| Abdomen 1 View (74018) |
$183.60 |
$306 |
2.1× |
| Abdomen 2 views (74019) |
$202.80 |
$338 |
2.0× |
| Acute venous thrombosis imaging, peptide Non-Facility (78456) |
$2,728.20 |
$4,547 |
2.1× |
| Angiography extremity bilateral rs&i (75716) |
$4,716.60 |
$7,861 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,716.60 |
$7,861 |
1.5× |
| Ankle 2 views (73600) |
$176.40 |
$294 |
2.1× |
| Aortography thoracic serialography rs&i (75605) |
$8,132.40 |
$13,554 |
1.5× |
| Aortography thoracic w/o serialography rs&i (75600) |
$7,819.80 |
$13,033 |
2.5× |
| Artery X-Rays Pelvis (75736) |
$8,131.80 |
$13,553 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$1,181.40 |
$1,969 |
3.0× |
| Bone Imaging Limited Area (78300) |
$1,134.60 |
$1,891 |
2.9× |
| Bone Imaging Whole Body (78306) |
$1,134.60 |
$1,891 |
2.9× |
| Chest 1 view (71045) |
$183.60 |
$306 |
2.1× |
| Chest 2 views (71046) |
$202.80 |
$338 |
2.4× |
| Chest 4 or more views (71048) |
$202.80 |
$338 |
2.0× |
| Clavicle complete (73000) |
$216 |
$360 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$196.80 |
$328 |
1.9× |
| Contrast Exam Abdominl Aorta (75625) |
$4,716.60 |
$7,861 |
1.5× |
| Contrast X-Ray Bladder (74430) |
$570 |
$950 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,324.40 |
$3,874 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,623.60 |
$2,706 |
6.9× |
| CT abdomen w contrast (74160) |
$1,207.20 |
$2,012 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,340.40 |
$2,234 |
7.8× |
| CT abdomen w/o contrast (74150) |
$770.40 |
$1,284 |
7.5× |
| CT Angio Abdomen and Pelvis (74174) |
$2,324.40 |
$3,874 |
6.8× |
| CT Angio Chest (71275) |
$1,591.80 |
$2,653 |
9.2× |
| CT Angio Head (70496) |
$1,359 |
$2,265 |
7.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,306.80 |
$2,178 |
7.6× |
| CT Angio Neck (70498) |
$1,359 |
$2,265 |
7.9× |
| CT cervical spine w/ contrast (72126) |
$1,207.20 |
$2,012 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$770.40 |
$1,284 |
7.5× |
| CT chest w contrast (71260) |
$1,207.20 |
$2,012 |
7.0× |
| CT chest w/wo contrast (71270) |
$1,341 |
$2,235 |
7.8× |
| CT head/brain with contrast (70460) |
$1,207.20 |
$2,012 |
7.0× |
| CT head/brain without and with contrast (70470) |
$1,341 |
$2,235 |
7.8× |
| CT iac w contrast (70481) |
$1,207.20 |
$2,012 |
7.0× |
| CT l-spine w&w/o contrast (72133) |
$1,359 |
$2,265 |
7.9× |
| CT lower ext w/o (73700) |
$868.20 |
$1,447 |
8.4× |
| CT lower extremity w/contrast material (73701) |
$1,161 |
$1,935 |
6.7× |
| CT lumbar spine w contrast (72132) |
$1,207.80 |
$2,013 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$770.40 |
$1,284 |
7.5× |
| CT maxillofacial w contrast (70487) |
$1,656 |
$2,760 |
9.6× |
| CT maxillofacial wo contrast (70486) |
$939 |
$1,565 |
9.1× |
| CT neck tissue combo (70492) |
$1,341 |
$2,235 |
7.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,341 |
$2,235 |
7.8× |
| CT orbits w/o contrast (70480) |
$770.40 |
$1,284 |
7.5× |
| CT pelvis w&w/o contrast (72194) |
$1,341 |
$2,235 |
7.8× |
| CT pelvis w/o contrast (72192) |
$770.40 |
$1,284 |
7.5× |
| CT scan of leg combo (73702) |
$1,161 |
$1,935 |
6.7× |
| CT soft tissue neck w contrast (70491) |
$1,207.20 |
$2,012 |
7.0× |
| CT soft tissue neck w/o contrast (70490) |
$770.40 |
$1,284 |
7.5× |
| CT thoracic spine w contrast (72129) |
$1,359 |
$2,265 |
7.9× |
| CT thoracic spine w/o contrast (72128) |
$770.40 |
$1,284 |
7.5× |
