| Abdomen 1 View (74018) |
$236 |
$236 |
2.6× |
| Abdomen 2 views (74019) |
$356 |
$356 |
3.2× |
| Acute Gastrointestinal Blood Loss Imaging (78278) |
$1,290 |
$1,290 |
3.1× |
| Ankle 2 views (73600) |
$275 |
$275 |
3.0× |
| Bone Imaging 3 Phase (78315) |
$1,887 |
$1,887 |
4.5× |
| Bone Imaging Limited Area (78300) |
$1,267 |
$1,267 |
3.0× |
| Bone Imaging Multiple Areas (78305) |
$1,416 |
$1,416 |
3.4× |
| Bone Imaging Whole Body (78306) |
$1,657 |
$1,657 |
3.9× |
| Chest 1 view (71045) |
$299 |
$299 |
3.3× |
| Chest 2 views (71046) |
$308 |
$308 |
3.4× |
| Chest 3 views (71047) |
$370 |
$370 |
4.0× |
| Clavicle complete (73000) |
$275 |
$275 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$397 |
$397 |
3.6× |
| Contrast X-Ray Bladder (74430) |
$1,078 |
$1,078 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,019 |
$2,019 |
5.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,224 |
$2,224 |
8.8× |
| CT abdomen w contrast (74160) |
$2,138 |
$2,138 |
11.6× |
| CT abdomen w wo contrast (74170) |
$2,260 |
$2,260 |
12.2× |
| CT abdomen w/o contrast (74150) |
$2,019 |
$2,019 |
18.3× |
| CT Angio Chest (71275) |
$2,466 |
$2,466 |
13.3× |
| CT Angio Head (70496) |
$2,138 |
$2,138 |
11.6× |
| CT Angio Neck (70498) |
$2,138 |
$2,138 |
11.6× |
| CT cervical spine w/o contrast (72125) |
$2,204 |
$2,204 |
20.0× |
| CT chest w contrast (71260) |
$2,408 |
$2,408 |
13.0× |
| CT chest w/wo contrast (71270) |
$1,507 |
$1,507 |
8.1× |
| CT head/brain with contrast (70460) |
$2,019 |
$2,019 |
10.9× |
| CT head/brain without and with contrast (70470) |
$2,260 |
$2,260 |
12.2× |
| CT iac w contrast (70481) |
$1,140 |
$1,140 |
6.2× |
| CT lower ext w/o (73700) |
$2,019 |
$2,019 |
18.3× |
| CT lower extremity w/contrast material (73701) |
$2,506 |
$2,506 |
13.5× |
| CT lumbar spine w/o contrast (72131) |
$2,019 |
$2,019 |
18.3× |
| CT maxillofacial w contrast (70487) |
$1,537 |
$1,537 |
8.3× |
| CT maxillofacial wo contrast (70486) |
$2,019 |
$2,019 |
18.3× |
| CT neck tissue combo (70492) |
$1,537 |
$1,537 |
8.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,285 |
$1,285 |
6.9× |
| CT orbits w/o contrast (70480) |
$1,115 |
$1,115 |
10.1× |
| CT pelvis w&w/o contrast (72194) |
$2,138 |
$2,138 |
11.6× |
| CT pelvis w/o contrast (72192) |
$2,019 |
$2,019 |
18.3× |
| CT scan of leg combo (73702) |
$2,506 |
$2,506 |
13.5× |
| CT scans face/jaw combo (70488) |
$1,537 |
$1,537 |
8.3× |
| CT soft tissue neck w contrast (70491) |
$2,138 |
$2,138 |
11.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,537 |
$1,537 |
13.9× |
| CT thoracic spine w/o contrast (72128) |
$2,019 |
$2,019 |
18.3× |
| CT thorax w/o contrast (71250) |
$2,099 |
$2,099 |
19.0× |
| CT upper ext wo (73200) |
$4,038 |
$4,038 |
36.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,506 |
$2,506 |
13.5× |
| CT upper extremity with contrast (73201) |
$2,631 |
$2,631 |
7.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,380 |
$2,380 |
12.9× |
| Cta Abdomen (74175) |
$2,138 |
$2,138 |
11.6× |
| Dxa Bone Density Axial (77080) |
$597 |
$597 |
5.4× |
| Esophagram (74220) |
$865 |
$865 |
4.7× |
| Fluoroscopy up to 1 hr (76000) |
$802 |
$802 |
3.2× |
| Foot 2 views (73620) |
$275 |
$275 |
3.0× |
| Forearm 2 views (73090) |
$260 |
$260 |
2.8× |
| Gastric emptying imaging study (78264) |
$1,341 |
$1,341 |
3.2× |
| Gated Heart Planar Single (78472) |
$1,880 |
$1,880 |
4.5× |
| Hepatobil Syst Image W/Drug (78227) |
$1,898 |
$1,898 |
3.3× |
| Hepatobiliary System Imaging (78226) |
$2,019 |
$2,019 |
4.8× |
| Ht Muscle Image Spect Sing (78451) |
$4,380 |
$4,380 |
3.2× |
| Infusion Ivp (74410) |
$865 |
$865 |
4.7× |
| K Flow/Funct Image Multiple (78709) |
$1,693 |
$1,693 |
3.0× |
| K Flow/Funct Image W/Drug (78708) |
$1,625 |
$1,625 |
2.8× |
| K Flow/Funct Image W/O Drug (78707) |
$1,625 |
$1,625 |
2.8× |
| Kidney Imaging Morphol (78700) |
$1,267 |
$1,267 |
3.0× |
