| Abdomen 2 views (74019) |
$112.40 |
$281 |
1.2× |
| Ankle 2 views (73600) |
$87.20 |
$218 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$416 |
$1,040 |
1.1× |
| Cervical spine 2 or 3 views (72040) |
$87.20 |
$218 |
1.1× |
| Chest 1 view (71045) |
$87.20 |
$218 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$182.80 |
$457 |
1.1× |
| Clavicle complete (73000) |
$87.20 |
$218 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$111.20 |
$278 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$590 |
$1,475 |
1.9× |
| CT abdomen and pelvis without contrast (74176) |
$392 |
$980 |
1.8× |
| CT abdomen w contrast (74160) |
$882.40 |
$2,206 |
5.5× |
| CT abdomen w wo contrast (74170) |
$904 |
$2,260 |
5.7× |
| CT abdomen w/o contrast (74150) |
$518.80 |
$1,297 |
5.5× |
| CT angio hrt w/3d image (75574) |
$936.80 |
$2,342 |
2.9× |
| CT angiography upper extremity lt (73206) |
$356 |
$890 |
2.2× |
| CT c-spine w/o contrast (72125) |
$382.80 |
$957 |
4.0× |
| CT cervical spine with contrast (72126) |
$391.60 |
$979 |
1.2× |
| CT chest w/wo contrast (71270) |
$448.40 |
$1,121 |
2.8× |
| CT chest with contrast (71260) |
$548 |
$1,370 |
3.4× |
| CT head/brain with contrast (70460) |
$391.60 |
$979 |
2.5× |
| CT head/brain without and with contrast (70470) |
$342 |
$855 |
2.1× |
| CT iac w contrast (70481) |
$391.60 |
$979 |
2.5× |
| CT lower ext w/o (73700) |
$382.80 |
$957 |
4.0× |
| CT lower extremity w wo contrast (73702) |
$430.80 |
$1,077 |
2.7× |
| CT lower extremity with contrast (73701) |
$356 |
$890 |
2.2× |
| CT lumbar spine w & w/o contrast (72133) |
$376.20 |
$940.50 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$356 |
$890 |
3.7× |
| CT maxillofacial w contrast (70487) |
$356 |
$890 |
2.2× |
| CT maxillofacial w/o contrast (70486) |
$413.16 |
$1,032.91 |
4.3× |
| CT maxillofacial w/wo contrast (70488) |
$489.45 |
$1,223.62 |
3.1× |
| CT neck soft tissue w contrast (70491) |
$390.40 |
$976 |
2.4× |
| CT orbits w/o contrast (70480) |
$378.40 |
$946 |
4.0× |
| CT pelvis w & w/o contrast (72194) |
$503.12 |
$1,257.81 |
3.2× |
| CT pelvis w/o contrast (72192) |
$464 |
$1,160 |
4.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$86.80 |
$217 |
1.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$509.60 |
$1,274 |
3.2× |
| CT soft tissue neck w/o contrast (70490) |
$458 |
$1,145 |
4.8× |
| CT thoracic spine w/o contrast (72128) |
$382.80 |
$957 |
4.0× |
| CT thorax w/o contrast (71250) |
$421.20 |
$1,053 |
4.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$391.60 |
$979 |
2.5× |
| CT upper extremity w/o contrast rt (73200) |
$378.40 |
$946 |
4.0× |
| CT upper extremity with contrast (73201) |
$390.40 |
$976 |
1.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$576 |
$1,440 |
3.6× |
| Cta Abdomen (74175) |
$391.60 |
$979 |
2.5× |
| CTA abdomen pelvis (74174) |
$950.40 |
$2,376 |
3.0× |
| CTA chest (71275) |
$547.80 |
$1,369.50 |
3.4× |
| Cta Head (70496) |
$430.76 |
$1,076.90 |
2.7× |
| Cta Neck (70498) |
$473.84 |
$1,184.59 |
3.0× |
| Esophagus (74220) |
$252.80 |
$632 |
1.6× |
| Fluoroscopy up to 1 hr (76000) |
$235.20 |
$588 |
1.1× |
| Foot 2 views (73620) |
$87.20 |
$218 |
1.1× |
| Forearm 2 views (73090) |
$87.20 |
$218 |
1.1× |
| Hand 2 views (73120) |
$112.40 |
$281 |
1.2× |
| Hand 3 views (73130) |
$87.20 |
$218 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$515.20 |
$1,288 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$87.20 |
$218 |
1.1× |
| Hysterosalpingogram (74740) |
$235.20 |
$588 |
1.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$515.20 |
$1,288 |
1.0× |
| Knee 3 views (73562) |
$87.20 |
$218 |
1.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$756.80 |
$1,892 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$682 |
$1,705 |
3.1× |
| MRI c-spine with contrast (72142) |
$640 |
$1,600 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$620 |
$1,550 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$640 |
$1,600 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$640 |
$1,600 |
2.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$659.60 |
$1,649 |
2.1× |
| MRI pelvis w/o contrast (72195) |
$750.20 |
$1,875.50 |
3.5× |
| MRI scan of arm joint before and after contrast (73223) |
$640 |
$1,600 |
2.0× |
| MRI scan of leg joint before and after contrast (73723) |
$620 |
$1,550 |
2.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$627 |
$1,567.50 |
2.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$704 |
$1,760 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$860.55 |
$2,151.38 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$758.67 |