| CT thorax w/o contrast (71250) |
$770.40 |
$1,284 |
7.5× |
| CT upper ext wo (73200) |
$741 |
$1,235 |
7.2× |
| CT upper extremity with contrast (73201) |
$1,161 |
$1,935 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,359 |
$2,265 |
7.9× |
| Cta Abdomen (74175) |
$1,359 |
$2,265 |
7.9× |
| CTA pelvis (72191) |
$1,359 |
$2,265 |
7.9× |
| Dxa Bone Density Axial (77080) |
$315.60 |
$526 |
3.1× |
| Dxa bone density study (77085) |
$240 |
$400 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$196.80 |
$328 |
2.3× |
| Echograp Trans R Pros Study (76873) |
$169.20 |
$282 |
1.6× |
| Esophagram (74220) |
$345.60 |
$576 |
2.0× |
| Fluoroscopy up to 1 hr (76000) |
$363 |
$605 |
1.5× |
| Follow-Up Angiography (75898) |
$4,716.60 |
$7,861 |
1.5× |
| Foot 2 views (73620) |
$216 |
$360 |
2.5× |
| Forearm 2 views (73090) |
$216 |
$360 |
2.5× |
| Gastric emptying imaging study (78264) |
$1,134.60 |
$1,891 |
2.9× |
| Gated Heart, Multiple (78473) |
$1,273.20 |
$2,122 |
3.2× |
| Hand 2 views (73120) |
$176.40 |
$294 |
1.7× |
| Hysterosalpingogram (74740) |
$363 |
$605 |
1.5× |
| Knee 3 Views (73562) |
$238.80 |
$398 |
2.8× |
| Liver & Spleen Imaging Static Only (78215) |
$1,273.20 |
$2,122 |
3.2× |
| Lymph System Imaging (78195) |
$1,251 |
$2,085 |
2.3× |
| Magnetic Image Jaw Joint (70336) |
$1,656 |
$2,760 |
7.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,140.20 |
$3,567 |
6.2× |
| MRA head w/o contrast (70544) |
$1,359 |
$2,265 |
5.8× |
| MRA head with contrast (70545) |
$1,748.40 |
$2,914 |
5.1× |
| MRA neck w contrast (70548) |
$1,748.40 |
$2,914 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,140.20 |
$3,567 |
6.2× |
| MRA neck w/o contrast (70547) |
$1,748.40 |
$2,914 |
7.4× |
| MRI abdomen w contrast (74182) |
$2,140.20 |
$3,567 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,359 |
$2,265 |
5.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,681.20 |
$2,802 |
2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,058 |
$3,430 |
6.0× |
| MRI Breast W/O Contrast Bilateral (77047) |
$1,561.80 |
$2,603 |
6.6× |
| MRI Breast Without Contrast Material Unilateral (77046) |
$781.20 |
$1,302 |
3.3× |
| MRI cervical spine w contrast (72142) |
$1,748.40 |
$2,914 |
5.1× |
| MRI cervical spine w/o cont (72141) |
$1,359 |
$2,265 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,359 |
$2,265 |
5.8× |
| MRI chest wo w contrast (71552) |
$2,140.20 |
$3,567 |
6.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,681.20 |
$2,802 |
4.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,058 |
$3,430 |
6.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,592.40 |
$2,654 |
6.8× |
| MRI lumbar spine w contrast (72149) |
$1,748.40 |
$2,914 |
5.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,140.20 |
$3,567 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,359 |
$2,265 |
5.8× |
| MRI orbit face neck w contrast (70542) |
$1,748.40 |
$2,914 |
5.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,140.20 |
$3,567 |
6.2× |
| MRI pelvis w contrast (72196) |
$1,748.40 |
$2,914 |
5.1× |
| MRI pelvis w/o & w contrast (72197) |
$2,140.20 |
$3,567 |
6.2× |
| MRI pelvis w/o contrast (72195) |
$2,140.20 |
$3,567 |
9.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,359 |
$2,265 |
5.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,592.40 |
$2,654 |
6.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,592.40 |
$2,654 |
4.6× |
| MRI, abdomen, combo (74183) |
$2,140.20 |
$3,567 |
