| Abdomen 2 views (74019) |
$372.80 |
$466 |
3.5× |
| Ankle 2 views (73600) |
$269.60 |
$337 |
3.0× |
| Arthrogram knee (73580) |
$1,076 |
$1,345 |
3.0× |
| Arthrogram shoulder (73040) |
$1,074.40 |
$1,343 |
3.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,308 |
$1,635 |
3.2× |
| Bone &/joint imaging whole body (78306) |
$1,789.60 |
$2,237 |
4.3× |
| Bone Imaging 3 Phase (78315) |
$2,024 |
$2,530 |
4.9× |
| Bone survey complete (77075) |
$968 |
$1,210 |
9.0× |
| Cervical spine 2 or 3 views (72040) |
$319.20 |
$399 |
3.6× |
| Chest 1 view (71045) |
$284 |
$355 |
3.2× |
| Clavicle complete (73000) |
$237.60 |
$297 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$476 |
$595 |
4.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,182.40 |
$3,978 |
8.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,921.60 |
$2,402 |
7.8× |
| CT abdomen w contrast (74160) |
$2,612 |
$3,265 |
14.4× |
| CT abdomen w wo contrast (74170) |
$2,805.60 |
$3,507 |
15.5× |
| CT abdomen w/o contrast (74150) |
$1,972 |
$2,465 |
18.3× |
| CT c-spine w/contrast (72126) |
$2,329.60 |
$2,912 |
6.5× |
| CT c-spine w/o contrast (72125) |
$1,886.40 |
$2,358 |
17.5× |
| CT chest w contrast (71260) |
$2,164.80 |
$2,706 |
12.0× |
| CT chest w/wo contrast (71270) |
$2,877.60 |
$3,597 |
15.9× |
| CT head/brain with contrast (70460) |
$2,254.40 |
$2,818 |
12.5× |
| CT head/brain without and with contrast (70470) |
$2,337.60 |
$2,922 |
12.9× |
| CT iac w contrast (70481) |
$2,416.80 |
$3,021 |
13.4× |
| CT lower ext w/o (73700) |
$1,649.60 |
$2,062 |
15.3× |
| CT lower extremity w wo contrast (73702) |
$2,336.80 |
$2,921 |
12.9× |
| CT lower extremity w/contrast material (73701) |
$1,960.80 |
$2,451 |
10.8× |
| CT lumbar spine w/contrast (72132) |
$2,468.80 |
$3,086 |
6.9× |
| CT lumbar spine w/o contrast (72131) |
$1,872 |
$2,340 |
17.3× |
| CT maxillofacial w contrast (70487) |
$2,423.20 |
$3,029 |
13.4× |
| CT maxillofacial w/wo contrast (70488) |
$2,821.60 |
$3,527 |
15.6× |
| CT maxillofacial wo contrast (70486) |
$1,629.60 |
$2,037 |
15.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,632 |
$3,290 |
14.5× |
| CT orbits w/o contrast (70480) |
$2,074.40 |
$2,593 |
19.2× |
| CT pelvis w/o contrast (72192) |
$1,703.20 |
$2,129 |
15.8× |
| CT pelvis w/wo contrast (72194) |
$2,530.40 |
$3,163 |
14.0× |
| CT soft tissue neck w contrast (70491) |
$2,027.20 |
$2,534 |
11.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,808 |
$3,510 |
15.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,901.60 |
$2,377 |
17.6× |
| CT thoracic spine w/o contrast (72128) |
$1,844 |
$2,305 |
17.1× |
| CT thorax w/o contrast (71250) |
$1,728 |
$2,160 |
16.0× |
| CT upper ext wo (73200) |
$1,801.60 |
$2,252 |
16.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,617.60 |
$3,272 |
14.5× |
| Cta Abdomen (74175) |
$2,570.40 |
$3,213 |
14.2× |
| CTA abdomen pelvis (74174) |
$3,984.80 |
$4,981 |
11.1× |
| CTA chest (71275) |
$2,612 |
$3,265 |
14.4× |
| Cta Head (70496) |
$2,555.20 |
$3,194 |
14.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,060 |
$3,825 |
8.5× |
| Cta Neck (70498) |
$2,536.80 |
$3,171 |
14.0× |
| Cystography minimum 3 views rs&i (74430) |
$804 |
$1,005 |
2.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$484.80 |
$606 |
4.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$312 |
$390 |
3.5× |
| Facial bones min 3 views (70150) |
$532 |
$665 |
4.9× |
| Fetal biophysical profile non-stress testing (76818) |
$887.20 |
$1,109 |
8.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$656 |
$820 |
6.1× |
| Foot 2 views (73620) |
$264.80 |
$331 |
2.9× |
| Forearm 2 views (73090) |
$296.80 |
$371 |
3.3× |
| Hand 2 views (73120) |
$280.80 |
$351 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,907.20 |
$2,384 |
3.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,769.60 |
$2,212 |
4.3× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$2,049.60 |
$2,562 |
3.7× |
| Knee 3 views (73562) |
$272 |
$340 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,300 |
$4,125 |
4.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,620 |
$4,525 |
10.1× |
| MRA head w/o contrast (70544) |
$2,638.40 |
$3,298 |
10.7× |
