| Abdomen 2 views (74019) |
$92.06 |
$167.38 |
1.0× |
| Ankle 2 views (73600) |
$48.15 |
$87.55 |
0.6× |
| Arthrogram hip (73525) |
$353.61 |
$642.93 |
1.1× |
| Arthrogram shoulder (73040) |
$219.72 |
$399.49 |
0.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$227.05 |
$412.82 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$474.44 |
$862.62 |
1.3× |
| Bone Imaging 3 Phase (78315) |
$460.28 |
$836.88 |
1.3× |
| Bone survey complete (77075) |
$92.06 |
$167.38 |
1.0× |
| Cervical spine 2 or 3 views (72040) |
$48.15 |
$87.55 |
0.6× |
| Chest 1 view (71045) |
$48.15 |
$87.55 |
0.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$107.24 |
$194.98 |
0.7× |
| Clavicle complete (73000) |
$48.15 |
$87.55 |
0.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$313.22 |
$569.49 |
3.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,521.90 |
$2,767.10 |
4.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,101.28 |
$2,002.32 |
5.1× |
| CT abdomen w contrast (74160) |
$926.06 |
$1,683.74 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,120.31 |
$2,036.93 |
7.0× |
| CT abdomen w/o contrast (74150) |
$730.39 |
$1,327.98 |
7.7× |
| CT angiography upper extremity lt (73206) |
$1,051.31 |
$1,911.47 |
6.6× |
| CT c-spine w/o contrast (72125) |
$794.86 |
$1,445.19 |
8.4× |
| CT cervical spine w&w/o contrast (72127) |
$736.73 |
$1,339.52 |
4.6× |
| CT cervical spine with contrast (72126) |
$644.68 |
$1,172.14 |
2.0× |
| CT chest w/wo contrast (71270) |
$1,072.04 |
$1,949.17 |
6.7× |
| CT chest with contrast (71260) |
$1,023.27 |
$1,860.49 |
6.4× |
| CT head/brain with contrast (70460) |
$825.33 |
$1,500.61 |
5.2× |
| CT head/brain without and with contrast (70470) |
$869.41 |
$1,580.74 |
5.4× |
| CT iac w contrast (70481) |
$520.61 |
$946.57 |
3.3× |
| CT lower ext w/o (73700) |
$350.55 |
$637.36 |
3.7× |
| CT lower extremity w wo contrast (73702) |
$701.50 |
$1,275.45 |
4.4× |
| CT lower extremity with contrast (73701) |
$436.54 |
$793.72 |
2.7× |
| CT lumbar spine w/o contrast (72131) |
$691.30 |
$1,256.91 |
7.3× |
| CT lumbar spine with contrast (72132) |
$867.88 |
$1,577.96 |
2.7× |
| CT maxillofacial w contrast (70487) |
$721.21 |
$1,311.29 |
4.5× |
| CT maxillofacial w/o contrast (70486) |
$753.11 |
$1,369.28 |
7.9× |
| CT maxillofacial w/wo contrast (70488) |
$788.57 |
$1,433.76 |
4.9× |
| CT neck soft tissue w contrast (70491) |
$656.74 |
$1,194.08 |
4.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$641.05 |
$1,165.55 |
4.0× |
| CT orbits w/o contrast (70480) |
$529.11 |
$962.02 |
5.6× |
| CT pelvis w & w/o contrast (72194) |
$804.88 |
$1,463.42 |
5.0× |
| CT pelvis w/o contrast (72192) |
$730.39 |
$1,327.98 |
7.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$859.38 |
$1,562.51 |
5.4× |
| CT soft tissue neck w/o contrast (70490) |
$658.05 |
$1,196.45 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$691.30 |
$1,256.91 |
7.3× |
| CT thorax w/o contrast (71250) |
$603.61 |
$1,097.46 |
6.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$701.50 |
$1,275.45 |
4.4× |
| CT upper extremity w/o contrast rt (73200) |
$525.68 |
$955.79 |
5.5× |
| CT upper extremity with contrast (73201) |
$436.54 |
$793.72 |
1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$684.33 |
$1,244.24 |
4.3× |
| Cta Abdomen (74175) |
$730.39 |
$1,327.98 |
4.6× |
| CTA abdomen pelvis (74174) |
$684.33 |
$1,244.24 |
2.2× |
| CTA chest (71275) |
$514.89 |
$936.17 |
3.2× |
| Cta Head (70496) |
$502.03 |
$912.79 |
3.1× |
| CTA lwr ext w&w/o contrast (73706) |
$105.48 |
$191.79 |
0.7× |
| Cta Neck (70498) |
$859.38 |
$1,562.51 |
5.4× |
| Cta Pelvis (72191) |
$105.48 |
$191.79 |
0.7× |
| Cystography minimum 3 views rs&i (74430) |
$195.84 |
$356.07 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$92.06 |
$167.38 |
1.0× |
| Esophagus (74220) |
$195.84 |
$356.07 |
1.2× |
| Fetal biophysical profile non-stress testing (76818) |
$250.39 |
$455.26 |
2.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$139.87 |
$254.31 |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$247.67 |
$450.32 |
1.1× |
| Foot 2 views (73620) |
$48.15 |
$87.55 |
0.6× |
| Forearm 2 views (73090) |
$48.15 |
$87.55 |
0.6× |
| Hand 2 views (73120) |
$92.06 |
$167.38 |
1.0× |
| Hand 3 views (73130) |
$48.15 |
$87.55 |
0.6× |
| Heart infarct image w ef (78468) |
$320.07 |
$581.95 |
0.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$634.71 |
$1,154.01 |
1.3× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$634.71 |
$1,154.01 |
1.7× |
| Ht muscle image spect sing (78451) |
$602.81 |
$1,096.02 |
0.5× |
| Humerus Min 2 Views Left (73060) |
$48.15 |
$87.55 |
0.6× |
| Hysterosalpingogram (74740) |
$190 |
$345.46 |
0.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$436.88 |
$794.34 |
0.9× |
| Knee 3 views (73562) |
$48.15 |
$87.55 |
0.6× |
| MRA head w/o contrast (70544) |
$872.24 |
$1,585.89 |
4.0× |
| MRA neck w contrast (70548) |
$719.06 |
$1,307.38 |
2.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$926.06 |
$1,683.74 |
2.9× |
| MRA neck w/o contrast (70547) |
$556.81 |
$1,012.39 |
2.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,263.52 |
$2,297.31 |
4.0× |
| MRI abdomen w/o contrast (74181) |
