| Abdomen 2 views (74019) |
$178.85 |
$255.50 |
1.5× |
| Ankle 2 views (73600) |
$137.90 |
$197 |
1.4× |
| Arthrogram shoulder (73040) |
$631.75 |
$902.50 |
1.6× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$447.65 |
$639.50 |
1.0× |
| Bone &/joint imaging whole body (78306) |
$726.25 |
$1,037.50 |
1.6× |
| Bone Imaging 3 Phase (78315) |
$591.29 |
$844.70 |
1.3× |
| Bone survey complete (77075) |
$162.40 |
$232 |
1.4× |
| Bone survey infant (77076) |
$257.60 |
$368 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$40.60 |
$58 |
0.4× |
| Chest 1 view (71045) |
$73.68 |
$105.25 |
0.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$513.10 |
$733 |
2.6× |
| Clavicle complete (73000) |
$122.50 |
$175 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$131.60 |
$188 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,488.90 |
$2,127 |
3.8× |
| CT abdomen and pelvis without contrast (74176) |
$692.57 |
$989.38 |
2.6× |
| CT abdomen w contrast (74160) |
$261.10 |
$373 |
1.3× |
| CT abdomen w wo contrast (74170) |
$289.10 |
$413 |
1.5× |
| CT abdomen w/o contrast (74150) |
$245 |
$350 |
2.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,205.75 |
$1,722.50 |
6.2× |
| CT angiography upper extremity lt (73206) |
$1,104.25 |
$1,577.50 |
5.6× |
| CT c-spine w/contrast (72126) |
$729.75 |
$1,042.50 |
1.9× |
| CT c-spine w/o contrast (72125) |
$240.42 |
$343.45 |
2.1× |
| CT cervical spine w&w/o contrast (72127) |
$947.45 |
$1,353.50 |
4.8× |
| CT chest w contrast (71260) |
$410.90 |
$587 |
2.1× |
| CT head/brain with contrast (70460) |
$424.90 |
$607 |
2.2× |
| CT head/brain without and with contrast (70470) |
$179.17 |
$255.96 |
0.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$140.35 |
$200.50 |
1.4× |
| CT iac w contrast (70481) |
$1,116.15 |
$1,594.50 |
5.7× |
| CT lower ext w/o (73700) |
$207.20 |
$296 |
1.8× |
| CT lower extremity w wo contrast (73702) |
$831.25 |
$1,187.50 |
4.3× |
| CT lower extremity w/contrast material (73701) |
$240.10 |
$343 |
1.2× |
| CT lumbar spine w & w/o contrast (72133) |
$722.05 |
$1,031.50 |
3.7× |
| CT lumbar spine w/contrast (72132) |
$258.98 |
$369.98 |
0.7× |
| CT lumbar spine w/o contrast (72131) |
$219.33 |
$313.32 |
1.9× |
| CT maxillofacial w contrast (70487) |
$565.17 |
$807.38 |
2.9× |
| CT maxillofacial w/wo contrast (70488) |
$464.72 |
$663.88 |
2.4× |
| CT maxillofacial wo contrast (70486) |
$241.85 |
$345.50 |
2.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$801.50 |
$1,145 |
4.1× |
| CT orbits w/o contrast (70480) |
$584.32 |
$834.74 |
5.0× |
| CT pelvis w/o contrast (72192) |
$575.40 |
$822 |
4.9× |
| CT pelvis w/wo contrast (72194) |
$1,052.10 |
$1,503 |
5.4× |
| CT scan of arm combo (73202) |
$984.90 |
$1,407 |
5.0× |
| CT soft tissue neck w contrast (70491) |
$368.55 |
$526.50 |
1.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$794.50 |
$1,135 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$232.64 |
$332.35 |
2.0× |
| CT thoracic spine w/contrast (72129) |
$923.65 |
$1,319.50 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$223.98 |
$319.96 |
1.9× |
| CT thoracic spine w/wo contrast (72130) |
$726.60 |
$1,038 |
3.7× |
| CT thorax w/o contrast (71250) |
$514.15 |
$734.50 |
4.4× |
| CT upper ext wo (73200) |
$212.45 |
$303.50 |
1.8× |
| CT upper extremity with contrast (73201) |
$252.70 |
$361 |
0.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,519 |
$2,170 |
7.8× |
| Cta Abdomen (74175) |
$1,324.75 |
$1,892.50 |
6.8× |
| CTA abdomen pelvis (74174) |
$1,646.40 |
$2,352 |
4.2× |
| CTA chest (71275) |
$1,373.40 |
$1,962 |
7.0× |
| Cta Head (70496) |
$1,348.20 |
$1,926 |
6.9× |
| Cta Neck (70498) |
$359.80 |
$514 |
1.8× |
| Esophagus (74220) |
$427.35 |
$610.50 |
2.2× |
| Facial bones min 3 views (70150) |
$113.05 |
$161.50 |
1.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$159.95 |
$228.50 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$197.05 |
$281.50 |
0.7× |
| Foot 2 views (73620) |
$106.05 |
$151.50 |
1.1× |
| Forearm 2 views (73090) |
$109.90 |
$157 |
1.1× |
| Hand 2 views (73120) |
$133 |
$190 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$904.75 |
$1,292.50 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$103.60 |
$148 |
0.2× |
