| Abdomen 2 views (74019) |
$114.35 |
$114.35 |
1.3× |
| Bone survey complete (77075) |
$400 |
$400 |
4.4× |
| Cervical spine 2 or 3 views (72040) |
$95.86 |
$95.86 |
1.3× |
| Chest 1 view (71045) |
$92.50 |
$92.50 |
1.2× |
| Chest 3 views (71047) |
$126.85 |
$126.85 |
1.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,996 |
$1,996 |
6.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,624.80 |
$1,624.80 |
7.9× |
| CT abdomen w contrast (74160) |
$921.80 |
$921.80 |
6.1× |
| CT abdomen w wo contrast (74170) |
$998 |
$998 |
6.6× |
| CT abdomen w/o contrast (74150) |
$811.80 |
$811.80 |
9.0× |
| CT angiography upper extremity lt (73206) |
$1,319 |
$1,319 |
8.7× |
| CT c-spine w/o contrast (72125) |
$585 |
$585 |
6.5× |
| CT cervical spine w&w/o contrast (72127) |
$998 |
$998 |
6.6× |
| CT cervical spine with contrast (72126) |
$922 |
$922 |
3.1× |
| CT chest w/wo contrast (71270) |
$998 |
$998 |
6.6× |
| CT chest with contrast (71260) |
$922 |
$922 |
6.1× |
| CT head/brain with contrast (70460) |
$922 |
$922 |
6.1× |
| CT head/brain without and with contrast (70470) |
$988 |
$988 |
6.5× |
| CT iac w contrast (70481) |
$922 |
$922 |
6.1× |
| CT lower ext w/o (73700) |
$813 |
$813 |
9.0× |
| CT lower extremity w wo contrast (73702) |
$998 |
$998 |
6.6× |
| CT lower extremity with contrast (73701) |
$922 |
$922 |
6.1× |
| CT lumbar spine w & w/o contrast (72133) |
$998 |
$998 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$585 |
$585 |
6.5× |
| CT lumbar spine with contrast (72132) |
$922 |
$922 |
3.1× |
| CT maxillofacial w contrast (70487) |
$922 |
$922 |
6.1× |
| CT maxillofacial w/o contrast (70486) |
$813 |
$813 |
9.0× |
| CT maxillofacial w/wo contrast (70488) |
$998 |
$998 |
6.6× |
| CT neck soft tissue w contrast (70491) |
$922 |
$922 |
6.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$998 |
$998 |
6.6× |
| CT orbits w/o contrast (70480) |
$813 |
$813 |
9.0× |
| CT pelvis w & w/o contrast (72194) |
$998 |
$998 |
6.6× |
| CT pelvis w/o contrast (72192) |
$585 |
$585 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$998 |
$998 |
6.6× |
| CT soft tissue neck w/o contrast (70490) |
$585 |
$585 |
6.5× |
| CT thoracic spine w/contrast (72129) |
$922 |
$922 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$813 |
$813 |
9.0× |
| CT thoracic spine w/wo contrast (72130) |
$998 |
$998 |
6.6× |
| CT thorax w/o contrast (71250) |
$585 |
$585 |
6.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$998 |
$998 |
6.6× |
| CT upper extremity w/o contrast rt (73200) |
$813 |
$813 |
9.0× |
| CT upper extremity with contrast (73201) |
$923 |
$923 |
3.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,219 |
$2,219 |
14.7× |
| Cta Abdomen (74175) |
$1,219 |
$1,219 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,219 |
$2,219 |
7.4× |
| CTA chest (71275) |
$1,219 |
$1,219 |
8.1× |
| Cta Head (70496) |
$1,119 |
$1,119 |
7.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,129.50 |
$1,129.50 |
3.8× |
| CTA lwr ext w&w/o contrast (73706) |
$1,319 |
$1,319 |
8.7× |
| Cta Neck (70498) |
$1,219 |
$1,219 |
8.1× |
| Cta Pelvis (72191) |
$1,219 |
$1,219 |
8.1× |
| Cystography minimum 3 views rs&i (74430) |
$281.60 |
$281.60 |
0.9× |
| Esophagus (74220) |
$173.44 |
$173.44 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$105.10 |
$105.10 |
0.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$81.40 |
$81.40 |
1.1× |
| MRA head w & w/o contrast (70546) |
$2,732 |
$2,732 |
9.1× |
| MRA head w/o contrast (70544) |
$1,646 |
$1,646 |
8.0× |
| MRA head with contrast (70545) |
$1,646 |
$1,646 |
5.5× |
| MRA neck w contrast (70548) |
$1,646 |
$1,646 |
5.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,138 |
$2,138 |
7.1× |
| MRA neck w/o contrast (70547) |
$1,646 |
$1,646 |
8.0× |
| MRI abdomen w contrast (74182) |
$1,501 |
$1,501 |
5.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,620 |
$1,620 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$1,012 |
$1,012 |
4.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,613 |
$1,613 |
2.4× |
| MRI c-spine with contrast (72142) |
$2,647 |
$2,647 |
8.8× |
| MRI cervical spine w/o contrast (72141) |
$2,033 |
$2,033 |
9.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,377 |
$2,377 |
7.9× |
| MRI chest with contrast (71551) |
$1,300 |
$1,300 |
1.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,625 |
$1,625 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,972.50 |
$2,972.50 |
14.5× |
| MRI orbit/face/neck w/contrast (70542) |
$1,652 |
$1,652 |
5.5× |
| MRI scan of leg joint before and after contrast (73723) |
$2,395 |
$2,395 |
8.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,374 |
$3,374 |
