| Abdomen 2 views (74019) |
$148.07 |
$324 |
1.3× |
| Ankle 2 views (73600) |
$119.28 |
$261 |
1.3× |
| Arthrogram hip (73525) |
$466.14 |
$1,020 |
1.3× |
| Arthrogram shoulder (73040) |
$486.25 |
$1,064 |
1.3× |
| Bone &/Joint Imaging Limited Area (78300) |
$926.80 |
$2,028 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$1,217.45 |
$2,664 |
2.9× |
| Bone age studies (77072) |
$119.73 |
$262 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$1,376.03 |
$3,011 |
3.2× |
| Bone survey complete (77075) |
$340.46 |
$745 |
3.0× |
| Bowel imaging (78290) |
$1,380.60 |
$3,021 |
3.2× |
| Cervical spine 2 or 3 views (72040) |
$133.90 |
$293 |
1.4× |
| Chest 1 view (71045) |
$121.56 |
$266 |
1.3× |
| Chest xray 3 views (71047) |
$153.55 |
$336 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$471.62 |
$1,032 |
2.5× |
| Clavicle complete (73000) |
$113.79 |
$249 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$950.10 |
$2,079 |
8.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,111.34 |
$4,620 |
5.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,248.07 |
$2,731 |
4.9× |
| CT abdomen w contrast (74160) |
$1,133.82 |
$2,481 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,406.19 |
$3,077 |
7.5× |
| CT abdomen w/o contrast (74150) |
$783.30 |
$1,714 |
7.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,457.83 |
$3,190 |
7.8× |
| CT angiography upper extremity lt (73206) |
$1,379.23 |
$3,018 |
7.4× |
| CT c-spine w/contrast (72126) |
$935.94 |
$2,048 |
2.5× |
| CT c-spine w/o contrast (72125) |
$785.58 |
$1,719 |
7.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,153.92 |
$2,525 |
6.2× |
| CT chest w contrast (71260) |
$1,093.14 |
$2,392 |
5.8× |
| CT chest w/wo contrast (71270) |
$1,266.35 |
$2,771 |
6.8× |
| CT head/brain with contrast (70460) |
$872.87 |
$1,910 |
4.7× |
| CT head/brain without and with contrast (70470) |
$1,145.24 |
$2,506 |
6.1× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$184.17 |
$403 |
2.0× |
| CT iac w contrast (70481) |
$918.57 |
$2,010 |
4.9× |
| CT limited/localized follow up study (76380) |
$406.27 |
$889 |
4.4× |
| CT lower ext w/o (73700) |
$645.74 |
$1,413 |
5.8× |
| CT lower extremity w wo contrast (73702) |
$1,151.64 |
$2,520 |
6.1× |
| CT lower extremity w/contrast material (73701) |
$937.76 |
$2,052 |
5.0× |
| CT lumbar spine w & w/o contrast (72133) |
$1,152.10 |
$2,521 |
6.2× |
| CT lumbar spine w/contrast (72132) |
$934.11 |
$2,044 |
2.5× |
| CT lumbar spine w/o contrast (72131) |
$785.58 |
$1,719 |
7.0× |
| CT maxillofacial w contrast (70487) |
$872.87 |
$1,910 |
4.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,145.24 |
$2,506 |
6.1× |
| CT maxillofacial wo contrast (70486) |
$804.32 |
$1,760 |
7.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,145.24 |
$2,506 |
6.1× |
| CT orbits w/o contrast (70480) |
$804.32 |
$1,760 |
7.2× |
| CT pelvis w/o contrast (72192) |
$895.26 |
$1,959 |
8.0× |
| CT pelvis w/wo contrast (72194) |
$1,286.91 |
$2,816 |
6.9× |
| CT scan of arm combo (73202) |
$1,137.47 |
$2,489 |
6.1× |
| CT soft tissue neck w contrast (70491) |
$872.87 |
$1,910 |
4.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,145.24 |
$2,506 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$804.32 |
$1,760 |
7.2× |
| CT thoracic spine w/contrast (72129) |
$939.14 |
$2,055 |
5.0× |
| CT thoracic spine w/o contrast (72128) |
$785.58 |
$1,719 |
7.0× |
| CT thorax w/o contrast (71250) |
$645.74 |
$1,413 |
5.8× |
| CT upper ext wo (73200) |
$623.35 |
$1,364 |
5.6× |
| CT upper extremity with contrast (73201) |
$917.66 |
$2,008 |
2.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,465.60 |
$3,207 |
7.8× |
| Cta Abdomen (74175) |
$1,360.03 |
$2,976 |
7.3× |
| CTA abdomen pelvis (74174) |
$1,250.81 |
$2,737 |
3.4× |
| CTA chest (71275) |
$1,360.03 |
$2,976 |
7.3× |
| Cta Head (70496) |
$1,275.49 |
$2,791 |
6.8× |
| Cta Neck (70498) |
$1,275.49 |
$2,791 |
6.8× |
| Cta Pelvis (72191) |
$1,267.26 |
$2,773 |
6.8× |
| Cystography minimum 3 views rs&i (74430) |
$127.05 |
$278 |
0.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$251.81 |
$551 |
2.3× |
| Esophagus (74220) |
$319.90 |
$700 |
1.7× |
| Facial bones min 3 views (70150) |
$161.32 |
$353 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$216.62 |
$474 |
0.9× |
| Foot 2 views (73620) |
$101.45 |
$222 |
1.1× |
| Forearm 2 views (73090) |
$100.08 |
$219 |
1.1× |
| Hand 2 views (73120) |
$109.22 |
$239 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,874.16 |
$4,101 |
3.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,373.28 |
$3,005 |
3.2× |
| Hysterosalpingogram (74740) |
$349.15 |
$764 |
1.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$144.41 |
$316 |
