| Abdomen 2 views (74019) |
$67.85 |
$295 |
0.7× |
| Angiography internal mammary rs&i (75756) |
$443.90 |
$1,930 |
0.2× |
| Ankle 2 views (73600) |
$64.63 |
$281 |
0.8× |
| Bone &/joint imaging whole body (78306) |
$443.90 |
$1,930 |
1.2× |
| Bone age studies (77072) |
$67.85 |
$295 |
0.7× |
| Bone Imaging 3 Phase (78315) |
$443.90 |
$1,930 |
1.2× |
| Bone survey complete (77075) |
$71.53 |
$311 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$67.85 |
$295 |
0.9× |
| Chest 1 view (71045) |
$64.63 |
$281 |
0.8× |
| Chest 3 views (71047) |
$71.53 |
$311 |
0.9× |
| Clavicle complete (73000) |
$66.24 |
$288 |
0.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$89.47 |
$389 |
0.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$576.61 |
$2,507 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$521.87 |
$2,269 |
2.4× |
| CT abdomen w contrast (74160) |
$576.61 |
$2,507 |
3.6× |
| CT abdomen w wo contrast (74170) |
$605.36 |
$2,632 |
3.8× |
| CT abdomen w/o contrast (74150) |
$549.24 |
$2,388 |
5.8× |
| CT angiography upper extremity lt (73206) |
$549.24 |
$2,388 |
3.5× |
| CT c-spine w/o contrast (72125) |
$521.87 |
$2,269 |
5.5× |
| CT cervical spine with contrast (72126) |
$549.24 |
$2,388 |
1.7× |
| CT chest w/wo contrast (71270) |
$576.61 |
$2,507 |
3.6× |
| CT chest with contrast (71260) |
$549.24 |
$2,388 |
3.5× |
| CT head/brain with contrast (70460) |
$549.24 |
$2,388 |
3.5× |
| CT head/brain without and with contrast (70470) |
$576.61 |
$2,507 |
3.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$7.13 |
$31 |
0.1× |
| CT iac w contrast (70481) |
$549.24 |
$2,388 |
3.5× |
| CT limited/localized follow up study (76380) |
$549.24 |
$2,388 |
7.0× |
| CT lower ext w/o (73700) |
$521.87 |
$2,269 |
5.5× |
| CT lower extremity w wo contrast (73702) |
$576.61 |
$2,507 |
3.6× |
| CT lower extremity with contrast (73701) |
$549.24 |
$2,388 |
3.5× |
| CT lumbar spine w & w/o contrast (72133) |
$576.61 |
$2,507 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$521.87 |
$2,269 |
5.5× |
| CT lumbar spine with contrast (72132) |
$549.24 |
$2,388 |
1.7× |
| CT maxillofacial w contrast (70487) |
$549.24 |
$2,388 |
3.5× |
| CT maxillofacial w/o contrast (70486) |
$521.87 |
$2,269 |
5.5× |
| CT maxillofacial w/wo contrast (70488) |
$576.61 |
$2,507 |
3.6× |
| CT neck soft tissue w contrast (70491) |
$549.24 |
$2,388 |
3.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$576.61 |
$2,507 |
3.6× |
| CT orbits w/o contrast (70480) |
$549.24 |
$2,388 |
5.8× |
| CT pelvis w & w/o contrast (72194) |
$635.95 |
$2,765 |
4.0× |
| CT pelvis w/o contrast (72192) |
$576.61 |
$2,507 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$576.61 |
$2,507 |
3.6× |
| CT soft tissue neck w/o contrast (70490) |
$521.87 |
$2,269 |
5.5× |
| CT thoracic spine w/contrast (72129) |
$549.24 |
$2,388 |
3.5× |
| CT thoracic spine w/o contrast (72128) |
$521.87 |
$2,269 |
5.5× |
| CT thoracic spine w/wo contrast (72130) |
$576.61 |
$2,507 |
3.6× |
| CT thorax w/o contrast (71250) |
$521.87 |
$2,269 |
5.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$576.61 |
$2,507 |
3.6× |
| CT upper extremity w/o contrast rt (73200) |
$521.87 |
$2,269 |
5.5× |
| CT upper extremity with contrast (73201) |
$549.24 |
$2,388 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$507.84 |
$2,208 |
3.2× |
| Cta Abdomen (74175) |
$576.61 |
$2,507 |
3.6× |
| CTA abdomen pelvis (74174) |
$614.33 |
$2,671 |
1.9× |
| CTA chest (71275) |
$576.61 |
$2,507 |
3.6× |
| Cta Head (70496) |
$549.24 |
$2,388 |
3.5× |
| CTA lwr ext w&w/o contrast (73706) |
$549.24 |
$2,388 |
3.5× |
| Cta Neck (70498) |
$549.24 |
$2,388 |
3.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$77.28 |
$336 |
0.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$67.85 |
$295 |
0.9× |
| Foot 2 views (73620) |
$64.63 |
$281 |
0.8× |
| Forearm 2 views (73090) |
$67.85 |
$295 |
0.9× |
| Gated Heart Planar Single (78472) |
$422.74 |
$1,838 |
1.2× |
| Hand 2 views (73120) |
$67.85 |
$295 |
0.7× |
| Hand 3 views (73130) |
$76.94 |
$334.50 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$443.90 |
$1,930 |
0.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$443.90 |
$1,930 |
1.2× |
| Ht muscle image spect sing (78451) |
$422.74 |
$1,838 |
0.4× |
| Humerus Min 2 Views Left (73060) |
$67.85 |
$295 |
0.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$67.85 |
$295 |
0.7× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$443.90 |
