| Abdomen 2 views (74019) |
$332.80 |
$512 |
2.9× |
| Ankle 2 views (73600) |
$349.70 |
$538 |
3.6× |
| Arthrogram hip (73525) |
$781.30 |
$1,202 |
2.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,128.40 |
$1,736 |
2.5× |
| Bone &/joint imaging whole body (78306) |
$1,587.95 |
$2,443 |
3.6× |
| Bone age studies (77072) |
$575.25 |
$885 |
4.9× |
| Bone Imaging 3 Phase (78315) |
$1,693.90 |
$2,606 |
3.8× |
| Bone survey complete (77075) |
$575.25 |
$885 |
4.9× |
| Cervical spine 2 or 3 views (72040) |
$575.25 |
$885 |
5.9× |
| Chest 1 view (71045) |
$380.90 |
$586 |
3.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$547.30 |
$842 |
2.8× |
| Clavicle complete (73000) |
$349.70 |
$538 |
3.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,116.15 |
$7,871 |
13.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,732.60 |
$4,204 |
10.3× |
| CT abdomen w contrast (74160) |
$3,060.20 |
$4,708 |
15.7× |
| CT abdomen w wo contrast (74170) |
$3,426.15 |
$5,271 |
17.5× |
| CT abdomen w/o contrast (74150) |
$1,773.85 |
$2,729 |
15.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,890.25 |
$5,985 |
19.9× |
| CT angiography upper extremity lt (73206) |
$3,890.25 |
$5,985 |
19.9× |
| CT c-spine w/contrast (72126) |
$3,503.50 |
$5,390 |
9.0× |
| CT c-spine w/o contrast (72125) |
$2,126.23 |
$3,271.13 |
18.3× |
| CT chest w contrast (71260) |
$3,060.20 |
$4,708 |
15.7× |
| CT head/brain with contrast (70460) |
$2,093 |
$3,220 |
10.7× |
| CT head/brain without and with contrast (70470) |
$2,929.55 |
$4,507 |
15.0× |
| CT iac w contrast (70481) |
$2,185.30 |
$3,362 |
11.2× |
| CT lower ext w/o (73700) |
$2,087.15 |
$3,211 |
17.9× |
| CT lower extremity w/contrast material (73701) |
$2,093 |
$3,220 |
10.7× |
| CT lumbar spine w/contrast (72132) |
$2,727.40 |
$4,196 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$2,126.23 |
$3,271.13 |
18.3× |
| CT maxillofacial w contrast (70487) |
$2,510.95 |
$3,863 |
12.8× |
| CT maxillofacial wo contrast (70486) |
$2,093 |
$3,220 |
18.0× |
| CT orbits w/o contrast (70480) |
$2,093 |
$3,220 |
18.0× |
| CT pelvis w/o contrast (72192) |
$2,510.95 |
$3,863 |
21.6× |
| CT soft tissue neck w contrast (70491) |
$2,260.70 |
$3,478 |
11.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,547.35 |
$3,919 |
13.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,588.60 |
$2,444 |
13.6× |
| CT thoracic spine w/o contrast (72128) |
$2,910.70 |
$4,478 |
25.0× |
| CT thorax w/o contrast (71250) |
$2,127.87 |
$3,273.65 |
18.3× |
| CT upper ext wo (73200) |
$2,087.15 |
$3,211 |
17.9× |
| CT upper extremity with contrast (73201) |
$2,739.39 |
$4,214.44 |
7.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,890.25 |
$5,985 |
19.9× |
| Cta Abdomen (74175) |
$3,177.20 |
$4,888 |
16.3× |
| CTA abdomen pelvis (74174) |
$4,335.50 |
$6,670 |
11.2× |
| CTA chest (71275) |
$3,643.90 |
$5,606 |
18.6× |
| Cta Head (70496) |
$3,701.10 |
$5,694 |
18.9× |
| Cta Neck (70498) |
$3,701.10 |
$5,694 |
18.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$409.50 |
$630 |
3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$227.50 |
$350 |
2.3× |
| Esophagus (74220) |
$547.30 |
$842 |
2.8× |
| Facial bones min 3 views (70150) |
$575.25 |
$885 |
4.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$478.40 |
$736 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$897.65 |
$1,381 |
3.4× |
| Foot 2 views (73620) |
$349.70 |
$538 |
3.6× |
| Forearm 2 views (73090) |
$349.70 |
$538 |
3.6× |
| Hand 2 views (73120) |
$575.25 |
$885 |
4.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$2,226.90 |
$3,426 |
3.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,115.75 |
$3,255 |
3.5× |
| Knee 3 views (73562) |
$349.70 |
$538 |
3.6× |
| Lymphoscintigraphy (78195) |
$2,069.60 |
$3,184 |
3.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,730 |
$4,200 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,693.95 |
$5,683 |
9.5× |
| MRA head w/o contrast (70544) |
$1,625 |
$2,500 |
6.1× |
| MRA neck w/o contrast (70547) |
$1,625 |
$2,500 |
6.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,693.95 |
$5,683 |
9.5× |
| MRI abdomen w/o contrast (74181) |
$1,885 |
$2,900 |
7.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,577.90 |
$3,966 |
3.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,770 |
$5,800 |
9.7× |
| MRI c-spine with contrast (72142) |
$2,474.55 |
$3,807 |
6.4× |
| MRI cervical spine w/o contrast (72141) |
$1,625 |
$2,500 |
6.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,577.90 |
$3,966 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,770 |
$5,800 |
9.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,885 |
$2,900 |
7.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,770.30 |
$4,262 |
7.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,835 |
$5,900 |
9.9× |
| MRI pelvis w/o contrast (72195) |
$1,885 |
$2,900 |
7.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,860 |
$4,400 |
7.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,693.95 |
$5,683 |
9.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,913.95 |
$4,483 |
7.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,885 |
$2,900 |
7.1× |
| MRI up ext w/o contrast (73218) |
$1,885 |
$2,900 |
7.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,885 |
$2,900 |
7.1× |
| MRI, joint upper extrem combo (73223) |
$3,770 |
$5,800 |
9.7× |
