| Ankle 2 views (73600) |
$413.50 |
$413.50 |
4.5× |
| Bone age studies (77072) |
$764 |
$764 |
7.0× |
| Clavicle complete (73000) |
$567.50 |
$567.50 |
6.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,405 |
$4,405 |
12.1× |
| CT abdomen w wo contrast (74170) |
$2,785 |
$2,785 |
15.2× |
| CT abdomen w/o contrast (74150) |
$2,835 |
$2,835 |
26.0× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$5,794 |
$5,794 |
15.9× |
| CT angio abdom w/o & w/dye (74175) |
$2,909 |
$2,909 |
15.9× |
| CT angio hrt w/3d image (75574) |
$2,275 |
$2,275 |
6.2× |
| CT cervical spine w/o contrast (72125) |
$2,785 |
$2,785 |
25.5× |
| CT head/brain without and with contrast (70470) |
$2,295 |
$2,295 |
12.5× |
| CT lower extremity w contrast (73701) |
$2,444 |
$2,444 |
13.3× |
| CT lower extremity w/o contrast unilateral (73700) |
$2,373 |
$2,373 |
21.7× |
| CT lumbar spine w/o contrast (72131) |
$2,785 |
$2,785 |
25.5× |
| CT maxillofacial area w/o contrast (70486) |
$2,939.50 |
$2,939.50 |
26.9× |
| CT orbit sella ear w/o con (70480) |
$2,295 |
$2,295 |
21.0× |
| CT pelvis w/o contrast (72192) |
$2,535 |
$2,535 |
23.2× |
| CT thoracic spine w/contrast (72129) |
$2,373 |
$2,373 |
13.0× |
| CT thoracic spine w/o contrast (72128) |
$2,365 |
$2,365 |
21.7× |
| CT upper extremity w/dye (73201) |
$2,373 |
$2,373 |
6.5× |
| CT upper extremity w/o contrast rt (73200) |
$2,517.50 |
$2,517.50 |
23.1× |
| CTA chest w/wo contrast (71275) |
$5,032 |
$5,032 |
27.5× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$5,667 |
$5,667 |
30.9× |
| CTA upper extremity w/wo contrast unilateral (73206) |
$2,897 |
$2,897 |
15.8× |
| Fluoroscopy up to 1 hour physician/qhp time (76000) |
$787 |
$787 |
3.2× |
| Gastric emptying study (78264) |
$2,009 |
$2,009 |
4.8× |
| Hepatobiliary system imaging (78226) |
$1,557 |
$1,557 |
3.7× |
| Humerus min 2 views (73060) |
$424 |
$424 |
4.7× |
| Lung ventilat&perfus imaging (78582) |
$1,715 |
$1,715 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$4,400 |
$4,400 |
12.1× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$4,400 |
$4,400 |
12.1× |
| MRI joint upr extrem w/o dye (73221) |
$5,759 |
$5,759 |
23.1× |
| Mri Lower Extremity W/O Dye (73718) |
$5,759 |
$5,759 |
23.1× |
| MRI lwr ext w/o jnts with con rt (73719) |
$3,645 |
$3,645 |
10.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,458 |
$3,458 |
13.9× |
| Nm bone imaging whole body (78306) |
$1,709 |
$1,709 |
4.1× |
| Nm heart perfusion spect stress rest (78452) |
$2,192 |
$2,192 |
1.6× |
| Nose to rectum for fb child (76010) |
$627 |
$627 |
6.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$909 |
$909 |
10.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$528.50 |
$528.50 |
5.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$523.50 |
$523.50 |
4.8× |
| Radex spine cervical 2 or 3 views (72040) |
$791 |
$791 |
8.7× |
| Radex spine cervical 4 or 5 views (72050) |
$994 |
$994 |
9.1× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$398 |
$398 |
4.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$514 |
$514 |
5.7× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$491 |
$491 |
4.5× |
| Screening digital breast tomosynthesis; bilateral (77063) |
$112 |
$112 |
4.8× |
| Ultrasound breast limited (76642) |
$670 |
$670 |
7.4× |
| Ultrasound, abdomen limited (76705) |
$453 |
$453 |
4.1× |
| Us abdominal aorta real time screen study aaa (76706) |
$863 |
$863 |
7.9× |
| Us breast uni real time with image complete (76641) |
$1,695 |
$1,695 |
15.5× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$453 |
$453 |
4.1× |
| Us pelvic limited or f/u non-ob (76857) |
$453 |
$453 |
4.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$514 |
$514 |
5.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$403 |
$403 |
4.4× |
| X-ray exam of finger(s) (73140) |
$480 |
$480 |
5.3× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$408 |
$408 |
4.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$398 |
$398 |
4.4× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$235 |
$235 |
2.2× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$398 |
$398 |
4.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$398 |
$398 |
4.4× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$876 |
$876 |
9.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$398 |
$398 |
3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$439 |
$439 |
4.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$500 |
$500 |
4.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$398 |
$398 |
3.6× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$837 |
$837 |
7.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$884 |
$884 |
9.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$417 |
$417 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$477 |
$477 |
4.4× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$289 |
$289 |
3.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$406 |
$406 |
4.5× |
| Xr abdomen 1 view (74018) |
$529 |
$529 |
5.8× |
| Xr abdomen 2 views (74019) |
$398 |
$398 |
3.6× |
| Xr bone density appendicular (77081) |
$398 |
$398 |
4.4× |
| Xr bone density axial (77080) |
$770 |
$770 |
7.1× |
| Xr facial bones 3 views (70150) |
$417 |
$417 |
3.8× |
| Xr nasal bones (70160) |
$742 |
$742 |
8.2× |
| Xr upper extremity 2 views infant (73092) |
$709.50 |
$709.50 |
6.5× |
| Xray elbow 2 views (73070) |
$375 |
$375 |
4.1× |
| Xray forearm 2 views (73090) |
$402 |
$402 |
4.4× |
| Xray knee 1 or 2 views rt (73560) |
$617.50 |
$617.50 |
6.8× |
| Xray pelvis 1 or 2 views (72170) |
$530 |
$530 |
4.9× |
| Xray shoulder 1 view (73020) |
$398 |
$398 |
4.4× |
| Xray tibia-fibula 2 views bil (73590) |
$683 |
$683 |
7.5× |