| Abdomen 2 views (74019) |
$258.50 |
$258.50 |
2.4× |
| Acute gi blood loss imaging (78278) |
$636 |
$636 |
1.5× |
| Ankle 2 views (73600) |
$167.50 |
$167.50 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$722 |
$722 |
1.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$824.50 |
$824.50 |
2.0× |
| Bone &/joint imaging whole body (78306) |
$881 |
$881 |
2.1× |
| Bone age studies (77072) |
$154 |
$154 |
1.4× |
| Bone Imaging 3 Phase (78315) |
$1,172 |
$1,172 |
2.8× |
| Bowel imaging (78290) |
$636 |
$636 |
1.5× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$940 |
$940 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$218.50 |
$218.50 |
2.4× |
| Chest 1 view (71045) |
$151 |
$151 |
1.7× |
| Chest xray 3 views (71047) |
$209.50 |
$209.50 |
2.3× |
| Clavicle complete (73000) |
$167.50 |
$167.50 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$730 |
$730 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,193 |
$2,193 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,661.50 |
$1,661.50 |
6.7× |
| CT abdomen w contrast (74160) |
$1,431 |
$1,431 |
7.9× |
| CT abdomen w wo contrast (74170) |
$1,838.50 |
$1,838.50 |
10.2× |
| CT abdomen w/o contrast (74150) |
$1,086 |
$1,086 |
10.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,123 |
$2,123 |
11.7× |
| CT angiography upper extremity lt (73206) |
$1,947 |
$1,947 |
10.8× |
| CT c-spine w/contrast (72126) |
$1,407 |
$1,407 |
3.9× |
| CT c-spine w/o contrast (72125) |
$1,225.50 |
$1,225.50 |
11.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,577 |
$1,577 |
8.7× |
| CT chest w contrast (71260) |
$1,340 |
$1,340 |
7.4× |
| CT chest w/wo contrast (71270) |
$1,627 |
$1,627 |
9.0× |
| CT head/brain with contrast (70460) |
$1,106 |
$1,106 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,348 |
$1,348 |
7.4× |
| CT iac w contrast (70481) |
$1,503.50 |
$1,503.50 |
8.3× |
| CT limited/localized follow up study (76380) |
$881 |
$881 |
9.8× |
| CT lower ext w/o (73700) |
$1,058.50 |
$1,058.50 |
9.8× |
| CT lower extremity w wo contrast (73702) |
$1,651.50 |
$1,651.50 |
9.1× |
| CT lower extremity w/contrast material (73701) |
$1,288 |
$1,288 |
7.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,644 |
$1,644 |
9.1× |
| CT lumbar spine w/contrast (72132) |
$1,445.50 |
$1,445.50 |
4.0× |
| CT lumbar spine w/o contrast (72131) |
$1,203 |
$1,203 |
11.1× |
| CT maxillofacial w contrast (70487) |
$1,337.50 |
$1,337.50 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,596.50 |
$1,596.50 |
8.8× |
| CT maxillofacial wo contrast (70486) |
$1,115.50 |
$1,115.50 |
10.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,716.50 |
$1,716.50 |
9.5× |
| CT orbits w/o contrast (70480) |
$1,364 |
$1,364 |
12.6× |
| CT pelvis w/o contrast (72192) |
$1,065 |
$1,065 |
9.9× |
| CT pelvis w/wo contrast (72194) |
$1,574.50 |
$1,574.50 |
8.7× |
| CT scan of arm combo (73202) |
$1,591 |
$1,591 |
8.8× |
| CT soft tissue neck w contrast (70491) |
$1,320 |
$1,320 |
7.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,586 |
$1,586 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,094 |
$1,094 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,416.50 |
$1,416.50 |
7.8× |
| CT thoracic spine w/o contrast (72128) |
$1,203 |
$1,203 |
11.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,596.50 |
$1,596.50 |
8.8× |
| CT thorax w/o contrast (71250) |
$1,148 |
$1,148 |
10.6× |
| CT upper ext wo (73200) |
$1,074.50 |
$1,074.50 |
10.0× |
| CT upper extremity with contrast (73201) |
$1,288 |
$1,288 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,180 |
$2,180 |
12.0× |
| Cta Abdomen (74175) |
$2,134.50 |
$2,134.50 |
11.8× |
| CTA abdomen pelvis (74174) |
$2,532.50 |
$2,532.50 |
7.0× |
| CTA chest (71275) |
$2,053 |
$2,053 |
11.3× |
| Cta Head (70496) |
$2,166.50 |
$2,166.50 |
12.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,850 |
$1,850 |
5.1× |
| Cta Neck (70498) |
$2,166.50 |
$2,166.50 |
12.0× |
| Cta Pelvis (72191) |
$2,050 |
$2,050 |
11.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$303.50 |
$303.50 |
2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$182.50 |
$182.50 |
2.0× |
| Facial bones min 3 views (70150) |
$243.50 |
$243.50 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$318 |
$318 |
2.9× |
| Foot 2 views (73620) |
$157 |
$157 |
1.7× |
| Forearm 2 views (73090) |
$164.50 |
$164.50 |
1.8× |
| Hand 2 views (73120) |
$159.50 |
$159.50 |
1.5× |
| Heart Infarct Image (78466) |
$636 |
$636 |
1.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,081.50 |
$1,081.50 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$949 |
$949 |
2.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$283.50 |
$283.50 |
2.6× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$834.50 |
