| Abdomen 2 views (74019) |
$434.35 |
$511 |
4.0× |
| Ankle 2 views (73600) |
$217.60 |
$256 |
2.4× |
| Bone &/joint imaging whole body (78306) |
$1,358.30 |
$1,598 |
3.3× |
| Bone age studies (77072) |
$180.20 |
$212 |
1.7× |
| Bone Imaging 3 Phase (78315) |
$1,428.85 |
$1,681 |
3.5× |
| Bone survey complete (77075) |
$1,771.40 |
$2,084 |
16.4× |
| Cervical spine 2 or 3 views (72040) |
$351.05 |
$413 |
3.9× |
| Chest 1 view (71045) |
$243.10 |
$286 |
2.7× |
| Cholecystography, oral contrast Non-Facility (74290) |
$399.50 |
$470 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$653.65 |
$769 |
3.6× |
| Clavicle complete (73000) |
$220.15 |
$259 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$590.75 |
$695 |
5.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,347.30 |
$3,938 |
9.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,609.05 |
$1,893 |
6.5× |
| CT abdomen w contrast (74160) |
$1,542.75 |
$1,815 |
8.5× |
| CT abdomen w wo contrast (74170) |
$1,707.65 |
$2,009 |
9.4× |
| CT abdomen w/o contrast (74150) |
$1,375.30 |
$1,618 |
12.7× |
| CT angio hrt w/3d image (75574) |
$796.45 |
$937 |
2.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,676.65 |
$3,149 |
14.8× |
| CT angiography upper extremity lt (73206) |
$2,650.30 |
$3,118 |
14.6× |
| CT c-spine w/o contrast (72125) |
$1,375.30 |
$1,618 |
12.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,640.50 |
$1,930 |
9.1× |
| CT chest w contrast (71260) |
$1,542.75 |
$1,815 |
8.5× |
| CT chest w/wo contrast (71270) |
$1,665.15 |
$1,959 |
9.2× |
| CT head/brain with contrast (70460) |
$1,511.30 |
$1,778 |
8.3× |
| CT head/brain without and with contrast (70470) |
$1,707.65 |
$2,009 |
9.4× |
| CT iac w contrast (70481) |
$1,511.30 |
$1,778 |
8.3× |
| CT lower ext w/o (73700) |
$1,348.10 |
$1,586 |
12.5× |
| CT lower extremity w wo contrast (73702) |
$1,576.75 |
$1,855 |
8.7× |
| CT lower extremity w/contrast material (73701) |
$1,482.40 |
$1,744 |
8.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,673.65 |
$1,969 |
9.2× |
| CT lumbar spine w/contrast (72132) |
$1,542.75 |
$1,815 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$1,348.10 |
$1,586 |
12.5× |
| CT maxillofacial w contrast (70487) |
$1,542.75 |
$1,815 |
8.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,667.70 |
$1,962 |
9.2× |
| CT maxillofacial wo contrast (70486) |
$1,348.95 |
$1,587 |
12.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,749.30 |
$2,058 |
9.7× |
| CT orbits w/o contrast (70480) |
$1,375.30 |
$1,618 |
12.7× |
| CT pelvis w/o contrast (72192) |
$1,348.95 |
$1,587 |
12.5× |
| CT scan of arm combo (73202) |
$1,640.50 |
$1,930 |
9.1× |
| CT soft tissue neck w contrast (70491) |
$1,542.75 |
$1,815 |
8.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,707.65 |
$2,009 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,229.10 |
$1,446 |
11.4× |
| CT thoracic spine w/contrast (72129) |
$1,482.40 |
$1,744 |
8.2× |
| CT thoracic spine w/o contrast (72128) |
$1,348.10 |
$1,586 |
12.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,667.70 |
$1,962 |
9.2× |
| CT thorax w/o contrast (71250) |
$1,375.30 |
$1,618 |
12.7× |
| CT upper ext wo (73200) |
$1,348.10 |
$1,586 |
12.5× |
| CT upper extremity with contrast (73201) |
$1,482.40 |
$1,744 |
4.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,888.75 |
$4,575 |
21.5× |
| Cta Abdomen (74175) |
$1,982.20 |
$2,332 |
10.9× |
| CTA abdomen pelvis (74174) |
$3,090.60 |
$3,636 |
8.6× |
| CTA chest (71275) |
$2,346.85 |
$2,761 |
13.0× |
| Cta Head (70496) |
$1,982.20 |
$2,332 |
10.9× |
| Cta Neck (70498) |
$2,114.80 |
$2,488 |
11.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$425 |
$500 |
3.9× |
| Facial bones min 3 views (70150) |
$257.55 |
$303 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$170 |
$200 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$436.48 |
$513.50 |
4.0× |
| Fluoroscopy up to 1 hr (76000) |
$396.95 |
$467 |
1.6× |
| Foot 2 views (73620) |
$217.60 |
$256 |
2.4× |
| Forearm 2 views (73090) |
$236.30 |
$278 |
2.6× |
| Hand 2 views (73120) |
$217.60 |
$256 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,593.75 |
$1,875 |
2.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,380.40 |
