| Abdomen 2 views (74019) |
$238.90 |
$341.29 |
2.2× |
| Acute gi blood loss imaging (78278) |
$888.30 |
$1,269 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$5,211.50 |
$7,445 |
1.6× |
| Angiography extremity unilateral rs&i (75710) |
$5,544 |
$7,920 |
1.7× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$5,211.50 |
$7,445 |
1.6× |
| Ankle 2 views (73600) |
$144.77 |
$206.82 |
1.6× |
| Aortogram thoracic (75605) |
$3,665.20 |
$5,236 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$4,708.90 |
$6,727 |
1.4× |
| Aortography abdominal serialography rs&i (75625) |
$4,731.30 |
$6,759 |
1.4× |
| Arthrogram hip (73525) |
$491.60 |
$702.29 |
1.3× |
| Arthrogram knee (73580) |
$416.50 |
$595 |
1.1× |
| Arthrogram shoulder (73040) |
$1,073.10 |
$1,533 |
2.9× |
| Arthrogram wrist (73115) |
$427 |
$610 |
1.2× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,181.60 |
$1,688 |
2.8× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$781.90 |
$1,117 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,493.80 |
$2,134 |
3.5× |
| Bowel imaging (78290) |
$1,529.36 |
$2,184.80 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$183.31 |
$261.87 |
2.0× |
| Chest 1 view (71045) |
$196.57 |
$280.82 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$424.91 |
$607.01 |
2.3× |
| Clavicle complete (73000) |
$153.62 |
$219.45 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$648.96 |
$927.09 |
5.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,035.51 |
$4,336.44 |
8.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,916.75 |
$2,738.22 |
7.6× |
| CT abdomen w contrast (74160) |
$1,434.61 |
$2,049.44 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,591.72 |
$2,273.88 |
8.6× |
| CT abdomen w/o contrast (74150) |
$1,206.84 |
$1,724.06 |
10.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,326.38 |
$1,894.83 |
7.2× |
| CT angiography upper extremity lt (73206) |
$1,325.80 |
$1,894 |
7.2× |
| CT c-spine w/contrast (72126) |
$1,444.58 |
$2,063.69 |
3.9× |
| CT c-spine w/o contrast (72125) |
$1,138.19 |
$1,625.98 |
10.3× |
| CT chest w contrast (71260) |
$1,613.16 |
$2,304.51 |
8.7× |
| CT chest w/wo contrast (71270) |
$2,023 |
$2,890 |
10.9× |
| CT head/brain with contrast (70460) |
$1,044.75 |
$1,492.50 |
5.6× |
| CT head/brain without and with contrast (70470) |
$1,176.09 |
$1,680.13 |
6.4× |
| CT iac w contrast (70481) |
$1,052.56 |
$1,503.66 |
5.7× |
| CT lower ext w/o (73700) |
$1,037.77 |
$1,482.53 |
9.4× |
| CT lower extremity w wo contrast (73702) |
$2,196.60 |
$3,138 |
11.9× |
| CT lower extremity w/contrast material (73701) |
$1,171.51 |
$1,673.59 |
6.3× |
| CT lumbar spine w/contrast (72132) |
$1,474.68 |
$2,106.68 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,182.74 |
$1,689.63 |
10.7× |
| CT maxillofacial w contrast (70487) |
$1,118.07 |
$1,597.24 |
6.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,342.17 |
$1,917.39 |
7.3× |
| CT maxillofacial wo contrast (70486) |
$890.30 |
$1,271.86 |
8.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,008.30 |
$2,869 |
10.8× |
| CT orbits w/o contrast (70480) |
$919.65 |
$1,313.78 |
8.3× |
| CT pelvis w/o contrast (72192) |
$1,503.60 |
$2,148 |
13.6× |
| CT pelvis w/wo contrast (72194) |
$2,368.10 |
$3,383 |
12.8× |
| CT scan of arm combo (73202) |
$2,079 |
$2,970 |
11.2× |
| CT soft tissue neck w contrast (70491) |
$1,115.24 |
$1,593.20 |
6.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,272.35 |
$1,817.64 |
6.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,002.02 |
$1,431.46 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$1,839.84 |
$2,628.34 |
9.9× |
| CT thoracic spine w/o contrast (72128) |
$1,075.51 |
$1,536.44 |
9.7× |
| CT thorax w/o contrast (71250) |
$1,301.70 |
$1,859.57 |
11.8× |
| CT upper ext wo (73200) |
$1,019.82 |
$1,456.88 |
9.2× |
| CT upper extremity with contrast (73201) |
$1,178.75 |
$1,683.93 |
3.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,322.64 |
$1,889.48 |
7.1× |
| Cta Abdomen (74175) |
$1,439.10 |
$2,055.85 |
7.8× |
| CTA chest (71275) |
$1,613.49 |
$2,304.99 |
8.7× |
| Cta Head (70496) |
$1,427.38 |
$2,039.11 |
7.7× |
| Cta Neck (70498) |
$1,427.38 |
$2,039.11 |
7.7× |
| Cystography minimum 3 views rs&i (74430) |
$719.60 |
$1,028 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$274.40 |
$392 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$52.50 |
$75 |
0.6× |
| Esophagus (74220) |
$367.15 |
$524.50 |
2.0× |
| Facial bones min 3 views (70150) |
$262.05 |
$374.35 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$548.80 |
$784 |
5.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$455 |
