| Abdomen 2 views (74019) |
$329.47 |
$541 |
2.9× |
| Acute gi blood loss imaging (78278) |
$1,180.85 |
$1,939 |
2.7× |
| Ankle 2 views (73600) |
$266.74 |
$438 |
2.8× |
| Arthrogram hip (73525) |
$562.11 |
$923 |
1.5× |
| Arthrogram shoulder (73040) |
$562.72 |
$924 |
1.5× |
| Arthrogram wrist (73115) |
$526.79 |
$865 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$876.96 |
$1,440 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$1,272.81 |
$2,090 |
3.0× |
| Bone age studies (77072) |
$109.01 |
$179 |
1.0× |
| Bone Imaging 3 Phase (78315) |
$1,202.17 |
$1,974 |
2.8× |
| Bone survey complete (77075) |
$109.01 |
$179 |
1.0× |
| Bone survey infant (77076) |
$430.56 |
$707 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$309.98 |
$509 |
3.3× |
| Chest 1 view (71045) |
$279.53 |
$459 |
3.0× |
| Chest xray 3 views (71047) |
$222.29 |
$365 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$390.98 |
$642 |
2.1× |
| Clavicle complete (73000) |
$266.74 |
$438 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$101.70 |
$167 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,217.37 |
$3,641 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,895.21 |
$3,112 |
7.4× |
| CT abdomen w contrast (74160) |
$1,579.75 |
$2,594 |
8.4× |
| CT abdomen w wo contrast (74170) |
$1,760.62 |
$2,891 |
9.3× |
| CT abdomen w/o contrast (74150) |
$1,420.80 |
$2,333 |
12.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,250.26 |
$3,695 |
11.9× |
| CT c-spine w/contrast (72126) |
$1,789.24 |
$2,938 |
4.8× |
| CT c-spine w/o contrast (72125) |
$1,342.85 |
$2,205 |
11.9× |
| CT chest w contrast (71260) |
$1,633.34 |
$2,682 |
8.6× |
| CT chest w/wo contrast (71270) |
$1,696.67 |
$2,786 |
9.0× |
| CT colonography screening (74263) |
$873.31 |
$1,434 |
3.4× |
| CT colonography w/o cntrst (74261) |
$873.31 |
$1,434 |
7.8× |
| CT head/brain with contrast (70460) |
$1,214.96 |
$1,995 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,529.20 |
$2,511 |
8.1× |
| CT iac w contrast (70481) |
$675.99 |
$1,110 |
3.6× |
| CT limited/localized follow up study (76380) |
$566.98 |
$931 |
6.0× |
| CT lower ext w/o (73700) |
$1,387.91 |
$2,279 |
12.3× |
| CT lower extremity w wo contrast (73702) |
$1,568.78 |
$2,576 |
8.3× |
| CT lower extremity w/contrast material (73701) |
$1,343.45 |
$2,206 |
7.1× |
| CT lumbar spine w/contrast (72132) |
$1,422.02 |
$2,335 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,502.40 |
$2,467 |
13.3× |
| CT maxillofacial w contrast (70487) |
$1,406.18 |
$2,309 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,490.22 |
$2,447 |
7.9× |
| CT maxillofacial wo contrast (70486) |
$1,300.82 |
$2,136 |
11.6× |
| CT orbits w/o contrast (70480) |
$632.75 |
$1,039 |
5.6× |
| CT pelvis w/o contrast (72192) |
$1,406.18 |
$2,309 |
12.5× |
| CT pelvis w/wo contrast (72194) |
$1,543.21 |
$2,534 |
8.2× |
| CT scan of arm combo (73202) |
$1,568.78 |
$2,576 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$1,343.45 |
$2,206 |
7.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,453.07 |
$2,386 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,158.93 |
$1,903 |
10.3× |
| CT thoracic spine w/o contrast (72128) |
$1,343.45 |
$2,206 |
11.9× |
| CT thorax w/o contrast (71250) |
$1,406.18 |
$2,309 |
12.5× |
| CT upper ext wo (73200) |
$1,387.91 |
$2,279 |
12.3× |
| CT upper extremity with contrast (73201) |
$1,365.99 |
$2,243 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,784.37 |
$2,930 |
9.4× |
| Cta Abdomen (74175) |
$1,390.35 |
$2,283 |
7.4× |
| CTA abdomen pelvis (74174) |
$1,909.22 |
$3,135 |
5.1× |
| CTA chest (71275) |
$1,920.18 |
$3,153 |
10.2× |
| Cta Head (70496) |
$1,571.22 |
$2,580 |
8.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,779.50 |
$2,922 |
4.7× |
| Cta Neck (70498) |
$1,543.21 |
$2,534 |
8.2× |
| Cta Pelvis (72191) |
$1,089.50 |
$1,789 |
5.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$246.04 |
$404 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$187.57 |
$308 |
2.0× |
| Dxa bone density study axial skeleton (77085) |
$111.45 |
$183 |
1.0× |
| Esophagus (74220) |
$443.96 |
$729 |
2.3× |
| Facial bones min 3 views (70150) |
$329.47 |
$541 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$652.85 |
$1,072 |
5.8× |