| Knee 3 Views (73562) |
$357 |
$357 |
3.9× |
| Liver & Spleen Imaging Static Only (78215) |
$1,267 |
$1,267 |
3.0× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$1,267 |
$1,267 |
3.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$2,315 |
$2,315 |
4.0× |
| Lung Ventilation Imaging (78579) |
$1,330 |
$1,330 |
3.2× |
| Lymph System Imaging (78195) |
$1,663 |
$1,663 |
2.9× |
| Magnetic Image Jaw Joint (70336) |
$2,929 |
$2,929 |
11.6× |
| Meckels Divert Exam (78290) |
$1,267 |
$1,267 |
3.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,796 |
$3,796 |
10.3× |
| MRA head w/o contrast (70544) |
$3,164 |
$3,164 |
12.6× |
| MRA head with contrast (70545) |
$3,368 |
$3,368 |
9.2× |
| MRA neck w contrast (70548) |
$3,164 |
$3,164 |
8.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,796 |
$3,796 |
10.3× |
| MRA neck w/o contrast (70547) |
$3,344 |
$3,344 |
13.3× |
| MRI abdomen w contrast (74182) |
$2,544 |
$2,544 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$2,251 |
$2,251 |
8.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,003 |
$3,003 |
3.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,344 |
$3,344 |
9.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,358 |
$2,358 |
2.9× |
| MRI cervical spine w/o cont (72141) |
$3,603 |
$3,603 |
14.3× |
| MRI chest w/o contrast (71550) |
$2,251 |
$2,251 |
8.9× |
| MRI chest wo w contrast (71552) |
$3,796 |
$3,796 |
10.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,464 |
$3,464 |
9.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,464 |
$3,464 |
13.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,224 |
$3,224 |
8.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,251 |
$2,251 |
8.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,102 |
$3,102 |
8.4× |
| MRI pelvis w/o & w contrast (72197) |
$3,344 |
$3,344 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$3,224 |
$3,224 |
12.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,544 |
$2,544 |
10.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,464 |
$3,464 |
13.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,344 |
$3,344 |
9.1× |
| MRI, abdomen, combo (74183) |
$2,911 |
$2,911 |
7.9× |
| MRI, dorsal spine combo (72157) |
$3,344 |
$3,344 |
9.1× |
| MRI, joint upper extrem (73221) |
$3,586 |
$3,586 |
14.2× |
| MRI, joint upper extrem combo (73223) |
$3,102 |
$3,102 |
8.4× |
| MRI, lumbar spine combo (72158) |
$3,344 |
$3,344 |
9.1× |
| Myocardial Spect Multiple Studies (78452) |
$4,380 |
$4,380 |
3.2× |
| Neck soft tissue (70360) |
$277 |
$277 |
3.0× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$376 |
$376 |
3.4× |
| Parathyroid Planar Imaging (78070) |
$1,537 |
$1,537 |
3.6× |
| Pelvis 1 or 2 views (72170) |
$386 |
$386 |
3.5× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,267 |
$1,267 |
3.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$480 |
$480 |
4.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$351 |
$351 |
3.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$275 |
$275 |
3.0× |
| Radex elbow complete minimum 3 views (73080) |
$297 |
$297 |
3.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$393 |
$393 |
3.6× |
| Radex fingr minimum 2 views (73140) |
$275 |
$275 |
3.0× |
| Radex foot complete minimum 3 views (73630) |
$430 |
$430 |
4.7× |
| Radex Hand Minimum 3 Views (73130) |
$310 |
$310 |
3.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$275 |
$275 |
3.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$275 |
$275 |
3.0× |
| Radex shoulder complete minimum 2 views (73030) |
$341 |
$341 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$275 |
$275 |
3.0× |
| Radex Sternum Minimum 2 Views (71120) |
$243 |
$243 |
2.6× |
| Radex Toe Minimum 2 Views (73660) |
$275 |
$275 |
3.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$341 |
$341 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$386 |