11.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,383 |
$2,383 |
7.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,037 |
$3,037 |
10.1× |
| MRI upper ext joint w/o contrast (73221) |
$2,074 |
$2,074 |
10.1× |
| Neck soft tissue (70360) |
$90.08 |
$90.08 |
1.2× |
| Osseous survey infant (77076) |
$96.80 |
$96.80 |
1.1× |
| Osseous survey limited (77074) |
$165 |
$165 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$90.08 |
$90.08 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,501 |
$1,501 |
5.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$254.10 |
$254.10 |
2.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$165.15 |
$165.15 |
1.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$127.10 |
$127.10 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$117.80 |
$117.80 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90.08 |
$90.08 |
1.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$311.49 |
$311.49 |
3.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$121.25 |
$121.25 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$216 |
$216 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$222.90 |
$222.90 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$203.30 |
$203.30 |
1.3× |
| Ribs bilateral 3 views (71110) |
$190.55 |
$190.55 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$101.65 |
$101.65 |
1.1× |
| Sella turcica (70240) |
$76.25 |
$76.25 |
1.0× |
| Small bowel series (74250) |
$177.85 |
$177.85 |
1.2× |
| Spine thoracic 3 views (72072) |
$127.05 |
$127.05 |
1.4× |
| Thoracolumbar 2 views (72080) |
$108.55 |
$108.55 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$232.02 |
$232.02 |
2.6× |
| Upper Extremity Infant (73092) |
$70.45 |
$70.45 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$352.24 |
$352.24 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$365.79 |
$365.79 |
4.1× |
| Us breast unilateral complete (76641) |
$218.52 |
$218.52 |
2.4× |
| Us breast unilateral limited (76642) |
$165.26 |
$165.26 |
2.2× |
| Us chest (76604) |
$218.55 |
$218.55 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$327.39 |
$327.39 |
3.6× |
| Us ob transvaginal (76817) |
$205.26 |
$205.26 |
2.3× |
| Us pelvic non ob complete (76856) |
$282.84 |
$282.84 |
3.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$139.75 |
$139.75 |
1.6× |
| Us pregnancy ltd (76815) |
$185.85 |
$185.85 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$250.17 |
$250.17 |
2.8× |
| Us retroperitoneal complete (76770) |
$312.48 |
$312.48 |
3.5× |
| Us scrotum and contents (76870) |
$286.95 |
$286.95 |
3.2× |
| Us soft tissue head/neck (76536) |
$253.26 |
$253.26 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$220 |
$220 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$151.72 |
$151.72 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$76.90 |
$76.90 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$279.50 |
$279.50 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$159.40 |
$159.40 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$83.15 |
$83.15 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$108.55 |
$108.55 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$108.55 |
$108.55 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$285.15 |
$285.15 |
3.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$70.45 |
$70.45 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$70.45 |
$70.45 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$127.05 |
$127.05 |
1.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$127.05 |
$127.05 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$254.10 |
$254.10 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$101.65 |
$101.65 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$101.65 |
$101.65 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$127.05 |
$127.05 |
1.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$90.08 |
$90.08 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$152.45 |
$152.45 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$101.65 |
$101.65 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$127.05 |
$127.05 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$88.95 |
$88.95 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$108.55 |
$108.55 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$177.90 |
$177.90 |
2.0× |
| Xr chest 4+ views (71048) |
$190.60 |
$190.60 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$90.08 |
$90.08 |
1.2× |
| Xr internal auditory meati complete (70134) |
$127.05 |
$127.05 |
0.3× |
| Xr spine cervical 4 or 5 views (72050) |
$165 |
$165 |
1.8× |
| Xr tmj bilateral (70330) |
$95.85 |
$95.85 |
1.3× |