$650 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$522.90 |
$747 |
2.1× |
| Foot 2 views (73620) |
$130.24 |
$186.06 |
1.4× |
| Forearm 2 views (73090) |
$159.94 |
$228.48 |
1.7× |
| Hand 2 views (73120) |
$159.94 |
$228.48 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,690.50 |
$2,415 |
2.9× |
| Hysterosalpingogram (74740) |
$765.10 |
$1,093 |
3.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,488.20 |
$2,126 |
2.6× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,488.20 |
$2,126 |
2.6× |
| Knee 3 views (73562) |
$184.80 |
$264 |
2.0× |
| Liver & spleen imaging static only (78215) |
$1,240.40 |
$1,772 |
2.9× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,599.22 |
$2,284.60 |
3.8× |
| Lymphoscintigraphy (78195) |
$1,528.10 |
$2,183 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,567.48 |
$2,239.25 |
1.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,923.78 |
$2,748.26 |
5.2× |
| MRA head w/o contrast (70544) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRA head with contrast (70545) |
$616.70 |
$881 |
1.7× |
| MRA neck w contrast (70548) |
$2,326.21 |
$3,323.15 |
6.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,326.21 |
$3,323.15 |
6.3× |
| MRA neck w/o contrast (70547) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI abdomen w contrast (74182) |
$1,364.05 |
$1,948.64 |
3.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,953.48 |
$2,790.68 |
5.3× |
| MRI abdomen w/o contrast (74181) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,923.78 |
$2,748.26 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,326.21 |
$3,323.15 |
6.3× |
| MRI c-spine with contrast (72142) |
$1,211.17 |
$1,730.24 |
3.3× |
| MRI cervical spine w/o contrast (72141) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI chest with contrast (71551) |
$2,798.20 |
$3,997.43 |
3.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,923.78 |
$2,748.26 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,882.08 |
$2,688.69 |
7.5× |
| MRI orbit face neck w contrast (70542) |
$1,364.05 |
$1,948.64 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,326.21 |
$3,323.15 |
6.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,956.63 |
$2,795.19 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,409.60 |
$3,442.28 |
6.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,211.17 |
$1,730.24 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,882.08 |
$2,688.69 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,211.17 |
$1,730.24 |
3.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,409.60 |
$3,442.28 |
6.5× |
| MRI temporomandibular joint (70336) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI up ext w/o contrast (73218) |
$1,923.78 |
$2,748.26 |
7.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,211.17 |
$1,730.24 |
4.8× |
| MRI, joint upper extrem combo (73223) |
$884.87 |
$1,264.10 |
2.4× |
| Myocardial Spect Multiple Studies (78452) |
$3,872.75 |
$5,532.50 |
2.8× |
| Myocardial spect single study at rest or stress (78451) |
$2,954.70 |
$4,221 |
2.2× |
| Nm cardiac blood pool multiple (78473) |
$1,016.40 |
$1,452 |
2.4× |
| Nm gastric emptying study (78264) |
$1,414 |
$2,020 |
3.4× |
| Nonvascular shunt X-ray (75809) |
$495.60 |
$708 |
4.5× |
| Parathyroid Planar Imaging (78070) |
$1,333.01 |
$1,904.30 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$176.36 |
$251.94 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,816.51 |
$2,595.02 |
3.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$183.31 |
$261.87 |
2.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$183.31 |
$261.87 |
2.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$198.47 |
$283.53 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$280 |
$400 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$144.77 |
$206.82 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$144.77 |
$206.82 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$183.31 |
$261.87 |
2.0× |
| Radex Humerus Minimum 2 Views (73060) |
$198.47 |
$283.53 |
2.2× |
| Radex Kne 1/2 Views (73560) |
$183.31 |
$261.87 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$221.21 |
$316.02 |
2.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$256.33 |
$366.18 |
2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$160.37 |
$229.10 |
1.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$215.53 |
$307.90 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$135.93 |
$194.18 |
1.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$215.53 |
$307.90 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$153.62 |
