| Abdomen 2 views (74019) |
$157.60 |
$197 |
1.6× |
| Acute gastrointestinal blood loss imaging (78278) |
$640 |
$800 |
1.7× |
| Ankle 2 views (73600) |
$137.60 |
$172 |
1.7× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$1,560 |
$1,950 |
0.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$496 |
$620 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$520 |
$650 |
1.4× |
| Bone &/joint imaging whole body (78306) |
$560 |
$700 |
1.5× |
| Bone age studies (77072) |
$251.20 |
$314 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$672 |
$840 |
1.8× |
| Bone survey complete (77075) |
$264.80 |
$331 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$158.40 |
$198 |
2.0× |
| Chest 1 view (71045) |
$112.80 |
$141 |
1.4× |
| Chest 3 views (71047) |
$156 |
$195 |
1.9× |
| Clavicle complete (73000) |
$113.60 |
$142 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$120 |
$150 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,319.20 |
$1,649 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,205.60 |
$1,507 |
5.5× |
| CT abdomen w contrast (74160) |
$786.40 |
$983 |
4.9× |
| CT abdomen w wo contrast (74170) |
$973.60 |
$1,217 |
6.0× |
| CT abdomen w/o contrast (74150) |
$690.40 |
$863 |
7.2× |
| CT c-spine w/o contrast (72125) |
$708.80 |
$886 |
7.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,040 |
$1,300 |
6.4× |
| CT cervical spine with contrast (72126) |
$742.40 |
$928 |
2.3× |
| CT chest w/wo contrast (71270) |
$992 |
$1,240 |
6.1× |
| CT chest with contrast (71260) |
$792.80 |
$991 |
4.9× |
| CT head/brain with contrast (70460) |
$1,042.40 |
$1,303 |
6.5× |
| CT head/brain without and with contrast (70470) |
$929.60 |
$1,162 |
5.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$59.20 |
$74 |
0.7× |
| CT iac w contrast (70481) |
$937.60 |
$1,172 |
5.8× |
| CT limited/localized follow up study (76380) |
$285.60 |
$357 |
3.6× |
| CT lower ext w/o (73700) |
$643.60 |
$804.50 |
6.7× |
| CT lower extremity w wo contrast (73702) |
$798.40 |
$998 |
4.9× |
| CT lower extremity with contrast (73701) |
$722.40 |
$903 |
4.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,040 |
$1,300 |
6.4× |
| CT lumbar spine w/o contrast (72131) |
$674.40 |
$843 |
7.0× |
| CT lumbar spine with contrast (72132) |
$728 |
$910 |
2.3× |
| CT maxillofacial w contrast (70487) |
$937.60 |
$1,172 |
5.8× |
| CT maxillofacial w/o contrast (70486) |
$658.40 |
$823 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$870.40 |
$1,088 |
5.4× |
| CT neck soft tissue w contrast (70491) |
$794.40 |
$993 |
4.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$932 |
$1,165 |
5.8× |
| CT orbits w/o contrast (70480) |
$593.60 |
$742 |
6.2× |
| CT pelvis w & w/o contrast (72194) |
$923.20 |
$1,154 |
5.7× |
| CT pelvis w/o contrast (72192) |
$711.20 |
$889 |
7.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$856.80 |
$1,071 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$708.80 |
$886 |
7.4× |
| CT thoracic spine w/contrast (72129) |
$700 |
$875 |
4.3× |
| CT thoracic spine w/o contrast (72128) |
$702.40 |
$878 |
7.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,040 |
$1,300 |
6.4× |
| CT thorax w/o contrast (71250) |
$740.80 |
$926 |
7.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$803.20 |
$1,004 |
5.0× |
| CT upper extremity w/o contrast rt (73200) |
$623.20 |
$779 |
6.5× |
| CT upper extremity with contrast (73201) |
$722.40 |
$903 |
2.3× |
| CTA abdomen pelvis (74174) |
$1,687.20 |
$2,109 |
5.3× |
| CTA chest (71275) |
$1,132.80 |
$1,416 |
7.0× |
| Cta Head (70496) |
$1,147.20 |
$1,434 |
7.1× |
| Cta Neck (70498) |
$1,148 |
$1,435 |
7.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$216 |
$270 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$285.60 |
$357 |
3.0× |
| Foot 2 views (73620) |
$138.80 |
$173.50 |
1.7× |
| Forearm 2 views (73090) |
$143.60 |
$179.50 |
1.8× |
| Gated Heart Planar Single (78472) |
$552 |
$690 |
1.5× |
| Hand 2 views (73120) |
$137.60 |
$172 |
1.4× |
| Hand 3 views (73130) |
$152.40 |
$190.50 |
1.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$736 |
$920 |
1.5× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$600 |
$750 |
1.6× |
| Ht muscle image spect sing (78451) |
$640 |
$800 |
0.5× |
| Humerus Min 2 Views Left (73060) |
$150.80 |
$188.50 |
1.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$560 |
$700 |
1.1× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$600 |
$750 |
1.2× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$720 |
$900 |
1.4× |
| Knee 3 views (73562) |
$205.20 |
$256.50 |
2.6× |
| Meckels Diverticulum (78290) |
$448 |
$560 |
1.2× |
| MRA head w & w/o contrast (70546) |
$952 |
$1,190 |
3.0× |
| MRA head w/o contrast (70544) |
$972.80 |
$1,216 |
4.4× |
| MRA neck w contrast (70548) |
$1,145.60 |
$1,432 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$956 |
$1,195 |
3.0× |
| MRA neck w/o contrast (70547) |
$935.20 |
$1,169 |
4.3× |
| MRI abdomen w contrast (74182) |
$1,004 |
$1,255 |
3.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,402.40 |
$1,753 |
4.4× |
| MRI abdomen w/o contrast (74181) |
$936 |
$1,170 |
4.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,127.60 |
$1,409.50 |
1.6× |
| MRI c-spine with contrast (72142) |
$1,476 |
$1,845 |
4.6× |
| MRI cervical spine w/o contrast (72141) |
$1,048 |
$1,310 |
4.8× |
| MRI chest w/o contrast (71550) |
$1,198.40 |
$1,498 |
5.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,622.80 |
$2,028.50 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,442.40 |
$1,803 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$946 |
$1,182.50 |
4.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$932 |
$1,165 |
4.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,232.80 |
$1,541 |
3.8× |
| MRI pelvis w contrast (72196) |
$1,178.40 |
$1,473 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,383.20 |
$1,729 |
4.3× |
| MRI pelvis w/o contrast (72195) |
$1,008 |
$1,260 |
4.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,020.80 |
$2,526 |
6.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,058.40 |
$2,573 |
