| Abdomen 2 views (74019) |
$212.67 |
$861 |
1.9× |
| Ankle 2 views (73600) |
$171.67 |
$695 |
1.8× |
| Antegrade urography radiological supvj & interpj (74425) |
$315.67 |
$1,278 |
0.8× |
| Arthrogram elbow (73085) |
$409.28 |
$1,657 |
1.1× |
| Arthrogram hip (73525) |
$470.05 |
$1,903 |
1.3× |
| Arthrogram shoulder (73040) |
$411.51 |
$1,666 |
1.1× |
| Arthrogram wrist (73115) |
$474.74 |
$1,922 |
1.3× |
| Arthrography knee lt (73580) |
$409.28 |
$1,657 |
1.1× |
| Bone survey complete (77075) |
$485.36 |
$1,965 |
4.4× |
| Cervical spine 2 or 3 views (72040) |
$247.75 |
$1,003 |
2.7× |
| Chest 1 view (71045) |
$151.42 |
$613 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$176.36 |
$714 |
0.9× |
| Clavicle complete (73000) |
$262.56 |
$1,063 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$44.22 |
$179 |
0.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,177.31 |
$8,815 |
5.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,295.03 |
$5,243 |
5.1× |
| CT abdomen w contrast (74160) |
$1,198.20 |
$4,851 |
6.4× |
| CT abdomen w wo contrast (74170) |
$1,425.94 |
$5,773 |
7.6× |
| CT abdomen w/o contrast (74150) |
$742.98 |
$3,008 |
6.7× |
| CT angio hrt w/3d image (75574) |
$1,101.62 |
$4,460 |
3.0× |
| CT angiography upper extremity lt (73206) |
$527.60 |
$2,136 |
2.8× |
| CT c-spine w/o contrast (72125) |
$1,116.44 |
$4,520 |
10.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,775.19 |
$7,187 |
9.5× |
| CT cervical spine with contrast (72126) |
$1,272.80 |
$5,153 |
3.4× |
| CT chest w/wo contrast (71270) |
$1,428.41 |
$5,783 |
7.6× |
| CT chest with contrast (71260) |
$1,185.36 |
$4,799 |
6.3× |
| CT head/brain with contrast (70460) |
$1,204.13 |
$4,875 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,455.82 |
$5,894 |
7.8× |
| CT heart contrast eval cardiac structure&morph (75572) |
$887.72 |
$3,594 |
2.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$802.01 |
$3,247 |
8.6× |
| CT hrt w/3d image congen (75573) |
$887.72 |
$3,594 |
2.4× |
| CT iac w contrast (70481) |
$1,014.68 |
$4,108 |
5.4× |
| CT limited/localized follow up study (76380) |
$120.54 |
$488 |
1.3× |
| CT lower ext w/o (73700) |
$555.02 |
$2,247 |
5.0× |
| CT lower extremity w wo contrast (73702) |
$839.93 |
$3,400.50 |
4.5× |
| CT lower extremity with contrast (73701) |
$591.57 |
$2,395 |
3.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,775.19 |
$7,187 |
9.5× |
| CT lumbar spine w/o contrast (72131) |
$1,116.44 |
$4,520 |
10.0× |
| CT lumbar spine with contrast (72132) |
$1,272.80 |
$5,153 |
3.4× |
| CT maxillofacial w contrast (70487) |
$1,165.10 |
$4,717 |
6.2× |
| CT maxillofacial w/o contrast (70486) |
$742.24 |
$3,005 |
6.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,380.49 |
$5,589 |
7.4× |
| CT neck soft tissue w contrast (70491) |
$1,006.53 |
$4,075 |
5.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,222.90 |
$4,951 |
6.5× |
| CT orbits w/o contrast (70480) |
$947.99 |
$3,838 |
8.5× |
| CT pelvis w & w/o contrast (72194) |
$1,506.95 |
$6,101 |
8.1× |
| CT pelvis w/o contrast (72192) |
$1,186.59 |
$4,804 |
10.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,006.53 |
$4,075 |
5.4× |
| CT soft tissue neck w/o contrast (70490) |
$734.58 |
$2,974 |
6.6× |
| CT thoracic spine w/contrast (72129) |
$1,272.80 |
$5,153 |
6.8× |
| CT thoracic spine w/o contrast (72128) |
$1,116.44 |
$4,520 |
10.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,775.19 |
$7,187 |
9.5× |
| CT thorax w/o contrast (71250) |
$736.31 |
$2,981 |
6.6× |
| CT upper extremity w/o contrast rt (73200) |
$515.74 |
$2,088 |
4.6× |
| CT upper extremity with contrast (73201) |
$685.92 |
$2,777 |
1.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,032.71 |
$4,181 |
5.5× |
| Cta Abdomen (74175) |
$1,513.62 |
$6,128 |
8.1× |
| CTA abdomen pelvis (74174) |
$1,915.98 |
$7,757 |
5.1× |
| CTA chest (71275) |
$1,206.85 |
$4,886 |
6.4× |
| Cta Head (70496) |
$1,390.61 |
$5,630 |
7.4× |
| CTA lwr ext w&w/o contrast (73706) |
$546.12 |
$2,211 |
2.9× |
| Cta Neck (70498) |
$1,335.53 |
$5,407 |
7.1× |
| Cta Pelvis (72191) |
$680.24 |
$2,754 |
3.6× |
| Cystography minimum 3 views rs&i (74430) |
$309 |
$1,251 |
0.8× |
| Echoencephalography real time imaging (76506) |
$232.18 |
$940 |
2.1× |
| Esophagus (74220) |
$276.89 |
$1,121 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$242.06 |
$980 |
1.0× |
| Foot 2 views (73620) |
$140.05 |
$567 |
1.5× |
| Forearm 2 views (73090) |
$168.95 |
$684 |
1.8× |
| Hand 2 views (73120) |
$158.58 |
$642 |
1.4× |
| Hand 3 views (73130) |
$262.94 |
$1,064.50 |
2.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$780.03 |
$3,158 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$569.34 |
$2,305 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$194.40 |