6.2× |
| MRI, dorsal spine combo (72157) |
$2,140.20 |
$3,567 |
6.2× |
| MRI, dorsal spine contrast (72147) |
$2,140.20 |
$3,567 |
6.2× |
| MRI, joint upper extrem (73221) |
$1,592.40 |
$2,654 |
6.8× |
| MRI, joint upper extrem combo (73223) |
$2,140.20 |
$3,567 |
6.2× |
| MRI, lumbar spine combo (72158) |
$2,140.20 |
$3,567 |
6.2× |
| Neck soft tissue (70360) |
$183.60 |
$306 |
2.1× |
| Nonvascular Shunt X-Ray (75809) |
$371.40 |
$619 |
3.6× |
| Pelvis 1 or 2 views (72170) |
$183.60 |
$306 |
1.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$379.80 |
$633 |
3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,023.60 |
$1,706 |
1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$238.80 |
$398 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$176.40 |
$294 |
2.1× |
| Radex elbow complete minimum 3 views (73080) |
$238.80 |
$398 |
2.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$202.80 |
$338 |
2.0× |
| Radex fingr minimum 2 views (73140) |
$176.40 |
$294 |
2.1× |
| Radex foot complete minimum 3 views (73630) |
$238.80 |
$398 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$216 |
$360 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$202.80 |
$338 |
2.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$202.80 |
$338 |
2.4× |
| Radex shoulder complete minimum 2 views (73030) |
$238.80 |
$398 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$183.60 |
$306 |
2.1× |
| Radex Spine 1 View Specify Level (72020) |
$183.60 |
$306 |
2.1× |
| Radex Sternum Minimum 2 Views (71120) |
$183.60 |
$306 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$183.60 |
$306 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$176.40 |
$294 |
2.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$238.80 |
$398 |
2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$757.80 |
$1,263 |
7.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$271.80 |
$453 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$183.60 |
$306 |
1.8× |
| Radiologic exam colon double contrast study (74280) |
$573 |
$955 |
3.3× |
| Radiologic exam colon single contrast study (74270) |
$345.60 |
$576 |
2.0× |
| Radiologic exam knee complete 4/more views (73564) |
$202.80 |
$338 |
2.0× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$345.60 |
$576 |
2.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$345.60 |
$576 |
2.0× |
| Radiologic examination femur minimum 2 views (73552) |
$264 |
$440 |
3.1× |
| Radiologic examination knee 1/2 views (73560) |
$216 |
$360 |
2.5× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$135 |
$225 |
1.6× |
| Ribs bilateral 3 views (71110) |
$248.40 |
$414 |
2.4× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,282.80 |
$2,138 |
3.3× |
| Scapula (73010) |
$176.40 |
$294 |
1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$58.80 |
$98 |
2.5× |
| Shoulder 1 view (73020) |
$176.40 |
$294 |
2.1× |
| Skull less than 4 views (70250) |
$183.60 |
$306 |
1.8× |
| Sternoclavicular joints (71130) |
$183.60 |
$306 |
2.1× |
| Thoracic spine 2 views (72070) |
$202.80 |
$338 |
2.0× |
| Thoracic spine 3 views (72072) |
$202.80 |
$338 |
2.0× |
| Thoracolumbar 2 views (72080) |
$183.60 |
$306 |
2.1× |
| Ultrasound Breast Limited (76642) |
$921.60 |
$1,536 |
10.7× |
| Ultrasound Exam Aaa Screen (76706) |
$379.80 |
$633 |
3.7× |
| Ultrasound, abdomen limited (76705) |
$391.20 |
$652 |
3.8× |
| Unlisted Dx Radiographic Procedure (76499) |
$183.60 |
$306 |
2.1× |
