| Abdomen 2 views (74019) |
$271.95 |
$388.50 |
2.5× |
| Ankle 2 views (73600) |
$271.95 |
$388.50 |
3.0× |
| Arthrogram elbow (73085) |
$434.70 |
$621 |
1.2× |
| Arthrogram hip (73525) |
$434.70 |
$621 |
1.2× |
| Arthrogram knee (73580) |
$434.70 |
$621 |
1.2× |
| Arthrogram shoulder (73040) |
$434.70 |
$621 |
1.2× |
| Arthrogram wrist (73115) |
$295.40 |
$422 |
0.8× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,921.50 |
$2,745 |
4.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$2,059.40 |
$2,942 |
5.0× |
| Bone &/joint imaging whole body (78306) |
$2,287.60 |
$3,268 |
5.5× |
| Bone age studies (77072) |
$239.40 |
$342 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$2,120.30 |
$3,029 |
5.1× |
| Bone survey complete (77075) |
$812.70 |
$1,161 |
7.5× |
| Bone survey infant (77076) |
$812.70 |
$1,161 |
7.5× |
| Cervical spine 2 or 3 views (72040) |
$311.85 |
$445.50 |
3.5× |
| Chest 1 view (71045) |
$239.05 |
$341.50 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$191.80 |
$274 |
1.1× |
| Clavicle complete (73000) |
$239.05 |
$341.50 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,526.70 |
$2,181 |
14.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,819.60 |
$4,028 |
7.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,074.10 |
$2,963 |
8.4× |
| CT abdomen w contrast (74160) |
$1,778.70 |
$2,541 |
9.8× |
| CT abdomen w wo contrast (74170) |
$2,279.20 |
$3,256 |
12.6× |
| CT abdomen w/o contrast (74150) |
$1,526.70 |
$2,181 |
14.1× |
| CT angio hrt w/3d image (75574) |
$3,127.60 |
$4,468 |
8.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,128 |
$3,040 |
11.8× |
| CT angiography upper extremity lt (73206) |
$1,953 |
$2,790 |
10.8× |
| CT c-spine w/contrast (72126) |
$1,778.70 |
$2,541 |
4.9× |
| CT c-spine w/o contrast (72125) |
$2,204.30 |
$3,149 |
20.4× |
| CT cervical spine w&w/o contrast (72127) |
$3,103.80 |
$4,434 |
17.1× |
| CT chest w contrast (71260) |
$1,778.70 |
$2,541 |
9.8× |
| CT chest w/wo contrast (71270) |
$2,279.20 |
$3,256 |
12.6× |
| CT head/brain with contrast (70460) |
$1,778.70 |
$2,541 |
9.8× |
| CT head/brain without and with contrast (70470) |
$2,279.20 |
$3,256 |
12.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,703.10 |
$2,433 |
19.0× |
| CT iac w contrast (70481) |
$1,778.70 |
$2,541 |
9.8× |
| CT lower ext w/o (73700) |
$1,526.70 |
$2,181 |
14.1× |
| CT lower extremity w wo contrast (73702) |
$2,279.20 |
$3,256 |
12.6× |
| CT lower extremity w/contrast material (73701) |
$1,852.90 |
$2,647 |
10.2× |
| CT lumbar spine w & w/o contrast (72133) |
$2,279.20 |
$3,256 |
12.6× |
| CT lumbar spine w/contrast (72132) |
$1,778.70 |
$2,541 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$1,526.70 |
$2,181 |
14.1× |
| CT maxillofacial w contrast (70487) |
$1,778.70 |
$2,541 |
9.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,279.20 |
$3,256 |
12.6× |
| CT maxillofacial wo contrast (70486) |
$2,204.30 |
$3,149 |
20.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,279.20 |
$3,256 |
12.6× |
| CT orbits w/o contrast (70480) |
$1,526.70 |
$2,181 |
14.1× |
| CT pelvis w/o contrast (72192) |
$1,526.70 |
$2,181 |
14.1× |
| CT pelvis w/wo contrast (72194) |
$2,279.20 |
$3,256 |
12.6× |
| CT scan of arm combo (73202) |
$3,103.80 |
$4,434 |
17.1× |
| CT soft tissue neck w contrast (70491) |
$1,778.70 |
$2,541 |
9.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,279.20 |
$3,256 |
12.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,526.70 |
$2,181 |
14.1× |
| CT thoracic spine w/contrast (72129) |
$1,778.70 |
$2,541 |
9.8× |
| CT thoracic spine w/o contrast (72128) |
$1,526.70 |
$2,181 |
14.1× |
| CT thorax w/o contrast (71250) |
$1,526.70 |
$2,181 |
14.1× |
| CT upper ext wo (73200) |
$1,525.30 |
$2,179 |
14.1× |
| CT upper extremity with contrast (73201) |
$1,778.70 |
$2,541 |
4.9× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,796.50 |
$3,995 |
15.4× |
| Cta Abdomen (74175) |
$2,053.80 |
$2,934 |
11.3× |
| CTA abdomen pelvis (74174) |
$2,053.80 |
$2,934 |
5.7× |
| CTA chest (71275) |
$1,953 |
$2,790 |
10.8× |
| Cta Head (70496) |
$2,053.80 |
$2,934 |
11.3× |
| Cta Neck (70498) |
$2,053.80 |
$2,934 |
11.3× |
| Cta Pelvis (72191) |
$1,778.70 |
$2,541 |
9.8× |
| Cystography minimum 3 views rs&i (74430) |
$411.60 |
$588 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$336.70 |
$481 |
3.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$233.10 |
$333 |
2.6× |
| Esophagus (74220) |
$295.40 |
$422 |
1.6× |
| Facial bones min 3 views (70150) |
$295.40 |
$422 |
2.7× |
| Fetal biophysical profile non-stress testing (76818) |
$753.90 |
$1,077 |
7.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$753.90 |
$1,077 |
7.0× |
| Fluoroscopy up to 1 hr (76000) |
$298.20 |
$426 |
1.2× |
| Foot 2 views (73620) |
$271.95 |
$388.50 |
3.0× |
| Forearm 2 views (73090) |
$255.50 |
$365 |
2.8× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$1,914.50 |
$2,735 |
4.6× |
| Hand 2 views (73120) |
