| Abdomen 2 views (74019) |
$147 |
$245 |
1.6× |
| Ankle 2 views (73600) |
$75 |
$125 |
1.0× |
| Bone &/Joint Imaging Limited Area (78300) |
$652.80 |
$1,088 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$742.20 |
$1,237 |
2.1× |
| Bone age studies (77072) |
$75 |
$125 |
0.8× |
| Bone Imaging 3 Phase (78315) |
$771 |
$1,285 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$109.80 |
$183 |
1.4× |
| Chest 1 view (71045) |
$56.40 |
$94 |
0.7× |
| Clavicle complete (73000) |
$107.40 |
$179 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$150 |
$250 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$661.20 |
$1,102 |
2.1× |
| CT abdomen and pelvis without contrast (74176) |
$378 |
$630 |
1.7× |
| CT abdomen w contrast (74160) |
$597 |
$995 |
3.8× |
| CT abdomen w wo contrast (74170) |
$661.20 |
$1,102 |
4.2× |
| CT abdomen w/o contrast (74150) |
$378 |
$630 |
4.0× |
| CT angiography upper extremity lt (73206) |
$1,014 |
$1,690 |
6.4× |
| CT c-spine w/o contrast (72125) |
$378 |
$630 |
4.0× |
| CT cervical spine w&w/o contrast (72127) |
$661.20 |
$1,102 |
4.2× |
| CT chest w/wo contrast (71270) |
$661.20 |
$1,102 |
4.2× |
| CT chest with contrast (71260) |
$597 |
$995 |
3.8× |
| CT head/brain with contrast (70460) |
$597 |
$995 |
3.8× |
| CT head/brain without and with contrast (70470) |
$661.20 |
$1,102 |
4.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$150 |
$250 |
1.9× |
| CT iac w contrast (70481) |
$597 |
$995 |
3.8× |
| CT lower ext w/o (73700) |
$378 |
$630 |
4.0× |
| CT lower extremity w wo contrast (73702) |
$661.20 |
$1,102 |
4.2× |
| CT lower extremity with contrast (73701) |
$597 |
$995 |
3.8× |
| CT lumbar spine w & w/o contrast (72133) |
$661.20 |
$1,102 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$519.60 |
$866 |
5.5× |
| CT lumbar spine with contrast (72132) |
$597 |
$995 |
1.9× |
| CT maxillofacial w contrast (70487) |
$597 |
$995 |
3.8× |
| CT maxillofacial w/o contrast (70486) |
$378 |
$630 |
4.0× |
| CT maxillofacial w/wo contrast (70488) |
$661.20 |
$1,102 |
4.2× |
| CT neck soft tissue w contrast (70491) |
$597 |
$995 |
3.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$661.20 |
$1,102 |
4.2× |
| CT orbits w/o contrast (70480) |
$378 |
$630 |
4.0× |
| CT pelvis w & w/o contrast (72194) |
$661.20 |
$1,102 |
4.2× |
| CT pelvis w/o contrast (72192) |
$378 |
$630 |
4.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$661.20 |
$1,102 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$378 |
$630 |
4.0× |
| CT thoracic spine w/contrast (72129) |
$597 |
$995 |
3.8× |
| CT thoracic spine w/o contrast (72128) |
$378 |
$630 |
4.0× |
| CT thoracic spine w/wo contrast (72130) |
$661.20 |
$1,102 |
4.2× |
| CT thorax w/o contrast (71250) |
$378 |
$630 |
4.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$661.20 |
$1,102 |
4.2× |
| CT upper extremity w/o contrast rt (73200) |
$378 |
$630 |
4.0× |
| CT upper extremity with contrast (73201) |
$597 |
$995 |
1.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,230 |
$2,050 |
7.7× |
| Cta Abdomen (74175) |
$1,200 |
$2,000 |
7.6× |
| CTA abdomen pelvis (74174) |
$1,785 |
$2,975 |
5.7× |
| CTA chest (71275) |
$1,140 |
$1,900 |
7.2× |
| Cta Head (70496) |
$1,479 |
$2,465 |
9.3× |
| CTA lwr ext w&w/o contrast (73706) |
$1,146 |
$1,910 |
7.2× |
| Cta Neck (70498) |
$1,551 |
$2,585 |
9.8× |
| Cta Pelvis (72191) |
$1,227 |
$2,045 |
7.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$195.60 |
$326 |
2.1× |
| Esophagus (74220) |
$136.80 |
$228 |
0.9× |
| Fetal biophysical profile non-stress testing (76818) |
$208.80 |
$348 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$237 |
$395 |
1.1× |
| Forearm 2 views (73090) |
$107.40 |
$179 |
1.4× |
| Hand 2 views (73120) |
$81 |
$135 |
0.9× |
| Hand 3 views (73130) |
$107.40 |
$179 |
1.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$652.80 |
$1,088 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$107.40 |
$179 |
1.4× |
| Hysterosalpingogram (74740) |
$405.60 |
$676 |
1.9× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$768.60 |
$1,281 |
1.6× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,239 |
$2,065 |
2.5× |
| Knee 3 views (73562) |
$116.40 |
$194 |
1.5× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$549.60 |
$916 |
1.5× |
| Lung perf&ventilat diferentl (78598) |
$831 |
$1,385 |
1.7× |
| Lung perfusion differential (78597) |
$496.80 |
$828 |
1.4× |
| MRA head w/o contrast (70544) |
$727.80 |
$1,213 |
3.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$859.80 |
$1,433 |
2.7× |
| MRI abdomen w/o contrast (74181) |
$727.80 |
$1,213 |
3.4× |
| MRI any jnt lwr ext with con lt (73722) |
$859.80 |
$1,433 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$859.80 |
$1,433 |
1.2× |
| MRI c-spine with contrast (72142) |
$859.80 |
$1,433 |
2.7× |
| MRI cervical spine w/o contrast (72141) |
$727.80 |
$1,213 |
3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$859.80 |
$1,433 |
2.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$727.80 |
$1,213 |
3.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$727.80 |
$1,213 |
3.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$859.80 |
$1,433 |
2.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$859.80 |
$1,433 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$727.80 |
$1,213 |
3.4× |
| MRI scan of arm joint before and after contrast (73223) |
$859.80 |
$1,433 |
2.7× |
| MRI scan of leg joint before and after contrast (73723) |
$859.80 |
$1,433 |
2.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$859.80 |
$1,433 |