| Upper gi w/o kub (74240) |
$345.60 |
$576 |
2.0× |
| Us breast unilateral complete (76641) |
$625.20 |
$1,042 |
6.1× |
| Us chest (76604) |
$442.80 |
$738 |
4.3× |
| Us complete joint (76881) |
$452.40 |
$754 |
4.4× |
| Us exam, pelvic, limited (76857) |
$255.60 |
$426 |
2.5× |
| Us kidney transplant (76776) |
$391.20 |
$652 |
3.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$443.40 |
$739 |
4.3× |
| Us ob transvaginal (76817) |
$255.60 |
$426 |
2.5× |
| Us pelvic non ob complete (76856) |
$391.20 |
$652 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$391.20 |
$652 |
3.8× |
| Us retroperitoneal complete (76770) |
$478.80 |
$798 |
4.6× |
| Us retroperitoneal limited (76775) |
$478.80 |
$798 |
4.6× |
| Us scrotum and contents (76870) |
$391.20 |
$652 |
3.8× |
| Us thyroid (76536) |
$391.20 |
$652 |
3.8× |
| Us transrectal (76872) |
$391.20 |
$652 |
3.8× |
| Venography extremity unilateral rs&i (75820) |
$2,370.60 |
$3,951 |
1.5× |
| Venous thrombosis imaging (78457) |
$809.40 |
$1,349 |
1.5× |
| Vertebral fracture assessment via dxa (77086) |
$196.80 |
$328 |
2.3× |
| Wrist 2 views (73100) |
$216 |
$360 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$183.60 |
$306 |
2.1× |
| X-ray antegrade pyelogram tube (74425) |
$939.60 |
$1,566 |
2.7× |
| X-Ray Aorta Leg Arteries (75630) |
$4,716.60 |
$7,861 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$199.20 |
$332 |
2.3× |
| X-Ray Exam Breast Specimen (76098) |
$1,107.60 |
$1,846 |
2.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$224.40 |
$374 |
2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$358.80 |
$598 |
3.5× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$757.80 |
$1,263 |
7.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$253.80 |
$423 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$264 |
$440 |
3.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$379.80 |
$633 |
3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$358.80 |
$598 |
3.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$307.20 |
$512 |
3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$345.60 |
$576 |
4.0× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$307.20 |
$512 |
3.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$202.80 |
$338 |
2.0× |
| X-ray eye for foreign body (70030) |
$183.60 |
$306 |
2.1× |
| X-ray humerus (73060) |
$216 |
$360 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$738.60 |
$1,231 |
4.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$202.80 |
$338 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$183.60 |
$306 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$183.60 |
$306 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$295.20 |
$492 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$202.80 |
$338 |
2.0× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$183.60 |
$306 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$183.60 |
$306 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$202.80 |
$338 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$307.20 |
$512 |
3.0× |
| X-ray thoracic spine 4 vw (72074) |
$202.80 |
$338 |
2.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$570 |
$950 |
1.7× |
| X-Rays Bone Survey Complete (77075) |
$286.80 |
$478 |
2.8× |
| Xr c-spine 4 or 5 views (72050) |
$307.20 |
$512 |
3.0× |
| Xr facial bones less than 3 views (70140) |
$183.60 |
$306 |
2.1× |
| Xr orbits complete 4 views (70200) |
$202.80 |
$338 |
2.0× |