| Myocardial Spect Multiple Studies (78452) |
$3,965 |
$6,100 |
2.7× |
| Neck soft tissue (70360) |
$332.80 |
$512 |
3.4× |
| Nm gastric emptying study (78264) |
$2,218.45 |
$3,413 |
5.0× |
| Pelvis 1 or 2 views (72170) |
$575.25 |
$885 |
4.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$2,107.95 |
$3,243 |
4.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,977.30 |
$3,042 |
3.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$349.70 |
$538 |
3.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$349.70 |
$538 |
3.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$349.70 |
$538 |
3.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$512.85 |
$789 |
4.4× |
| Radex fingr minimum 2 views (73140) |
$349.70 |
$538 |
3.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$349.70 |
$538 |
3.6× |
| Radex Hand Minimum 3 Views (73130) |
$387.40 |
$596 |
4.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$327.60 |
$504 |
3.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$653.25 |
$1,005 |
5.6× |
| Radex Humerus Minimum 2 Views (73060) |
$349.70 |
$538 |
3.6× |
| Radex Kne 1/2 Views (73560) |
$349.70 |
$538 |
3.6× |
| Radex Kne Compl 4/More Views (73564) |
$575.25 |
$885 |
4.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$575.25 |
$885 |
4.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$349.70 |
$538 |
3.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$575.25 |
$885 |
4.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$349.70 |
$538 |
3.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$349.70 |
$538 |
3.6× |
| Radex Toe Minimum 2 Views (73660) |
$349.70 |
$538 |
3.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$349.70 |
$538 |
3.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$332.80 |
$512 |
3.4× |
| Radiologic exam chest 2 views (71046) |
$380.90 |
$586 |
3.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$791.05 |
$1,217 |
4.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$771.55 |
$1,187 |
3.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$349.70 |
$538 |
3.6× |
| Ribs bilateral 3 views (71110) |
$575.25 |
$885 |
4.9× |
| Scapula (73010) |
$349.70 |
$538 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$60.45 |
$93 |
2.6× |
| Shoulder 1 view (73020) |
$349.70 |
$538 |
3.6× |
| Small bowel series (74250) |
$547.30 |
$842 |
2.8× |
| Spine thoracic 3 views (72072) |
$575.25 |
$885 |
4.9× |
| Thoracolumbar 2 views (72080) |
$349.70 |
$538 |
3.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,235 |
$1,900 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$583.05 |
$897 |
5.0× |
| Ultrasound, abdomen limited (76705) |
$759.85 |
$1,169 |
6.5× |
| Urethrocystogram voiding (74455) |
$839.15 |
$1,291 |
3.2× |
| Us breast unilateral limited (76642) |
$653.25 |
$1,005 |
6.7× |
| Us chest (76604) |
$728.65 |
$1,121 |
6.3× |
| Us encephalogram (76506) |
$759.85 |
$1,169 |
6.5× |
| Us hips infant static (76886) |
$368.55 |
$567 |
3.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$668.85 |
$1,029 |
5.7× |
| Us ob limited (76815) |
$416 |
$640 |
3.6× |
| Us ob transvaginal (76817) |
$707.20 |
$1,088 |
6.1× |
| Us pelvic non ob complete (76856) |
$768.95 |
$1,183 |
6.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,045.20 |
$1,608 |
9.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$919.10 |
$1,414 |
7.9× |
| Us retroperitoneal complete (76770) |
$979.55 |
$1,507 |
8.4× |
| Us scrotum and contents (76870) |
$626.66 |
$964.09 |
5.4× |
| Us soft tissue head/neck (76536) |
$759.85 |
$1,169 |
6.5× |
| Us spinal canal and contents (76800) |
$323.70 |
$498 |
2.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$581.10 |
$894 |
5.0× |
| Wrist 2 views (73100) |
$349.70 |
$538 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$547.30 |
$842 |
4.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$253.50 |
$390 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,041.95 |
$1,603 |
5.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$349.70 |
$538 |
3.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$598.65 |
$921 |
6.2× |
| X-ray exam of femur 2/> (73552) |
$723.45 |
$1,113 |
7.5× |
| X-ray eye for foreign body (70030) |
$332.80 |
$512 |
3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$349.70 |
$538 |
3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$349.70 |
$538 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$575.25 |
$885 |
4.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$575.25 |
$885 |
4.9× |
| X-ray nose-rectum child f.b. (76010) |
$1,041.95 |
$1,603 |
10.7× |
| X-ray retrograde pyelogram (74420) |
$1,905.15 |
$2,931 |
4.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$349.70 |
$538 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$575.25 |
$885 |
4.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$575.25 |
$885 |
4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$575.25 |
$885 |
4.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$349.70 |
$538 |
3.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$349.70 |
$538 |
3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$575.25 |
$885 |
4.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$575.25 |
$885 |
4.9× |
| Xr c-spine 4 or 5 views (72050) |
$575.25 |
$885 |
4.9× |
| Xr c-spine 6 or more views (72052) |
$575.25 |
$885 |
4.9× |
| Xr urogram antegrade (74425) |
$1,473.55 |
$2,267 |
3.8× |