$1,289.69 |
$2,344.90 |
5.9× |
| MRI any jnt lwr ext with con lt (73722) |
$857.06 |
$1,558.29 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$857.06 |
$1,558.29 |
1.2× |
| MRI breast w/o contrast bilateral (77047) |
$160.26 |
$291.39 |
0.7× |
| MRI cervical spine w/o contrast (72141) |
$1,657.58 |
$3,013.78 |
7.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$757.13 |
$1,376.60 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,004.86 |
$1,827.01 |
3.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,263.52 |
$2,297.31 |
4.0× |
| MRI pelvis w/o contrast (72195) |
$730.39 |
$1,327.98 |
3.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,094.42 |
$1,989.86 |
3.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,094.42 |
$1,989.86 |
3.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,704.49 |
$3,099.06 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,490.35 |
$2,709.72 |
4.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,591.07 |
$2,892.86 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,515.22 |
$2,754.94 |
7.0× |
| MRI tmj (70336) |
$1,135.69 |
$2,064.89 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$757.13 |
$1,376.60 |
3.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,094.42 |
$1,989.86 |
3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$757.13 |
$1,376.60 |
3.5× |
| Myelogram Cervical (72240) |
$528.32 |
$960.58 |
0.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,210.16 |
$2,200.29 |
1.0× |
| Neck soft tissue (70360) |
$48.15 |
$87.55 |
0.6× |
| Nm gastric emptying study (78264) |
$356.22 |
$647.66 |
1.0× |
| Parathyroid imaging (78070) |
$217.71 |
$395.83 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$92.06 |
$167.38 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,094.42 |
$1,989.86 |
3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$315.77 |
$574.12 |
0.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$338.31 |
$615.12 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$48.15 |
$87.55 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$92.06 |
$167.38 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$92.06 |
$167.38 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$92.06 |
$167.38 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$113.64 |
$206.62 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$92.06 |
$167.38 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$119.47 |
$217.23 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$195.84 |
$356.07 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$97.66 |
$177.57 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$84.86 |
$154.29 |
0.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$48.15 |
$87.55 |
0.6× |
| Radiological examination surgical specimen (76098) |
$377.12 |
$685.67 |
0.8× |
| Ribs bilateral 3 views (71110) |
$92.06 |
$167.38 |
1.0× |
| Scapula complete (73010) |
$92.06 |
$167.38 |
1.0× |
| Small bowel series (74250) |
$92.06 |
$167.38 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$375.93 |
$683.51 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$220.09 |
$400.16 |
2.3× |
| Umbilical-artery Doppler (OB) (76820) |
$84.98 |
$154.50 |
0.9× |
| Urethrocystography voiding (74455) |
$190 |
$345.46 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$195.84 |
$356.07 |
1.2× |
| Us abdl aorta screen aaa (76706) |
$236.23 |
$429.51 |
2.5× |
| Us breast unilateral complete (76641) |
$166.72 |
$303.13 |
1.8× |
| Us breast unilateral limited (76642) |
$166.72 |
$303.13 |
2.1× |
| Us chest (76604) |
$104.12 |
$189.31 |
1.1× |
| Us infant hips dynamic (76885) |
$182.30 |
$331.45 |
2.3× |
| Us ob detailed single fetus (76811) |
$269.43 |
$489.87 |
1.2× |
| Us ob transvaginal (76817) |
$263.14 |
$478.44 |
2.8× |
| Us pelvic non ob complete (76856) |
$423.23 |
$769.51 |
4.4× |
| Us pregnancy ltd (76815) |
$156.92 |
$285.31 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$263.14 |
$478.44 |
2.8× |
| Us retroperitoneal complete (76770) |
$236.23 |
$429.51 |
2.5× |
| Us retroperitoneal limited (76775) |
$52.12 |
$94.76 |
0.5× |
| Us scrotum and contents (76870) |
$270.33 |
$491.52 |
2.8× |
| Us soft tissue head/neck (76536) |
$228.36 |
$415.19 |
2.4× |
| Us xtr non-vasc lmtd (76882) |
$149.90 |
$272.54 |
1.6× |
| Wrist 2 views (73100) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$206.38 |
$375.23 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$195.84 |
$356.07 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$48.15 |
$87.55 |
0.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$92.06 |
$167.38 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$92.06 |
$167.38 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$48.15 |
$87.55 |
0.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$48.15 |
$87.55 |
0.6× |
| Xr c-spine 6 or more views (72052) |
$92.06 |
$167.38 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$48.15 |
$87.55 |
0.6× |
| Xr shoulder 1 view (73020) |
$48.15 |
$87.55 |
0.6× |
| Xr spine cervical 4 or 5 views (72050) |
$92.06 |
$167.38 |
1.0× |
| Xr tibia/fibula 2 views (73590) |
$48.15 |
$87.55 |
0.6× |
| Xray knee 1 or 2 views rt (73560) |
$48.15 |
$87.55 |
0.6× |