| Abdomen 2 views (74019) |
$320.80 |
$401 |
3.2× |
| Ankle 2 views (73600) |
$178.40 |
$223 |
2.1× |
| Bone survey complete (77075) |
$320.80 |
$401 |
3.2× |
| Cervical spine 2 or 3 views (72040) |
$178.40 |
$223 |
2.1× |
| Chest 1 view (71045) |
$157.60 |
$197 |
1.9× |
| Clavicle complete (73000) |
$178.40 |
$223 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$941.51 |
$1,176.89 |
9.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,480 |
$1,850 |
4.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,280 |
$1,600 |
5.6× |
| CT abdomen w contrast (74160) |
$1,300 |
$1,625 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,400 |
$1,750 |
8.3× |
| CT abdomen w/o contrast (74150) |
$1,200 |
$1,500 |
11.9× |
| CT angio hrt w/3d image (75574) |
$1,160 |
$1,450 |
3.5× |
| CT c-spine w/o contrast (72125) |
$911.20 |
$1,139 |
9.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,240 |
$1,550 |
7.4× |
| CT cervical spine with contrast (72126) |
$1,099.20 |
$1,374 |
3.3× |
| CT chest w/wo contrast (71270) |
$1,200 |
$1,500 |
7.1× |
| CT chest with contrast (71260) |
$1,096 |
$1,370 |
6.5× |
| CT head/brain with contrast (70460) |
$576 |
$720 |
3.4× |
| CT head/brain without and with contrast (70470) |
$644 |
$805 |
3.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,026.40 |
$1,283 |
12.3× |
| CT lower ext w/o (73700) |
$1,096 |
$1,370 |
10.9× |
| CT lower extremity w wo contrast (73702) |
$1,432 |
$1,790 |
8.5× |
| CT lower extremity with contrast (73701) |
$1,216 |
$1,520 |
7.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,240 |
$1,550 |
7.4× |
| CT lumbar spine w/o contrast (72131) |
$911.20 |
$1,139 |
9.1× |
| CT lumbar spine with contrast (72132) |
$1,099.20 |
$1,374 |
3.3× |
| CT maxillofacial w contrast (70487) |
$1,096 |
$1,370 |
6.5× |
| CT maxillofacial w/o contrast (70486) |
$969.60 |
$1,212 |
9.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,188 |
$1,485 |
7.0× |
| CT neck soft tissue w contrast (70491) |
$1,096 |
$1,370 |
6.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,212 |
$1,515 |
7.2× |
| CT orbits w/o contrast (70480) |
$1,008 |
$1,260 |
10.0× |
| CT pelvis w & w/o contrast (72194) |
$1,346.40 |
$1,683 |
8.0× |
| CT pelvis w/o contrast (72192) |
$1,191.20 |
$1,489 |
11.8× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$442.40 |
$553 |
5.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,200 |
$1,500 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$969.60 |
$1,212 |
9.6× |
| CT thoracic spine w/contrast (72129) |
$1,099.20 |
$1,374 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$911.20 |
$1,139 |
9.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,240 |
$1,550 |
7.4× |
| CT thorax w/o contrast (71250) |
$969.60 |
$1,212 |
9.6× |
| CT upper extremity w/o contrast rt (73200) |
$969.60 |
$1,212 |
9.6× |
| CT upper extremity with contrast (73201) |
$1,099.20 |
$1,374 |
3.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,479.20 |
$1,849 |
8.8× |
| Cta Abdomen (74175) |
$1,340 |
$1,675 |
7.9× |
| CTA abdomen pelvis (74174) |
$1,380 |
$1,725 |
4.1× |
| CTA chest (71275) |
$1,479.20 |
$1,849 |
8.8× |
| Cta Head (70496) |
$919.20 |
$1,149 |
5.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$865.60 |
$1,082 |
2.6× |
| Cta Neck (70498) |
$1,096 |
$1,370 |
6.5× |
| Fluoroscopy up to 1 hr (76000) |
$657.60 |
$822 |
2.9× |
| Foot 2 views (73620) |
$178.40 |
$223 |
2.1× |
| Forearm 2 views (73090) |
$178.40 |
$223 |
2.1× |
| Hand 2 views (73120) |
$284 |
$355 |
2.8× |
| Hand 3 views (73130) |
$300 |
$375 |
3.6× |
| Humerus Min 2 Views Left (73060) |
$178.40 |
$223 |
2.1× |
| Knee 3 views (73562) |
$210.40 |
$263 |
2.5× |
| MRA head w/o contrast (70544) |
$1,177.60 |
$1,472 |
5.1× |
| MRA head with contrast (70545) |
$2,024 |
$2,530 |
6.0× |
| MRA neck w contrast (70548) |
$2,084 |
$2,605 |
6.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,355.20 |
$2,944 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,758.40 |
$3,448 |
8.2× |
| MRI abdomen w/o contrast (74181) |
$1,379.20 |
$1,724 |
6.0× |
| MRI cervical spine w/o contrast (72141) |
$1,041.60 |
$1,302 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,156 |
$1,445 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,156 |
$1,445 |
5.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,312.80 |
$2,891 |
6.9× |
| MRI orbit/face/neck w/contrast (70542) |
$2,046.40 |
$2,558 |
6.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,312.80 |
$2,891 |
6.9× |
| MRI pelvis w/o contrast (72195) |
$1,156 |
$1,445 |
5.0× |
| MRI scan of leg joint before and after contrast (73723) |
$1,880 |
$2,350 |
5.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,276 |
$1,595 |
