| Abdomen 2 views (74019) |
$30.60 |
$45 |
0.3× |
| Ankle 2 views (73600) |
$88.40 |
$130 |
1.1× |
| Arthrogram hip (73525) |
$323 |
$475 |
1.0× |
| Arthrogram shoulder (73040) |
$255 |
$375 |
0.8× |
| Arthrogram wrist (73115) |
$238 |
$350 |
0.7× |
| Bone &/joint imaging whole body (78306) |
$812.60 |
$1,195 |
2.1× |
| Bone age studies (77072) |
$91.80 |
$135 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$880.60 |
$1,295 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$146.20 |
$215 |
1.8× |
| Chest 1 view (71045) |
$105.40 |
$155 |
1.3× |
| Chest 3 views (71047) |
$153 |
$225 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$258.40 |
$380 |
1.5× |
| Clavicle complete (73000) |
$88.40 |
$130 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$476 |
$700 |
4.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,006 |
$2,950 |
6.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,870 |
$2,750 |
8.2× |
| CT abdomen w contrast (74160) |
$1,020 |
$1,500 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,088 |
$1,600 |
6.5× |
| CT abdomen w/o contrast (74150) |
$952 |
$1,400 |
9.5× |
| CT angiography upper extremity lt (73206) |
$1,300.50 |
$1,912.50 |
7.8× |
| CT c-spine w/o contrast (72125) |
$1,020 |
$1,500 |
10.2× |
| CT chest with contrast (71260) |
$1,020 |
$1,500 |
6.1× |
| CT head/brain without and with contrast (70470) |
$935 |
$1,375 |
5.6× |
| CT iac w contrast (70481) |
$935 |
$1,375 |
5.6× |
| CT lower ext w/o (73700) |
$799 |
$1,175 |
8.0× |
| CT lower extremity w wo contrast (73702) |
$935 |
$1,375 |
5.6× |
| CT lower extremity with contrast (73701) |
$867 |
$1,275 |
5.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,088 |
$1,600 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$952 |
$1,400 |
9.5× |
| CT maxillofacial w contrast (70487) |
$935 |
$1,375 |
5.6× |
| CT maxillofacial w/o contrast (70486) |
$867 |
$1,275 |
8.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,003 |
$1,475 |
6.0× |
| CT neck soft tissue w contrast (70491) |
$935 |
$1,375 |
5.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,003 |
$1,475 |
6.0× |
| CT orbits w/o contrast (70480) |
$867 |
$1,275 |
8.7× |
| CT pelvis w & w/o contrast (72194) |
$1,054 |
$1,550 |
6.3× |
| CT pelvis w/o contrast (72192) |
$918 |
$1,350 |
9.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,003 |
$1,475 |
6.0× |
| CT soft tissue neck w/o contrast (70490) |
$867 |
$1,275 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$952 |
$1,400 |
9.5× |
| CT thorax w/o contrast (71250) |
$952 |
$1,400 |
9.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$935 |
$1,375 |
5.6× |
| CT upper extremity w/o contrast rt (73200) |
$799 |
$1,175 |
8.0× |
| CT upper extremity with contrast (73201) |
$867 |
$1,275 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,122 |
$1,650 |
6.7× |
| Cta Abdomen (74175) |
$1,122 |
$1,650 |
6.7× |
| CTA abdomen pelvis (74174) |
$2,210 |
$3,250 |
6.6× |
| CTA chest (71275) |
$1,292 |
$1,900 |
7.7× |
| Cta Head (70496) |
$1,071 |
$1,575 |
6.4× |
| Cta Neck (70498) |
$1,071 |
$1,575 |
6.4× |
| Cta Pelvis (72191) |
$1,088 |
$1,600 |
6.5× |
| Cystography minimum 3 views rs&i (74430) |
$295.80 |
$435 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$141.10 |
$207.50 |
1.4× |
| Echoencephalography real time imaging (76506) |
$261.80 |
$385 |
2.6× |
| Esophagus (74220) |
$231.20 |
$340 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$170 |
$250 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$141.78 |
$208.50 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$149.60 |
$220 |
0.7× |
| Foot 2 views (73620) |
$88.40 |
$130 |
1.1× |
| Forearm 2 views (73090) |
$63.58 |
$93.50 |
0.8× |
| Hand 2 views (73120) |
$88.40 |
$130 |
0.9× |
| Hand 3 views (73130) |
$95.20 |
$140 |
1.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$714 |
$1,050 |
1.4× |
| Ht muscle image spect sing (78451) |
$1,173 |
$1,725 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$122.40 |
$180 |
1.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$765 |
$1,125 |
1.5× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$867 |
$1,275 |
1.7× |
| Knee 3 views (73562) |
$119 |
$175 |
1.4× |
| Meckels Diverticulum (78290) |
$731 |
$1,075 |
1.9× |
| MRA head w/o contrast (70544) |
$1,360 |
$2,000 |
6.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,496 |
$2,200 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,360 |
$2,000 |
6.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,564 |
$2,300 |
4.7× |
| MRI abdomen w/o contrast (74181) |
$1,428 |
$2,100 |
6.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,428 |
$2,100 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,870 |
$2,750 |
2.5× |
| MRI breast w/o contrast bilateral (77047) |
$1,139 |
$1,675 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$1,496 |
$2,200 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,632 |
$2,400 |
4.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,428 |
$2,100 |
6.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,564 |
$2,300 |
6.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,700 |
$2,500 |
5.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,632 |
$2,400 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,496 |
$2,200 |
6.6× |
| MRI scan of arm joint before and after contrast (73223) |
$1,564 |
$2,300 |
4.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,496 |
$2,200 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,632 |
$2,400 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,564 |
$2,300 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,632 |
$2,400 |
4.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,632 |
$2,400 |
4.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,496 |
$2,200 |
6.6× |
| MRI tmj (70336) |
$1,360 |
$2,000 |
6.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,428 |
$2,100 |
6.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,564 |
$2,300 |