| Fluoroscopy up to 1 hr (76000) |
$233.25 |
$383 |
0.9× |
| Foot 2 views (73620) |
$266.74 |
$438 |
2.8× |
| Forearm 2 views (73090) |
$279.53 |
$459 |
3.0× |
| Hand 2 views (73120) |
$236.29 |
$388 |
2.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,116.91 |
$1,834 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$161.39 |
$265 |
1.4× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$538.36 |
$884 |
0.9× |
| Knee 3 views (73562) |
$261.87 |
$430 |
2.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,668.66 |
$2,740 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,777.04 |
$4,560 |
7.4× |
| MRA head w & w/o contrast (70546) |
$2,245.99 |
$3,688 |
6.0× |
| MRA head w/o contrast (70544) |
$2,140.03 |
$3,514 |
8.3× |
| MRA neck w contrast (70548) |
$2,140.03 |
$3,514 |
5.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,777.65 |
$4,561 |
7.4× |
| MRA neck w/o contrast (70547) |
$2,140.03 |
$3,514 |
8.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,971.92 |
$4,880 |
7.9× |
| MRI abdomen w/o contrast (74181) |
$2,140.03 |
$3,514 |
8.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,668.66 |
$2,740 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,425.65 |
$3,983 |
6.5× |
| MRI c-spine with contrast (72142) |
$2,140.03 |
$3,514 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$2,140.03 |
$3,514 |
8.3× |
| MRI chest w/o & w/contrast material (71552) |
$2,777.04 |
$4,560 |
7.4× |
| MRI chest w/o contrast (71550) |
$2,140.03 |
$3,514 |
8.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,971.92 |
$4,880 |
7.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,668.66 |
$2,740 |
6.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,140.03 |
$3,514 |
8.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,777.04 |
$4,560 |
7.4× |
| MRI pelvis w/contrast (72196) |
$2,140.03 |
$3,514 |
5.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,777.04 |
$4,560 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$2,140.03 |
$3,514 |
8.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,140.03 |
$3,514 |
5.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,140.03 |
$3,514 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,140.03 |
$3,514 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,140.03 |
$3,514 |
5.7× |
| MRI temporomandibular joint (70336) |
$2,140.03 |
$3,514 |
8.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,140.03 |
$3,514 |
8.3× |
| MRI up ext w/o contrast (73218) |
$1,668.66 |
$2,740 |
6.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,668.66 |
$2,740 |
6.5× |
| MRI, joint upper extrem combo (73223) |
$2,594.95 |
$4,261 |
6.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,405.57 |
$2,308 |
1.0× |
| Neck soft tissue (70360) |
$233.25 |
$383 |
2.5× |
| Nm gastric emptying study (78264) |
$910.46 |
$1,495 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$266.74 |
$438 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$2,946.95 |
$4,839 |
1.9× |
| PET imaging for CT attenuation whole body (78816) |
$2,950.61 |
$4,845 |
1.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$286.84 |
$471 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$236.29 |
$388 |
2.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$329.47 |
$541 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$266.74 |
$438 |
2.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$286.84 |
$471 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$286.84 |
$471 |
3.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$231.42 |
$380 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$751.51 |
$1,234 |
6.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$389.76 |
$640 |
3.5× |
| Radex Humerus Minimum 2 Views (73060) |
$266.74 |
$438 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$266.74 |
$438 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$309.98 |
$509 |
2.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$311.20 |
$511 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$279.53 |
$459 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$323.99 |
$532 |
2.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$309.98 |
$509 |
3.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$222.29 |
