| Abdomen 2 views (74019) |
$94.13 |
$375 |
1.0× |
| Ankle 2 views (73600) |
$72.79 |
$290 |
0.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$221.63 |
$883 |
0.6× |
| Bone &/joint imaging whole body (78306) |
$414.15 |
$1,650 |
1.1× |
| Bone age studies (77072) |
$112.20 |
$447 |
1.2× |
| Bone survey complete (77075) |
$188.75 |
$752 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$91.11 |
$363 |
1.2× |
| Chest 1 view (71045) |
$71.28 |
$284 |
0.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$104.67 |
$417 |
0.7× |
| Clavicle complete (73000) |
$89.11 |
$355 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$881.26 |
$3,511 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$822.53 |
$3,277 |
3.8× |
| CT abdomen w contrast (74160) |
$798.68 |
$3,182 |
5.0× |
| CT abdomen w wo contrast (74170) |
$895.82 |
$3,569 |
5.6× |
| CT abdomen w/o contrast (74150) |
$627.50 |
$2,500 |
6.6× |
| CT c-spine w/o contrast (72125) |
$706.06 |
$2,813 |
7.4× |
| CT cervical spine w&w/o contrast (72127) |
$883.77 |
$3,521 |
5.6× |
| CT cervical spine with contrast (72126) |
$779.61 |
$3,106 |
2.5× |
| CT chest w/wo contrast (71270) |
$881.26 |
$3,511 |
5.5× |
| CT chest with contrast (71260) |
$798.68 |
$3,182 |
5.0× |
| CT head/brain with contrast (70460) |
$779.61 |
$3,106 |
4.9× |
| CT head/brain without and with contrast (70470) |
$895.82 |
$3,569 |
5.6× |
| CT iac w contrast (70481) |
$673.44 |
$2,683 |
4.2× |
| CT limited/localized follow up study (76380) |
$299.19 |
$1,192 |
3.8× |
| CT lower ext w/o (73700) |
$565.75 |
$2,254 |
6.0× |
| CT lower extremity w wo contrast (73702) |
$883.77 |
$3,521 |
5.6× |
| CT lower extremity with contrast (73701) |
$779.61 |
$3,106 |
4.9× |
| CT lumbar spine w & w/o contrast (72133) |
$883.77 |
$3,521 |
5.6× |
| CT lumbar spine w/o contrast (72131) |
$706.06 |
$2,813 |
7.4× |
| CT lumbar spine with contrast (72132) |
$779.61 |
$3,106 |
2.5× |
| CT maxillofacial w contrast (70487) |
$779.61 |
$3,106 |
4.9× |
| CT maxillofacial w/o contrast (70486) |
$567.26 |
$2,260 |
6.0× |
| CT maxillofacial w/wo contrast (70488) |
$889.80 |
$3,545 |
5.6× |
| CT neck soft tissue w contrast (70491) |
$779.61 |
$3,106 |
4.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$883.77 |
$3,521 |
5.6× |
| CT pelvis w & w/o contrast (72194) |
$883.77 |
$3,521 |
5.6× |
| CT pelvis w/o contrast (72192) |
$627.50 |
$2,500 |
6.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$883.77 |
$3,521 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$567.26 |
$2,260 |
6.0× |
| CT thoracic spine w/contrast (72129) |
$779.61 |
$3,106 |
4.9× |
| CT thoracic spine w/o contrast (72128) |
$706.06 |
$2,813 |
7.4× |
| CT thoracic spine w/wo contrast (72130) |
$883.77 |
$3,521 |
5.6× |
| CT thorax w/o contrast (71250) |
$627.50 |
$2,500 |
6.6× |
| CT upper extremity w/o contrast rt (73200) |
$565.75 |
$2,254 |
6.0× |
| CT upper extremity with contrast (73201) |
$779.61 |
$3,106 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$881.26 |
$3,511 |
5.5× |
| Cta Abdomen (74175) |
$881.26 |
$3,511 |
5.5× |
| CTA abdomen pelvis (74174) |
$881.26 |
$3,511 |
2.8× |
| CTA chest (71275) |
$881.26 |
$3,511 |
5.5× |
| Cta Head (70496) |
$567.51 |
$2,261 |
3.6× |
| Cta Neck (70498) |
$822.53 |
$3,277 |
5.2× |
| Esophagus (74220) |
$152.11 |
$606 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$135.04 |
$538 |
0.6× |
| Foot 2 views (73620) |
$72.79 |
$290 |
0.9× |
| Forearm 2 views (73090) |
$78.31 |
$312 |
1.0× |
| Hand 2 views (73120) |
$72.79 |
$290 |
0.8× |
| Hand 3 views (73130) |
$92.12 |
$367 |
1.2× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$403.36 |
$1,607 |
1.1× |
| Ht muscle image spect sing (78451) |
$767.06 |
$3,056 |
0.7× |
| Humerus Min 2 Views Left (73060) |
$78.31 |
$312 |
1.0× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$287.40 |
$1,145 |
0.6× |
| Knee 3 views (73562) |
$93.37 |
$372 |
1.2× |
| Liver & spleen imaging static only (78215) |
$221.63 |
$883 |
0.6× |
| Lung Ventilation Imaging (78579) |
$221.63 |
$883 |
0.6× |
| MRA head w/o contrast (70544) |
$732.92 |
$2,920 |
3.4× |
