| Abdomen 2 views (74019) |
$293.25 |
$345 |
2.8× |
| Acute gi blood loss imaging (78278) |
$1,203.60 |
$1,416 |
3.0× |
| Ankle 2 views (73600) |
$182.75 |
$215 |
2.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$928.20 |
$1,092 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$1,689.80 |
$1,988 |
4.3× |
| Bone age studies (77072) |
$136 |
$160 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$1,612.45 |
$1,897 |
4.1× |
| Bone survey complete (77075) |
$531.25 |
$625 |
5.1× |
| Bowel imaging (78290) |
$855.10 |
$1,006 |
2.2× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$891.65 |
$1,049 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$272 |
$320 |
3.2× |
| Chest 1 view (71045) |
$232.69 |
$273.75 |
2.7× |
| Cholecystography, oral contrast Non-Facility (74290) |
$227.80 |
$268 |
1.3× |
| Clavicle complete (73000) |
$251.60 |
$296 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$510 |
$600 |
4.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,507.50 |
$2,950 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,867.88 |
$2,197.50 |
7.9× |
| CT abdomen w contrast (74160) |
$1,445 |
$1,700 |
8.3× |
| CT abdomen w wo contrast (74170) |
$1,615 |
$1,900 |
9.3× |
| CT abdomen w/o contrast (74150) |
$1,062.50 |
$1,250 |
10.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,955 |
$2,300 |
11.3× |
| CT angiography upper extremity lt (73206) |
$1,742.50 |
$2,050 |
10.1× |
| CT c-spine w/contrast (72126) |
$1,234.20 |
$1,452 |
3.6× |
| CT c-spine w/o contrast (72125) |
$1,253.75 |
$1,475 |
12.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,374.45 |
$1,617 |
7.9× |
| CT chest w contrast (71260) |
$1,530 |
$1,800 |
8.8× |
| CT chest w/wo contrast (71270) |
$1,666 |
$1,960 |
9.6× |
| CT head/brain with contrast (70460) |
$1,275 |
$1,500 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,402.50 |
$1,650 |
8.1× |
| CT iac w contrast (70481) |
$1,300.50 |
$1,530 |
7.5× |
| CT limited/localized follow up study (76380) |
$447.10 |
$526 |
5.2× |
| CT lower ext w/o (73700) |
$1,105 |
$1,300 |
10.7× |
| CT lower extremity w wo contrast (73702) |
$1,385.50 |
$1,630 |
8.0× |
| CT lower extremity w/contrast material (73701) |
$1,211.25 |
$1,425 |
7.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,351.50 |
$1,590 |
7.8× |
| CT lumbar spine w/contrast (72132) |
$1,225.70 |
$1,442 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,232.50 |
$1,450 |
11.9× |
| CT maxillofacial w contrast (70487) |
$1,426.30 |
$1,678 |
8.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,487.50 |
$1,750 |
8.6× |
| CT maxillofacial wo contrast (70486) |
$1,147.50 |
$1,350 |
11.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,423.75 |
$1,675 |
8.2× |
| CT orbits w/o contrast (70480) |
$1,207 |
$1,420 |
11.7× |
| CT pelvis w/o contrast (72192) |
$1,211.25 |
$1,425 |
11.7× |
| CT pelvis w/wo contrast (72194) |
$1,530 |
$1,800 |
8.8× |
| CT scan of arm combo (73202) |
$1,649 |
$1,940 |
9.5× |
| CT soft tissue neck w contrast (70491) |
$1,402.50 |
$1,650 |
8.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,487.50 |
$1,750 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,020 |
$1,200 |
9.9× |
| CT thoracic spine w/contrast (72129) |
$1,433.95 |
$1,687 |
8.3× |
| CT thoracic spine w/o contrast (72128) |
$1,190 |
$1,400 |
11.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,610.75 |
$1,895 |
9.3× |
| CT thorax w/o contrast (71250) |
$1,317.50 |
$1,550 |
12.8× |
| CT upper ext wo (73200) |
$1,020 |
$1,200 |
9.9× |
| CT upper extremity with contrast (73201) |
$1,162.80 |
$1,368 |
3.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,010.36 |
$2,365.13 |
11.6× |
| Cta Abdomen (74175) |
$1,870 |
$2,200 |
10.8× |
| CTA abdomen pelvis (74174) |
$2,125 |
$2,500 |
6.2× |
| CTA chest (71275) |
$1,678.75 |
$1,975 |
9.7× |
| Cta Head (70496) |
$1,651.55 |
$1,943 |
9.5× |
| Cta Neck (70498) |
$1,656.65 |
$1,949 |
9.6× |
| Facial bones min 3 views (70150) |
$240.55 |
$283 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$406.30 |
$478 |
3.9× |
| Fluoroscopy up to 1 hr (76000) |
$416.50 |
$490 |
1.8× |
| Foot 2 views (73620) |
$209.32 |
$246.25 |
2.4× |
| Forearm 2 views (73090) |
$250.75 |
$295 |
2.9× |
| Hand 2 views (73120) |
$214.20 |
$252 |
2.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,676.20 |
$1,972 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,386.35 |
$1,631 |
3.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$968.15 |
$1,139 |
1.8× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$838.10 |
$986 |
1.6× |
| Knee 3 views (73562) |
$295.80 |
$348 |
3.4× |
| Lung ventilation imaging (78579) |
$1,677.90 |
$1,974 |
4.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,933.75 |