$1,930 |
0.9× |
| Knee 3 views (73562) |
$69.69 |
$303 |
0.9× |
| Mr safety determination physician/other qhp (76016) |
$39.10 |
$170 |
0.5× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$25.30 |
$110 |
0.5× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$10.81 |
$47 |
0.4× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$38.87 |
$169 |
0.5× |
| Mr safety med physics xm customization plng&mntr (76017) |
$102.35 |
$445 |
0.5× |
| MRA head w & w/o contrast (70546) |
$656.19 |
$2,853 |
2.1× |
| MRA head w/o contrast (70544) |
$593.63 |
$2,581 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$656.19 |
$2,853 |
2.1× |
| MRA neck w/o contrast (70547) |
$593.63 |
$2,581 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$656.19 |
$2,853 |
2.1× |
| MRI abdomen w/o contrast (74181) |
$593.63 |
$2,581 |
2.7× |
| MRI c-spine with contrast (72142) |
$624.68 |
$2,716 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$593.63 |
$2,581 |
2.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$630.32 |
$2,740.50 |
2.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$593.63 |
$2,581 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$656.19 |
$2,853 |
2.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$656.19 |
$2,853 |
2.1× |
| MRI pelvis w/o contrast (72195) |
$593.63 |
$2,581 |
2.7× |
| MRI scan of arm joint before and after contrast (73223) |
$645.72 |
$2,807.50 |
2.0× |
| MRI scan of leg joint before and after contrast (73723) |
$656.19 |
$2,853 |
2.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$656.19 |
$2,853 |
2.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$624.68 |
$2,716 |
2.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$656.19 |
$2,853 |
2.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$624.68 |
$2,716 |
2.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$656.19 |
$2,853 |
2.1× |
| MRI thoracic spine w/o contrast (72146) |
$593.63 |
$2,581 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$609.16 |
$2,648.50 |
2.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$656.19 |
$2,853 |
2.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$593.63 |
$2,581 |
2.7× |
| Myocardial Spect Multiple Studies (78452) |
$443.90 |
$1,930 |
0.4× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$1,346.88 |
$5,856 |
1.7× |
| Neck soft tissue (70360) |
$67.85 |
$295 |
0.9× |
| Nm gastric emptying study (78264) |
$443.90 |
$1,930 |
1.2× |
| Nuclear medicine study of kidney and blood flow (78701) |
$411.01 |
$1,787 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$94.99 |
$413 |
1.0× |
| Osseous survey infant (77076) |
$67.85 |
$295 |
0.7× |
| Pelvis 1 or 2 views (72170) |
$64.63 |
$281 |
0.7× |
| Plasma Vol Radiopharm Vol Dilute Spx Mult Smples (78111) |
$571.55 |
$2,485 |
0.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$645.72 |
$2,807.50 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$64.63 |
$281 |
0.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$67.85 |
$295 |
0.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$64.63 |
$281 |
0.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$67.85 |
$295 |
0.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$83.72 |
$364 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$67.85 |
$295 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$64.63 |
$281 |
0.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$71.53 |
$311 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$67.85 |
$295 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$69.69 |
$303 |
0.9× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$217.58 |
$946 |
0.4× |
| Ribs bilateral 3 views (71110) |
$71.53 |
$311 |
0.8× |
| Sacroiliac Joints < 3 Views (72200) |
$64.63 |
$281 |
0.7× |
| Scapula complete (73010) |
$67.85 |
$295 |
0.7× |
| Screening digital breast tomosynthesis (77063) |
$72.68 |
$316 |
3.1× |
| Spine thoracic 3 views (72072) |
$67.85 |
$295 |
0.7× |
| Thoracolumbar 2 views (72080) |
$75.21 |
$327 |
1.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$443.90 |
$1,930 |
1.2× |
| Tmj unilateral (70328) |
$64.63 |
$281 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$94.76 |
$412 |
1.0× |
| Upper Extremity Infant (73092) |
$81.19 |
$353 |
0.9× |
| Ureteral Reflux Study Rp Voiding Cystogram (78740) |
$179.17 |
$779 |
0.5× |
| Us abdl aorta screen aaa (76706) |
$99.82 |
$434 |
1.1× |
| Us breast unilateral complete (76641) |