$787 |
2.1× |
| Hysterosalpingogram (74740) |
$437.69 |
$1,772 |
1.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$759.78 |
$3,076 |
1.3× |
| Knee 3 views (73562) |
$306.28 |
$1,240 |
3.3× |
| MRA head w & w/o contrast (70546) |
$2,923.50 |
$11,836 |
7.9× |
| MRA head w/o contrast (70544) |
$1,015.17 |
$4,110 |
4.0× |
| MRA head with contrast (70545) |
$1,715.42 |
$6,945 |
4.6× |
| MRA neck w contrast (70548) |
$1,119.41 |
$4,532 |
3.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,210.80 |
$4,902 |
3.3× |
| MRA neck w/o contrast (70547) |
$761.51 |
$3,083 |
3.0× |
| MRI abdomen w contrast (74182) |
$1,539.06 |
$6,231 |
4.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,093.08 |
$8,474 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,026.04 |
$4,154 |
4.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,400.25 |
$5,669 |
1.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$979.24 |
$3,964.50 |
1.2× |
| MRI c-spine with contrast (72142) |
$1,127.81 |
$4,566 |
3.0× |
| MRI cervical spine w/o contrast (72141) |
$797.81 |
$3,230 |
3.1× |
| MRI chest w/o & w/contrast material (71552) |
$871.91 |
$3,530 |
2.3× |
| MRI chest w/o contrast (71550) |
$581.20 |
$2,353 |
2.3× |
| MRI chest with contrast (71551) |
$871.91 |
$3,530 |
1.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$902.30 |
$3,653 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,123.61 |
$4,549 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$759.04 |
$3,073 |
3.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$607.87 |
$2,461 |
2.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,350.60 |
$5,468 |
3.6× |
| MRI orbit/face/neck w/contrast (70542) |
$905.01 |
$3,664 |
2.4× |
| MRI pelvis w contrast (72196) |
$1,558.33 |
$6,309 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,032.07 |
$8,227 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$995.66 |
$4,031 |
3.9× |
| MRI scan of arm joint before and after contrast (73223) |
$952.68 |
$3,857 |
2.6× |
| MRI scan of leg joint before and after contrast (73723) |
$1,848.06 |
$7,482 |
5.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,750.60 |
$11,136 |
7.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,126.57 |
$4,561 |
3.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,503.60 |
$10,136 |
6.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,452.12 |
$5,879 |
3.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,503.60 |
$10,136 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$926.25 |
$3,750 |
3.6× |
| MRI tmj (70336) |
$438.68 |
$1,776 |
1.7× |
| MRI upper ext joint w/o contrast (73221) |
$807.45 |
$3,269 |
3.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,025.55 |
$4,152 |
2.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$506.85 |
$2,052 |
2.0× |
| Myelogram Cervical (72240) |
$1,085.32 |
$4,394 |
1.3× |
| Myelogram Lumbar (72265) |
$1,085.32 |
$4,394 |
1.3× |
| Myelogram thoracic (72255) |
$1,085.32 |
$4,394 |
1.3× |
| Myelography 2 or more regions (72270) |
$1,085.32 |
$4,394 |
1.3× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,626.50 |
$6,585 |
1.8× |
| Neck soft tissue (70360) |
$163.02 |
$660 |
1.8× |
| Nm gastric emptying study (78264) |
$958.61 |
$3,881 |
2.2× |
| Osseous survey infant (77076) |
$489.31 |
$1,981 |
4.4× |
| Osseous survey limited (77074) |
$325.30 |
$1,317 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$153.89 |
$623 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,267.86 |
$5,133 |
3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$468.81 |
$1,898 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$693.33 |
$2,807 |
1.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$391.99 |
$1,587 |
0.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$233.42 |
$945 |
2.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$380.38 |
$1,540 |
3.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$224.28 |
$908 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$186.74 |
$756 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$238.61 |
$966 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$196.86 |
$797 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$242.81 |
$983 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$298.63 |
$1,209 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$268.99 |
$1,089 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$303.57 |
$1,229 |
3.3× |
| Sacroiliac Joints < 3 Views (72200) |
$86.21 |
$349 |
0.8× |
| Scanogram (77073) |
$92.75 |
$375.50 |
0.8× |
| Scapula complete (73010) |
$199.33 |
$807 |
1.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$251.70 |
$1,019 |
2.3× |
| Small bowel series (74250) |
$212.67 |
$861 |
1.1× |
| Spine thoracic 3 views (72072) |
