| Abdomen 2 views (74019) |
$161.50 |
$161.50 |
1.5× |
| Ankle 2 views (73600) |
$115 |
$115 |
1.3× |
| Arthrogram hip (73525) |
$512.50 |
$512.50 |
1.5× |
| Arthrogram shoulder (73040) |
$948 |
$948 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$199 |
$199 |
2.3× |
| Chest 1 view (71045) |
$117 |
$117 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$276.50 |
$276.50 |
1.6× |
| Clavicle complete (73000) |
$115.50 |
$115.50 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$323 |
$323 |
3.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,754.50 |
$1,754.50 |
5.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,153.50 |
$1,153.50 |
4.8× |
| CT abdomen w contrast (74160) |
$878 |
$878 |
5.0× |
| CT abdomen w wo contrast (74170) |
$904.50 |
$904.50 |
5.1× |
| CT abdomen w/o contrast (74150) |
$587 |
$587 |
5.6× |
| CT c-spine w/o contrast (72125) |
$569.50 |
$569.50 |
5.4× |
| CT chest w/wo contrast (71270) |
$891.50 |
$891.50 |
5.1× |
| CT chest with contrast (71260) |
$868 |
$868 |
4.9× |
| CT head/brain without and with contrast (70470) |
$893.50 |
$893.50 |
5.1× |
| CT iac w contrast (70481) |
$880.50 |
$880.50 |
5.0× |
| CT lower ext w/o (73700) |
$569.50 |
$569.50 |
5.4× |
| CT lumbar spine w/o contrast (72131) |
$569.50 |
$569.50 |
5.4× |
| CT lumbar spine with contrast (72132) |
$1,738.50 |
$1,738.50 |
5.0× |
| CT maxillofacial w contrast (70487) |
$701.50 |
$701.50 |
4.0× |
| CT maxillofacial w/o contrast (70486) |
$544 |
$544 |
5.2× |
| CT neck soft tissue w contrast (70491) |
$903.50 |
$903.50 |
5.1× |
| CT orbits w/o contrast (70480) |
$596.50 |
$596.50 |
5.7× |
| CT pelvis w/o contrast (72192) |
$578 |
$578 |
5.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$925 |
$925 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$583.50 |
$583.50 |
5.6× |
| CT thoracic spine w/contrast (72129) |
$889 |
$889 |
5.1× |
| CT thoracic spine w/o contrast (72128) |
$569.50 |
$569.50 |
5.4× |
| CT thorax w/o contrast (71250) |
$577.50 |
$577.50 |
5.5× |
| CT upper extremity w/o contrast rt (73200) |
$569.50 |
$569.50 |
5.4× |
| CT upper extremity with contrast (73201) |
$3,139 |
$3,139 |
9.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$988 |
$988 |
5.6× |
| CTA abdomen pelvis (74174) |
$1,829.50 |
$1,829.50 |
5.2× |
| CTA chest (71275) |
$944.50 |
$944.50 |
5.4× |
| Cta Head (70496) |
$937.50 |
$937.50 |
5.3× |
| Cta Neck (70498) |
$937.50 |
$937.50 |
5.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$158 |
$158 |
1.5× |
| Foot 2 views (73620) |
$114 |
$114 |
1.3× |
| Forearm 2 views (73090) |
$199 |
$199 |
2.3× |
| Hand 2 views (73120) |
$279 |
$279 |
2.7× |
| Hand 3 views (73130) |
$199 |
$199 |
2.3× |
| Humerus Min 2 Views Left (73060) |
$199 |
$199 |
2.3× |
| Knee 3 views (73562) |
$117.50 |
$117.50 |
1.3× |
| MRA head w/o contrast (70544) |
$731 |
$731 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,221 |
$1,221 |
3.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,886.50 |
$1,886.50 |
2.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,114 |
$3,114 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$757.50 |
$757.50 |
3.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$745.50 |
$745.50 |
3.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,187 |
$3,187 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$2,703 |
$2,703 |
11.3× |
| MRI scan of arm joint before and after contrast (73223) |
$4,878 |
$4,878 |
14.0× |
| MRI scan of leg joint before and after contrast (73723) |
$1,180 |
$1,180 |
3.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$213,893 |
$213,893 |
612.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,230.50 |
$1,230.50 |
3.5× |
| MRI thoracic spine w/o contrast (72146) |
$757.50 |
$757.50 |
3.2× |
| MRI upper ext joint w/o contrast (73221) |
$746 |
$746 |
3.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,181 |
$1,181 |
3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$746 |
$746 |
3.1× |
| Neck soft tissue (70360) |
$117.50 |
$117.50 |
1.3× |
| Nm cisternogram (78630) |
$1,167 |
$1,167 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$156 |
$156 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,217 |
$1,217 |
3.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$200 |
$200 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$117 |
$117 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$122 |
$122 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$341 |
$341 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$117 |
$117 |
1.3× |
| Scapula complete (73010) |
$291 |
$291 |
2.8× |
| Screening digital breast tomosynthesis (77063) |
$100.50 |
$100.50 |
4.3× |
| Spine thoracic 3 views (72072) |
$160.50 |
$160.50 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$238 |
$238 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$289.50 |
$289.50 |
2.8× |
| Us breast unilateral complete (76641) |
$465 |
$465 |
4.4× |
| Us breast unilateral limited (76642) |
$240 |
$240 |
2.8× |
| Us chest (76604) |
$286 |
$286 |
2.7× |
| Us pelvic non ob complete (76856) |
$303 |
$303 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$283.50 |
$283.50 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$358 |
$358 |
3.4× |
| Us retroperitoneal complete (76770) |
$307.50 |
$307.50 |
2.9× |
| Us soft tissue head/neck (76536) |
$285 |
$285 |
2.7× |
| Us xtr non-vasc lmtd (76882) |
$236 |
$236 |
2.3× |
| Wrist 2 views (73100) |
$115.50 |
$115.50 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$170 |
$170 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$217 |
$217 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$118 |
$118 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$199 |
$199 |
2.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$173 |
$173 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$203 |
$203 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$167 |
$167 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$215 |
$215 |
2.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$115.50 |
$115.50 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$153 |
$153 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$919 |
$919 |
8.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$160.50 |
$160.50 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$215 |
$215 |
2.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$116 |
$116 |
1.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$126 |
$126 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$376 |
$376 |
3.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$121 |
$121 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$279 |
$279 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$160.50 |
$160.50 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$116 |
$116 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$119.50 |
$119.50 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$153 |
$153 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$199 |
$199 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$158.50 |
$158.50 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$89 |
$89 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$116 |
$116 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$168 |
$168 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$113 |
$113 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$279 |
$279 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$115 |
$115 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$117.50 |
$117.50 |
1.3× |