| Abdomen 1 View (74018) |
$87.20 |
$218 |
1.1× |
| Abdomen 2 views (74019) |
$112.40 |
$281 |
1.2× |
| Ankle 2 views (73600) |
$87.20 |
$218 |
1.1× |
| Bone Imaging Whole Body (78306) |
$416 |
$1,040 |
1.1× |
| Chest 1 view (71045) |
$87.20 |
$218 |
1.1× |
| Chest 2 views (71046) |
$87.20 |
$218 |
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 Abdomen and Pelvis (74174) |
$950.40 |
$2,376 |
3.0× |
| CT Angio Chest (71275) |
$547.80 |
$1,369.50 |
3.4× |
| CT Angio Head (70496) |
$430.76 |
$1,076.90 |
2.7× |
| CT angio hrt w/3d image (75574) |
$936.80 |
$2,342 |
2.9× |
| CT Angio Neck (70498) |
$473.84 |
$1,184.59 |
3.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$356 |
$890 |
2.2× |
| CT bone density (77078) |
$86.80 |
$217 |
1.1× |
| CT cervical spine w/ contrast (72126) |
$391.60 |
$979 |
1.2× |
| CT cervical spine w/o contrast (72125) |
$382.80 |
$957 |
4.0× |
| CT chest w contrast (71260) |
$548 |
$1,370 |
3.4× |
| CT chest w/wo contrast (71270) |
$448.40 |
$1,121 |
2.8× |
| 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 l-spine w&w/o contrast (72133) |
$376.20 |
$940.50 |
2.4× |
| CT lower ext w/o (73700) |
$382.80 |
$957 |
4.0× |
| CT lower extremity w/contrast material (73701) |
$356 |
$890 |
2.2× |
| CT lumbar spine w/o contrast (72131) |
$356 |
$890 |
3.7× |
| CT maxillofacial w contrast (70487) |
$356 |
$890 |
2.2× |
| CT maxillofacial wo contrast (70486) |
$413.16 |
$1,032.91 |
4.3× |
| CT neck tissue combo (70492) |
$509.60 |
$1,274 |
3.2× |
| 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 of leg combo (73702) |
$430.80 |
$1,077 |
2.7× |
| CT scans face/jaw combo (70488) |
$489.45 |
$1,223.62 |
3.1× |
| CT soft tissue neck w contrast (70491) |
$390.40 |
$976 |
2.4× |
| 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 ext wo (73200) |
$378.40 |
$946 |
4.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$391.60 |
$979 |
2.5× |
| 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× |
| Esophagram (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× |
| Gastric emptying imaging study (78264) |
$393.20 |
$983 |
1.1× |
| Hand 2 views (73120) |
$112.40 |
$281 |
1.2× |
| Hepatobil Syst Image W/Drug (78227) |
$515.20 |
$1,288 |
1.0× |
| Hysterosalpingogram (74740) |
$235.20 |
$588 |
1.1× |
| K Flow/Funct Image W/Drug (78708) |
$515.20 |
$1,288 |
1.0× |
| Knee 3 Views (73562) |
$87.20 |
$218 |
1.1× |
| Lung Ventilat&Perfus Imaging (78582) |
$532.40 |
$1,331 |
1.1× |
| MRI abdomen w/o contrast (74181) |
$682 |
$1,705 |
3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$620 |
$1,550 |
2.0× |
| MRI cervical spine w contrast (72142) |
$640 |
$1,600 |
2.0× |
| MRI cervical spine w/o cont (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 & w/contr matr (73720) |
$704 |
$1,760 |
2.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$640 |
$1,600 |
2.9× |
| MRI lumbar spine w contrast (72149) |
$704 |
$1,760 |
2.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$627 |
$1,567.50 |
2.0× |
| MRI pelvis w/o & w contrast (72197) |
$659.60 |
$1,649 |
2.1× |
| MRI pelvis w/o contrast (72195) |
$750.20 |
$1,875.50 |
3.5× |
| MRI thoracic spine w/o contrast (72146) |
$620 |
$1,550 |
2.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$620 |
$1,550 |
2.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$640 |
$1,600 |
2.0× |
| MRI, abdomen, combo (74183) |
$756.80 |
$1,892 |
2.4× |
| MRI, dorsal spine combo (72157) |
$758.67 |
$1,896.68 |
2.4× |
| MRI, joint upper extrem (73221) |
$620 |
$1,550 |
2.9× |
| MRI, joint upper extrem combo (73223) |
$640 |
$1,600 |
2.0× |
| MRI, lumbar spine combo (72158) |
$860.55 |
$2,151.38 |
2.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,353.20 |
$3,383 |
