| Abdomen 2 views (74019) |
$384.60 |
$641 |
3.7× |
| Ankle 2 views (73600) |
$306.60 |
$511 |
3.5× |
| Arthrogram elbow (73085) |
$476.40 |
$794 |
1.4× |
| Arthrogram shoulder (73040) |
$590.40 |
$984 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$597.60 |
$996 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,732.80 |
$2,888 |
4.3× |
| Bone age studies (77072) |
$183.60 |
$306 |
1.8× |
| Bone Imaging 3 Phase (78315) |
$2,075.40 |
$3,459 |
5.2× |
| Bone survey complete (77075) |
$588.60 |
$981 |
5.6× |
| Cervical spine 2 or 3 views (72040) |
$373.80 |
$623 |
4.3× |
| Chest 1 view (71045) |
$141.60 |
$236 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$376.80 |
$628 |
2.1× |
| Clavicle complete (73000) |
$315.60 |
$526 |
3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$945 |
$1,575 |
9.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,631.20 |
$6,052 |
10.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,948.20 |
$3,247 |
8.2× |
| CT abdomen w contrast (74160) |
$1,084.80 |
$1,808 |
6.2× |
| CT abdomen w wo contrast (74170) |
$1,577.40 |
$2,629 |
9.0× |
| CT abdomen w/o contrast (74150) |
$903 |
$1,505 |
8.6× |
| CT angio hrt w/3d image (75574) |
$1,737.60 |
$2,896 |
5.0× |
| CT angiography upper extremity lt (73206) |
$1,332.60 |
$2,221 |
7.6× |
| CT c-spine w/o contrast (72125) |
$1,010.40 |
$1,684 |
9.6× |
| CT cervical spine with contrast (72126) |
$1,326.60 |
$2,211 |
3.8× |
| CT chest w/wo contrast (71270) |
$1,339.80 |
$2,233 |
7.6× |
| CT chest with contrast (71260) |
$1,272 |
$2,120 |
7.2× |
| CT head/brain with contrast (70460) |
$1,210.20 |
$2,017 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,390.20 |
$2,317 |
7.9× |
| CT heart no contrast quant eval coronry calcium (75571) |
$140 |
$170 |
1.6× |
| CT iac w contrast (70481) |
$1,375.80 |
$2,293 |
7.8× |
| CT limited/localized follow up study (76380) |
$362.40 |
$604 |
4.2× |
| CT lower ext w/o (73700) |
$804 |
$1,340 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$1,239.60 |
$2,066 |
7.1× |
| CT lower extremity with contrast (73701) |
$915.60 |
$1,526 |
5.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,390.20 |
$2,317 |
7.9× |
| CT lumbar spine w/o contrast (72131) |
$853.80 |
$1,423 |
8.2× |
| CT lumbar spine with contrast (72132) |
$1,246.20 |
$2,077 |
3.6× |
| CT maxillofacial w contrast (70487) |
$1,150.80 |
$1,918 |
6.6× |
| CT maxillofacial w/o contrast (70486) |
$1,017.60 |
$1,696 |
9.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,232.40 |
$2,054 |
7.0× |
| CT neck soft tissue w contrast (70491) |
$1,218.60 |
$2,031 |
6.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,870.20 |
$3,117 |
10.6× |
| CT orbits w/o contrast (70480) |
$1,125 |
$1,875 |
10.7× |
| CT pelvis w & w/o contrast (72194) |
$1,378.80 |
$2,298 |
7.8× |
| CT pelvis w/o contrast (72192) |
$720 |
$1,200 |
6.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,587.60 |
$2,646 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$784.20 |
$1,307 |
7.5× |
| CT thoracic spine w/contrast (72129) |
$1,021.20 |
$1,702 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$893.40 |
$1,489 |
8.5× |
| CT thorax w/o contrast (71250) |
$895.20 |
$1,492 |
8.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,211.40 |
$2,019 |
6.9× |
| CT upper extremity w/o contrast rt (73200) |
$895.20 |
$1,492 |
8.5× |
| CT upper extremity with contrast (73201) |
$1,015.80 |
$1,693 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,222.80 |
$2,038 |
7.0× |
| Cta Abdomen (74175) |
$1,735.20 |
$2,892 |
9.9× |
| CTA abdomen pelvis (74174) |
$3,994.20 |
$6,657 |
11.4× |
| CTA chest (71275) |
$1,473.60 |
$2,456 |
8.4× |
| Cta Head (70496) |
$1,529.40 |
$2,549 |
8.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,363.80 |
$2,273 |
7.8× |
| Cta Neck (70498) |
$1,746.60 |
$2,911 |
9.9× |
| Cta Pelvis (72191) |
$1,516.80 |
$2,528 |
8.6× |
| Cystography minimum 3 views rs&i (74430) |
$417 |
$695 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$369 |
$615 |
3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$165.60 |
$276 |
1.9× |
| Dxa bone density study axial skeleton (77085) |
$171 |
$285 |
1.6× |
| Esophagus (74220) |
$550.80 |
$918 |
3.1× |
| Fetal biophysical profile non-stress testing (76818) |
$599.40 |
$999 |
5.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$630 |
$1,050 |
6.0× |
| Fluoroscopy up to 1 hr (76000) |
$288.60 |
$481 |
1.2× |
| Foot 2 views (73620) |
$323.40 |
$539 |
3.7× |
| Forearm 2 views (73090) |
$313.20 |
$522 |
3.6× |
| Gated Heart Planar Single (78472) |
$1,904.40 |
$3,174 |
4.8× |
| Hand 2 views (73120) |
$303 |
$505 |
2.9× |
| Hand 3 views (73130) |
$339.60 |
$566 |
3.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,975.20 |
$3,292 |
3.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,810.80 |
