| Abdomen 2 views (74019) |
$207.90 |
$297 |
1.9× |
| Ankle 2 views (73600) |
$131.60 |
$188 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$579.25 |
$827.50 |
1.4× |
| Bone age studies (77072) |
$165.90 |
$237 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$918.40 |
$1,312 |
2.2× |
| Bone survey complete (77075) |
$397.60 |
$568 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$89.95 |
$128.50 |
1.0× |
| Chest 1 view (71045) |
$137.20 |
$196 |
1.5× |
| Chest xray 3 views (71047) |
$189.70 |
$271 |
2.1× |
| Clavicle complete (73000) |
$151.20 |
$216 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$535.50 |
$765 |
4.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,051 |
$2,930 |
5.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,479.10 |
$2,113 |
5.9× |
| CT abdomen w contrast (74160) |
$651 |
$930 |
3.6× |
| CT abdomen w wo contrast (74170) |
$818.30 |
$1,169 |
4.5× |
| CT abdomen w/o contrast (74150) |
$550.90 |
$787 |
5.0× |
| CT c-spine w/contrast (72126) |
$1,260 |
$1,800 |
3.5× |
| CT c-spine w/o contrast (72125) |
$568.05 |
$811.50 |
5.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,463 |
$2,090 |
8.0× |
| CT chest w contrast (71260) |
$1,154.30 |
$1,649 |
6.3× |
| CT chest w/wo contrast (71270) |
$1,154.30 |
$1,649 |
6.3× |
| CT head/brain with contrast (70460) |
$1,124.20 |
$1,606 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,308.30 |
$1,869 |
7.1× |
| CT iac w contrast (70481) |
$1,039.50 |
$1,485 |
5.7× |
| CT limited/localized follow up study (76380) |
$542.50 |
$775 |
6.0× |
| CT lower ext w/o (73700) |
$844.20 |
$1,206 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$1,131.90 |
$1,617 |
6.2× |
| CT lower extremity w/contrast material (73701) |
$1,371.30 |
$1,959 |
7.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,421 |
$2,030 |
7.8× |
| CT lumbar spine w/contrast (72132) |
$1,225 |
$1,750 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$564.90 |
$807 |
5.2× |
| CT maxillofacial w contrast (70487) |
$583.45 |
$833.50 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,239 |
$1,770 |
6.8× |
| CT maxillofacial wo contrast (70486) |
$501.55 |
$716.50 |
4.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,260 |
$1,800 |
6.9× |
| CT orbits w/o contrast (70480) |
$525.35 |
$750.50 |
4.8× |
| CT pelvis w/o contrast (72192) |
$549.85 |
$785.50 |
5.0× |
| CT pelvis w/wo contrast (72194) |
$731.50 |
$1,045 |
4.0× |
| CT scan of arm combo (73202) |
$1,131.90 |
$1,617 |
6.2× |
| CT soft tissue neck w contrast (70491) |
$1,020.60 |
$1,458 |
5.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,254.40 |
$1,792 |
6.8× |
| CT soft tissue neck w/o contrast (70490) |
$896.70 |
$1,281 |
8.2× |
| CT thoracic spine w/contrast (72129) |
$1,260 |
$1,800 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$1,039.50 |
$1,485 |
9.5× |
| CT thoracic spine w/wo contrast (72130) |
$734.65 |
$1,049.50 |
4.0× |
| CT thorax w/o contrast (71250) |
$536.90 |
$767 |
4.9× |
| CT upper ext wo (73200) |
$886.90 |
$1,267 |
8.1× |
| CT upper extremity with contrast (73201) |
$1,173.20 |
$1,676 |
3.2× |
| Cta Abdomen (74175) |
$1,365 |
$1,950 |
7.5× |
| CTA abdomen pelvis (74174) |
$1,673 |
$2,390 |
4.6× |
| CTA chest (71275) |
$1,318.80 |
$1,884 |
7.2× |
| Cta Head (70496) |
$1,344.70 |
$1,921 |
7.3× |
| Cta Neck (70498) |
$1,369.55 |
$1,956.50 |
7.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$153.65 |
$219.50 |
1.4× |
| Dxa bone density study axial skeleton (77085) |
$278.60 |
$398 |
2.6× |
| Esophagus (74220) |
$270.90 |
$387 |
1.5× |
| Facial bones min 3 views (70150) |
$98.70 |
$141 |
0.9× |
| Foot 2 views (73620) |
$130.20 |
$186 |
1.4× |
| Forearm 2 views (73090) |
$148.40 |
$212 |
1.6× |
| Hand 2 views (73120) |
$134.40 |
$192 |
1.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$597.10 |
$853 |
1.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$597.10 |
$853 |
1.4× |
| Liver imaging static only (78201) |
$821.41 |
$1,173.44 |
1.4× |
| MRA head w & w/o contrast (70546) |
$1,256.50 |
$1,795 |
3.4× |
| MRA head w/o contrast (70544) |
$1,134.70 |
$1,621 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,134.70 |
$1,621 |
4.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,134.70 |
$1,621 |
1.4× |
| MRI cervical spine w/o contrast (72141) |
$1,134.70 |
$1,621 |
4.6× |
| MRI chest w/o contrast (71550) |
$948.50 |
$1,355 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,134.70 |
$1,621 |
4.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,134.70 |
$1,621 |
4.6× |
| MRI, joint upper extrem combo (73223) |
$1,397.20 |
$1,996 |
3.8× |
| Neck soft tissue (70360) |
$71.40 |
$102 |
0.8× |
| Noncardiac Vascular Flow Imaging (78445) |
$206.50 |
$295 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$78.40 |
$112 |
0.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$170.10 |
$243 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$129.50 |
$185 |
1.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$175.70 |
$251 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$189 |
$270 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$236.60 |
$338 |
2.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$245 |
$350 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$130.20 |
$186 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$159.60 |
$228 |
1.8× |