2.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$859.80 |
$1,433 |
2.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$859.80 |
$1,433 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$859.80 |
$1,433 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$727.80 |
$1,213 |
3.4× |
| MRI upper ext joint w/o contrast (73221) |
$727.80 |
$1,213 |
3.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$859.80 |
$1,433 |
2.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$727.80 |
$1,213 |
3.4× |
| Myocardial Spect Multiple Studies (78452) |
$1,895.40 |
$3,159 |
1.6× |
| Nm gastric emptying study (78264) |
$688.20 |
$1,147 |
1.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$267 |
$445 |
2.8× |
| Osseous survey limited (77074) |
$99 |
$165 |
1.0× |
| Parathyroid imaging (78070) |
$504.60 |
$841 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$107.40 |
$179 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$859.80 |
$1,433 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$90 |
$150 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$107.40 |
$179 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$124.80 |
$208 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$117 |
$195 |
1.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$107.40 |
$179 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$130.20 |
$217 |
0.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$107.40 |
$179 |
1.4× |
| Ribs bilateral 3 views (71110) |
$201 |
$335 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$154.20 |
$257 |
1.6× |
| Scapula complete (73010) |
$107.40 |
$179 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$36.45 |
$60.75 |
1.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$496.20 |
$827 |
5.2× |
| Spine thoracic 3 views (72072) |
$123 |
$205 |
1.3× |
| Thyroid Imaging With Vascular Flow (78013) |
$417.60 |
$696 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$232.20 |
$387 |
2.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$87 |
$145 |
1.1× |
| Upper Extremity Infant (73092) |
$75 |
$125 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$222.60 |
$371 |
1.4× |
| Us abdl aorta screen aaa (76706) |
$27 |
$45 |
0.3× |
| Us breast unilateral limited (76642) |
$208.80 |
$348 |
2.6× |
| Us chest (76604) |
$179.40 |
$299 |
1.9× |
| Us ob detailed single fetus (76811) |
$274.80 |
$458 |
1.3× |
| Us ob transvaginal (76817) |
$198.60 |
$331 |
2.1× |
| Us pelvic non ob complete (76856) |
$274.80 |
$458 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$232.20 |
$387 |
2.5× |
| Us pregnancy ltd (76815) |
$203.40 |
$339 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$271.80 |
$453 |
2.9× |
| Us retroperitoneal complete (76770) |
$298.20 |
$497 |
3.1× |
| Us retroperitoneal limited (76775) |
$232.20 |
$387 |
2.5× |
| Us scrotum and contents (76870) |
$180 |
$300 |
1.9× |
| Us soft tissue head/neck (76536) |
$278.40 |
$464 |
2.9× |
| Us xtr non-vasc lmtd (76882) |
$345 |
$575 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$172.80 |
$288 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$212.40 |
$354 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$107.40 |
$179 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$150 |
$250 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$107.40 |
$179 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$107.40 |
$179 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$107.40 |
$179 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$123 |
$205 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$107.40 |
$179 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$107.40 |
$179 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$107.40 |
$179 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$75 |
$125 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$136.20 |
$227 |
1.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$165 |
$275 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$123 |
$205 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$123 |
$205 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$200.40 |
$334 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$147 |
$245 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$222 |
$370 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$276.60 |
$461 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$136.20 |
$227 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$107.40 |
$179 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$147 |
$245 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$87 |
$145 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$174 |
$290 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$87 |
$145 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$87 |
$145 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$107.40 |
$179 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$123 |
$205 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$107.40 |
$179 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$107.40 |
$179 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$120 |
$200 |
1.3× |
| Xr chest 4+ views (71048) |
$70.80 |
$118 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$107.40 |
$179 |
1.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$51 |
$85 |
0.5× |
| Xr spine cervical 4 or 5 views (72050) |
$120 |
$200 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$107.40 |
$179 |
1.4× |
| Xr tmj bilateral (70330) |
$123 |
$205 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$107.40 |
$179 |
1.4× |