1.3× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,085.83 |
$2,376 |
1.9× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$873.78 |
$1,912 |
1.5× |
| Knee 3 views (73562) |
$147.61 |
$323 |
1.6× |
| Lymphoscintigraphy (78195) |
$1,388.82 |
$3,039 |
2.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,968.76 |
$4,308 |
2.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,192.69 |
$4,798 |
5.9× |
| MRA head w & w/o contrast (70546) |
$1,966.01 |
$4,302 |
5.3× |
| MRA head w/o contrast (70544) |
$1,073.04 |
$2,348 |
4.2× |
| MRA head with contrast (70545) |
$1,503.99 |
$3,291 |
4.0× |
| MRA neck w contrast (70548) |
$1,503.99 |
$3,291 |
4.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,966.01 |
$4,302 |
5.3× |
| MRA neck w/o contrast (70547) |
$1,073.04 |
$2,348 |
4.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,243.41 |
$4,909 |
6.0× |
| MRI abdomen w/o contrast (74181) |
$1,294.68 |
$2,833 |
5.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,676.28 |
$3,668 |
2.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,028.17 |
$4,438 |
5.4× |
| MRI breast w/o contrast bilateral (77047) |
$466 |
$466 |
1.8× |
| MRI c-spine with contrast (72142) |
$1,515.41 |
$3,316 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,382.42 |
$3,025 |
5.4× |
| MRI chest w/o & w/contrast material (71552) |
$2,359.49 |
$5,163 |
6.3× |
| MRI chest w/o contrast (71550) |
$1,248.98 |
$2,733 |
4.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,028.17 |
$4,438 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,259.49 |
$2,756 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,017.66 |
$4,415 |
5.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,192.69 |
$4,798 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$1,248.98 |
$2,733 |
4.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,968.76 |
$4,308 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,515.41 |
$3,316 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,968.76 |
$4,308 |
5.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,515.41 |
$3,316 |
4.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,968.76 |
$4,308 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,382.42 |
$3,025 |
5.4× |
| MRI up ext w/o contrast (73218) |
$1,251.27 |
$2,738 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,251.27 |
$2,738 |
4.9× |
| MRI, joint upper extrem combo (73223) |
$2,023.60 |
$4,428 |
5.4× |
| Myelogram Lumbar (72265) |
$418.16 |
$915 |
0.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,837.14 |
$4,020 |
1.3× |
| Myocardial spect single study at rest or stress (78451) |
$1,564.77 |
$3,424 |
1.1× |
| Neck soft tissue (70360) |
$109.22 |
$239 |
1.2× |
| Nm gastric emptying study (78264) |
$1,379.23 |
$3,018 |
3.2× |
| Osseous survey limited (77074) |
$232.61 |
$509 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$129.33 |
$283 |
1.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$939.14 |
$2,055 |
2.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$161.32 |
$353 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$105.57 |
$231 |
1.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$125.68 |
$275 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$143.50 |
$314 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$258.66 |
$566 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$288.37 |
$631 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$146.24 |
$320 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$151.72 |
$332 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$133.90 |
$293 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$113.34 |
$248 |
1.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$157.21 |
$344 |
1.4× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$226.67 |
$496 |
2.0× |
| Radex Humerus Minimum 2 Views (73060) |
$115.16 |
$252 |
1.2× |
| Radex Kne 1/2 Views (73560) |
$125.68 |
$275 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$200.62 |
$439 |
1.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$148.07 |
$324 |
1.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$137.10 |
$300 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$150.81 |
$330 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$178.69 |
$391 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$116.99 |
$256 |
1.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$198.80 |
$435 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$119.28 |
$261 |
1.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$152.18 |
$333 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$121.56 |
$266 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$175.03 |
$383 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$145.78 |
