| Abdomen 2 views (74019) |
$287.50 |
$287.50 |
2.3× |
| Ankle 2 views (73600) |
$340 |
$340 |
3.3× |
| Arthrogram elbow (73085) |
$1,187 |
$1,187 |
2.8× |
| Arthrogram hip (73525) |
$795 |
$795 |
1.9× |
| Arthrogram knee (73580) |
$586 |
$586 |
1.4× |
| Arthrogram shoulder (73040) |
$1,739 |
$1,739 |
4.2× |
| Arthrogram wrist (73115) |
$586 |
$586 |
1.4× |
| Bone age studies (77072) |
$202 |
$202 |
1.6× |
| Bone survey complete (77075) |
$972 |
$972 |
7.8× |
| Cervical spine 2 or 3 views (72040) |
$148 |
$148 |
1.4× |
| Chest 1 view (71045) |
$411 |
$411 |
3.9× |
| Chest xray 3 views (71047) |
$95 |
$95 |
0.9× |
| Cholecystography, oral contrast Non-Facility (74290) |
$281 |
$281 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$666 |
$666 |
3.2× |
| Clavicle complete (73000) |
$292 |
$292 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,330 |
$1,330 |
10.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,121 |
$4,121 |
9.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,432 |
$2,432 |
8.5× |
| CT abdomen w contrast (74160) |
$1,447 |
$1,447 |
6.9× |
| CT abdomen w wo contrast (74170) |
$2,104 |
$2,104 |
10.0× |
| CT abdomen w/o contrast (74150) |
$1,209 |
$1,209 |
9.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,911 |
$1,911 |
9.1× |
| CT angiography upper extremity lt (73206) |
$1,190 |
$1,190 |
5.7× |
| CT c-spine w/contrast (72126) |
$2,277 |
$2,277 |
5.4× |
| CT c-spine w/o contrast (72125) |
$1,980 |
$1,980 |
15.8× |
| CT cervical spine w&w/o contrast (72127) |
$2,277 |
$2,277 |
10.8× |
| CT chest w contrast (71260) |
$1,845 |
$1,845 |
8.8× |
| CT chest w/wo contrast (71270) |
$2,011 |
$2,011 |
9.6× |
| CT head/brain with contrast (70460) |
$1,552 |
$1,552 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,642 |
$1,642 |
7.8× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$49.50 |
$49.50 |
0.5× |
| CT iac w contrast (70481) |
$1,325 |
$1,325 |
6.3× |
| CT limited/localized follow up study (76380) |
$707 |
$707 |
6.8× |
| CT lower ext w/o (73700) |
$1,406 |
$1,406 |
11.2× |
| CT lower extremity w wo contrast (73702) |
$1,416 |
$1,416 |
6.7× |
| CT lower extremity w/contrast material (73701) |
$1,908 |
$1,908 |
9.1× |
| CT lumbar spine w & w/o contrast (72133) |
$2,277 |
$2,277 |
10.8× |
| CT lumbar spine w/contrast (72132) |
$1,980 |
$1,980 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,980 |
$1,980 |
15.8× |
| CT maxillofacial w contrast (70487) |
$1,325 |
$1,325 |
6.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,886 |
$1,886 |
9.0× |
| CT maxillofacial wo contrast (70486) |
$880 |
$880 |
7.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,886 |
$1,886 |
9.0× |
| CT orbits w/o contrast (70480) |
$880 |
$880 |
7.0× |
| CT pelvis w/o contrast (72192) |
$1,223 |
$1,223 |
9.8× |
| CT pelvis w/wo contrast (72194) |
$2,017 |
$2,017 |
9.6× |
| CT scan of arm combo (73202) |
$1,416 |
$1,416 |
6.7× |
| CT soft tissue neck w contrast (70491) |
$1,362 |
$1,362 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,793 |
$1,793 |
8.5× |
| CT soft tissue neck w/o contrast (70490) |
$947 |
$947 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$2,277 |
$2,277 |
10.8× |
| CT thoracic spine w/o contrast (72128) |
$1,980 |
$1,980 |
15.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,277 |
$2,277 |
10.8× |
| CT thorax w/o contrast (71250) |
$1,330 |
$1,330 |
10.6× |
| CT upper ext wo (73200) |
$1,406 |
$1,406 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,908 |
$1,908 |
4.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,594 |
$1,594 |
7.6× |
| Cta Abdomen (74175) |
$1,350 |
$1,350 |
6.4× |
| CTA abdomen pelvis (74174) |
$2,771 |
$2,771 |
6.6× |
| CTA chest (71275) |
$1,044 |
$1,044 |
5.0× |
| Cta Head (70496) |
$1,395 |
$1,395 |
6.6× |
| Cta Neck (70498) |
$1,297 |
$1,297 |
6.2× |
| Cta Pelvis (72191) |
$1,464 |
$1,464 |
7.0× |
| Cystography minimum 3 views rs&i (74430) |
$586 |
$586 |
1.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$1,222 |
$1,222 |
9.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$365 |
$365 |
3.5× |
| Esophagus (74220) |
$666 |
$666 |
3.2× |
| Facial bones min 3 views (70150) |
$405 |
$405 |
3.2× |