$3,018 |
4.5× |
| Humerus Min 2 Views Left (73060) |
$264 |
$440 |
3.0× |
| Hysterosalpingogram (74740) |
$472.80 |
$788 |
2.0× |
| Knee 3 views (73562) |
$400.20 |
$667 |
4.6× |
| Liver & spleen imaging static only (78215) |
$465.60 |
$776 |
1.2× |
| Mr elastography (76391) |
$1,713 |
$2,855 |
7.2× |
| MRA head w & w/o contrast (70546) |
$3,026.40 |
$5,044 |
8.7× |
| MRA head w/o contrast (70544) |
$2,176.80 |
$3,628 |
9.1× |
| MRA head with contrast (70545) |
$2,341.80 |
$3,903 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,622 |
$4,370 |
7.5× |
| MRA neck w/o contrast (70547) |
$1,366.80 |
$2,278 |
5.7× |
| MRI abdomen w contrast (74182) |
$1,670.40 |
$2,784 |
4.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,789.40 |
$4,649 |
8.0× |
| MRI abdomen w/o contrast (74181) |
$1,444.80 |
$2,408 |
6.0× |
| MRI any jnt lwr ext with con lt (73722) |
$2,236.20 |
$3,727 |
2.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,755.80 |
$4,593 |
3.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,488 |
$2,480 |
6.2× |
| MRI cervical spine w/o contrast (72141) |
$2,549.40 |
$4,249 |
10.7× |
| MRI chest w/o & w/contrast material (71552) |
$2,034.60 |
$3,391 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,371.60 |
$2,286 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,509.60 |
$2,516 |
6.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,481.40 |
$2,469 |
6.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,128.40 |
$5,214 |
9.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,912.80 |
$3,188 |
5.5× |
| MRI pelvis w/o contrast (72195) |
$1,398.60 |
$2,331 |
5.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,920.80 |
$4,868 |
8.4× |
| MRI scan of leg joint before and after contrast (73723) |
$2,328 |
$3,880 |
6.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,810.40 |
$4,684 |
8.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,909.40 |
$4,849 |
8.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,618.80 |
$2,698 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,699.80 |
$2,833 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,305.60 |
$2,176 |
5.5× |
| MRI tmj (70336) |
$1,263.60 |
$2,106 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$2,478.60 |
$4,131 |
10.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,858.40 |
$4,764 |
8.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,064 |
$3,440 |
8.6× |
| Myocardial Spect Multiple Studies (78452) |
$4,739.40 |
$7,899 |
3.7× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$3,201 |
$5,335 |
3.7× |
| Neck soft tissue (70360) |
$269.40 |
$449 |
3.1× |
| Nm gastric emptying study (78264) |
$1,717.20 |
$2,862 |
4.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$532.20 |
$887 |
5.1× |
| Osseous survey infant (77076) |
$247.80 |
$413 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$244.80 |
$408 |
2.3× |
| PET image w/CT, skull-thigh (78815) |
$3,396.60 |
$5,661 |
2.4× |
| PET imaging for CT attenuation whole body (78816) |
$4,395.60 |
$7,326 |
3.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,866 |
$3,110 |
5.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$679.20 |
$1,132 |
1.7× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,231.20 |
$2,052 |
2.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$630 |
$1,050 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$478.80 |
$798 |
5.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$502.20 |
$837 |
4.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$449.40 |
$749 |
4.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$621 |
$1,035 |
5.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$421.20 |
$702 |
4.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$306.60 |
$511 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$444 |
$740 |
4.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$330.60 |
$551 |
3.8× |
| Radiologic exam colon single contrast study (74270) |
$422.40 |
$704 |
2.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$608.40 |
$1,014 |
3.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$835.80 |
$1,393 |
4.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$732.60 |
$1,221 |
4.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$291 |
$485 |
3.3× |
| Ribs bilateral 3 views (71110) |
$463.20 |
$772 |
4.4× |
| Sacroiliac Joints < 3 Views (72200) |
$247.80 |
$413 |
2.4× |
| Scanogram (77073) |
$360.60 |
$601 |
3.4× |
| Scapula complete (73010) |
$276 |
$460 |
2.6× |
| Screening digital breast tomosynthesis (77063) |
$30 |
$50 |
1.3× |
| Small bowel series (74250) |
$358.20 |
$597 |
2.0× |
| Speech evaluation complex (70371) |
$630 |
$1,050 |
2.6× |
| Spine thoracic 3 views (72072) |
$436.80 |
$728 |
4.2× |
| Thoracolumbar 2 views (72080) |
$300 |