$2,275 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,636.25 |
$1,925 |
4.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,082.50 |
$2,450 |
6.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$209.95 |
$247 |
2.4× |
| MRA head w & w/o contrast (70546) |
$2,078.25 |
$2,445 |
6.0× |
| MRA head w/o contrast (70544) |
$1,657.50 |
$1,950 |
7.0× |
| MRA head with contrast (70545) |
$1,606.50 |
$1,890 |
4.7× |
| MRA neck w contrast (70548) |
$1,487.50 |
$1,750 |
4.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,513 |
$1,780 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,398.25 |
$1,645 |
5.9× |
| MRI abdomen w contrast (74182) |
$1,615 |
$1,900 |
4.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,125 |
$2,500 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,742.50 |
$2,050 |
7.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,610.75 |
$1,895 |
2.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,422.50 |
$2,850 |
7.0× |
| MRI bone marrow blood supply (77084) |
$1,360 |
$1,600 |
5.8× |
| MRI breast w/o contrast bilateral (77047) |
$1,785 |
$2,100 |
7.6× |
| MRI breast wo contrast unilateral (77046) |
$1,700 |
$2,000 |
7.2× |
| MRI c-spine with contrast (72142) |
$2,125 |
$2,500 |
6.2× |
| MRI cervical spine w/o contrast (72141) |
$1,955 |
$2,300 |
8.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,742.50 |
$2,050 |
5.1× |
| MRI chest w/o contrast (71550) |
$1,385.50 |
$1,630 |
5.9× |
| MRI chest with contrast (71551) |
$1,593.75 |
$1,875 |
2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,657.50 |
$1,950 |
4.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,997.50 |
$2,350 |
5.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,487.50 |
$1,750 |
6.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,555.50 |
$1,830 |
6.6× |
| MRI orbit face neck w contrast (70542) |
$1,657.50 |
$1,950 |
4.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,235.50 |
$2,630 |
6.5× |
| MRI pelvis w/contrast (72196) |
$1,462 |
$1,720 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,167.50 |
$2,550 |
6.3× |
| MRI pelvis w/o contrast (72195) |
$1,615 |
$1,900 |
6.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,337.50 |
$2,750 |
6.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,955 |
$2,300 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,550 |
$3,000 |
7.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,870.85 |
$2,201 |
5.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,337.50 |
$2,750 |
6.8× |
| MRI temporomandibular joint (70336) |
$1,610.75 |
$1,895 |
6.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,997.50 |
$2,350 |
8.5× |
| MRI up ext w/o contrast (73218) |
$1,572.50 |
$1,850 |
6.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,657.50 |
$1,950 |
7.0× |
| MRI, joint upper extrem combo (73223) |
$2,252.50 |
$2,650 |
6.5× |
| Myelogram Cervical (72240) |
$833 |
$980 |
1.1× |
| Myocardial Spect Multiple Studies (78452) |
$3,060 |
$3,600 |
2.4× |
| Myocardial spect single study at rest or stress (78451) |
$2,890 |
$3,400 |
2.3× |
| Neck soft tissue (70360) |
$199.75 |
$235 |
2.3× |
| Nm gastric emptying study (78264) |
$1,579.30 |
$1,858 |
4.0× |
| Nonvascular shunt X-ray (75809) |
$347.44 |
$408.75 |
3.4× |
| Osseous survey limited (77074) |
$413.95 |
$487 |
4.0× |
| Parathyroid Planar Imaging (78070) |
$1,170.52 |
$1,377.08 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$246.50 |
$290 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,079.50 |
$1,270 |
2.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,269.50 |
$2,670 |
4.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$267.75 |
$315 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$235.34 |
$276.88 |
2.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$255 |
$300 |
3.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$337.45 |
$397 |
3.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$354.45 |
$417 |
3.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$303.88 |
$357.50 |
2.9× |
| Radex fingr minimum 2 views (73140) |
$217.82 |
$256.25 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$250.75 |
$295 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$255 |
$300 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$133.88 |
$157.50 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$214.20 |
$252 |
2.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$263.50 |
$310 |
2.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$295.38 |
$347.50 |
2.9× |
| Radex Humerus Minimum 2 Views (73060) |
$250.75 |
$295 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$233.75 |
$275 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$327.25 |
$385 |
3.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$227.80 |