| Radex Hand Minimum 3 Views (73130) |
$165.90 |
$237 |
1.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$139.30 |
$199 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$270.90 |
$387 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$225.40 |
$322 |
2.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$364.70 |
$521 |
3.3× |
| Radex Humerus Minimum 2 Views (73060) |
$156.10 |
$223 |
1.7× |
| Radex Kne 1/2 Views (73560) |
$137.20 |
$196 |
1.5× |
| Radex Kne Compl 4/More Views (73564) |
$198.10 |
$283 |
1.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$193.20 |
$276 |
1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$75.95 |
$108.50 |
0.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$186.90 |
$267 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$130.90 |
$187 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$196.70 |
$281 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$133.70 |
$191 |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$134.40 |
$192 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$166.60 |
$238 |
1.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$359.80 |
$514 |
3.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$176.40 |
$252 |
1.9× |
| Radiologic exam chest 2 views (71046) |
$166.60 |
$238 |
1.8× |
| Radiologic exam colon single contrast study (74270) |
$37.50 |
$53.57 |
0.2× |
| Radiologic examination femur 1 view (73551) |
$152.60 |
$218 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$156.10 |
$223 |
1.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$181.30 |
$259 |
1.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$140.70 |
$201 |
1.3× |
| Ribs bilateral 3 views (71110) |
$196.70 |
$281 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$137.20 |
$196 |
1.3× |
| Scapula (73010) |
$154 |
$220 |
1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.55 |
$66.50 |
2.0× |
| Shoulder 1 view (73020) |
$128.80 |
$184 |
1.4× |
| Spine thoracic 3 views (72072) |
$108.85 |
$155.50 |
1.0× |
| Thyroid imaging w/blood flow (78013) |
$486.50 |
$695 |
1.2× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$685.30 |
$979 |
1.6× |
| Tmj unilateral (70328) |
$147.70 |
$211 |
1.6× |
| Ultrasound breast complete (76641) |
$260.40 |
$372 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$203.70 |
$291 |
1.9× |
| Us breast unilateral limited (76642) |
$242.20 |
$346 |
2.7× |
| Us chest (76604) |
$294 |
$420 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$308.70 |
$441 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$262.50 |
$375 |
2.4× |
| Us ob detailed single fetus (76811) |
$324.10 |
$463 |
1.3× |
| Us ob transvaginal (76817) |
$354.90 |
$507 |
3.3× |
| Us pelvic non ob complete (76856) |
$223.30 |
$319 |
2.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$257.60 |
$368 |
2.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$214.20 |
$306 |
2.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$247.80 |
$354 |
2.3× |
| Us retroperitoneal complete (76770) |
$220.15 |
$314.50 |
2.0× |
| Us retroperitoneal limited (76775) |
$350 |
$500 |
3.2× |
| Us scrotum and contents (76870) |
$210.70 |
$301 |
1.9× |
| Us soft tissue head/neck (76536) |
$354.20 |
$506 |
3.2× |
| Wrist 2 views (73100) |
$132.30 |
$189 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$138.60 |
$198 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$135.10 |
$193 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$140.70 |
$201 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$173.60 |
$248 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$289.80 |
$414 |
2.7× |
| X-ray exam of femur 2/> (73552) |
$175 |
$250 |
1.9× |
| X-ray eye for foreign body (70030) |
$89.95 |
$128.50 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$133 |
$190 |
1.5× |
| X-ray IV pyelogram (ivp) (74400) |
$411.60 |
$588 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$130.20 |
$186 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$136.50 |
$195 |
1.5× |
| X-ray leg, infant (73592) |
$142.80 |
$204 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$93.80 |
$134 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$277.20 |
$396 |
2.5× |
| X-ray nose-rectum child f.b. (76010) |
$132.30 |
$189 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$188.30 |
$269 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$157.50 |
$225 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$197.40 |
$282 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$134.75 |
$192.50 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$169.40 |
$242 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$77 |
$110 |
0.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$99.75 |
$142.50 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$121.80 |
$174 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$78.05 |
$111.50 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$70 |
$100 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$138.60 |
$198 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$141.40 |
$202 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$165.90 |
$237 |
1.5× |
| Xr bone length studies (77073) |
$219.10 |
$313 |
2.0× |
| Xr c-spine 4 or 5 views (72050) |
$137.20 |
$196 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$289.10 |
$413 |
2.6× |