6.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,512 |
$1,890 |
4.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,258.40 |
$1,573 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,646.40 |
$2,058 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,430.40 |
$1,788 |
4.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,504 |
$1,880 |
4.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,112 |
$1,390 |
5.1× |
| MRI tmj (70336) |
$1,656.80 |
$2,071 |
7.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,335.20 |
$1,669 |
6.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,315.60 |
$2,894.50 |
7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,092 |
$1,365 |
5.0× |
| Myocardial Spect Multiple Studies (78452) |
$952 |
$1,190 |
0.8× |
| Neck soft tissue (70360) |
$124 |
$155 |
1.5× |
| Nm gastric emptying study (78264) |
$608 |
$760 |
1.7× |
| Parathyroid imaging (78070) |
$960 |
$1,200 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$116.80 |
$146 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,058.40 |
$2,573 |
6.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$560 |
$700 |
1.5× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$640 |
$800 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$180 |
$225 |
1.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$134.40 |
$168 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$170.40 |
$213 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$148 |
$185 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$133.60 |
$167 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$128.80 |
$161 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$130.40 |
$163 |
1.6× |
| Ribs bilateral 3 views (71110) |
$152.80 |
$191 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$160 |
$200 |
1.7× |
| Scapula complete (73010) |
$136.80 |
$171 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$40 |
$50 |
1.7× |
| Sella turcica (70240) |
$111.20 |
$139 |
1.4× |
| Thoracolumbar 2 views (72080) |
$190.40 |
$238 |
2.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$480 |
$600 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$560 |
$700 |
1.5× |
| Tmj unilateral (70328) |
$109.60 |
$137 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$242.40 |
$303 |
2.5× |
| Upper Extremity Infant (73092) |
$111.20 |
$139 |
1.2× |
| Us abdl aorta screen aaa (76706) |
$360 |
$450 |
3.7× |
| Us chest (76604) |
$320.80 |
$401 |
3.3× |
| Us ob transvaginal (76817) |
$285.60 |
$357 |
3.0× |
| Us pelvic non ob complete (76856) |
$255.20 |
$319 |
2.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$171.60 |
$214.50 |
1.8× |
| Us pregnancy ltd (76815) |
$296 |
$370 |
3.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$260.80 |
$326 |
2.7× |
| Us retroperitoneal complete (76770) |
$283.20 |
$354 |
2.9× |
| Us retroperitoneal limited (76775) |
$158.40 |
$198 |
1.6× |
| Us scrotum and contents (76870) |
$264.80 |
$331 |
2.8× |
| Us soft tissue head/neck (76536) |
$476 |
$595 |
5.0× |
| Us transrectal (76872) |
$244.80 |
$306 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$140 |
$175 |
1.5× |
| Wrist 2 views (73100) |
$137.60 |
$172 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$261.60 |
$327 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$140 |
$175 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$163.60 |
$204.50 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$124.80 |
$156 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$146.40 |
$183 |
1.8× |
| X-ray exam hip uni 1 view (73501) |
$100 |
$125 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$120 |
$150 |
1.5× |
| X-ray eye for foreign body (70030) |
$137.60 |
$172 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$188 |
$235 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$127.20 |
$159 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$148.80 |
$186 |
1.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$137.60 |
$172 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$121.60 |
$152 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$228 |
$285 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$165.60 |
$207 |
2.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$109.60 |
$137 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$172.80 |
$216 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$296 |
$370 |
3.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$231.20 |
$289 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$146.40 |
$183 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$180 |
$225 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$162.40 |
$203 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$176 |
$220 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$352 |
$440 |
3.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$141.60 |
$177 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$167.20 |
$209 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$148 |
$185 |
1.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$180.80 |
$226 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$180.80 |
$226 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$143.20 |
$179 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$123.20 |
$154 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$196 |
$245 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$143.20 |
$179 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$142.40 |
$178 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$98.40 |
$123 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$167.20 |
$209 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$268.80 |
$336 |
2.8× |
| Xr finger(s) 2+ views (73140) |
$93.20 |
$116.50 |
1.2× |
| Xr optic foramina (70190) |
$128 |
$160 |
1.6× |
| Xr shoulder 1 view (73020) |
$104.80 |
$131 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$228 |
$285 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$169.60 |
$212 |
2.1× |
| Xr tmj bilateral (70330) |
$203.20 |
$254 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$142.40 |
$178 |
1.8× |