$94.99 |
$413 |
1.0× |
| Us breast unilateral limited (76642) |
$90.16 |
$392 |
1.1× |
| Us chest (76604) |
$99.82 |
$434 |
1.1× |
| Us compl joint r-t w/image documentation (76881) |
$99.82 |
$434 |
1.1× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$99.82 |
$434 |
1.1× |
| Us ob transvaginal (76817) |
$99.82 |
$434 |
1.1× |
| Us pelvic non ob complete (76856) |
$99.82 |
$434 |
1.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$99.82 |
$434 |
1.1× |
| Us pregnancy ltd (76815) |
$99.82 |
$434 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$99.82 |
$434 |
1.1× |
| Us retroperitoneal complete (76770) |
$99.82 |
$434 |
1.1× |
| Us retroperitoneal limited (76775) |
$94.76 |
$412 |
1.0× |
| Us scrotum and contents (76870) |
$99.82 |
$434 |
1.1× |
| Us soft tissue head/neck (76536) |
$99.82 |
$434 |
1.1× |
| Us xtr non-vasc lmtd (76882) |
$97.29 |
$423 |
1.0× |
| Wrist 2 views (73100) |
$64.63 |
$281 |
0.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$67.85 |
$295 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$67.85 |
$295 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$73.37 |
$319 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$64.63 |
$281 |
0.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$73.37 |
$319 |
0.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$71.53 |
$311 |
0.8× |
| X-ray exam hip uni 1 view (73501) |
$64.63 |
$281 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$67.85 |
$295 |
0.9× |
| X-ray exam hip uni 4/> views (73503) |
$71.53 |
$311 |
0.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$67.85 |
$295 |
0.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$71.53 |
$311 |
0.8× |
| X-ray exam of femur 1 (73551) |
$64.63 |
$281 |
0.8× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$245.87 |
$1,069 |
1.5× |
| X-ray eye for foreign body (70030) |
$67.85 |
$295 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$67.85 |
$295 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$64.63 |
$281 |
0.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$73.37 |
$319 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$69.69 |
$303 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$64.63 |
$281 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$76.94 |
$334.50 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$67.85 |
$295 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$66.24 |
$288 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$64.63 |
$281 |
0.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$71.53 |
$311 |
0.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$61.41 |
$267 |
0.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$67.85 |
$295 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$67.85 |
$295 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$67.85 |
$295 |
0.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$67.85 |
$295 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$64.63 |
$281 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$67.85 |
$295 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$75.21 |
$327 |
0.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$67.85 |
$295 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$67.85 |
$295 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$73.37 |
$319 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$67.85 |
$295 |
0.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$34.04 |
$148 |
0.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$67.85 |
$295 |
0.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$64.63 |
$281 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$64.63 |
$281 |
0.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$64.63 |
$281 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$64.63 |
$281 |
0.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$67.85 |
$295 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$73.37 |
$319 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$75.21 |
$327 |
0.8× |
| Xr finger(s) 2+ views (73140) |
$69.69 |
$303 |
0.9× |
| Xr optic foramina (70190) |
$67.85 |
$295 |
0.9× |
| Xr shoulder 1 view (73020) |
$66.24 |
$288 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$71.53 |
$311 |
0.8× |
| Xr tibia/fibula 2 views (73590) |
$67.85 |
$295 |
0.9× |
| Xr tmj bilateral (70330) |
$67.85 |
$295 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$63.02 |
$274 |
0.8× |