| Abdomen 2 views (74019) |
$391.20 |
$652 |
3.9× |
| Ankle 2 views (73600) |
$217.20 |
$362 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$217.20 |
$362 |
2.6× |
| Chest 1 view (71045) |
$217.20 |
$362 |
2.6× |
| Chest 3 views (71047) |
$217.20 |
$362 |
2.6× |
| Clavicle complete (73000) |
$217.20 |
$362 |
2.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,632.60 |
$2,721 |
4.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,392 |
$2,320 |
6.1× |
| CT abdomen w contrast (74160) |
$1,447.80 |
$2,413 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,632.60 |
$2,721 |
9.7× |
| CT abdomen w/o contrast (74150) |
$946.80 |
$1,578 |
9.4× |
| CT c-spine w/o contrast (72125) |
$1,020.60 |
$1,701 |
10.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,669.20 |
$2,782 |
9.9× |
| CT cervical spine with contrast (72126) |
$1,457.40 |
$2,429 |
4.3× |
| CT chest w/wo contrast (71270) |
$1,632.60 |
$2,721 |
9.7× |
| CT chest with contrast (71260) |
$1,463.40 |
$2,439 |
8.7× |
| CT head/brain with contrast (70460) |
$1,578 |
$2,630 |
9.4× |
| CT head/brain without and with contrast (70470) |
$1,760.40 |
$2,934 |
10.4× |
| CT iac w contrast (70481) |
$1,463.40 |
$2,439 |
8.7× |
| CT lower ext w/o (73700) |
$1,020.60 |
$1,701 |
10.2× |
| CT lower extremity w wo contrast (73702) |
$1,774.20 |
$2,957 |
10.5× |
| CT lower extremity with contrast (73701) |
$1,463.40 |
$2,439 |
8.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,632.60 |
$2,721 |
9.7× |
| CT lumbar spine w/o contrast (72131) |
$1,020.60 |
$1,701 |
10.2× |
| CT lumbar spine with contrast (72132) |
$1,457.40 |
$2,429 |
4.3× |
| CT maxillofacial w contrast (70487) |
$1,463.40 |
$2,439 |
8.7× |
| CT maxillofacial w/o contrast (70486) |
$1,463.40 |
$2,439 |
14.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,632.60 |
$2,721 |
9.7× |
| CT neck soft tissue w contrast (70491) |
$1,463.40 |
$2,439 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,660.80 |
$2,768 |
9.8× |
| CT orbits w/o contrast (70480) |
$1,020.60 |
$1,701 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,632.60 |
$2,721 |
9.7× |
| CT pelvis w/o contrast (72192) |
$1,020.60 |
$1,701 |
10.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,632.60 |
$2,721 |
9.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,020.60 |
$1,701 |
10.2× |
| CT thoracic spine w/o contrast (72128) |
$946.80 |
$1,578 |
9.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,043.40 |
$1,739 |
6.2× |
| CT thorax w/o contrast (71250) |
$1,020.60 |
$1,701 |
10.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$701.40 |
$1,169 |
4.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,020.60 |
$1,701 |
10.2× |
| CT upper extremity with contrast (73201) |
$1,463.40 |
$2,439 |
4.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,311.60 |
$2,186 |
7.8× |
| Cta Abdomen (74175) |
$1,632.60 |
$2,721 |
9.7× |
| CTA abdomen pelvis (74174) |
$1,632.60 |
$2,721 |
4.9× |
| CTA chest (71275) |
$1,653 |
$2,755 |
9.8× |
| Cta Head (70496) |
$701.40 |
$1,169 |
4.2× |
| Cta Neck (70498) |
$1,653 |
$2,755 |
9.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$148.80 |
$248 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$283.80 |
$473 |
2.8× |
| Esophagus (74220) |
$304.20 |
$507 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$147.60 |
$246 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$337.20 |
$562 |
1.5× |
| Foot 2 views (73620) |
$217.20 |
$362 |
2.6× |
| Forearm 2 views (73090) |
$217.20 |
$362 |
2.6× |
| Hand 2 views (73120) |
$217.20 |
$362 |
2.2× |
| Hand 3 views (73130) |
$217.20 |
$362 |
2.6× |
| Ht muscle image spect sing (78451) |
$2,448.60 |
$4,081 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$217.20 |
$362 |
2.6× |
| Knee 3 views (73562) |
$217.20 |
$362 |
2.6× |
| MRA head w & w/o contrast (70546) |
$2,007 |
$3,345 |
6.0× |
| MRA head w/o contrast (70544) |
$1,369.20 |
$2,282 |
6.0× |
| MRA head with contrast (70545) |
$1,441.20 |
$2,402 |
4.3× |
| MRA neck w contrast (70548) |
$1,512.60 |
$2,521 |
4.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,995.60 |
$3,326 |
5.9× |
| MRA neck w/o contrast (70547) |
$1,370.40 |
$2,284 |
6.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,085 |
$3,475 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,486.20 |
$2,477 |
6.5× |
| MRI cervical spine w/o contrast (72141) |
$1,437 |
$2,395 |
6.3× |
| MRI chest w/o & w/contrast material (71552) |
$2,118 |
$3,530 |
6.3× |
| MRI chest w/o contrast (71550) |
$1,390.80 |
$2,318 |
6.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,393.80 |
$2,323 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,392 |
$2,320 |
6.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,053.20 |
$3,422 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,049 |
$3,415 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,401 |
$2,335 |
6.1× |
| MRI scan of arm joint before and after contrast (73223) |
$2,011.20 |
$3,352 |
6.0× |
| MRI scan of leg joint before and after contrast (73723) |
$2,038.20 |
$3,397 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,155.20 |
$3,592 |
6.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,157 |
$3,595 |
6.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,151.60 |
$3,586 |
6.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,450.20 |
$2,417 |
6.3× |
| MRI tmj (70336) |
$1,321.20 |
$2,202 |
