| Abdomen 2 views (74019) |
$267.73 |
$334.66 |
2.5× |
| Ankle 2 views (73600) |
$178.40 |
$223 |
2.0× |
| Arthrogram hip (73525) |
$660 |
$825 |
1.8× |
| Arthrogram shoulder (73040) |
$622.40 |
$778 |
1.7× |
| Bone &/joint imaging whole body (78306) |
$1,296.80 |
$1,621 |
3.1× |
| Bone age studies (77072) |
$200 |
$250 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$1,402.40 |
$1,753 |
3.4× |
| Cervical spine 2 or 3 views (72040) |
$234.92 |
$293.65 |
2.6× |
| Chest 1 view (71045) |
$185.86 |
$232.33 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$376.83 |
$471.04 |
2.1× |
| Clavicle complete (73000) |
$224.11 |
$280.14 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,413.60 |
$1,767 |
13.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,141.85 |
$5,177.31 |
11.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,865 |
$3,581.24 |
11.6× |
| CT abdomen w contrast (74160) |
$2,096 |
$2,620 |
11.5× |
| CT abdomen w wo contrast (74170) |
$2,284.80 |
$2,856 |
12.5× |
| CT abdomen w/o contrast (74150) |
$1,741.60 |
$2,177 |
16.0× |
| CT angiography upper extremity lt (73206) |
$2,300.80 |
$2,876 |
12.6× |
| CT c-spine w/o contrast (72125) |
$1,614.73 |
$2,018.41 |
14.9× |
| CT chest with contrast (71260) |
$1,884.73 |
$2,355.91 |
10.3× |
| CT head/brain without and with contrast (70470) |
$1,910.40 |
$2,388 |
10.5× |
| CT lower ext w/o (73700) |
$1,398.30 |
$1,747.87 |
12.9× |
| CT lower extremity with contrast (73701) |
$1,689.71 |
$2,112.14 |
9.3× |
| CT lumbar spine w/o contrast (72131) |
$1,653.39 |
$2,066.73 |
15.2× |
| CT lumbar spine with contrast (72132) |
$2,167.20 |
$2,709 |
6.0× |
| CT maxillofacial w contrast (70487) |
$1,663.05 |
$2,078.82 |
9.1× |
| CT maxillofacial w/o contrast (70486) |
$1,486.37 |
$1,857.96 |
13.7× |
| CT neck soft tissue w contrast (70491) |
$1,823.31 |
$2,279.14 |
10.0× |
| CT orbits w/o contrast (70480) |
$1,291.20 |
$1,614 |
11.9× |
| CT pelvis w & w/o contrast (72194) |
$2,729.60 |
$3,412 |
15.0× |
| CT pelvis w/o contrast (72192) |
$1,482.24 |
$1,852.80 |
13.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,618.29 |
$2,022.86 |
8.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,368 |
$1,710 |
12.6× |
| CT thoracic spine w/o contrast (72128) |
$1,656.87 |
$2,071.09 |
15.3× |
| CT thorax w/o contrast (71250) |
$1,539.22 |
$1,924.02 |
14.2× |
| CT unlisted procedure (76497) |
$2,000 |
$2,500 |
22.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,251.20 |
$1,564 |
11.5× |
| CT upper extremity with contrast (73201) |
$1,916.80 |
$2,396 |
5.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,809.87 |
$3,512.33 |
15.4× |
| Cta Abdomen (74175) |
$2,718.40 |
$3,398 |
14.9× |
| CTA abdomen pelvis (74174) |
$3,969.93 |
$4,962.41 |
11.0× |
| CTA chest (71275) |
$2,412.92 |
$3,016.15 |
13.2× |
| Cta Head (70496) |
$2,379.49 |
$2,974.36 |
13.1× |
| Cta Neck (70498) |
$2,365.23 |
$2,956.54 |
13.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$384.21 |
$480.26 |
3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$330.40 |
$413 |
3.7× |
| Esophagus (74220) |
$368 |
$460 |
2.0× |
| Fetal biophysical profile non-stress testing (76818) |
$376.80 |
$471 |
3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$360 |
$450 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$434.83 |
$543.54 |
1.8× |
| Foot 2 views (73620) |
$188 |
$235 |
2.1× |
| Forearm 2 views (73090) |
$200.80 |
$251 |
2.2× |
| Hand 2 views (73120) |
$164.87 |
$206.09 |
1.5× |
| Hand 3 views (73130) |
$184.53 |
$230.67 |
2.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,372 |
$1,715 |
2.4× |
| Humerus Min 2 Views Left (73060) |
$126.96 |
$158.70 |
1.4× |
| Knee 3 views (73562) |
$210.82 |
$263.53 |
2.3× |
| MRA head w & w/o contrast (70546) |
$3,504.80 |
$4,381 |
9.7× |
| MRA head w/o contrast (70544) |
$2,576 |
$3,220 |
10.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,044 |
$2,555 |
5.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,186.83 |
$3,983.53 |
8.8× |
| MRI abdomen w/o contrast (74181) |
$1,667.04 |
$2,083.80 |
6.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,624 |
$2,030 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,626.40 |
$2,033 |
2.0× |
| MRI c-spine with contrast (72142) |
$3,816.80 |
$4,771 |
10.5× |
| MRI cervical spine w/o contrast (72141) |
$2,644.62 |
$3,305.77 |
10.7× |
| MRI chest w/o contrast (71550) |
$2,691.20 |
$3,364 |
10.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,484.67 |
$1,855.84 |
6.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,949.60 |
$3,687 |
8.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,656 |
$3,320 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$1,700.80 |
$2,126 |
6.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,296 |
$2,870 |
6.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,550.40 |
$3,188 |
7.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,118.28 |
$3,897.85 |
8.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,928.88 |
$3,661.10 |
8.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,342.40 |
$4,178 |
9.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,672.80 |
$3,341 |
10.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,876.70 |
$2,345.88 |