$255.50 |
$365 |
2.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,207.50 |
$1,725 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,207.50 |
$1,725 |
2.9× |
| Hysterosalpingogram (74740) |
$448 |
$640 |
1.8× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,442 |
$2,060 |
2.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,628.20 |
$2,326 |
2.9× |
| Knee 3 views (73562) |
$311.85 |
$445.50 |
3.5× |
| Lung perf&ventilat diferentl (78598) |
$1,988 |
$2,840 |
3.5× |
| Lung perfusion differential (78597) |
$1,988 |
$2,840 |
4.8× |
| Lung ventilation imaging (78579) |
$1,988 |
$2,840 |
4.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,864.40 |
$4,092 |
3.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,103.80 |
$4,434 |
8.6× |
| MRA head w & w/o contrast (70546) |
$3,346 |
$4,780 |
9.3× |
| MRA head w/o contrast (70544) |
$2,791.60 |
$3,988 |
11.3× |
| MRA head with contrast (70545) |
$2,864.40 |
$4,092 |
8.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,346 |
$4,780 |
9.3× |
| MRA neck w/o contrast (70547) |
$2,791.60 |
$3,988 |
11.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,103.80 |
$4,434 |
8.6× |
| MRI abdomen w/o contrast (74181) |
$2,791.60 |
$3,988 |
11.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,864.40 |
$4,092 |
3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,103.80 |
$4,434 |
8.6× |
| MRI cervical spine w/o contrast (72141) |
$2,791.60 |
$3,988 |
11.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,103.80 |
$4,434 |
8.6× |
| MRI chest w/o contrast (71550) |
$2,791.60 |
$3,988 |
11.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,103.80 |
$4,434 |
8.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,791.60 |
$3,988 |
11.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,791.60 |
$3,988 |
11.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,103.80 |
$4,434 |
8.6× |
| MRI pelvis w/contrast (72196) |
$2,864.40 |
$4,092 |
8.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,103.80 |
$4,434 |
8.6× |
| MRI pelvis w/o contrast (72195) |
$2,791.60 |
$3,988 |
11.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,103.80 |
$4,434 |
8.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,864.40 |
$4,092 |
8.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,103.80 |
$4,434 |
8.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,103.80 |
$4,434 |
8.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,791.60 |
$3,988 |
11.3× |
| MRI up ext w/o contrast (73218) |
$2,791.60 |
$3,988 |
11.3× |
| MRI upper ext joint w/o contrast (73221) |
$2,791.60 |
$3,988 |
11.3× |
| MRI, joint upper extrem combo (73223) |
$3,103.80 |
$4,434 |
8.6× |
| Myocardial Spect Multiple Studies (78452) |
$4,925.20 |
$7,036 |
3.7× |
| Myocardial spect single study at rest or stress (78451) |
$2,464.70 |
$3,521 |
1.8× |
| Neck soft tissue (70360) |
$239.05 |
$341.50 |
2.7× |
| Nm gastric emptying study (78264) |
$1,914.50 |
$2,735 |
4.6× |
| Parathyroid Planar Imaging (78070) |
$1,605.80 |
$2,294 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$238.70 |
$341 |
2.2× |
| PET image w/CT, skull-thigh (78815) |
$1,899.10 |
$2,713 |
1.3× |
| PET imaging for CT attenuation whole body (78816) |
$1,899.10 |
$2,713 |
1.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,988 |
$2,840 |
4.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,988 |
$2,840 |
3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$298.20 |
$426 |
0.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$311.85 |
$445.50 |
3.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$255.50 |
$365 |
2.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$295.40 |
$422 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$271.95 |
$388.50 |
3.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$311.85 |
$445.50 |
3.5× |
| Radex Hand Minimum 3 Views (73130) |
$295.40 |
$422 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$238.70 |
$341 |
2.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$373.10 |
$533 |
3.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$356.65 |
$509.50 |
3.3× |
| Radex Humerus Minimum 2 Views (73060) |
$255.50 |
$365 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$271.95 |
$388.50 |
3.0× |
| Radex Kne Compl 4/More Views (73564) |
$340.20 |
$486 |
3.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$340.20 |
$486 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$295.40 |
$422 |
3.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$295.40 |
$422 |
2.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$268.80 |
$384 |
3.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$255.50 |
$365 |
2.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$255.50 |
$365 |
2.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$255.50 |
$365 |
2.8× |
| Radex Toe Minimum 2 Views (73660) |
$271.95 |
$388.50 |
3.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$255.50 |
$365 |
2.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$311.85 |