$834.50 |
1.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,034.50 |
$1,034.50 |
1.8× |
| Knee 3 views (73562) |
$206 |
$206 |
2.3× |
| Liver & spleen imaging static only (78215) |
$710.50 |
$710.50 |
1.7× |
| Lung ventilation imaging (78579) |
$967.50 |
$967.50 |
2.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,894 |
$1,894 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,945 |
$1,945 |
5.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,286 |
$2,286 |
6.3× |
| MRA head w & w/o contrast (70546) |
$2,471.50 |
$2,471.50 |
6.9× |
| MRA head w/o contrast (70544) |
$1,980.50 |
$1,980.50 |
8.0× |
| MRA head with contrast (70545) |
$1,980.50 |
$1,980.50 |
5.5× |
| MRA neck w contrast (70548) |
$2,063.50 |
$2,063.50 |
5.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,366 |
$2,366 |
6.6× |
| MRA neck w/o contrast (70547) |
$1,980.50 |
$1,980.50 |
8.0× |
| MRI abdomen w contrast (74182) |
$2,003.50 |
$2,003.50 |
5.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,391 |
$2,391 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,704 |
$1,704 |
6.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,894 |
$1,894 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,235 |
$2,235 |
6.2× |
| MRI c-spine with contrast (72142) |
$2,006 |
$2,006 |
5.6× |
| MRI cervical spine w/o contrast (72141) |
$1,732 |
$1,732 |
7.0× |
| MRI chest w/o & w/contrast material (71552) |
$2,396 |
$2,396 |
6.7× |
| MRI chest w/o contrast (71550) |
$1,933.50 |
$1,933.50 |
7.9× |
| MRI chest with contrast (71551) |
$2,105.50 |
$2,105.50 |
2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,932 |
$1,932 |
5.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,286 |
$2,286 |
6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,798 |
$1,798 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,759.50 |
$1,759.50 |
7.1× |
| MRI orbit face neck w contrast (70542) |
$2,047 |
$2,047 |
5.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,337 |
$2,337 |
6.5× |
| MRI pelvis w/contrast (72196) |
$2,156.50 |
$2,156.50 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,340 |
$2,340 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,806 |
$1,806 |
7.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,294 |
$2,294 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,006 |
$2,006 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,294 |
$2,294 |
6.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,955 |
$1,955 |
5.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,294 |
$2,294 |
6.4× |
| MRI temporomandibular joint (70336) |
$1,614 |
$1,614 |
6.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,744.50 |
$1,744.50 |
7.1× |
| MRI up ext w/o contrast (73218) |
$1,775.50 |
$1,775.50 |
7.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,724.50 |
$1,724.50 |
7.0× |
| MRI, joint upper extrem combo (73223) |
$2,235 |
$2,235 |
6.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,651 |
$1,651 |
1.2× |
| Neck soft tissue (70360) |
$163.50 |
$163.50 |
1.8× |
| Nm cardiac blood pool multiple (78473) |
$970 |
$970 |
2.4× |
| Nm gastric emptying study (78264) |
$742.50 |
$742.50 |
1.8× |
| Nm gastroesophageal reflux study (78262) |
$901.50 |
$901.50 |
2.2× |
| Parathyrd planar w/spect&CT (78072) |
$1,485 |
$1,485 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$161 |
$161 |
1.5× |
| PET image w/CT, skull-thigh (78815) |
$315 |
$315 |
0.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,153 |
$1,153 |
2.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,358 |
$1,358 |
2.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$185 |
$185 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$158.50 |
$158.50 |
1.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$198 |
$198 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$215.50 |
$215.50 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$249 |
$249 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$282 |
$282 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$177.50 |
$177.50 |
2.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$182 |
$182 |
2.0× |
| Radex Hand Minimum 3 Views (73130) |
$185.50 |
$185.50 |
2.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$158.50 |
$158.50 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$280.50 |
$280.50 |
2.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$230.50 |
$230.50 |
2.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$316.50 |
$316.50 |
2.9× |
| Radex Humerus Minimum 2 Views (73060) |
$180 |
$180 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$177.50 |
$177.50 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$229 |
$229 |
2.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$237 |