$365 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$221.07 |
$363 |
2.4× |
| Radex Toe Minimum 2 Views (73660) |
$266.74 |
$438 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$196.71 |
$323 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$286.84 |
$471 |
3.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$286.84 |
$471 |
3.1× |
| Radiologic exam chest 2 views (71046) |
$309.98 |
$509 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$752.72 |
$1,236 |
4.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$689.39 |
$1,132 |
3.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$266.74 |
$438 |
2.8× |
| Radiological examination surgical specimen (76098) |
$204.62 |
$336 |
0.3× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$1,450.64 |
$2,382 |
1.0× |
| Scapula (73010) |
$236.29 |
$388 |
2.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$19.49 |
$32 |
0.8× |
| Shoulder 1 view (73020) |
$266.74 |
$438 |
2.8× |
| Small bowel series (74250) |
$689.39 |
$1,132 |
3.6× |
| Spine thoracic 3 views (72072) |
$415.34 |
$682 |
3.7× |
| Thoracolumbar 2 views (72080) |
$82.82 |
$136 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,070.01 |
$1,757 |
2.5× |
| Tmj unilateral (70328) |
$221.07 |
$363 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$475.63 |
$781 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$475.63 |
$781 |
4.2× |
| Urethrocystogram voiding (74455) |
$674.77 |
$1,108 |
2.6× |
| Us breast unilateral limited (76642) |
$505.47 |
$830 |
5.4× |
| Us chest (76604) |
$475.63 |
$781 |
4.2× |
| Us compl joint r-t w/image documentation (76881) |
$398.29 |
$654 |
3.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$475.63 |
$781 |
4.2× |
| Us ob limited (76815) |
$517.65 |
$850 |
4.6× |
| Us ob transvaginal (76817) |
$311.20 |
$511 |
2.8× |
| Us pelvic non ob complete (76856) |
$441.53 |
$725 |
3.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$475.63 |
$781 |
4.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$651.63 |
$1,070 |
5.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$652.85 |
$1,072 |
5.8× |
| Us retroperitoneal complete (76770) |
$735.06 |
$1,207 |
6.5× |
| Us retroperitoneal limited (76775) |
$475.63 |
$781 |
4.2× |
| Us scrotum and contents (76870) |
$674.77 |
$1,108 |
6.0× |
| Us soft tissue head/neck (76536) |
$603.52 |
$991 |
5.4× |
| Wrist 2 views (73100) |
$266.74 |
$438 |
2.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$111.45 |
$183 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$236.29 |
$388 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$880.01 |
$1,445 |
4.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$250.30 |
$411 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$309.37 |
$508 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$111.45 |
$183 |
1.0× |
| X-ray exam of femur 2/> (73552) |
$266.13 |
$437 |
2.8× |
| X-ray eye for foreign body (70030) |
$83.43 |
$137 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$246.04 |
$404 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$247.25 |
$406 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$255.78 |
$420 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$381.23 |
$626 |
3.4× |
| X-ray nose-rectum child f.b. (76010) |
$196.71 |
$323 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$283.79 |
$466 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$219.85 |
$361 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$329.47 |
$541 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$360.53 |
$592 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$222.29 |
$365 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$266.74 |
$438 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$302.67 |
$497 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$360.53 |
$592 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$202.80 |
$333 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$216.20 |
$355 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$236.29 |
$388 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$222.29 |
$365 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$381.23 |
$626 |
3.4× |
| Xr c-spine 4 or 5 views (72050) |
$373.93 |
$614 |
3.3× |
| Xr c-spine 6 or more views (72052) |
$443.96 |
$729 |
3.9× |