$1,624 |
3.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$187 |
$220 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,190.85 |
$1,401 |
2.1× |
| Knee 3 views (73562) |
$255 |
$300 |
2.8× |
| Lung ventilation imaging (78579) |
$1,270.75 |
$1,495 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,371.50 |
$2,790 |
6.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,708.10 |
$3,186 |
7.5× |
| MRA head w & w/o contrast (70546) |
$2,142 |
$2,520 |
5.9× |
| MRA head w/o contrast (70544) |
$2,142 |
$2,520 |
8.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,521.95 |
$2,967 |
7.0× |
| MRA neck w/o contrast (70547) |
$2,142 |
$2,520 |
8.7× |
| MRI abdomen w contrast (74182) |
$2,416.55 |
$2,843 |
6.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,510.05 |
$2,953 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$2,142 |
$2,520 |
8.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,463.30 |
$2,898 |
6.8× |
| MRI c-spine with contrast (72142) |
$2,416.55 |
$2,843 |
6.7× |
| MRI cardiac w/o contrast (75557) |
$2,125 |
$2,500 |
8.6× |
| MRI cervical spine w/o contrast (72141) |
$2,142 |
$2,520 |
8.7× |
| MRI chest with contrast (71551) |
$2,416.55 |
$2,843 |
3.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,371.50 |
$2,790 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,521.95 |
$2,967 |
7.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,142 |
$2,520 |
8.7× |
| MRI orbit face neck w contrast (70542) |
$2,416.55 |
$2,843 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,463.30 |
$2,898 |
6.8× |
| MRI pelvis w/contrast (72196) |
$2,416.55 |
$2,843 |
6.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,657.95 |
$3,127 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$2,142 |
$2,520 |
8.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,521.95 |
$2,967 |
7.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,416.55 |
$2,843 |
6.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,521.95 |
$2,967 |
7.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,774.40 |
$3,264 |
7.7× |
| MRI thoracic spine w/o contrast (72146) |
$2,142 |
$2,520 |
8.7× |
| MRI up ext w/o contrast (73218) |
$2,142 |
$2,520 |
8.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,101.20 |
$2,472 |
8.5× |
| MRI, joint upper extrem combo (73223) |
$2,708.10 |
$3,186 |
7.5× |
| Myocardial Imaging Pet Metabolic Evaluation (78459) |
$3,683.05 |
$4,333 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$4,137.80 |
$4,868 |
3.1× |
| Myocardial spect single study at rest or stress (78451) |
$3,212.15 |
$3,779 |
2.4× |
| Neck soft tissue (70360) |
$280.50 |
$330 |
3.1× |
| Nm gastric emptying study (78264) |
$1,790.95 |
$2,107 |
4.3× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$1,147.50 |
$1,350 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$243.95 |
$287 |
2.3× |
| PET image w/CT, skull-thigh (78815) |
$5,398.35 |
$6,351 |
3.7× |
| PET imaging CT for attenuation limited area (78814) |
$3,683.05 |
$4,333 |
2.5× |
| PET imaging for CT attenuation whole body (78816) |
$5,386.45 |
$6,337 |
3.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,905.70 |
$2,242 |
3.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$237.15 |
$279 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$210.80 |
$248 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$268.60 |
$316 |
3.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$493.85 |
$581 |
4.6× |
| Radex fingr minimum 2 views (73140) |
$245.65 |
$289 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$245.65 |
$289 |
2.7× |
| Radex Hand Minimum 3 Views (73130) |
$265.20 |
$312 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$210.80 |
$248 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$397.80 |
$468 |
3.7× |
| Radex Humerus Minimum 2 Views (73060) |
$252.45 |
$297 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$251.60 |
$296 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$282.20 |
$332 |
2.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$362.10 |
$426 |
3.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$257.55 |
$303 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$312.80 |
$368 |