$445.50 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$239.05 |
$341.50 |
2.7× |
| Radiologic exam chest 2 views (71046) |
$271.95 |
$388.50 |
3.0× |
| Radiologic exam colon single contrast study (74270) |
$429.10 |
$613 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$429.10 |
$613 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$429.10 |
$613 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$255.50 |
$365 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$255.50 |
$365 |
2.8× |
| Radiological examination surgical specimen (76098) |
$222.60 |
$318 |
0.4× |
| Ribs bilateral 3 views (71110) |
$295.40 |
$422 |
2.7× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,988 |
$2,840 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$255.50 |
$365 |
2.4× |
| Scapula (73010) |
$246.40 |
$352 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$38.50 |
$55 |
1.6× |
| Shoulder 1 view (73020) |
$239.05 |
$341.50 |
2.7× |
| Small bowel series (74250) |
$455.70 |
$651 |
2.5× |
| Spine thoracic 3 views (72072) |
$295.40 |
$422 |
2.7× |
| Thoracolumbar 2 views (72080) |
$255.50 |
$365 |
2.8× |
| Thyroid uptake measurement (78012) |
$2,009.70 |
$2,871 |
4.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$2,009.70 |
$2,871 |
4.9× |
| Ultrasound breast complete (76641) |
$998.90 |
$1,427 |
9.3× |
| Ultrasound Exam Aaa Screen (76706) |
$742.70 |
$1,061 |
6.9× |
| Ultrasound, abdomen limited (76705) |
$757.75 |
$1,082.50 |
7.0× |
| Umbilical-artery Doppler (OB) (76820) |
$753.90 |
$1,077 |
7.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$191.80 |
$274 |
2.1× |
| Urethrocystogram voiding (74455) |
$443.10 |
$633 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$443.10 |
$633 |
1.8× |
| Us breast unilateral limited (76642) |
$742.70 |
$1,061 |
8.3× |
| Us chest (76604) |
$757.75 |
$1,082.50 |
7.0× |
| Us compl joint r-t w/image documentation (76881) |
$742.70 |
$1,061 |
6.9× |
| Us encephalogram (76506) |
$742.70 |
$1,061 |
6.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$742.70 |
$1,061 |
6.9× |
| Us ob detailed single fetus (76811) |
$742.70 |
$1,061 |
3.0× |
| Us ob limited (76815) |
$399.35 |
$570.50 |
3.7× |
| Us ob transvaginal (76817) |
$443.10 |
$633 |
4.1× |
| Us pelvic non ob complete (76856) |
$758.10 |
$1,083 |
7.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$566.30 |
$809 |
5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$742.70 |
$1,061 |
6.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$384.30 |
$549 |
3.6× |
| Us retroperitoneal complete (76770) |
$878.85 |
$1,255.50 |
8.1× |
| Us retroperitoneal limited (76775) |
$742.70 |
$1,061 |
6.9× |
| Us scrotum and contents (76870) |
$758.45 |
$1,083.50 |
7.0× |
| Us soft tissue head/neck (76536) |
$742.70 |
$1,061 |
6.9× |
| Us spinal canal and contents (76800) |
$742.70 |
$1,061 |
6.9× |
| Us transrectal (76872) |
$742.70 |
$1,061 |
6.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$443.10 |
$633 |
4.1× |
| Wrist 2 views (73100) |
$271.95 |
$388.50 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$255.50 |
$365 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$469.70 |
$671 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$255.50 |
$365 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$310.80 |
$444 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$255.50 |
$365 |
2.8× |
| X-ray eye for foreign body (70030) |
$255.50 |
$365 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$255.50 |
$365 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$295.40 |
$422 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$222.60 |
$318 |
2.5× |
| X-ray leg, infant (73592) |
$255.50 |
$365 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$271.95 |
$388.50 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$401.10 |
$573 |
3.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$340.20 |
$486 |
3.2× |
| X-ray retrograde pyelogram (74420) |
$800.10 |
$1,143 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$255.50 |
$365 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$295.40 |
$422 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$390.60 |
$558 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$295.40 |
$422 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$255.50 |
$365 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$295.40 |
$422 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$340.20 |
$486 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$295.40 |
$422 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$238.70 |
$341 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$255.50 |
$365 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$255.50 |
$365 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$340.20 |
$486 |
3.2× |
| Xr c-spine 6 or more views (72052) |
$401.10 |
$573 |
3.7× |
| Xr chest 4+ views (71048) |
$340.20 |
$486 |
3.2× |
| Xr urogram antegrade (74425) |
$800.10 |
$1,143 |
2.2× |