4.7× |
| Myocardial Spect Multiple Studies (78452) |
$1,343 |
$1,975 |
1.1× |
| Neck soft tissue (70360) |
$125.80 |
$185 |
1.5× |
| Nm gastric emptying study (78264) |
$799 |
$1,175 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$86.36 |
$127 |
0.9× |
| Osseous survey infant (77076) |
$200.60 |
$295 |
2.0× |
| Osseous survey limited (77074) |
$241.40 |
$355 |
2.4× |
| Parathyroid imaging (78070) |
$540.60 |
$795 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$132.60 |
$195 |
1.3× |
| PET image w/CT, skull-thigh (78815) |
$2,023 |
$2,975 |
1.5× |
| PET imaging for CT attenuation whole body (78816) |
$2,023 |
$2,975 |
1.5× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,564 |
$2,300 |
4.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$578 |
$850 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$83.64 |
$123 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$217.60 |
$320 |
2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$102 |
$150 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$112.20 |
$165 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$166.60 |
$245 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$135.32 |
$199 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$346.80 |
$510 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$309.40 |
$455 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$115.60 |
$170 |
1.4× |
| Radiological examination surgical specimen (76098) |
$272 |
$400 |
0.5× |
| Sacroiliac Joints < 3 Views (72200) |
$102 |
$150 |
1.0× |
| Scapula complete (73010) |
$108.80 |
$160 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$40.80 |
$60 |
1.7× |
| Small bowel series (74250) |
$272 |
$400 |
1.6× |
| Spine thoracic 3 views (72072) |
$156.40 |
$230 |
1.6× |
| Thoracolumbar 2 views (72080) |
$234.60 |
$345 |
2.8× |
| Thyroid uptake measurement (78012) |
$540.60 |
$795 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$340 |
$500 |
3.4× |
| Umbilical-artery Doppler (OB) (76820) |
$86.36 |
$127 |
0.9× |
| Upper Extremity Infant (73092) |
$135.32 |
$199 |
1.4× |
| Urethrocystography retrograde rs&i (74450) |
$275.40 |
$405 |
1.2× |
| Us abdl aorta screen aaa (76706) |
$329.80 |
$485 |
3.3× |
| Us breast unilateral complete (76641) |
$224.40 |
$330 |
2.2× |
| Us breast unilateral limited (76642) |
$224.40 |
$330 |
2.7× |
| Us chest (76604) |
$292.40 |
$430 |
2.9× |
| Us compl joint r-t w/image documentation (76881) |
$289 |
$425 |
2.9× |
| Us infant hips dynamic (76885) |
$268.60 |
$395 |
3.2× |
| Us ob detailed single fetus (76811) |
$178.16 |
$262 |
0.8× |
| Us ob transvaginal (76817) |
$141.44 |
$208 |
1.4× |
| Us pelvic non ob complete (76856) |
$179.52 |
$264 |
1.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$275.40 |
$405 |
2.8× |
| Us pregnancy ltd (76815) |
$178.16 |
$262 |
1.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$126.48 |
$186 |
1.3× |
| Us retroperitoneal complete (76770) |
$167.96 |
$247 |
1.7× |
| Us retroperitoneal limited (76775) |
$329.80 |
$485 |
3.3× |
| Us scrotum and contents (76870) |
$336.60 |
$495 |
3.4× |
| Us soft tissue head/neck (76536) |
$333.20 |
$490 |
3.3× |
| Us spinal canal and contents (76800) |
$268.60 |
$395 |
2.7× |
| Us transrectal (76872) |
$123.76 |
$182 |
1.2× |
| Wrist 2 views (73100) |
$88.40 |
$130 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$217.60 |
$320 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$98.60 |
$145 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$374 |
$550 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$97.92 |
$144 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$95.20 |
$140 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$134.64 |
$198 |
1.6× |
| X-ray eye for foreign body (70030) |
$81.60 |
$120 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$163.20 |
$240 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$100.30 |
$147.50 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$95.20 |
$140 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$91.80 |
$135 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$132.60 |
$195 |
1.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$132.60 |
$195 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$98.60 |
$145 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$110.50 |
$162.50 |
1.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$95.20 |
$140 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$144.50 |
$212.50 |
1.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$42.84 |
$63 |
0.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$329.80 |
$485 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$135.32 |
$199 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$197.20 |
$290 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$162.86 |
$239.50 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$93.16 |
$137 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$125.80 |
$185 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$95.20 |
$140 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$176.80 |
$260 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$163.20 |
$240 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$132.60 |
$195 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$102 |
$150 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$132.60 |
$195 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$81.60 |
$120 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$98.60 |
$145 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$108.46 |
$159.50 |
1.1× |
| Xr chest 4+ views (71048) |
$200.60 |
$295 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$81.60 |
$120 |
1.0× |
| Xr shoulder 1 view (73020) |
$85 |
$125 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$115.60 |
$170 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$95.20 |
$140 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$98.60 |
$145 |
1.2× |