$386 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$399 |
$399 |
3.6× |
| Radiologic exam colon double contrast study (74280) |
$824 |
$824 |
4.5× |
| Radiologic exam colon single contrast study (74270) |
$865 |
$865 |
4.7× |
| Radiologic exam knee complete 4/more views (73564) |
$393 |
$393 |
3.6× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$393 |
$393 |
3.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$511 |
$511 |
2.8× |
| Radiologic exam swallow function contrast study (74230) |
$511 |
$511 |
2.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$865 |
$865 |
4.7× |
| Radiologic examination femur minimum 2 views (73552) |
$297 |
$297 |
3.2× |
| Radiologic examination knee 1/2 views (73560) |
$344 |
$344 |
3.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$320 |
$320 |
3.5× |
| Ribs bilateral 3 views (71110) |
$419 |
$419 |
3.8× |
| Rp loclzj tum plnr 1 area single day imaging (78800) |
$1,267 |
$1,267 |
3.0× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,791 |
$1,791 |
4.2× |
| Scapula (73010) |
$393 |
$393 |
3.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$145 |
$145 |
6.2× |
| Shoulder 1 view (73020) |
$275 |
$275 |
3.0× |
| Skull less than 4 views (70250) |
$393 |
$393 |
3.6× |
| Testicular Imaging W/Flow (78761) |
$1,267 |
$1,267 |
3.0× |
| Thoracic spine 2 views (72070) |
$445 |
$445 |
4.0× |
| Thoracic spine 3 views (72072) |
$393 |
$393 |
3.6× |
| Thyroid Uptake Measurement (78012) |
$1,267 |
$1,267 |
3.0× |
| Ultrasound, abdomen limited (76705) |
$776 |
$776 |
7.0× |
| Upper gi w/o kub (74240) |
$795 |
$795 |
4.3× |
| Ureteral Reflux Study (78740) |
$1,267 |
$1,267 |
3.0× |
| Urethrocystogram voiding (74455) |
$802 |
$802 |
3.2× |
| Us breast unilateral complete (76641) |
$345 |
$345 |
3.1× |
| Us complete joint (76881) |
$393 |
$393 |
3.6× |
| Us exam, pelvic, limited (76857) |
$393 |
$393 |
3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$345 |
$345 |
3.1× |
| Us ob limited 1 or more fetuses (76815) |
$393 |
$393 |
3.6× |
| Us pelvic non ob complete (76856) |
$513 |
$513 |
4.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$513 |
$513 |
4.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$393 |
$393 |
3.6× |
| Us retroperitoneal complete (76770) |
$769 |
$769 |
7.0× |
| Us retroperitoneal limited (76775) |
$393 |
$393 |
3.6× |
| Us scrotum and contents (76870) |
$452 |
$452 |
4.1× |
| Us thyroid (76536) |
$637 |
$637 |
5.8× |
| Wrist 2 views (73100) |
$275 |
$275 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$243 |
$243 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$275 |
$275 |
3.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$335 |
$335 |
3.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$446 |
$446 |
4.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$275 |
$275 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$457 |
$457 |
5.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$334 |
$334 |
3.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$393 |
$393 |
4.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$393 |
$393 |
3.6× |
| X-ray humerus (73060) |
$275 |
$275 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$275 |
$275 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$785 |
$785 |
8.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$450 |
$450 |
4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$393 |
$393 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$275 |
$275 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$393 |
$393 |
4.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$393 |
$393 |
3.6× |
| X-Rays Bone Length Studies (77073) |
$491 |
$491 |
4.5× |
| X-Rays Bone Survey Complete (77075) |
$393 |
$393 |
3.6× |
| Xr c-spine 4 or 5 views (72050) |
$426 |
$426 |
3.9× |
| Xr facial bones less than 3 views (70140) |
$275 |
$275 |
3.0× |
| Xr orbits complete 4 views (70200) |
$393 |
$393 |
3.6× |