| Hysterosalpingogram (74740) |
$92.91 |
$132.73 |
0.3× |
| Knee 3 views (73562) |
$175.35 |
$250.50 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,283.80 |
$1,834 |
1.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,222.90 |
$1,747 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,684.55 |
$2,406.50 |
4.3× |
| MRA head w & w/o contrast (70546) |
$1,354.85 |
$1,935.50 |
3.5× |
| MRA head w/o contrast (70544) |
$966.35 |
$1,380.50 |
3.6× |
| MRA head with contrast (70545) |
$1,150.10 |
$1,643 |
3.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,554.70 |
$2,221 |
4.0× |
| MRA neck w/o contrast (70547) |
$969.50 |
$1,385 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,984.15 |
$2,834.50 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,097.60 |
$1,568 |
4.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,171.45 |
$1,673.50 |
1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,870.05 |
$2,671.50 |
4.8× |
| MRI cervical spine w/o contrast (72141) |
$711.90 |
$1,017 |
2.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$948.50 |
$1,355 |
2.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,330.70 |
$1,901 |
3.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$886.90 |
$1,267 |
3.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$900.55 |
$1,286.50 |
3.4× |
| MRI orbit face neck w contrast (70542) |
$967.75 |
$1,382.50 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,368.15 |
$1,954.50 |
3.5× |
| MRI pelvis w/contrast (72196) |
$1,174.25 |
$1,677.50 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,520.40 |
$2,172 |
3.9× |
| MRI pelvis w/o contrast (72195) |
$1,034.25 |
$1,477.50 |
3.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,223.25 |
$1,747.50 |
3.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,218.70 |
$1,741 |
3.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,225 |
$1,750 |
3.2× |
| MRI temporomandibular joint (70336) |
$1,106.35 |
$1,580.50 |
4.2× |
| MRI thoracic spine w/o contrast (72146) |
$710.85 |
$1,015.50 |
2.7× |
| MRI up ext w/o contrast (73218) |
$1,267.70 |
$1,811 |
4.8× |
| MRI upper ext joint w/o contrast (73221) |
$776.65 |
$1,109.50 |
2.9× |
| MRI, joint upper extrem combo (73223) |
$1,876 |
$2,680 |
4.8× |
| Myocardial Spect Multiple Studies (78452) |
$178.50 |
$255 |
0.1× |
| Neck soft tissue (70360) |
$134.40 |
$192 |
1.4× |
| Nm gastric emptying study (78264) |
$206.66 |
$295.22 |
0.5× |
| Osseous survey limited (77074) |
$172.20 |
$246 |
1.5× |
| Pelvis 1 or 2 views (72170) |
$118.30 |
$169 |
1.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$513.37 |
$733.38 |
0.8× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$155.40 |
$222 |
0.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$128.10 |
$183 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$127.75 |
$182.50 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$123.20 |
$176 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$302.40 |
$432 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$149.45 |
$213.50 |
1.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$133 |
$190 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$129.57 |
$185.10 |
1.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$121.10 |
$173 |
1.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$117.95 |
$168.50 |
1.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$175.70 |
$251 |
1.5× |
| Radex Humerus Minimum 2 Views (73060) |
$121.80 |
$174 |
1.3× |
| Radex Kne 1/2 Views (73560) |
$146.30 |
$209 |
1.5× |
| Radex Kne Compl 4/More Views (73564) |
$198.10 |
$283 |
1.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$186.55 |
$266.50 |
1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$164.85 |
$235.50 |
1.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$179.90 |
$257 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$129.85 |
$185.50 |
1.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$123.20 |
$176 |
1.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$90.65 |
$129.50 |
0.8× |
| Radex Toe Minimum 2 Views (73660) |
$67.20 |
$96 |
0.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$79.80 |
$114 |
0.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$143.54 |
$205.05 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$32.90 |