2.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$284.75 |
$335 |
3.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$212.50 |
$250 |
2.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$286.45 |
$337 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$311.10 |
$366 |
3.5× |
| Radex Toe Minimum 2 Views (73660) |
$245.65 |
$289 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$261.80 |
$308 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$248.20 |
$292 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$247.35 |
$291 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$449.65 |
$529 |
4.2× |
| Radiologic exam chest 2 views (71046) |
$306 |
$360 |
3.4× |
| Radiologic examination femur 1 view (73551) |
$210.80 |
$248 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$250.75 |
$295 |
2.8× |
| Radiological examination surgical specimen (76098) |
$123.25 |
$145 |
0.2× |
| Sacroiliac Joints < 3 Views (72200) |
$289 |
$340 |
2.7× |
| Scapula (73010) |
$220.15 |
$259 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$61.20 |
$72 |
2.6× |
| Shoulder 1 view (73020) |
$209.10 |
$246 |
2.3× |
| Spine thoracic 3 views (72072) |
$369.75 |
$435 |
3.4× |
| Testicular Imaging With Vascular Flow (78761) |
$1,234.20 |
$1,452 |
3.0× |
| Thoracolumbar 2 views (72080) |
$332.35 |
$391 |
3.7× |
| Thyroid imaging w/blood flow (78013) |
$1,031.05 |
$1,213 |
2.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,559.75 |
$1,835 |
3.8× |
| Ultrasound breast complete (76641) |
$556.75 |
$655 |
5.2× |
| Ultrasound Exam Aaa Screen (76706) |
$615.40 |
$724 |
5.7× |
| Ultrasound, abdomen limited (76705) |
$646 |
$760 |
6.0× |
| Umbilical-artery Doppler (OB) (76820) |
$377.40 |
$444 |
3.5× |
| Us breast unilateral limited (76642) |
$357.85 |
$421 |
4.0× |
| Us chest (76604) |
$515.95 |
$607 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$379.10 |
$446 |
3.5× |
| Us ob detailed single fetus (76811) |
$714 |
$840 |
2.9× |
| Us ob limited (76815) |
$379.10 |
$446 |
3.5× |
| Us ob transvaginal (76817) |
$342.12 |
$402.50 |
3.2× |
| Us pelvic non ob complete (76856) |
$440.30 |
$518 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$391 |
$460 |
3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$432.65 |
$509 |
4.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$376.98 |
$443.50 |
3.5× |
| Us retroperitoneal complete (76770) |
$790.50 |
$930 |
7.3× |
| Us retroperitoneal limited (76775) |
$646 |
$760 |
6.0× |
| Us scrotum and contents (76870) |
$546.55 |
$643 |
5.1× |
| Us soft tissue head/neck (76536) |
$492.15 |
$579 |
4.6× |
| Us transrectal (76872) |
$387.60 |
$456 |
3.6× |
| Us, eye b-scan (76512) |
$355.30 |
$418 |
3.3× |
| Wrist 2 views (73100) |
$220.15 |
$259 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$294.95 |
$347 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$236.30 |
$278 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$266.05 |
$313 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$321.30 |
$378 |
3.0× |
| X-ray exam of femur 2/> (73552) |
$288.15 |
$339 |
3.2× |
| X-ray eye for foreign body (70030) |
$246.50 |
$290 |
2.7× |
| X-ray leg, infant (73592) |
$259.25 |
$305 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$332.35 |
$391 |
3.1× |
| X-ray nose-rectum child f.b. (76010) |
$288.15 |
$339 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$307.70 |
$362 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$357.85 |
$421 |
4.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$465.80 |
$548 |
4.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$682.55 |
$803 |
6.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$431.80 |
$508 |
4.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$282.20 |
$332 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$311.10 |
$366 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$218.45 |
$257 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$238.85 |
$281 |
2.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$294.95 |
$347 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$313.65 |
$369 |
3.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$286.45 |
$337 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$400.35 |
$471 |
3.7× |