3.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,276 |
$1,595 |
3.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,276 |
$1,595 |
3.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,041.60 |
$1,302 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,175.20 |
$1,469 |
5.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,156 |
$1,445 |
5.0× |
| N-Invas Est C Ffr Augmnt Sw Alys Cta I&R Phy/Qhp (75580) |
$413.60 |
$517 |
0.5× |
| Neck soft tissue (70360) |
$178.40 |
$223 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$284 |
$355 |
2.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,080 |
$2,600 |
6.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$178.40 |
$223 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$178.40 |
$223 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$178.40 |
$223 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$178.40 |
$223 |
2.1× |
| Ribs bilateral 3 views (71110) |
$284 |
$355 |
2.8× |
| Scapula complete (73010) |
$320.80 |
$401 |
3.2× |
| Spine thoracic 3 views (72072) |
$320.80 |
$401 |
3.2× |
| Thoracolumbar 2 views (72080) |
$178.40 |
$223 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$435.20 |
$544 |
4.3× |
| Us abdl aorta screen aaa (76706) |
$492 |
$615 |
4.9× |
| Us chest (76604) |
$492 |
$615 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$492 |
$615 |
4.9× |
| Us ob transvaginal (76817) |
$521.60 |
$652 |
5.2× |
| Us pelvic non ob complete (76856) |
$492 |
$615 |
4.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$435.20 |
$544 |
4.3× |
| Us pregnancy ltd (76815) |
$461.60 |
$577 |
4.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$461.60 |
$577 |
4.6× |
| Us retroperitoneal complete (76770) |
$492 |
$615 |
4.9× |
| Us retroperitoneal limited (76775) |
$435.20 |
$544 |
4.3× |
| Us scrotum and contents (76870) |
$492 |
$615 |
4.9× |
| Us soft tissue head/neck (76536) |
$492 |
$615 |
4.9× |
| Us xtr non-vasc lmtd (76882) |
$435.20 |
$544 |
4.3× |
| Wrist 2 views (73100) |
$157.60 |
$197 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$320.80 |
$401 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$157.60 |
$197 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$178.40 |
$223 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$157.60 |
$197 |
1.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$178.40 |
$223 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$178.40 |
$223 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$212 |
$265 |
2.5× |
| X-ray exam hip uni 4/> views (73503) |
$284 |
$355 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$392 |
$490 |
3.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$400 |
$500 |
4.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$320.80 |
$401 |
3.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$178.40 |
$223 |
2.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$228 |
$285 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$178.40 |
$223 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$320.80 |
$401 |
3.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$178.40 |
$223 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$284 |
$355 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$340 |
$425 |
3.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$86.40 |
$108 |
0.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$178.40 |
$223 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$320.80 |
$401 |
3.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$320.80 |
$401 |
3.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$178.40 |
$223 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$284 |
$355 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$320.80 |
$401 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$320.80 |
$401 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$178.40 |
$223 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$178.40 |
$223 |
2.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$284 |
$355 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$157.60 |
$197 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$157.60 |
$197 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$284 |
$355 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$178.40 |
$223 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$178.40 |
$223 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$320.80 |
$401 |
3.2× |
| Xr finger(s) 2+ views (73140) |
$178.40 |
$223 |
2.1× |
| Xr shoulder 1 view (73020) |
$157.60 |
$197 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$320.80 |
$401 |
3.2× |
| Xr tibia/fibula 2 views (73590) |
$178.40 |
$223 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$178.40 |
$223 |
2.1× |