$237 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$188 |
$188 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$230 |
$230 |
2.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$188 |
$188 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$180.50 |
$180.50 |
2.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$280.50 |
$280.50 |
2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$252 |
$252 |
2.8× |
| Radex Toe Minimum 2 Views (73660) |
$163.50 |
$163.50 |
1.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$219 |
$219 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$321.50 |
$321.50 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$151 |
$151 |
1.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$338.50 |
$338.50 |
3.1× |
| Radiologic exam chest 2 views (71046) |
$184.50 |
$184.50 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$169.50 |
$169.50 |
1.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$216 |
$216 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$165 |
$165 |
1.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$190 |
$190 |
1.8× |
| Ribs bilateral 3 views (71110) |
$314 |
$314 |
2.9× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$764 |
$764 |
1.9× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$802 |
$802 |
1.9× |
| Sacroiliac Joints < 3 Views (72200) |
$219 |
$219 |
2.0× |
| Scapula (73010) |
$170 |
$170 |
1.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$92 |
$92 |
3.9× |
| Shoulder 1 view (73020) |
$154.50 |
$154.50 |
1.7× |
| Spine thoracic 3 views (72072) |
$218.50 |
$218.50 |
2.0× |
| Thoracolumbar 2 views (72080) |
$208.50 |
$208.50 |
2.3× |
| Thyroid imaging w/blood flow (78013) |
$556 |
$556 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$750 |
$750 |
1.8× |
| Tmj unilateral (70328) |
$179.50 |
$179.50 |
2.0× |
| Ultrasound Exam Aaa Screen (76706) |
$281 |
$281 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$314 |
$314 |
2.9× |
| Umbilical-artery Doppler (OB) (76820) |
$336 |
$336 |
3.1× |
| Unlisted ultrasound procedure (76999) |
$318 |
$318 |
3.5× |
| Us chest (76604) |
$314 |
$314 |
2.9× |
| Us compl joint r-t w/image documentation (76881) |
$443.50 |
$443.50 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$301 |
$301 |
2.8× |
| Us ob limited (76815) |
$321 |
$321 |
3.0× |
| Us ob transvaginal (76817) |
$343 |
$343 |
3.2× |
| Us pelvic non ob complete (76856) |
$361.50 |
$361.50 |
3.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$298.50 |
$298.50 |
2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$401.50 |
$401.50 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$304 |
$304 |
2.8× |
| Us retroperitoneal complete (76770) |
$398.50 |
$398.50 |
3.7× |
| Us scrotum and contents (76870) |
$354 |
$354 |
3.3× |
| Us soft tissue head/neck (76536) |
$333 |
$333 |
3.1× |
| Wrist 2 views (73100) |
$177.50 |
$177.50 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$345.50 |
$345.50 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$216 |
$216 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$162 |
$162 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$218.50 |
$218.50 |
2.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$283 |
$283 |
2.6× |
| X-ray exam of femur 2/> (73552) |
$222 |
$222 |
2.5× |
| X-ray eye for foreign body (70030) |
$228 |
$228 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$504 |
$504 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$182 |
$182 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$190.50 |
$190.50 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$224 |
$224 |
2.1× |
| X-ray nose-rectum child f.b. (76010) |
$169.50 |
$169.50 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$271.50 |
$271.50 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$215.50 |
$215.50 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$295.50 |
$295.50 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$359.50 |
$359.50 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$221.50 |
$221.50 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$172.50 |
$172.50 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$224.50 |
$224.50 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$276.50 |
$276.50 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$209.50 |
$209.50 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$154.50 |
$154.50 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$195 |
$195 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$209 |
$209 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$248 |
$248 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$284 |
$284 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$356 |
$356 |
3.3× |
| Xr chest 4+ views (71048) |
$255.50 |
$255.50 |
2.4× |