$233.17 |
$944 |
2.1× |
| Therapeutic Enema (74283) |
$422.37 |
$1,710 |
2.3× |
| Thoracolumbar 2 views (72080) |
$142.03 |
$575 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$448.06 |
$1,814 |
4.0× |
| Upper Extremity Infant (73092) |
$94.61 |
$383 |
0.8× |
| Urethrocystography retrograde rs&i (74450) |
$292.45 |
$1,184 |
1.1× |
| Urethrocystography voiding (74455) |
$276.15 |
$1,118 |
1.1× |
| Us breast unilateral complete (76641) |
$291.59 |
$1,180.50 |
2.6× |
| Us breast unilateral limited (76642) |
$131.04 |
$530.50 |
1.4× |
| Us chest (76604) |
$323.82 |
$1,311 |
2.9× |
| Us infant hips dynamic (76885) |
$270.96 |
$1,097 |
2.9× |
| Us infant hips limited static (76886) |
$88.92 |
$360 |
1.0× |
| Us ob transvaginal (76817) |
$342.35 |
$1,386 |
3.1× |
| Us pelvic non ob complete (76856) |
$474.74 |
$1,922 |
4.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$322.83 |
$1,307 |
2.9× |
| Us pregnancy ltd (76815) |
$186.74 |
$756 |
1.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$388.29 |
$1,572 |
3.5× |
| Us retroperitoneal complete (76770) |
$400.14 |
$1,620 |
3.6× |
| Us retroperitoneal limited (76775) |
$236.14 |
$956 |
2.1× |
| Us scrotum and contents (76870) |
$417.43 |
$1,690 |
3.7× |
| Us soft tissue head/neck (76536) |
$277.14 |
$1,122 |
2.5× |
| Us transrectal (76872) |
$116.84 |
$473 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$118.56 |
$480 |
1.1× |
| Wrist 2 views (73100) |
$142.28 |
$576 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$224.53 |
$909 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$151.91 |
$615 |
1.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$362.60 |
$1,468 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$339.88 |
$1,376 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$159.07 |
$644 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$263.68 |
$1,067.50 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$141.54 |
$573 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$141.54 |
$573 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$233.42 |
$945 |
2.1× |
| X-ray exam of femur 1 (73551) |
$97.32 |
$394 |
1.0× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$816.59 |
$3,306 |
4.4× |
| X-ray eye for foreign body (70030) |
$110.17 |
$446 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$185.25 |
$750 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$118.81 |
$481 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$218.72 |
$885.50 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$160.43 |
$649.50 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$195.13 |
$790 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$358.65 |
$1,452 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$258.12 |
$1,045 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$93.37 |
$378 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$352.47 |
$1,427 |
3.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$341.85 |
$1,384 |
3.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$398.17 |
$1,612 |
3.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$100.53 |
$407 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$185.50 |
$751 |
2.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$186.98 |
$757 |
1.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$276.15 |
$1,118 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$135.11 |
$547 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$220.82 |
$894 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$329.75 |
$1,335 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$120.05 |
$486 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$148.45 |
$601 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$301.84 |
$1,222 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$117.08 |
$474 |
1.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$92.38 |
$374 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$211.68 |
$857 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$203.29 |
$823 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$115.11 |
$466 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$135.11 |
$547 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$138.57 |
$561 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$250.22 |
$1,013 |
2.7× |
| Xr arthrogram ankle (73615) |
$357.91 |
$1,449 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$468.07 |
$1,895 |
4.2× |
| Xr finger(s) 2+ views (73140) |
$135.85 |
$550 |
1.5× |
| Xr shoulder 1 view (73020) |
$158.58 |
$642 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$299.62 |
$1,213 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$201.80 |
$817 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$215.02 |
$870.50 |
2.3× |