| Fetal biophysical profile non-stress testing (76818) |
$1,659 |
$1,659 |
13.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$401 |
$401 |
3.2× |
| Fluoroscopy up to 1 hr (76000) |
$383 |
$383 |
1.3× |
| Foot 2 views (73620) |
$340 |
$340 |
3.3× |
| Forearm 2 views (73090) |
$95 |
$95 |
0.9× |
| Hand 2 views (73120) |
$171 |
$171 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,561 |
$1,561 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,561 |
$1,561 |
3.3× |
| Hysterosalpingogram (74740) |
$588 |
$588 |
2.1× |
| Knee 3 views (73562) |
$163 |
$163 |
1.6× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$95 |
$95 |
0.9× |
| Myelogram Lumbar (72265) |
$1,051 |
$1,051 |
1.1× |
| Neck soft tissue (70360) |
$153.50 |
$153.50 |
1.5× |
| Osseous survey limited (77074) |
$967 |
$967 |
7.7× |
| Parathyrd planar w/spect&CT (78072) |
$1,187 |
$1,187 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$292 |
$292 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$756 |
$756 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$163 |
$163 |
1.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$292 |
$292 |
2.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$395 |
$395 |
3.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$384 |
$384 |
3.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$572 |
$572 |
4.6× |
| Radex fingr minimum 2 views (73140) |
$202 |
$202 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$163 |
$163 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$163 |
$163 |
1.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$340 |
$340 |
3.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$383 |
$383 |
3.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$284 |
$284 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$1,092 |
$1,092 |
8.7× |
| Radex Humerus Minimum 2 Views (73060) |
$292 |
$292 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$292 |
$292 |
2.8× |
| Radex Kne Compl 4/More Views (73564) |
$491 |
$491 |
3.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$611 |
$611 |
4.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$202 |
$202 |
1.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$480 |
$480 |
3.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$163 |
$163 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$417 |
$417 |
4.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$412 |
$412 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$411 |
$411 |
3.9× |
| Radex Toe Minimum 2 Views (73660) |
$202 |
$202 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$171 |
$171 |
1.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$163 |
$163 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,092 |
$1,092 |
8.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$168 |
$168 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$329 |
$329 |
2.6× |
| Radiologic exam chest 2 views (71046) |
$163 |
$163 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$756 |
$756 |
3.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$791 |
$791 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$507 |
$507 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$384 |
$384 |
3.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$163 |
$163 |
1.6× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$756 |
$756 |
1.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$412 |
$412 |
3.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$390 |
$390 |
3.1× |
| Radiological examination surgical specimen (76098) |
$756 |
$756 |
1.2× |
| Ribs bilateral 3 views (71110) |
$548 |
$548 |
4.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,299 |
$1,299 |
2.0× |
| Rp loclzj tum spect w/CT 1 area 1 day imaging (78830) |
$2,777 |
$2,777 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$171 |
$171 |
1.4× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$372 |
$372 |
1.3× |
| Scapula (73010) |
$171 |
$171 |
1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$79 |
$79 |
3.4× |
| Shoulder 1 view (73020) |
$95 |
$95 |
0.9× |
| Sialogram (70390) |
$399 |
$399 |
1.4× |
| Small bowel series (74250) |
$605 |
$605 |
2.9× |
