| Abdomen 2 views (74019) |
$416 |
$832 |
4.5× |
| Ankle 2 views (73600) |
$272.50 |
$545 |
3.6× |
| Bone age studies (77072) |
$399 |
$798 |
4.4× |
| Bone survey complete (77075) |
$722 |
$1,444 |
7.9× |
| Cervical spine 2 or 3 views (72040) |
$399 |
$798 |
5.2× |
| Chest 1 view (71045) |
$276.50 |
$553 |
3.6× |
| Chest 3 views (71047) |
$369.50 |
$739 |
4.8× |
| Clavicle complete (73000) |
$348 |
$696 |
4.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$303.50 |
$607 |
3.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,032.50 |
$10,065 |
16.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,922 |
$7,844 |
18.8× |
| CT abdomen w contrast (74160) |
$2,421.50 |
$4,843 |
15.8× |
| CT abdomen w wo contrast (74170) |
$2,628 |
$5,256 |
17.1× |
| CT abdomen w/o contrast (74150) |
$2,182 |
$4,364 |
23.8× |
| CT angio hrt w/3d image (75574) |
$1,601.50 |
$3,203 |
5.2× |
| CT angiography upper extremity lt (73206) |
$1,202.50 |
$2,405 |
7.8× |
| CT c-spine w/o contrast (72125) |
$1,782.50 |
$3,565 |
19.5× |
| CT chest w/wo contrast (71270) |
$1,990 |
$3,980 |
12.9× |
| CT chest with contrast (71260) |
$2,010 |
$4,020 |
13.1× |
| CT head/brain without and with contrast (70470) |
$2,787.50 |
$5,575 |
18.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$360.50 |
$721 |
4.7× |
| CT iac w contrast (70481) |
$1,378 |
$2,756 |
9.0× |
| CT lower ext w/o (73700) |
$2,189 |
$4,378 |
23.9× |
| CT lower extremity with contrast (73701) |
$1,577 |
$3,154 |
10.3× |
| CT lumbar spine w/o contrast (72131) |
$2,164 |
$4,328 |
23.6× |
| CT maxillofacial w contrast (70487) |
$1,802.50 |
$3,605 |
11.7× |
| CT maxillofacial w/o contrast (70486) |
$1,683.50 |
$3,367 |
18.4× |
| CT neck soft tissue w contrast (70491) |
$1,773.50 |
$3,547 |
11.5× |
| CT orbits w/o contrast (70480) |
$1,159 |
$2,318 |
12.7× |
| CT pelvis w/o contrast (72192) |
$2,105.50 |
$4,211 |
23.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,417 |
$2,834 |
15.5× |
| CT thoracic spine w/o contrast (72128) |
$2,575.50 |
$5,151 |
28.1× |
| CT thorax w/o contrast (71250) |
$1,812 |
$3,624 |
19.8× |
| CT upper extremity w/o contrast rt (73200) |
$1,989.50 |
$3,979 |
21.7× |
| CT upper extremity with contrast (73201) |
$1,581.50 |
$3,163 |
5.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,287.50 |
$2,575 |
8.4× |
| CTA abdomen pelvis (74174) |
$1,648.50 |
$3,297 |
5.4× |
| CTA chest (71275) |
$2,392 |
$4,784 |
15.6× |
| Cta Head (70496) |
$1,932 |
$3,864 |
12.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,609.50 |
$3,219 |
10.5× |
| Cta Neck (70498) |
$1,932 |
$3,864 |
12.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$379.50 |
$759 |
4.1× |
| Esophagus (74220) |
$321 |
$642 |
2.1× |
| Foot 2 views (73620) |
$266.50 |
$533 |
3.5× |
| Forearm 2 views (73090) |
$428 |
$856 |
5.6× |
| Hand 2 views (73120) |
$280.50 |
$561 |
3.1× |
| Hand 3 views (73130) |
$486 |
$972 |
6.4× |
| Humerus Min 2 Views Left (73060) |
$404 |
$808 |
5.3× |
| Knee 3 views (73562) |
$271 |
$542 |
3.6× |
| Mr safety determination physician/other qhp (76016) |
$164 |
$328 |
2.2× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$110.50 |
$221 |
2.1× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$45.50 |
$91 |
1.8× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$171 |
$342 |
2.1× |
| Mr safety med physics xm customization plng&mntr (76017) |
$450.50 |
$901 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,599 |
$5,198 |
8.5× |
| MRA head w/o contrast (70544) |
$920 |
$1,840 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,149.50 |
$4,299 |
7.0× |
| MRA neck w/o contrast (70547) |
$920 |
$1,840 |
4.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,347 |
$6,694 |
10.9× |
| MRI abdomen w/o contrast (74181) |
$1,516 |
$3,032 |
7.3× |
| MRI cervical spine w/o contrast (72141) |
$1,148 |
$2,296 |
5.5× |
| MRI chest w/o & w/contrast material (71552) |
$3,318 |
$6,636 |
10.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,205.50 |
$2,411 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,368 |
$4,736 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,190.50 |
$6,381 |
10.4× |
| MRI pelvis w/o contrast (72195) |
$1,516 |
$3,032 |
7.3× |
| MRI scan of leg joint before and after contrast (73723) |
$4,384 |
$8,768 |
14.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,445.50 |
$4,891 |
8.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,393 |
$6,786 |
11.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,393 |
$6,786 |
11.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,702.50 |
$3,405 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$2,376.50 |
$4,753 |
11.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,910 |
$9,820 |
16.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,508 |
$3,016 |
7.2× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$3,148 |
$6,296 |
4.2× |
| Neck soft tissue (70360) |
$181.50 |
$363 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$404 |
$808 |
4.4× |
| PET image w/CT, skull-thigh (78815) |
$4,139 |
$8,278 |
3.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,338 |
$6,676 |
10.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$563.50 |
$1,127 |
7.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$468.50 |
$937 |
5.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$507 |
$1,014 |