| MRA head with contrast (70545) |
$3,037.60 |
$3,797 |
8.4× |
| MRA neck w contrast (70548) |
$2,885.60 |
$3,607 |
8.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,706.40 |
$4,633 |
10.3× |
| MRA neck w/o contrast (70547) |
$2,673.60 |
$3,342 |
10.9× |
| MRI abdomen w contrast (74182) |
$3,248 |
$4,060 |
9.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,704.80 |
$4,631 |
10.3× |
| MRI abdomen w/o contrast (74181) |
$2,712.80 |
$3,391 |
11.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,506.40 |
$4,383 |
9.7× |
| MRI c-spine with contrast (72142) |
$3,092 |
$3,865 |
8.6× |
| MRI cervical spine w/o contrast (72141) |
$2,809.60 |
$3,512 |
11.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,848 |
$4,810 |
10.7× |
| MRI chest w/o contrast (71550) |
$2,654.40 |
$3,318 |
10.8× |
| MRI chest with contrast (71551) |
$3,030.40 |
$3,788 |
3.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,662.40 |
$4,578 |
10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,508.80 |
$3,136 |
10.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,995.20 |
$3,744 |
12.2× |
| MRI orbit face neck w contrast (70542) |
$3,553.60 |
$4,442 |
9.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,076.80 |
$5,096 |
11.3× |
| MRI pelvis w/contrast (72196) |
$3,568.80 |
$4,461 |
9.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,416.80 |
$4,271 |
9.5× |
| MRI pelvis w/o contrast (72195) |
$2,810.40 |
$3,513 |
11.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,840 |
$4,800 |
10.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,036 |
$3,795 |
8.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,850.40 |
$4,813 |
10.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,275.20 |
$4,094 |
9.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,820 |
$4,775 |
10.6× |
| MRI temporomandibular joint (70336) |
$2,672 |
$3,340 |
10.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,879.20 |
$3,599 |
11.7× |
| MRI up ext w/o contrast (73218) |
$2,520 |
$3,150 |
10.2× |
| MRI upper ext joint w/o contrast (73221) |
$2,506.40 |
$3,133 |
10.2× |
| MRI, joint upper extrem combo (73223) |
$3,953.60 |
$4,942 |
11.0× |
| Myocardial Spect Multiple Studies (78452) |
$4,100.80 |
$5,126 |
3.1× |
| Neck soft tissue (70360) |
$274.40 |
$343 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$310.40 |
$388 |
2.9× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,407.20 |
$1,759 |
3.4× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,948 |
$2,435 |
3.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$327.20 |
$409 |
3.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$230.40 |
$288 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$329.60 |
$412 |
3.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$312 |
$390 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$452 |
$565 |
4.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$579.20 |
$724 |
5.4× |
| Radex fingr minimum 2 views (73140) |
$223.20 |
$279 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$292.80 |
$366 |
3.3× |
| Radex Hand Minimum 3 Views (73130) |
$329.60 |
$412 |
3.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$251.20 |
$314 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$352.80 |
$441 |
3.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$424 |
$530 |
3.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$634.40 |
$793 |
5.9× |
| Radex Humerus Minimum 2 Views (73060) |
$296 |
$370 |
3.3× |
| Radex Kne 1/2 Views (73560) |
$290.40 |
$363 |
3.2× |
| Radex Kne Compl 4/More Views (73564) |
$489.60 |
$612 |
4.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$481.60 |
$602 |
4.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$385.60 |
$482 |
4.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$400.80 |
$501 |
3.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$350.40 |
$438 |
3.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$253.60 |
$317 |
2.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$280 |
$350 |
2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$440 |
$550 |
4.9× |
| Radex Toe Minimum 2 Views (73660) |
$220.80 |
$276 |
2.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$277.60 |