7.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,380.80 |
$2,976 |
6.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,514.67 |
$1,893.33 |
6.1× |
| Neck soft tissue (70360) |
$228.23 |
$285.29 |
2.5× |
| Nm gastric emptying study (78264) |
$1,128 |
$1,410 |
2.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$301.85 |
$377.31 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$209.60 |
$262 |
1.9× |
| PET image w/CT, skull-thigh (78815) |
$5,320.84 |
$6,651.04 |
3.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,549.17 |
$3,186.46 |
7.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$208.80 |
$261 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$415.20 |
$519 |
3.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$582.40 |
$728 |
5.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$263.20 |
$329 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$199.48 |
$249.36 |
2.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$232.76 |
$290.95 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$328.80 |
$411 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$232.80 |
$291 |
2.6× |
| Ribs bilateral 3 views (71110) |
$261.60 |
$327 |
2.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,360 |
$1,700 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$265.87 |
$332.33 |
2.4× |
| Scanogram (77073) |
$458.40 |
$573 |
4.2× |
| Scapula complete (73010) |
$202.40 |
$253 |
1.9× |
| Screening digital breast tomosynthesis (77063) |
$84.30 |
$105.37 |
3.6× |
| Spine thoracic 3 views (72072) |
$316.32 |
$395.40 |
2.9× |
| Thoracolumbar 2 views (72080) |
$222.40 |
$278 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$463.55 |
$579.43 |
4.3× |
| Us abdl aorta screen aaa (76706) |
$449.60 |
$562 |
4.1× |
| Us breast unilateral complete (76641) |
$308 |
$385 |
2.8× |
| Us breast unilateral limited (76642) |
$248.80 |
$311 |
2.8× |
| Us chest (76604) |
$370.40 |
$463 |
3.4× |
| Us ob transvaginal (76817) |
$412.12 |
$515.15 |
3.8× |
| Us pelvic non ob complete (76856) |
$543.10 |
$678.87 |
5.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$219.60 |
$274.50 |
2.0× |
| Us pregnancy ltd (76815) |
$336.53 |
$420.67 |
3.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$613.30 |
$766.62 |
5.6× |
| Us retroperitoneal complete (76770) |
$569.99 |
$712.48 |
5.3× |
| Us retroperitoneal limited (76775) |
$445.60 |
$557 |
4.1× |
| Us scrotum and contents (76870) |
$443.98 |
$554.98 |
4.1× |
| Us soft tissue head/neck (76536) |
$450.32 |
$562.89 |
4.1× |
| Us xtr non-vasc lmtd (76882) |
$336.76 |
$420.95 |
3.1× |
| Wrist 2 views (73100) |
$178.67 |
$223.33 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$331.20 |
$414 |
3.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$188.37 |
$235.47 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$207.11 |
$258.89 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$257.48 |
$321.85 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$219.20 |
$274 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$284.80 |
$356 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$450.40 |
$563 |
4.1× |
| X-ray eye for foreign body (70030) |
$188 |
$235 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$258.40 |
$323 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$222.40 |
$278 |
2.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$199.20 |
$249 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$213.67 |
$267.09 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$186.29 |
$232.86 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$292.06 |
$365.07 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$321.60 |
$402 |
3.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$226.93 |
$283.67 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$216 |
$270 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$405.60 |
$507 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$228.31 |
$285.39 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$278.22 |
$347.77 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$370.08 |
$462.60 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$297.90 |
$372.38 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$203.52 |
$254.40 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$240.73 |
$300.92 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$271.20 |
$339 |
3.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$201.60 |
$252 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$178.40 |
$223 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$210.40 |
$263 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$237.34 |
$296.67 |
2.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$161.80 |
$202.25 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$213.26 |
$266.58 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$409.20 |
$511.50 |
3.8× |
| Xr finger(s) 2+ views (73140) |
$160 |
$200 |
1.8× |
| Xr shoulder 1 view (73020) |
$166.96 |
$208.71 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$334.80 |
$418.50 |
3.1× |
| Xr tibia/fibula 2 views (73590) |
$128.18 |
$160.22 |
1.4× |
| Xr tmj bilateral (70330) |
$303.60 |
$379.50 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$196.02 |
$245.03 |
2.2× |