5.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$542.50 |
$1,085 |
5.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$396 |
$792 |
5.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$429 |
$858 |
4.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$442.50 |
$885 |
5.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$725 |
$1,450 |
4.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$547.50 |
$1,095 |
3.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$352 |
$704 |
4.6× |
| Ribs bilateral 3 views (71110) |
$503.50 |
$1,007 |
5.5× |
| Sacroiliac Joints < 3 Views (72200) |
$251.50 |
$503 |
2.7× |
| Scanogram (77073) |
$289.50 |
$579 |
3.2× |
| Scapula complete (73010) |
$317.50 |
$635 |
3.5× |
| Screening digital breast tomosynthesis (77063) |
$55.50 |
$111 |
2.4× |
| Spine thoracic 3 views (72072) |
$594 |
$1,188 |
6.5× |
| Thoracolumbar 2 views (72080) |
$362 |
$724 |
4.7× |
| Ultrasound, abdomen limited (76705) |
$992.50 |
$1,985 |
10.8× |
| Unlisted Ultrasound Procedure (76999) |
$442.50 |
$885 |
5.8× |
| Upper Extremity Infant (73092) |
$123.50 |
$247 |
1.3× |
| Us abdl aorta screen aaa (76706) |
$410 |
$820 |
4.5× |
| Us breast unilateral complete (76641) |
$746 |
$1,492 |
8.1× |
| Us breast unilateral limited (76642) |
$579.50 |
$1,159 |
7.6× |
| Us chest (76604) |
$559 |
$1,118 |
6.1× |
| Us compl joint r-t w/image documentation (76881) |
$619.50 |
$1,239 |
6.8× |
| Us kidney transplant (76776) |
$437.50 |
$875 |
4.8× |
| Us ob transvaginal (76817) |
$459 |
$918 |
5.0× |
| Us pelvic non ob complete (76856) |
$680 |
$1,360 |
7.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$522.50 |
$1,045 |
5.7× |
| Us pregnancy ltd (76815) |
$619.50 |
$1,239 |
6.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$768 |
$1,536 |
8.4× |
| Us retroperitoneal complete (76770) |
$977 |
$1,954 |
10.7× |
| Us retroperitoneal limited (76775) |
$918.50 |
$1,837 |
10.0× |
| Us scrotum and contents (76870) |
$992.50 |
$1,985 |
10.8× |
| Us soft tissue head/neck (76536) |
$686.50 |
$1,373 |
7.5× |
| Us xtr non-vasc lmtd (76882) |
$495.50 |
$991 |
5.4× |
| Us, eye b-scan (76512) |
$320 |
$640 |
3.5× |
| Wrist 2 views (73100) |
$281.50 |
$563 |
3.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$594 |
$1,188 |
6.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$372.50 |
$745 |
4.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$280.50 |
$561 |
3.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$459.50 |
$919 |
6.0× |
| X-ray exam entire spi 4/5 vw (72083) |
$691.50 |
$1,383 |
7.5× |
| X-ray exam hip uni 1 view (73501) |
$260 |
$520 |
3.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$494 |
$988 |
6.5× |
| X-ray exam hip uni 4/> views (73503) |
$394.50 |
$789 |
4.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$637.50 |
$1,275 |
7.0× |
| X-ray exam of femur 1 (73551) |
$224 |
$448 |
2.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$399.50 |
$799 |
4.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$328 |
$656 |
4.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$488 |
$976 |
6.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$404 |
$808 |
5.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$299 |
$598 |
3.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$594 |
$1,188 |
6.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$210.50 |
$421 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$123.50 |
$247 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$500 |
$1,000 |
5.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$617 |
$1,234 |
6.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$413 |
$826 |
4.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$436.50 |
$873 |
5.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$497 |
$994 |
5.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$500 |
$1,000 |
6.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$620.50 |
$1,241 |
6.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$799 |
$1,598 |
8.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$186 |
$372 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$456.50 |
$913 |
6.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$474 |
$948 |
6.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$656.50 |
$1,313 |
8.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$248.50 |
$497 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$673.50 |
$1,347 |
7.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$526.50 |
$1,053 |
5.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$181 |
$362 |
2.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$192 |
$384 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$384.50 |
$769 |
5.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$398.50 |
$797 |
4.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$139.50 |
$279 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$300.50 |
$601 |
3.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$537 |
$1,074 |
7.0× |
| Xr c-spine 6 or more views (72052) |
$682.50 |
$1,365 |
7.4× |
| Xr finger(s) 2+ views (73140) |
$320 |
$640 |
4.2× |
| Xr shoulder 1 view (73020) |
$218 |
$436 |
2.9× |
| Xr spine cervical 4 or 5 views (72050) |
$850 |
$1,700 |
9.3× |
| Xr tibia/fibula 2 views (73590) |
$446 |
$892 |
5.8× |
| Xray knee 1 or 2 views rt (73560) |
$208.50 |
$417 |
2.7× |