| MRA neck w contrast (70548) |
$802.45 |
$3,197 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$873.98 |
$3,482 |
2.8× |
| MRA neck w/o contrast (70547) |
$682.47 |
$2,719 |
3.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$873.98 |
$3,482 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$732.92 |
$2,920 |
3.4× |
| MRI any jnt lwr ext with con lt (73722) |
$802.45 |
$3,197 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$802.45 |
$3,197 |
1.1× |
| MRI c-spine with contrast (72142) |
$802.45 |
$3,197 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$678.45 |
$2,703 |
3.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$802.45 |
$3,197 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$802.45 |
$3,197 |
2.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$682.47 |
$2,719 |
3.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$682.47 |
$2,719 |
3.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$825.29 |
$3,288 |
2.6× |
| MRI orbit/face/neck w/contrast (70542) |
$802.45 |
$3,197 |
2.5× |
| MRI pelvis w contrast (72196) |
$802.45 |
$3,197 |
2.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$873.98 |
$3,482 |
2.8× |
| MRI pelvis w/o contrast (72195) |
$696.02 |
$2,773 |
3.2× |
| MRI scan of arm joint before and after contrast (73223) |
$873.98 |
$3,482 |
2.8× |
| MRI scan of leg joint before and after contrast (73723) |
$902.60 |
$3,596 |
2.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,067.25 |
$4,252 |
3.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$802.45 |
$3,197 |
2.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,067.25 |
$4,252 |
3.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$802.45 |
$3,197 |
2.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$872.85 |
$3,477.50 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$678.45 |
$2,703 |
3.1× |
| MRI tmj (70336) |
$678.45 |
$2,703 |
3.1× |
| MRI upper ext joint w/o contrast (73221) |
$702.55 |
$2,799 |
3.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$822.78 |
$3,278 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$682.47 |
$2,719 |
3.2× |
| Myocardial Spect Multiple Studies (78452) |
$825.79 |
$3,290 |
0.7× |
| Neck soft tissue (70360) |
$65.51 |
$261 |
0.8× |
| Nm gastric emptying study (78264) |
$322.79 |
$1,286 |
0.9× |
| Osseous survey infant (77076) |
$325.80 |
$1,298 |
3.4× |
| Osseous survey limited (77074) |
$153.36 |
$611 |
1.6× |
| Parathyroid imaging (78070) |
$301.20 |
$1,200 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$64.01 |
$255 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$873.98 |
$3,482 |
2.8× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$221.63 |
$883 |
0.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$349.64 |
$1,393 |
0.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$94.38 |
$376 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$86.60 |
$345 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$110.19 |
$439 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$67.27 |
$268 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$94.38 |
$376 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$188.75 |
$752 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$240.46 |
$958 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$219.37 |
$874 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$94.63 |
$377 |
1.2× |
| Ribs bilateral 3 views (71110) |
$107.43 |
$428 |
1.1× |
| Sacroiliac Joints < 3 Views (72200) |
$64.01 |
$255 |
0.7× |
| Scapula complete (73010) |
$78.31 |
$312 |
0.8× |
| Small bowel series (74250) |
$158.13 |
$630 |
1.0× |
| Spine thoracic 3 views (72072) |
$91.11 |
$363 |
1.0× |
| Thoracolumbar 2 views (72080) |
$50.20 |
$200 |
0.6× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$221.63 |
$883 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$192.77 |
$768 |
2.0× |
| Upper Extremity Infant (73092) |
$64.01 |
$255 |
0.7× |
| Urethrocystography voiding (74455) |
$158.13 |
$630 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$359.68 |
$1,433 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$98.89 |
