| Abdomen 2 views (74019) |
$235.50 |
$471 |
2.2× |
| Ankle 2 views (73600) |
$226.50 |
$453 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$2,986.50 |
$5,973 |
7.4× |
| Bone age studies (77072) |
$253.50 |
$507 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$226.50 |
$453 |
2.6× |
| Chest 1 view (71045) |
$185 |
$370 |
2.1× |
| Clavicle complete (73000) |
$226.50 |
$453 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$218.50 |
$437 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,411 |
$8,822 |
12.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,896.50 |
$7,793 |
16.1× |
| CT abdomen w contrast (74160) |
$1,721 |
$3,442 |
9.7× |
| CT abdomen w wo contrast (74170) |
$2,029.50 |
$4,059 |
11.4× |
| CT abdomen w/o contrast (74150) |
$1,706 |
$3,412 |
16.1× |
| CT angiography upper extremity lt (73206) |
$1,217.50 |
$2,435 |
6.8× |
| CT c-spine w/o contrast (72125) |
$2,725 |
$5,450 |
25.7× |
| CT chest w/wo contrast (71270) |
$1,623.50 |
$3,247 |
9.1× |
| CT chest with contrast (71260) |
$1,675.50 |
$3,351 |
9.4× |
| CT head/brain with contrast (70460) |
$2,937 |
$5,874 |
16.5× |
| CT head/brain without and with contrast (70470) |
$3,974.50 |
$7,949 |
22.3× |
| CT iac w contrast (70481) |
$1,352 |
$2,704 |
7.6× |
| CT lower ext w/o (73700) |
$1,839.50 |
$3,679 |
17.3× |
| CT lower extremity with contrast (73701) |
$1,492.50 |
$2,985 |
8.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,492 |
$2,984 |
8.4× |
| CT lumbar spine w/o contrast (72131) |
$1,569.50 |
$3,139 |
14.8× |
| CT lumbar spine with contrast (72132) |
$1,290 |
$2,580 |
3.6× |
| CT maxillofacial w contrast (70487) |
$2,496.50 |
$4,993 |
14.0× |
| CT maxillofacial w/o contrast (70486) |
$2,203 |
$4,406 |
20.7× |
| CT neck soft tissue w contrast (70491) |
$2,642.50 |
$5,285 |
14.8× |
| CT orbits w/o contrast (70480) |
$1,784.50 |
$3,569 |
16.8× |
| CT pelvis w/o contrast (72192) |
$1,623.50 |
$3,247 |
15.3× |
| CT soft tissue neck w/o contrast (70490) |
$2,182 |
$4,364 |
20.5× |
| CT thoracic spine w/o contrast (72128) |
$1,978.50 |
$3,957 |
18.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,077.50 |
$4,155 |
11.7× |
| CT thorax w/o contrast (71250) |
$1,373.50 |
$2,747 |
12.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,689.50 |
$3,379 |
15.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,595.50 |
$3,191 |
9.0× |
| CTA abdomen pelvis (74174) |
$1,186.50 |
$2,373 |
3.3× |
| CTA chest (71275) |
$1,675.50 |
$3,351 |
9.4× |
| Cta Head (70496) |
$2,342 |
$4,684 |
13.1× |
| CTA lwr ext w&w/o contrast (73706) |
$1,263 |
$2,526 |
7.1× |
| Cta Neck (70498) |
$2,342 |
$4,684 |
13.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$281 |
$562 |
2.6× |
| Esophagus (74220) |
$232.50 |
$465 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$121.50 |
$243 |
0.5× |
| Foot 2 views (73620) |
$234 |
$468 |
2.6× |
| Forearm 2 views (73090) |
$226.50 |
$453 |
2.6× |
| Hand 2 views (73120) |
$282 |
$564 |
2.7× |
| Hand 3 views (73130) |
$226.50 |
$453 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$3,225 |
$6,450 |
5.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$2,064 |
$4,128 |
5.1× |
| Humerus Min 2 Views Left (73060) |
$226.50 |
$453 |
2.6× |
| Knee 3 views (73562) |
$226.50 |
$453 |
2.6× |
| MRA head w/o contrast (70544) |
$742.50 |
$1,485 |
3.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,117.50 |
$4,235 |
6.0× |
| MRA neck w/o contrast (70547) |
$966.50 |
$1,933 |
4.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,030.50 |
$4,061 |
5.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,952.50 |
$3,905 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$839.50 |
$1,679 |
3.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,654 |
$5,308 |
7.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,005.50 |
$4,011 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,489 |
$2,978 |
6.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,105 |
$4,210 |
5.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,383 |
$4,766 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,079.50 |
$2,159 |
4.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,998 |
$3,996 |
5.6× |
| MRI scan of leg joint before and after contrast (73723) |
$2,024.50 |
$4,049 |
5.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,705 |
$3,410 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,416 |
$4,832 |
6.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,416 |
$4,832 |
6.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,339.50 |
$2,679 |
5.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,861.50 |
$3,723 |
7.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,112.50 |
$4,225 |
6.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$858.50 |
$1,717 |
3.5× |
| Neck soft tissue (70360) |
$305 |
$610 |
3.5× |
| Nm gastric emptying study (78264) |
$2,818.50 |
$5,637 |
6.9× |
| Osseous survey infant (77076) |
$400.50 |
$801 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$305 |
$610 |
2.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,376.50 |
$4,753 |
6.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$408 |
$816 |
4.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$305 |
$610 |
2.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$305 |
$610 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$288 |
$576 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$305 |
$610 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$174.50 |