1.1× |
| Neck soft tissue (70360) |
$87.20 |
$218 |
1.1× |
| Parathyroid Planar Imaging (78070) |
$393.20 |
$983 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$112.40 |
$281 |
1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$112.40 |
$281 |
1.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$87.20 |
$218 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$87.20 |
$218 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$87.20 |
$218 |
1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$112.40 |
$281 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$87.20 |
$218 |
1.1× |
| Radex foot complete minimum 3 views (73630) |
$87.20 |
$218 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$87.20 |
$218 |
1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$87.20 |
$218 |
1.1× |
| Radex shoulder complete minimum 2 views (73030) |
$87.20 |
$218 |
1.1× |
| Radex Sternum Minimum 2 Views (71120) |
$87.20 |
$218 |
1.1× |
| Radex Toe Minimum 2 Views (73660) |
$87.20 |
$218 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$87.20 |
$218 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$112.40 |
$281 |
1.2× |
| Radiologic exam colon double contrast study (74280) |
$206 |
$515 |
1.3× |
| Radiologic exam colon single contrast study (74270) |
$182.80 |
$457 |
1.1× |
| Radiologic exam knee complete 4/more views (73564) |
$112 |
$280 |
1.2× |
| Radiologic exam swallow function contrast study (74230) |
$182.80 |
$457 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$252.80 |
$632 |
1.6× |
| Radiologic examination femur minimum 2 views (73552) |
$87.20 |
$218 |
1.1× |
| Radiologic examination knee 1/2 views (73560) |
$87.20 |
$218 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$87.20 |
$218 |
1.1× |
| Ribs bilateral 3 views (71110) |
$114.46 |
$286.15 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$50 |
$125 |
2.1× |
| Shoulder 1 view (73020) |
$87.20 |
$218 |
1.1× |
| Skull less than 4 views (70250) |
$112.40 |
$281 |
1.2× |
| Thoracic spine 2 views (72070) |
$112.40 |
$281 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$393.20 |
$983 |
1.1× |
| Ultrasound Breast Limited (76642) |
$87.20 |
$218 |
1.1× |
| Ultrasound Elastography Parenchyma (76981) |
$104.80 |
$262 |
1.1× |
| Ultrasound Exam Aaa Screen (76706) |
$144.40 |
$361 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$156.40 |
$391 |
1.6× |
| Upper gi w/o kub (74240) |
$252.80 |
$632 |
1.6× |
| Us breast unilateral complete (76641) |
$112.40 |
$281 |
1.2× |
| Us chest (76604) |
$112.40 |
$281 |
1.2× |
| Us exam, pelvic, limited (76857) |
$114.40 |
$286 |
1.2× |
| 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 pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$112.40 |
$281 |
1.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$112.40 |
$281 |
1.2× |
| Us retroperitoneal limited (76775) |
$176 |
$440 |
1.8× |
| Us scrotum and contents (76870) |
$112.40 |
$281 |
1.2× |
| Us thyroid (76536) |
$112.40 |
$281 |
1.2× |
| Wrist 2 views (73100) |
$87.20 |
$218 |
1.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$87.20 |
$218 |
1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$104.06 |
$260.15 |
1.3× |
| 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 Exam Hips Bi 2 Views (73521) |
$114.40 |
$286 |
1.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$112.40 |
$281 |
1.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$87.20 |
$218 |
1.1× |
| X-ray humerus (73060) |
$87.20 |
$218 |
1.1× |
| 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 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 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× |
| Xr c-spine 4 or 5 views (72050) |
$112.40 |
$281 |
1.2× |