$394 |
1.0× |
| Us breast unilateral complete (76641) |
$140.56 |
$560 |
1.5× |
| Us breast unilateral limited (76642) |
$144.83 |
$577 |
1.8× |
| Us chest (76604) |
$87.60 |
$349 |
0.9× |
| Us kidney transplant (76776) |
$75.30 |
$300 |
0.8× |
| Us pelvic non ob complete (76856) |
$203.81 |
$812 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$169.93 |
$677 |
1.8× |
| Us pregnancy ltd (76815) |
$147.59 |
$588 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$240.46 |
$958 |
2.5× |
| Us retroperitoneal complete (76770) |
$254.01 |
$1,012 |
2.7× |
| Us retroperitoneal limited (76775) |
$148.22 |
$590.50 |
1.6× |
| Us scrotum and contents (76870) |
$187.75 |
$748 |
2.0× |
| Us soft tissue head/neck (76536) |
$166.66 |
$664 |
1.8× |
| Us xtr non-vasc lmtd (76882) |
$132.03 |
$526 |
1.4× |
| Wrist 2 views (73100) |
$72.79 |
$290 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$160.39 |
$639 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$61.50 |
$245 |
0.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$92.12 |
$367 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$345.63 |
$1,377 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$78.31 |
$312 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$88.85 |
$354 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$59.74 |
$238 |
0.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$102.91 |
$410 |
1.3× |
| X-ray exam hip uni 4/> views (73503) |
$132.03 |
$526 |
1.4× |
| X-ray exam of femur 1 (73551) |
$53.21 |
$212 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$102.91 |
$410 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$72.54 |
$289 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$92.12 |
$367 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$68.27 |
$272 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$65.51 |
$261 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$107.43 |
$428 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$73.54 |
$293 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$55.72 |
$222 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$91.11 |
$363 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$148.09 |
$590 |
1.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$66.26 |
$264 |
0.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$72.54 |
$289 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$64.01 |
$255 |
0.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$67.77 |
$270 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$95.38 |
$380 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$120.48 |
$480 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$89.86 |
$358 |
0.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$91.11 |
$363 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$74.54 |
$297 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$78.31 |
$312 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$87.60 |
$349 |
1.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$68.27 |
$272 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$102.91 |
$410 |
1.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$64.01 |
$255 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$53.21 |
$212 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$71.28 |
$284 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$55.72 |
$222 |
0.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$92.12 |
$367 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$149.09 |
$594 |
1.6× |
| Xr Cholecystography Oral Contrast (74290) |
$104.67 |
$417 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$55.72 |
$222 |
0.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$74.05 |
$295 |
0.8× |
| Xr optic foramina (70190) |
$63.25 |
$252 |
0.8× |
| Xr shoulder 1 view (73020) |
$53.21 |
$212 |
0.7× |
| Xr spine cervical 4 or 5 views (72050) |
$118.22 |
$471 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$78.31 |
$312 |
1.0× |
| Xr tmj bilateral (70330) |
$110.19 |
$439 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$80.82 |
$322 |
1.0× |