$47 |
0.3× |
| Radiologic exam chest 2 views (71046) |
$79.45 |
$113.50 |
0.8× |
| Radiologic exam colon single contrast study (74270) |
$444.85 |
$635.50 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$608.65 |
$869.50 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$334.25 |
$477.50 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$120.05 |
$171.50 |
1.2× |
| Radiological examination surgical specimen (76098) |
$34.30 |
$49 |
0.1× |
| Ribs bilateral 3 views (71110) |
$177.45 |
$253.50 |
1.5× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$805 |
$1,150 |
1.3× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,255.45 |
$1,793.50 |
0.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$278.25 |
$397.50 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$87.15 |
$124.50 |
3.7× |
| Shoulder 1 view (73020) |
$76.30 |
$109 |
0.8× |
| Small bowel series (74250) |
$234.50 |
$335 |
1.2× |
| Spine thoracic 3 views (72072) |
$166.95 |
$238.50 |
1.4× |
| Thoracolumbar 2 views (72080) |
$129.50 |
$185 |
1.3× |
| Thyroid imaging w/blood flow (78013) |
$399.70 |
$571 |
0.9× |
| Ultrasound breast complete (76641) |
$158.55 |
$226.50 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$208.95 |
$298.50 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$187.95 |
$268.50 |
1.6× |
| Umbilical-artery Doppler (OB) (76820) |
$136.15 |
$194.50 |
1.2× |
| Urethrocystogram voiding (74455) |
$233.80 |
$334 |
0.9× |
| Us breast unilateral limited (76642) |
$131.95 |
$188.50 |
1.4× |
| Us chest (76604) |
$141.40 |
$202 |
1.2× |
| Us compl joint r-t w/image documentation (76881) |
$95.55 |
$136.50 |
0.8× |
| Us elastography parenchyma (76981) |
$251.30 |
$359 |
2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$86.10 |
$123 |
0.7× |
| Us ob limited (76815) |
$185.15 |
$264.50 |
1.6× |
| Us ob transvaginal (76817) |
$213.85 |
$305.50 |
1.8× |
| Us pelvic non ob complete (76856) |
$224 |
$320 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$120.40 |
$172 |
1.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$271.60 |
$388 |
2.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$247.80 |
$354 |
2.1× |
| Us retroperitoneal complete (76770) |
$232.75 |
$332.50 |
2.0× |
| Us retroperitoneal limited (76775) |
$112.70 |
$161 |
1.0× |
| Us scrotum and contents (76870) |
$154 |
$220 |
1.3× |
| Us soft tissue head/neck (76536) |
$218.40 |
$312 |
1.9× |
| Us spinal canal and contents (76800) |
$334.95 |
$478.50 |
2.9× |
| Wrist 2 views (73100) |
$129.85 |
$185.50 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$183.05 |
$261.50 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$95.20 |
$136 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$408.72 |
$583.88 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$108.85 |
$155.50 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$180.95 |
$258.50 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$229.25 |
$327.50 |
2.0× |
| X-ray exam of femur 2/> (73552) |
$134.40 |
$192 |
1.4× |
| X-ray eye for foreign body (70030) |
$122.15 |
$174.50 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$136.85 |
$195.50 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$86.80 |
$124 |
0.9× |
| X-ray leg, infant (73592) |
$236.60 |
$338 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$149.80 |
$214 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$136.15 |
$194.50 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$155.05 |
$221.50 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$211.40 |
$302 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$166.95 |
$238.50 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$139.30 |
$199 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$141.40 |
$202 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$98.35 |
$140.50 |
0.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$156.80 |
$224 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$60.20 |
$86 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$80.15 |
$114.50 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$139.65 |
$199.50 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$228.20 |
$326 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$266.70 |
$381 |
2.3× |