$268 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$257.13 |
$302.50 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$318.75 |
$375 |
3.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$280.50 |
$330 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$238 |
$280 |
2.8× |
| Radex Toe Minimum 2 Views (73660) |
$208.25 |
$245 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$218.45 |
$257 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$297.50 |
$350 |
3.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$392.70 |
$462 |
3.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$279.44 |
$328.75 |
3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$236.30 |
$278 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$263.50 |
$310 |
3.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$272 |
$320 |
3.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$205.70 |
$242 |
2.0× |
| Ribs bilateral 3 views (71110) |
$283.90 |
$334 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,110.95 |
$1,307 |
2.1× |
| Scapula (73010) |
$192.95 |
$227 |
1.9× |
| Shoulder 1 view (73020) |
$161.50 |
$190 |
1.9× |
| Spine thoracic 3 views (72072) |
$318.75 |
$375 |
3.1× |
| Thoracolumbar 2 views (72080) |
$219.30 |
$258 |
2.6× |
| Thyroid imaging w/blood flow (78013) |
$654.50 |
$770 |
1.7× |
| Thyroid uptake measurement (78012) |
$361.25 |
$425 |
0.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$977.50 |
$1,150 |
2.5× |
| Tmj unilateral (70328) |
$178.50 |
$210 |
2.1× |
| Ultrasound breast complete (76641) |
$352.75 |
$415 |
3.4× |
| Ultrasound Exam Aaa Screen (76706) |
$279.44 |
$328.75 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$574.27 |
$675.61 |
5.6× |
| Us breast unilateral limited (76642) |
$263.50 |
$310 |
3.1× |
| Us chest (76604) |
$357 |
$420 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$416.50 |
$490 |
4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$361.25 |
$425 |
3.5× |
| Us ob detailed single fetus (76811) |
$619.65 |
$729 |
2.6× |
| Us ob limited (76815) |
$463.25 |
$545 |
4.5× |
| Us ob transvaginal (76817) |
$468.35 |
$551 |
4.5× |
| Us pelvic non ob complete (76856) |
$535.50 |
$630 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$324.70 |
$382 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$550.23 |
$647.33 |
5.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$316.20 |
$372 |
3.1× |
| Us retroperitoneal complete (76770) |
$561.68 |
$660.80 |
5.4× |
| Us retroperitoneal limited (76775) |
$361.25 |
$425 |
3.5× |
| Us scrotum and contents (76870) |
$550.14 |
$647.22 |
5.3× |
| Us soft tissue head/neck (76536) |
$550.22 |
$647.32 |
5.3× |
| Wrist 2 views (73100) |
$212.50 |
$250 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$361.25 |
$425 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$227.80 |
$268 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$182.75 |
$215 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$276.25 |
$325 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$289 |
$340 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$260.95 |
$307 |
3.0× |
| X-ray eye for foreign body (70030) |
$161.50 |
$190 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$175.10 |
$206 |
2.0× |
| X-ray IV pyelogram (ivp) (74400) |
$446.25 |
$525 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$178.50 |
$210 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$140.25 |
$165 |
1.6× |
| X-ray leg, infant (73592) |
$208.25 |
$245 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$306 |
$360 |
3.0× |
| X-ray optic foramen (70190) |
$142.80 |
$168 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$259.25 |
$305 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$299.20 |
$352 |
3.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$331.50 |
$390 |
3.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$306 |
$360 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$267.75 |
$315 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$270.30 |
$318 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$259.25 |
$305 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$325.55 |
$383 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$242.25 |
$285 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$205.70 |
$242 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$214.20 |
$252 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$212.50 |
$250 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$276.25 |
$325 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$318.75 |
$375 |
3.1× |
| Xr c-spine 4 or 5 views (72050) |
$340 |
$400 |
3.3× |
| Xr c-spine 6 or more views (72052) |
$403.75 |
$475 |
3.9× |
| Xr chest 4+ views (71048) |
$266.05 |
$313 |
2.6× |