| Spine thoracic 3 views (72072) |
$412 |
$412 |
3.3× |
| Thoracolumbar 2 views (72080) |
$412 |
$412 |
4.0× |
| Tmj unilateral (70328) |
$239 |
$239 |
2.3× |
| Tomogram (76100) |
$397 |
$397 |
3.2× |
| Ultrasound breast complete (76641) |
$1,659 |
$1,659 |
13.2× |
| Ultrasound Exam Aaa Screen (76706) |
$1,659 |
$1,659 |
13.2× |
| Ultrasound, abdomen limited (76705) |
$1,659 |
$1,659 |
13.2× |
| Umbilical-artery Doppler (OB) (76820) |
$413 |
$413 |
3.3× |
| Urethrocystogram voiding (74455) |
$523 |
$523 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$691 |
$691 |
2.4× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$862 |
$862 |
4.1× |
| Us breast unilateral limited (76642) |
$1,659 |
$1,659 |
15.9× |
| Us chest (76604) |
$1,521 |
$1,521 |
12.1× |
| Us compl joint r-t w/image documentation (76881) |
$1,031 |
$1,031 |
8.2× |
| Us encephalogram (76506) |
$734 |
$734 |
5.9× |
| Us infant hips w manipulation (76885) |
$303 |
$303 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$271 |
$271 |
2.2× |
| Us ob limited (76815) |
$2,130 |
$2,130 |
17.0× |
| Us ob transvaginal (76817) |
$1,659 |
$1,659 |
13.2× |
| Us pelvic non ob complete (76856) |
$897 |
$897 |
7.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$897 |
$897 |
7.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$1,311 |
$1,311 |
10.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$878 |
$878 |
7.0× |
| Us retroperitoneal complete (76770) |
$1,659 |
$1,659 |
13.2× |
| Us retroperitoneal limited (76775) |
$1,659 |
$1,659 |
13.2× |
| Us scrotum and contents (76870) |
$814 |
$814 |
6.5× |
| Us soft tissue head/neck (76536) |
$604 |
$604 |
4.8× |
| Us spinal canal and contents (76800) |
$380 |
$380 |
3.0× |
| Us transrectal (76872) |
$1,659 |
$1,659 |
13.2× |
| Venogram extremity bilateral (75822) |
$1,661 |
$1,661 |
0.9× |
| Venogram Extremity Unilateral (75820) |
$942 |
$942 |
0.5× |
| Wrist 2 views (73100) |
$93 |
$93 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$692 |
$692 |
5.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$412 |
$412 |
4.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,076 |
$1,076 |
5.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$353 |
$353 |
3.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$151 |
$151 |
1.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$572 |
$572 |
4.6× |
| X-ray exam of femur 2/> (73552) |
$95 |
$95 |
0.9× |
| X-ray eye for foreign body (70030) |
$429 |
$429 |
4.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$417 |
$417 |
4.0× |
| X-ray IV pyelogram (ivp) (74400) |
$902 |
$902 |
4.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$163 |
$163 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$202 |
$202 |
1.9× |
| X-ray leg, infant (73592) |
$335 |
$335 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$163 |
$163 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$772 |
$772 |
6.2× |
| X-ray nose-rectum child f.b. (76010) |
$353 |
$353 |
3.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$412 |
$412 |
3.3× |
| X-ray retrograde pyelogram (74420) |
$692 |
$692 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$163 |
$163 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$258 |
$258 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$842 |
$842 |
6.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$213 |
$213 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$202 |
$202 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$151 |
$151 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$517 |
$517 |
4.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$412 |
$412 |
3.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$311 |
$311 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$317 |
$317 |
3.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$351 |
$351 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$150 |
$150 |
1.2× |
| Xr bone length studies (77073) |
$611 |
$611 |
4.9× |
| Xr c-spine 4 or 5 views (72050) |
$258 |
$258 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$756 |
$756 |
6.0× |
| Xr chest 4+ views (71048) |
$585 |
$585 |
4.7× |
| Xr urogram antegrade (74425) |
$586 |
$586 |
1.4× |