$1,896.68 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$620 |
$1,550 |
2.9× |
| MRI upper ext joint w/o contrast (73221) |
$620 |
$1,550 |
2.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$640 |
$1,600 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$620 |
$1,550 |
2.9× |
| Myocardial Spect Multiple Studies (78452) |
$1,353.20 |
$3,383 |
1.1× |
| Neck soft tissue (70360) |
$87.20 |
$218 |
1.1× |
| Nm gastric emptying study (78264) |
$393.20 |
$983 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$112.40 |
$281 |
1.2× |
| Parathyroid imaging (78070) |
$393.20 |
$983 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$112.40 |
$281 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$704 |
$1,760 |
2.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$532.40 |
$1,331 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$104.06 |
$260.15 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$114.40 |
$286 |
1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$112.40 |
$281 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$87.20 |
$218 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$87.20 |
$218 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$182.80 |
$457 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$252.80 |
$632 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$252.80 |
$632 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$87.20 |
$218 |
1.1× |
| Ribs bilateral 3 views (71110) |
$114.46 |
$286.15 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$50 |
$125 |
2.1× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$393.20 |
$983 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$156.40 |
$391 |
1.6× |
| Us abdl aorta screen aaa (76706) |
$144.40 |
$361 |
1.5× |
| Us breast unilateral complete (76641) |
$112.40 |
$281 |
1.2× |
| Us breast unilateral limited (76642) |
$87.20 |
$218 |
1.1× |
| Us chest (76604) |
$112.40 |
$281 |
1.2× |
| Us elastography parenchyma (76981) |
$104.80 |
$262 |
1.1× |
| Us ob detailed single fetus (76811) |
$235.20 |
$588 |
1.1× |
| Us ob transvaginal (76817) |
$112.40 |
$281 |
1.2× |
| Us pelvic non ob complete (76856) |
$112.40 |
$281 |
1.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$114.40 |
$286 |
1.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$112.40 |
$281 |
1.2× |
| Us retroperitoneal limited (76775) |
$176 |
$440 |
1.8× |
| Us scrotum and contents (76870) |
$112.40 |
$281 |
1.2× |
| Us soft tissue head/neck (76536) |
$112.40 |
$281 |
1.2× |
| Wrist 2 views (73100) |
$87.20 |
$218 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$112.40 |
$281 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$87.20 |
$218 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$87.20 |
$218 |
1.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$206 |
$515 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$87.20 |
$218 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$105.60 |
$264 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$130.40 |
$326 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$112.40 |
$281 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$87.20 |
$218 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$87.20 |
$218 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$112 |
$280 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$87.20 |
$218 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$112.40 |
$281 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$112.40 |
$281 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$87.20 |
$218 |
1.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$112.40 |
$281 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$114.46 |
$286.15 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$87.20 |
$218 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$87.20 |
$218 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$87.20 |
$218 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$112.40 |
$281 |
1.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$112.40 |
$281 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$87.20 |
$218 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$112.40 |
$281 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$87.20 |
$218 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$87.20 |
$218 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$87.20 |
$218 |
1.1× |
| Xr shoulder 1 view (73020) |
$87.20 |
$218 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$112.40 |
$281 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$87.20 |
$218 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$87.20 |
$218 |
1.1× |