$347 |
2.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$311.20 |
$389 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$299.20 |
$374 |
3.3× |
| Radiologic exam chest 2 views (71046) |
$328 |
$410 |
3.7× |
| Radiologic examination femur 1 view (73551) |
$280 |
$350 |
3.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$326.40 |
$408 |
3.6× |
| Ribs bilateral 3 views (71110) |
$574.40 |
$718 |
5.3× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,632.80 |
$3,291 |
4.7× |
| Scapula (73010) |
$396.80 |
$496 |
3.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$91.20 |
$114 |
3.9× |
| Shoulder 1 view (73020) |
$312 |
$390 |
3.5× |
| Spine thoracic 3 views (72072) |
$517.60 |
$647 |
4.8× |
| Thoracolumbar 2 views (72080) |
$388 |
$485 |
4.3× |
| Thyroid imaging w/blood flow (78013) |
$973.60 |
$1,217 |
2.4× |
| Ultrasound Exam Aaa Screen (76706) |
$476.80 |
$596 |
4.4× |
| Ultrasound, abdomen limited (76705) |
$704 |
$880 |
6.5× |
| Umbilical-artery Doppler (OB) (76820) |
$390.40 |
$488 |
3.6× |
| Unlisted ultrasound procedure (76999) |
$401.60 |
$502 |
4.5× |
| Urethrocystography retrograde rs&i (74450) |
$849.60 |
$1,062 |
3.5× |
| Us chest (76604) |
$543.20 |
$679 |
5.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$503.20 |
$629 |
4.7× |
| Us ob limited (76815) |
$546.40 |
$683 |
5.1× |
| Us ob transvaginal (76817) |
$624 |
$780 |
5.8× |
| Us pelvic non ob complete (76856) |
$776.80 |
$971 |
7.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$716.80 |
$896 |
6.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$680 |
$850 |
6.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$492.80 |
$616 |
4.6× |
| Us retroperitoneal complete (76770) |
$779.20 |
$974 |
7.2× |
| Us retroperitoneal limited (76775) |
$613.60 |
$767 |
5.7× |
| Us scrotum and contents (76870) |
$664 |
$830 |
6.2× |
| Us soft tissue head/neck (76536) |
$674.40 |
$843 |
6.3× |
| Us transrectal (76872) |
$718.40 |
$898 |
6.7× |
| Wrist 2 views (73100) |
$321.60 |
$402 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$568.80 |
$711 |
5.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$258.40 |
$323 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$280.80 |
$351 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$340.80 |
$426 |
3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$609.60 |
$762 |
5.6× |
| X-ray exam of femur 2/> (73552) |
$313.60 |
$392 |
3.5× |
| X-ray eye for foreign body (70030) |
$258.40 |
$323 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$348.80 |
$436 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$318.40 |
$398 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$291.20 |
$364 |
3.2× |
| X-ray leg, infant (73592) |
$292 |
$365 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$397.60 |
$497 |
3.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$720 |
$900 |
6.7× |
| X-ray nose-rectum child f.b. (76010) |
$297.60 |
$372 |
3.3× |
| X-ray optic foramen (70190) |
$86.40 |
$108 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$500.80 |
$626 |
4.6× |
| X-ray retrograde pyelogram (74420) |
$1,073.60 |
$1,342 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$282.40 |
$353 |
3.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$430.40 |
$538 |
4.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$588.80 |
$736 |
5.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$372.80 |
$466 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$336.80 |
$421 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$338.40 |
$423 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$570.40 |
$713 |
5.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$401.60 |
$502 |
3.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$272.80 |
$341 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$371.20 |
$464 |
4.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$355.20 |
$444 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$548.80 |
$686 |
5.1× |
| Xr c-spine 4 or 5 views (72050) |
$467.20 |
$584 |
4.3× |
| Xr c-spine 6 or more views (72052) |
$767.20 |
$959 |
7.1× |
| Xr chest 4+ views (71048) |
$478.40 |
$598 |
4.4× |