5.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,363.80 |
$2,273 |
5.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,002.80 |
$3,338 |
6.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,331.40 |
$2,219 |
5.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,448.60 |
$4,081 |
2.0× |
| Neck soft tissue (70360) |
$196.20 |
$327 |
2.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$147.60 |
$246 |
1.5× |
| Osseous survey infant (77076) |
$291.60 |
$486 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$196.20 |
$327 |
2.0× |
| PET image w/CT, skull-thigh (78815) |
$2,017.20 |
$3,362 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,935.60 |
$3,226 |
5.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$181.80 |
$303 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$391.20 |
$652 |
3.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$190.80 |
$318 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$181.80 |
$303 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$217.20 |
$362 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$217.20 |
$362 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$217.20 |
$362 |
2.6× |
| Ribs bilateral 3 views (71110) |
$391.20 |
$652 |
3.9× |
| Scapula complete (73010) |
$391.20 |
$652 |
3.9× |
| Speech evaluation complex (70371) |
$308.40 |
$514 |
1.3× |
| Spine thoracic 3 views (72072) |
$196.20 |
$327 |
2.0× |
| Thoracolumbar 2 views (72080) |
$190.80 |
$318 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$571.20 |
$952 |
5.7× |
| Umbilical-artery Doppler (OB) (76820) |
$147.60 |
$246 |
1.5× |
| Urethrocystography voiding (74455) |
$372 |
$620 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$826.80 |
$1,378 |
4.9× |
| Us abdl aorta screen aaa (76706) |
$148.80 |
$248 |
1.5× |
| Us breast unilateral complete (76641) |
$270.60 |
$451 |
2.7× |
| Us breast unilateral limited (76642) |
$343.20 |
$572 |
4.1× |
| Us chest (76604) |
$250.80 |
$418 |
2.5× |
| Us compl joint r-t w/image documentation (76881) |
$418.80 |
$698 |
4.2× |
| Us ob detailed single fetus (76811) |
$311.40 |
$519 |
1.4× |
| Us ob transvaginal (76817) |
$148.80 |
$248 |
1.5× |
| Us pelvic non ob complete (76856) |
$418.80 |
$698 |
4.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$418.80 |
$698 |
4.2× |
| Us pregnancy ltd (76815) |
$148.80 |
$248 |
1.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$388.20 |
$647 |
3.9× |
| Us retroperitoneal complete (76770) |
$418.80 |
$698 |
4.2× |
| Us retroperitoneal limited (76775) |
$388.20 |
$647 |
3.9× |
| Us scrotum and contents (76870) |
$418.80 |
$698 |
4.2× |
| Us soft tissue head/neck (76536) |
$485.40 |
$809 |
4.8× |
| Us xtr non-vasc lmtd (76882) |
$418.80 |
$698 |
4.2× |
| Vascular flow imaging (78445) |
$807 |
$1,345 |
2.1× |
| Wrist 2 views (73100) |
$217.20 |
$362 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$306 |
$510 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$111 |
$185 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$252 |
$420 |
3.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$217.20 |
$362 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$217.20 |
$362 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$181.80 |
$303 |
2.2× |
| X-ray exam hip uni 4/> views (73503) |
$181.80 |
$303 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$217.20 |
$362 |
2.2× |
| X-ray exam of femur 1 (73551) |
$217.20 |
$362 |
2.6× |
| X-ray eye for foreign body (70030) |
$181.80 |
$303 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$196.20 |
$327 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196.20 |
$327 |
2.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$217.20 |
$362 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$217.20 |
$362 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$252 |
$420 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$499.80 |
$833 |
5.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$181.80 |
$303 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$181.20 |
$302 |
1.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$535.80 |
$893 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$217.20 |
$362 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$252 |
$420 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$417.60 |
$696 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$181.20 |
$302 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$181.80 |
$303 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$217.20 |
$362 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$196.20 |
$327 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$181.80 |
$303 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$196.20 |
$327 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$217.20 |
$362 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$181.80 |
$303 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$196.20 |
$327 |
2.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$217.20 |
$362 |
2.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$217.20 |
$362 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$391.20 |
$652 |
3.9× |
| Xr finger(s) 2+ views (73140) |
$217.20 |
$362 |
2.6× |
| Xr shoulder 1 view (73020) |
$181.80 |
$303 |
2.2× |
| Xr tibia/fibula 2 views (73590) |
$217.20 |
$362 |
2.6× |
| Xr tmj bilateral (70330) |
$181.80 |
$303 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$217.20 |
$362 |
2.6× |