$500 |
3.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$462 |
$770 |
1.2× |
| Tmj unilateral (70328) |
$115.80 |
$193 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$852 |
$1,420 |
8.1× |
| Upper Extremity Infant (73092) |
$355.20 |
$592 |
3.4× |
| Us abdl aorta screen aaa (76706) |
$209.40 |
$349 |
2.0× |
| Us breast unilateral complete (76641) |
$1,085.40 |
$1,809 |
10.4× |
| Us breast unilateral limited (76642) |
$538.20 |
$897 |
6.2× |
| Us chest (76604) |
$583.80 |
$973 |
5.6× |
| Us compl joint r-t w/image documentation (76881) |
$577.80 |
$963 |
5.5× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$397.20 |
$662 |
3.8× |
| Us ob transvaginal (76817) |
$633.60 |
$1,056 |
6.1× |
| Us pelvic non ob complete (76856) |
$859.20 |
$1,432 |
8.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$518.40 |
$864 |
5.0× |
| Us pregnancy ltd (76815) |
$450.60 |
$751 |
4.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$703.20 |
$1,172 |
6.7× |
| Us retroperitoneal complete (76770) |
$854.40 |
$1,424 |
8.2× |
| Us retroperitoneal limited (76775) |
$506.40 |
$844 |
4.8× |
| Us scrotum and contents (76870) |
$795.60 |
$1,326 |
7.6× |
| Us soft tissue head/neck (76536) |
$733.20 |
$1,222 |
7.0× |
| Us xtr non-vasc lmtd (76882) |
$528 |
$880 |
5.0× |
| Wrist 2 views (73100) |
$306.60 |
$511 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$472.80 |
$788 |
4.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$220.20 |
$367 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$388.20 |
$647 |
4.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$618 |
$1,030 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$235.80 |
$393 |
2.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$339.60 |
$566 |
3.9× |
| X-ray exam hip uni 1 view (73501) |
$156.60 |
$261 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$340.80 |
$568 |
3.9× |
| X-ray exam hip uni 4/> views (73503) |
$436.20 |
$727 |
4.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$471.60 |
$786 |
4.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$535.20 |
$892 |
5.1× |
| X-ray exam of femur 1 (73551) |
$150 |
$250 |
1.7× |
| X-ray eye for foreign body (70030) |
$214.80 |
$358 |
2.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$424.80 |
$708 |
4.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$261 |
$435 |
3.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$357 |
$595 |
4.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$249.60 |
$416 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$115.80 |
$193 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$447 |
$745 |
4.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$296.40 |
$494 |
3.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$202.20 |
$337 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$403.80 |
$673 |
3.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$654.60 |
$1,091 |
6.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$354 |
$590 |
3.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$281.40 |
$469 |
3.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$189.60 |
$316 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$376.20 |
$627 |
3.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$359.40 |
$599 |
3.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$339 |
$565 |
3.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$361.20 |
$602 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$601.20 |
$1,002 |
5.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$398.40 |
$664 |
3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$376.20 |
$627 |
4.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$372 |
$620 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$408.60 |
$681 |
4.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$330.60 |
$551 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$257.40 |
$429 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$189 |
$315 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$244.80 |
$408 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$243 |
$405 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$363 |
$605 |
3.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$261.60 |
$436 |
3.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$326.40 |
$544 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$654 |
$1,090 |
6.2× |
| Xr chest 4+ views (71048) |
$364.80 |
$608 |
3.5× |
| Xr finger(s) 2+ views (73140) |
$243 |
$405 |
2.8× |
| Xr shoulder 1 view (73020) |
$159 |
$265 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$546 |
$910 |
5.2× |
| Xr tibia/fibula 2 views (73590) |
$257.40 |
$429 |
3.0× |
| Xr tmj bilateral (70330) |
$280.20 |
$467 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$324.60 |
$541 |
3.7× |