (73206) |
$748 |
$935 |
4.4× |
| CT c-spine w/contrast (72126) |
$1,711.20 |
$2,139 |
5.1× |
| CT c-spine w/o contrast (72125) |
$1,467.20 |
$1,834 |
14.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,750.40 |
$2,188 |
10.4× |
| CT chest w contrast (71260) |
$1,632.80 |
$2,041 |
9.7× |
| CT chest w/wo contrast (71270) |
$748 |
$935 |
4.4× |
| CT head/brain with contrast (70460) |
$778.40 |
$973 |
4.6× |
| CT head/brain without and with contrast (70470) |
$798 |
$997.50 |
4.7× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$165.60 |
$207 |
2.0× |
| CT iac w contrast (70481) |
$778.40 |
$973 |
4.6× |
| CT lower ext w/o (73700) |
$472 |
$590 |
4.7× |
| CT lower extremity w wo contrast (73702) |
$748 |
$935 |
4.4× |
| CT lower extremity w/contrast material (73701) |
$766.40 |
$958 |
4.6× |
| CT lumbar spine w & w/o contrast (72133) |
$729.60 |
$912 |
4.3× |
| CT lumbar spine w/contrast (72132) |
$1,528 |
$1,910 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$1,194.80 |
$1,493.50 |
11.9× |
| CT maxillofacial w contrast (70487) |
$798 |
$997.50 |
4.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,566.40 |
$1,958 |
9.3× |
| CT maxillofacial wo contrast (70486) |
$490.40 |
$613 |
4.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,460.80 |
$1,826 |
8.7× |
| CT orbits w/o contrast (70480) |
$490.40 |
$613 |
4.9× |
| CT pelvis w/o contrast (72192) |
$460.40 |
$575.50 |
4.6× |
| CT pelvis w/wo contrast (72194) |
$2,266.40 |
$2,833 |
13.5× |
| CT scan of arm combo (73202) |
$748 |
$935 |
4.4× |
| CT soft tissue neck w contrast (70491) |
$798 |
$997.50 |
4.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$798 |
$997.50 |
4.7× |
| CT soft tissue neck w/o contrast (70490) |
$490.40 |
$613 |
4.9× |
| CT thoracic spine w/contrast (72129) |
$729.60 |
$912 |
4.3× |
| CT thoracic spine w/o contrast (72128) |
$460.40 |
$575.50 |
4.6× |
| CT thoracic spine w/wo contrast (72130) |
$729.60 |
$912 |
4.3× |
| CT thorax w/o contrast (71250) |
$1,408 |
$1,760 |
14.0× |
| CT upper ext wo (73200) |
$460.40 |
$575.50 |
4.6× |
| CT upper extremity with contrast (73201) |
$1,604.80 |
$2,006 |
4.8× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$748 |
$935 |
4.4× |
| Cta Abdomen (74175) |
$729.60 |
$912 |
4.3× |
| CTA abdomen pelvis (74174) |
$1,566.40 |
$1,958 |
4.7× |
| CTA chest (71275) |
$1,957.60 |
$2,447 |
11.6× |
| Cta Head (70496) |
$798 |
$997.50 |
4.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,104 |
$2,630 |
6.3× |
| Cta Neck (70498) |
$798 |
$997.50 |
4.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$253.60 |
$317 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$132 |
$165 |
1.6× |
| Echo exam of eye (76529) |
$145.60 |
$182 |
1.7× |
| Esophagus (74220) |
$280.80 |
$351 |
1.7× |
| Facial bones min 3 views (70150) |
$242 |
$302.50 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$491.20 |
$614 |
2.1× |
| Foot 2 views (73620) |
$196.80 |
$246 |
2.4× |
| Forearm 2 views (73090) |
$196.80 |
$246 |
2.4× |
| Hand 2 views (73120) |
$242 |
$302.50 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,064.40 |
$1,330.50 |
2.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$665.20 |
$831.50 |
1.7× |
| Hysterosalpingogram (74740) |
$467.20 |
$584 |
2.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,054.80 |
$1,318.50 |
2.0× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,038.40 |
$1,298 |
2.0× |
| Knee 3 views (73562) |
$201.60 |
$252 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,763.60 |
$3,454.50 |
3.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,512.80 |
$1,891 |
4.5× |
| MRA head w & w/o contrast (70546) |
$2,552.80 |
$3,191 |
7.6× |
| MRA head w/o contrast (70544) |
$946.40 |
$1,183 |
4.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,512.80 |
$1,891 |
4.5× |
| MRA neck w/o contrast (70547) |
$923.20 |
$1,154 |
4.0× |
| MRI abdomen w contrast (74182) |
$2,206.40 |
$2,758 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$946.40 |
$1,183 |
4.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,696 |
$3,370 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI c-spine with contrast (72142) |
$2,733.60 |
$3,417 |
8.2× |
| MRI cervical spine w/o contrast (72141) |
$946.40 |
$1,183 |
4.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,512.80 |
$1,891 |
4.5× |
| MRI chest w/o contrast (71550) |
$923.20 |
$1,154 |
4.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$946.40 |
$1,183 |
4.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,680.80 |
$2,101 |
7.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$946.40 |
$1,183 |
4.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,292.80 |
$2,866 |
6.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,550.80 |
$1,938.50 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$946.40 |
$1,183 |
4.1× |
| MRI up ext w/o contrast (73218) |
$946.40 |
$1,183 |
4.1× |
| MRI upper ext joint w/o contrast (73221) |
$946.40 |
$1,183 |
4.1× |
| MRI, joint upper extrem combo (73223) |
$1,550.80 |
$1,938.50 |
4.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,869.20 |
$3,586.50 |
2.3× |
| N-invas est c ffr sw aly CTA (75580) |
$2,056 |
$2,570 |
2.5× |
| Neck soft tissue (70360) |
$196.80 |
$246 |
2.4× |
| Nm gastric emptying study (78264) |
$830.80 |
$1,038.50 |
2.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,109.60 |
$1,387 |
2.1× |
| Parathyroid Planar Imaging (78070) |
$830.80 |
$1,038.50 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$242 |
$302.50 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$3,172.80 |
$3,966 |
2.3× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,138.40 |
$1,423 |
2.2× |
| Quan&charac c atherosclerotc plaq asses sev c ds (75577) |
$1,425.60 |
$1,782 |
1.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$201.60 |
$252 |
2.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$196.80 |
$246 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$196.80 |