$349 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$235.50 |
$471 |
2.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$185 |
$370 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$514 |
$1,028 |
2.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$668 |
$1,336 |
3.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$619 |
$1,238 |
3.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$226.50 |
$453 |
2.6× |
| Ribs bilateral 3 views (71110) |
$277 |
$554 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$169.50 |
$339 |
1.6× |
| Scapula complete (73010) |
$277 |
$554 |
2.6× |
| Screening digital breast tomosynthesis (77063) |
$66.50 |
$133 |
2.8× |
| Small bowel series (74250) |
$391 |
$782 |
2.2× |
| Spine thoracic 3 views (72072) |
$277 |
$554 |
2.6× |
| Thoracolumbar 2 views (72080) |
$192 |
$384 |
2.2× |
| Tmj unilateral (70328) |
$592.50 |
$1,185 |
6.7× |
| Ultrasound, abdomen limited (76705) |
$571.50 |
$1,143 |
5.4× |
| Unlisted Ultrasound Procedure (76999) |
$392.50 |
$785 |
4.4× |
| Upper Extremity Infant (73092) |
$70 |
$140 |
0.7× |
| Us abdl aorta screen aaa (76706) |
$262.50 |
$525 |
2.5× |
| Us breast unilateral complete (76641) |
$746 |
$1,492 |
7.0× |
| Us breast unilateral limited (76642) |
$746 |
$1,492 |
8.4× |
| Us chest (76604) |
$559 |
$1,118 |
5.3× |
| Us compl joint r-t w/image documentation (76881) |
$620 |
$1,240 |
5.8× |
| Us ob detailed single fetus (76811) |
$443.50 |
$887 |
1.8× |
| Us ob transvaginal (76817) |
$399 |
$798 |
3.8× |
| Us pelvic non ob complete (76856) |
$552.50 |
$1,105 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$475.50 |
$951 |
4.5× |
| Us pregnancy ltd (76815) |
$587.50 |
$1,175 |
5.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$447.50 |
$895 |
4.2× |
| Us retroperitoneal complete (76770) |
$295.50 |
$591 |
2.8× |
| Us retroperitoneal limited (76775) |
$706 |
$1,412 |
6.6× |
| Us scrotum and contents (76870) |
$904 |
$1,808 |
8.5× |
| Us soft tissue head/neck (76536) |
$294 |
$588 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$497 |
$994 |
4.7× |
| Us, eye b-scan (76512) |
$319.50 |
$639 |
3.0× |
| Wrist 2 views (73100) |
$226.50 |
$453 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$235.50 |
$471 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$226.50 |
$453 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$600 |
$1,200 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$226.50 |
$453 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$226.50 |
$453 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$464.50 |
$929 |
5.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$226.50 |
$453 |
2.6× |
| X-ray exam hip uni 4/> views (73503) |
$305 |
$610 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$305 |
$610 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$305 |
$610 |
2.9× |
| X-ray eye for foreign body (70030) |
$311.50 |
$623 |
3.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$305 |
$610 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$592.50 |
$1,185 |
6.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$226.50 |
$453 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$335 |
$670 |
3.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$539 |
$1,078 |
6.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$277 |
$554 |
2.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$539 |
$1,078 |
6.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$305 |
$610 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$305 |
$610 |
2.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$401 |
$802 |
3.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$305 |
$610 |
3.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$305 |
$610 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$226.50 |
$453 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$305 |
$610 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$305 |
$610 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$464.50 |
$929 |
4.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$226.50 |
$453 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$226.50 |
$453 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$226.50 |
$453 |
2.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$205.50 |
$411 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$421.50 |
$843 |
4.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$394.50 |
$789 |
3.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$139 |
$278 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$570.50 |
$1,141 |
6.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$580.50 |
$1,161 |
6.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$305 |
$610 |
2.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$168.50 |
$337 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$209.50 |
$419 |
2.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$226.50 |
$453 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$305 |
$610 |
2.9× |
| Xr chest 4+ views (71048) |
$354.50 |
$709 |
3.3× |
| Xr finger(s) 2+ views (73140) |
$226.50 |
$453 |
2.6× |
| Xr shoulder 1 view (73020) |
$580.50 |
$1,161 |
6.6× |
| Xr spine cervical 4 or 5 views (72050) |
$305 |
$610 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$226.50 |
$453 |
2.6× |
| Xr tmj bilateral (70330) |
$193 |
$386 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$226.50 |
$453 |
2.6× |