| Abdomen 2 views (74019) |
$150 |
$591 |
1.6× |
| Ankle 2 views (73600) |
$150 |
$368 |
1.9× |
| Bone &/joint imaging whole body (78306) |
$1,021.08 |
$1,856 |
2.8× |
| Bone Imaging 3 Phase (78315) |
$1,021.08 |
$1,860 |
2.8× |
| Bone survey complete (77075) |
$267.03 |
$602 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$175 |
$540 |
2.2× |
| Chest 1 view (71045) |
$100 |
$327 |
1.3× |
| Clavicle complete (73000) |
$222.28 |
$333 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$475 |
$1,377 |
1.5× |
| CT abdomen and pelvis without contrast (74176) |
$375 |
$1,263 |
1.7× |
| CT abdomen w contrast (74160) |
$425 |
$1,368 |
2.7× |
| CT abdomen w wo contrast (74170) |
$425 |
$1,363 |
2.7× |
| CT abdomen w/o contrast (74150) |
$375 |
$675 |
3.9× |
| CT c-spine w/o contrast (72125) |
$375 |
$670 |
3.9× |
| CT cervical spine w&w/o contrast (72127) |
$475 |
$1,368 |
3.0× |
| CT cervical spine with contrast (72126) |
$425 |
$2,431 |
1.3× |
| CT chest w/wo contrast (71270) |
$475 |
$1,360 |
3.0× |
| CT chest with contrast (71260) |
$425 |
$1,358 |
2.7× |
| CT head/brain with contrast (70460) |
$425 |
$1,357 |
2.7× |
| CT head/brain without and with contrast (70470) |
$475 |
$1,368 |
3.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$90 |
$534 |
1.1× |
| CT lower ext w/o (73700) |
$375 |
$815 |
3.9× |
| CT lumbar spine w/o contrast (72131) |
$375 |
$670 |
3.9× |
| CT lumbar spine with contrast (72132) |
$425 |
$2,431 |
1.3× |
| CT maxillofacial w/o contrast (70486) |
$375 |
$667 |
3.9× |
| CT neck soft tissue w contrast (70491) |
$425 |
$1,368 |
2.7× |
| CT pelvis w & w/o contrast (72194) |
$475 |
$1,368 |
3.0× |
| CT pelvis w/o contrast (72192) |
$175 |
$672 |
1.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$475 |
$1,368 |
3.0× |
| CT thoracic spine w/contrast (72129) |
$425 |
$1,359 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$375 |
$670 |
3.9× |
| CT thorax w/o contrast (71250) |
$375 |
$672 |
3.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$475 |
$1,368 |
3.0× |
| CT upper extremity w/o contrast rt (73200) |
$375 |
$774 |
3.9× |
| CT upper extremity with contrast (73201) |
$425 |
$1,368 |
1.3× |
| CTA abdomen pelvis (74174) |
$425 |
$1,381 |
1.3× |
| CTA chest (71275) |
$425 |
$1,373 |
2.7× |
| Cta Head (70496) |
$475 |
$1,371 |
3.0× |
| Cta Neck (70498) |
$475 |
$1,371 |
3.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$120 |
$602 |
1.3× |
| Foot 2 views (73620) |
$150 |
$398 |
1.9× |
| Forearm 2 views (73090) |
$150 |
$497 |
1.9× |
| Hand 3 views (73130) |
$175 |
$415 |
2.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,021.08 |
$1,854 |
2.8× |
| Humerus Min 2 Views Left (73060) |
$150 |
$338 |
1.9× |
| Knee 3 views (73562) |
$175 |
$334 |
2.2× |
| MRA head w/o contrast (70544) |
$525 |
$1,380 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$750 |
$2,451 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$525 |
$1,386 |
2.4× |
| MRI any jnt lwr ext with con lt (73722) |
$625 |
$3,627 |
0.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$625 |
$3,627 |
0.9× |
| MRI breast w/o contrast bilateral (77047) |
$525 |
$1,245 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$525 |
$1,325 |
2.4× |
| MRI chest w/o contrast (71550) |
$525 |
$1,386 |
2.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$525 |
$1,383 |
2.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$525 |
$2,434 |
2.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$750 |
$2,451 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$750 |
$2,451 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$525 |
$1,386 |
2.4× |
| MRI scan of arm joint before and after contrast (73223) |
$750 |
$2,451 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$750 |
$2,451 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$750 |
$2,454 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$750 |
$2,454 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$750 |
$2,454 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$525 |
$1,325 |
2.4× |
| MRI upper ext joint w/o contrast (73221) |
$525 |
$1,384 |
2.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$750 |
$2,183 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$525 |
$1,229 |
2.4× |
| Parathyroid imaging (78070) |
$1,021.08 |
$1,888 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$267.03 |
$539 |
2.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$750 |
$2,458.50 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$100 |
$335 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$175 |
$593 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$150 |
$586 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$100 |
$327 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$150 |
$328 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$150 |
$609 |
1.9× |
| Radiological examination surgical specimen (76098) |
$1,395.63 |
$2,603 |
2.8× |
| Ribs bilateral 3 views (71110) |
$150 |
$611 |
1.6× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,500 |
$6,614 |
3.0× |
| Rp loclzj tum spect 2 area/sep acquisj img (78831) |
$1,500 |
$6,632 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$175 |
$590 |
1.8× |
| Scanogram (77073) |
$120 |
$549 |
1.3× |
| Spine thoracic 3 views (72072) |
$175 |
$632 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$200 |
$828 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$200 |
$602 |
2.1× |
| Us retroperitoneal complete (76770) |
$200 |
$602 |
2.1× |
| Us soft tissue head/neck (76536) |
$200 |
$617 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$200 |
$602 |
2.1× |
| Wrist 2 views (73100) |
$150 |
$330 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$175 |
$327 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$150 |
$333 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$150 |
$327 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$100 |
$313 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$175 |
$315 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$175 |
$588 |
1.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$175 |
$327 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$175 |
$557 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$175 |
$540 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$175 |
$585 |
1.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$175 |
$328 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$175 |
$592 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$150 |
$611 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$150 |
$578 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$175 |
$583 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$222.28 |
$332 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$150 |
$327 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$222.28 |
$332 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$175 |
$609 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$150 |
$334 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$150 |
$586 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$175 |
$577 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$150 |
$338 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$175 |
$327 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$175 |
$585 |
1.8× |
| Xr finger(s) 2+ views (73140) |
$198.64 |
$299 |
2.5× |
| Xr shoulder 1 view (73020) |
$100 |
$326 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$175 |
$527 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$150 |
$338 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$150 |
$327 |
1.9× |