$246 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$196.80 |
$246 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$173.60 |
$217 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$196.80 |
$246 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$201.60 |
$252 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$201.60 |
$252 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$196.80 |
$246 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$242 |
$302.50 |
2.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$242 |
$302.50 |
2.4× |
| Radex Humerus Minimum 2 Views (73060) |
$196.80 |
$246 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$201.60 |
$252 |
2.4× |
| Radex Kne Compl 4/More Views (73564) |
$248 |
$310 |
2.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$242 |
$302.50 |
2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$196.80 |
$246 |
2.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$242 |
$302.50 |
2.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$201.60 |
$252 |
2.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$196.80 |
$246 |
2.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$164.80 |
$206 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$136 |
$170 |
1.6× |
| Radex Toe Minimum 2 Views (73660) |
$196.80 |
$246 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$160 |
$200 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$201.60 |
$252 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$164.80 |
$206 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$196.80 |
$246 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$196 |
$245 |
2.0× |
| Radiologic exam chest 2 views (71046) |
$196.80 |
$246 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$406.80 |
$508.50 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$406.80 |
$508.50 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$406.80 |
$508.50 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$280.80 |
$351 |
1.7× |
| Radiologic examination femur 1 view (73551) |
$201.60 |
$252 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$201.60 |
$252 |
2.4× |
| Ribs bilateral 3 views (71110) |
$248 |
$310 |
2.5× |
| Scapula (73010) |
$242 |
$302.50 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$68.80 |
$86 |
2.9× |
| Shoulder 1 view (73020) |
$201.60 |
$252 |
2.4× |
| Small bowel series (74250) |
$406.80 |
$508.50 |
2.4× |
| Spine thoracic 3 views (72072) |
$242 |
$302.50 |
2.4× |
| Thoracolumbar 2 views (72080) |
$196.80 |
$246 |
2.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$830.80 |
$1,038.50 |
2.2× |
| Ultrasound breast complete (76641) |
$260 |
$325 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$253.60 |
$317 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$251.20 |
$314 |
2.5× |
| Us breast unilateral limited (76642) |
$134.40 |
$168 |
1.6× |
| Us chest (76604) |
$247.20 |
$309 |
2.5× |
| Us elastography parenchyma (76981) |
$251.20 |
$314 |
2.5× |
| Us hips infant static (76886) |
$180.40 |
$225.50 |
2.2× |
| Us infant hips w manipulation (76885) |
$176 |
$220 |
2.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$260 |
$325 |
2.6× |
| Us ob limited (76815) |
$304 |
$380 |
3.0× |
| Us pelvic non ob complete (76856) |
$253.60 |
$317 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$253.60 |
$317 |
2.5× |
| Us retroperitoneal complete (76770) |
$253.60 |
$317 |
2.5× |
| Us retroperitoneal limited (76775) |
$260 |
$325 |
2.6× |
| Us scrotum and contents (76870) |
$253.60 |
$317 |
2.5× |
| Us soft tissue head/neck (76536) |
$253.60 |
$317 |
2.5× |
| Us spinal canal and contents (76800) |
$260 |
$325 |
2.6× |
| Us transrectal (76872) |
$247.20 |
$309 |
2.5× |
| Us, eye b-scan (76512) |
$324.80 |
$406 |
3.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$253.60 |
$317 |
2.5× |
| Wrist 2 views (73100) |
$196.80 |
$246 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$242 |
$302.50 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$288 |
$360 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$196.80 |
$246 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$196.80 |
$246 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$242 |
$302.50 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$196.80 |
$246 |
2.4× |
| X-ray eye for foreign body (70030) |
$201.60 |
$252 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196.80 |
$246 |
2.4× |
| X-ray leg, infant (73592) |
$292.80 |
$366 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$169.20 |
$211.50 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$164.80 |
$206 |
1.6× |
| X-ray nose-rectum child f.b. (76010) |
$192 |
$240 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$178 |
$222.50 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$196.80 |
$246 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$242 |
$302.50 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$242 |
$302.50 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$242 |
$302.50 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$196.80 |
$246 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$196.80 |
$246 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$242 |
$302.50 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$248 |
$310 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$133.20 |
$166.50 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$196.80 |
$246 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$196.80 |
$246 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$242 |
$302.50 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$236 |
$295 |
2.4× |
| Xr bone length studies (77073) |
$178 |
$222.50 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$242 |
$302.50 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$242 |
$302.50 |
2.4× |
| Xr chest 4+ views (71048) |
$160.80 |
$201 |
1.6× |