$219.45 |
1.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$198.47 |
$283.53 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$159.77 |
$228.24 |
1.7× |
| Radiologic exam chest 2 views (71046) |
$205.42 |
$293.46 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$491.60 |
$702.29 |
2.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$614.80 |
$878.28 |
3.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$854 |
$1,220 |
4.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$198.47 |
$283.53 |
2.2× |
| Radiological examination surgical specimen (76098) |
$354.90 |
$507 |
0.6× |
| Scapula (73010) |
$221.21 |
$316.02 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$132.30 |
$189 |
5.7× |
| Small bowel series (74250) |
$476.44 |
$680.63 |
2.6× |
| Spine thoracic 3 views (72072) |
$277.44 |
$396.34 |
2.5× |
| Thyroid imaging w/blood flow (78013) |
$944.16 |
$1,348.80 |
2.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,131.90 |
$1,617 |
2.7× |
| Ultrasound breast complete (76641) |
$467.84 |
$668.34 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$371 |
$530 |
3.4× |
| Ultrasound, abdomen limited (76705) |
$480.03 |
$685.76 |
4.4× |
| Ureteral reflux study (78740) |
$903.74 |
$1,291.05 |
2.1× |
| Urethrocystogram voiding (74455) |
$774.90 |
$1,107 |
3.1× |
| Us breast unilateral limited (76642) |
$384.02 |
$548.60 |
4.2× |
| Us chest (76604) |
$377.65 |
$539.50 |
3.4× |
| Us encephalogram (76506) |
$522.90 |
$747 |
4.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$224.44 |
$320.62 |
2.0× |
| Us ob limited (76815) |
$353.24 |
$504.62 |
3.2× |
| Us ob transvaginal (76817) |
$339.93 |
$485.62 |
3.1× |
| Us pelvic non ob complete (76856) |
$401.44 |
$573.49 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$431.65 |
$616.64 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$383.66 |
$548.08 |
3.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$327.88 |
$468.40 |
3.0× |
| Us retroperitoneal complete (76770) |
$417.16 |
$595.94 |
3.8× |
| Us retroperitoneal limited (76775) |
$290.87 |
$415.52 |
2.6× |
| Us scrotum and contents (76870) |
$357.06 |
$510.08 |
3.2× |
| Us soft tissue head/neck (76536) |
$348.57 |
$497.96 |
3.2× |
| Us spinal canal and contents (76800) |
$522.90 |
$747 |
4.7× |
| Venogram extremity bilateral (75822) |
$3,270.40 |
$4,672 |
2.0× |
| Venogram Extremity Unilateral (75820) |
$1,785.70 |
$2,551 |
1.1× |
| Venography caval inferior serialography rs&i (75825) |
$6,381.90 |
$9,117 |
1.9× |
| Venography caval superior serialography rs&i (75827) |
$4,468.80 |
$6,384 |
2.7× |
| Wrist 2 views (73100) |
$159.94 |
$228.48 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$283.13 |
$404.47 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$208.31 |
$297.59 |
2.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$628.69 |
$898.13 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$159.94 |
$228.48 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$124.26 |
$177.52 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$280.93 |
$401.33 |
2.5× |
| X-ray exam of femur 2/> (73552) |
$124.26 |
$177.52 |
1.4× |
| X-ray IV pyelogram (ivp) (74400) |
$905.80 |
$1,294 |
4.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$156.11 |
$223.02 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$165.09 |
$235.84 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$215.53 |
$307.90 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$482.76 |
$689.66 |
4.4× |
| X-ray nose-rectum child f.b. (76010) |
$199.50 |
$285 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$311.26 |
$444.65 |
2.8× |
| X-ray retrograde pyelogram (74420) |
$902.30 |
$1,289 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$252.81 |
$361.15 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$329.88 |
$471.25 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$221.21 |
$316.02 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$238.27 |
$340.39 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$250.08 |
$357.25 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$270.29 |
$386.13 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$227.80 |
$325.43 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$174.40 |
$249.14 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$220.50 |
$315 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$203.39 |
$290.56 |
2.2× |
| Xr bone length studies (77073) |
$360.50 |
$515 |
3.3× |
| Xr c-spine 4 or 5 views (72050) |
$291.97 |
$417.10 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$375.99 |
$537.13 |
3.4× |