$319 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$520.07 |
$1,138 |
2.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$368.80 |
$807 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$447.86 |
$980 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$392.11 |
$858 |
2.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$113.34 |
$248 |
1.2× |
| Radiological examination surgical specimen (76098) |
$127.50 |
$279 |
0.2× |
| Ribs bilateral 3 views (71110) |
$139.84 |
$306 |
1.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,421.27 |
$3,110 |
2.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$391.19 |
$856 |
1.5× |
| Scapula (73010) |
$116.99 |
$256 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$112.42 |
$246 |
4.8× |
| Shoulder 1 view (73020) |
$83.63 |
$183 |
0.9× |
| Small bowel series (74250) |
$395.76 |
$866 |
2.1× |
| Spine thoracic 3 views (72072) |
$133.90 |
$293 |
1.2× |
| Thoracolumbar 2 views (72080) |
$113.79 |
$249 |
1.2× |
| Ultrasound breast complete (76641) |
$333.15 |
$729 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$373.83 |
$818 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$328.13 |
$718 |
2.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$194.22 |
$425 |
2.1× |
| Urethrocystogram voiding (74455) |
$409.02 |
$895 |
1.6× |
| Us breast unilateral limited (76642) |
$308.02 |
$674 |
3.3× |
| Us chest (76604) |
$287.91 |
$630 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$382.51 |
$837 |
3.4× |
| Us hips infant static (76886) |
$274.20 |
$600 |
3.0× |
| Us infant hips w manipulation (76885) |
$395.30 |
$865 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$148.98 |
$326 |
1.3× |
| Us ob limited (76815) |
$245.41 |
$537 |
2.2× |
| Us ob transvaginal (76817) |
$280.14 |
$613 |
2.5× |
| Us pelvic non ob complete (76856) |
$398.96 |
$873 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$195.14 |
$427 |
1.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$345.95 |
$757 |
3.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$339.09 |
$742 |
3.0× |
| Us retroperitoneal complete (76770) |
$359.20 |
$786 |
3.2× |
| Us retroperitoneal limited (76775) |
$139.39 |
$305 |
1.2× |
| Us scrotum and contents (76870) |
$324.47 |
$710 |
2.9× |
| Us soft tissue head/neck (76536) |
$415.41 |
$909 |
3.7× |
| Us transrectal (76872) |
$354.63 |
$776 |
3.2× |
| Us, eye b-scan (76512) |
$175.03 |
$383 |
1.6× |
| Wrist 2 views (73100) |
$120.19 |
$263 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$225.30 |
$493 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$139.39 |
$305 |
1.5× |
| X-ray b.e. reductn intuss (74283) |
$721.60 |
$1,579 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$741.25 |
$1,622 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$107.40 |
$235 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$170.92 |
$374 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$188.74 |
$413 |
1.7× |
| X-ray exam of femur 2/> (73552) |
$129.33 |
$283 |
1.4× |
| X-ray eye for foreign body (70030) |
$119.28 |
$261 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$119.28 |
$261 |
1.3× |
| X-ray IV pyelogram (ivp) (74400) |
$516.41 |
$1,130 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$190.11 |
$416 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$150.81 |
$330 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$135.27 |
$296 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$254.09 |
$556 |
2.3× |
| X-ray nose-rectum child f.b. (76010) |
$96.88 |
$212 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$159.95 |
$350 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$123.39 |
$270 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$137.10 |
$300 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$172.29 |
$377 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$132.53 |
$290 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$112.42 |
$246 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$139.39 |
$305 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$157.21 |
$344 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$131.16 |
$287 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$79.06 |
$173 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$143.04 |
$313 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$112.42 |
$246 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$127.50 |
$279 |
1.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$152.64 |
$334 |
1.4× |
| Xr bone length studies (77073) |
$194.22 |
$425 |
1.7× |
| Xr c-spine 4 or 5 views (72050) |
$257.29 |
$563 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$223.47 |
$489 |
2.0× |
| Xr chest 4+ views (71048) |
$164.06 |
$359 |
1.5× |