| Abdomen 2 views (74019) |
$123.75 |
$165 |
1.4× |
| Acute gastrointestinal blood loss imaging (78278) |
$328.12 |
$437.50 |
1.0× |
| Angiography extremity bilateral rs&i (75716) |
$4,050 |
$5,400 |
1.5× |
| Angiography extremity unilateral rs&i (75710) |
$4,050 |
$5,400 |
1.5× |
| Ankle 2 views (73600) |
$121.88 |
$162.50 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$328.12 |
$437.50 |
1.0× |
| Bone age studies (77072) |
$97.50 |
$130 |
1.1× |
| Brain image w/flow 4 + views (78606) |
$320.62 |
$427.50 |
0.7× |
| Brain Imaging Minimum 4 Static Views (78605) |
$270 |
$360 |
0.6× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,040.62 |
$1,387.50 |
3.5× |
| Cervical spine 2 or 3 views (72040) |
$112.50 |
$150 |
1.5× |
| Chest 1 view (71045) |
$82.12 |
$109.50 |
1.1× |
| Chest 3 views (71047) |
$86.25 |
$115 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$165 |
$220 |
1.1× |
| Clavicle complete (73000) |
$82.50 |
$110 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,265.62 |
$1,687.50 |
4.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,022.25 |
$1,363 |
5.0× |
| CT abdomen w contrast (74160) |
$616.88 |
$822.50 |
4.1× |
| CT abdomen w wo contrast (74170) |
$682.50 |
$910 |
4.5× |
| CT abdomen w/o contrast (74150) |
$572.25 |
$763 |
6.3× |
| CT angiography upper extremity lt (73206) |
$93.75 |
$125 |
0.6× |
| CT c-spine w/o contrast (72125) |
$384.75 |
$513 |
4.3× |
| CT cervical spine w&w/o contrast (72127) |
$570 |
$760 |
3.8× |
| CT cervical spine with contrast (72126) |
$466.88 |
$622.50 |
1.6× |
| CT chest w/wo contrast (71270) |
$682.50 |
$910 |
4.5× |
| CT chest with contrast (71260) |
$598.12 |
$797.50 |
4.0× |
| CT head/brain with contrast (70460) |
$497.25 |
$663 |
3.3× |
| CT head/brain without and with contrast (70470) |
$682.50 |
$910 |
4.5× |
| CT iac w contrast (70481) |
$438.75 |
$585 |
2.9× |
| CT lower ext w/o (73700) |
$534.75 |
$713 |
5.9× |
| CT lower extremity w wo contrast (73702) |
$429.38 |
$572.50 |
2.8× |
| CT lower extremity with contrast (73701) |
$343.12 |
$457.50 |
2.3× |
| CT lumbar spine w & w/o contrast (72133) |
$448.12 |
$597.50 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$366 |
$488 |
4.1× |
| CT lumbar spine with contrast (72132) |
$466.88 |
$622.50 |
1.6× |
| CT maxillofacial w contrast (70487) |
$463.50 |
$618 |
3.1× |
| CT maxillofacial w/o contrast (70486) |
$322.88 |
$430.50 |
3.6× |
| CT maxillofacial w/wo contrast (70488) |
$570 |
$760 |
3.8× |
| CT neck soft tissue w contrast (70491) |
$348.75 |
$465 |
2.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$570 |
$760 |
3.8× |
| CT orbits w/o contrast (70480) |
$356.25 |
$475 |
4.0× |
| CT pelvis w & w/o contrast (72194) |
$682.50 |
$910 |
4.5× |
| CT pelvis w/o contrast (72192) |
$534.75 |
$713 |
5.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$223.12 |
$297.50 |
3.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$495 |
$660 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$450.38 |
$600.50 |
5.0× |
| CT thoracic spine w/contrast (72129) |
$457.50 |
$610 |
3.0× |
| CT thoracic spine w/o contrast (72128) |
$366 |
$488 |
4.1× |
| CT thoracic spine w/wo contrast (72130) |
$448.12 |
$597.50 |
3.0× |
| CT thorax w/o contrast (71250) |
$516 |
$688 |
5.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$438.75 |
$585 |
2.9× |
| CT upper extremity w/o contrast rt (73200) |
$403.50 |
$538 |
4.5× |
| CT upper extremity with contrast (73201) |
$352.50 |
$470 |
1.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$375 |
$500 |
2.5× |
| Cta Abdomen (74175) |
$346.88 |
$462.50 |
2.3× |
| CTA abdomen pelvis (74174) |
$375 |
$500 |
1.2× |
| CTA chest (71275) |
$346.88 |
$462.50 |
2.3× |
| Cta Head (70496) |
$365.62 |
$487.50 |
2.4× |
| CTA lwr ext w&w/o contrast (73706) |
$346.88 |
$462.50 |
2.3× |
| Cta Neck (70498) |
$365.62 |
$487.50 |
2.4× |
| Cta Pelvis (72191) |
$346.88 |
$462.50 |
2.3× |
| Cystography minimum 3 views rs&i (74430) |
$279.38 |
$372.50 |
0.9× |
| Esophagus (74220) |
$150 |
$200 |
1.0× |
| Foot 2 views (73620) |
$82.50 |
$110 |
1.1× |
| Forearm 2 views (73090) |
$82.50 |
$110 |
1.1× |
| Hand 2 views (73120) |
$121.88 |
$162.50 |
1.4× |
| Hand 3 views (73130) |
$83.25 |
$111 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$82.50 |
$110 |
1.1× |
| Kidney imaging morphology (78700) |
$279.38 |
$372.50 |
0.8× |
| Knee 3 views (73562) |
$123.75 |
$165 |
1.6× |
| Liver & spleen imaging static only (78215) |
$268.12 |
$357.50 |
0.8× |
| Meckels Diverticulum (78290) |
$301.88 |
$402.50 |
0.9× |
| MRA head w/o contrast (70544) |
$956.25 |
$1,275 |
4.6× |
| MRA neck w contrast (70548) |
$956.25 |
$1,275 |
3.2× |
| MRA neck w/o contrast (70547) |
$956.25 |
$1,275 |
4.6× |
| MRI abdomen w contrast (74182) |
$881.25 |
$1,175 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI abdomen w/o contrast (74181) |
$787.50 |
$1,050 |
3.8× |
| MRI any jnt lwr ext with con lt (73722) |
$881.25 |
$1,175 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$881.25 |
$1,175 |
1.3× |
| MRI bone marrow blood supply (77084) |
$1,312.50 |
$1,750 |
6.4× |
| MRI c-spine with contrast (72142) |
$881.25 |
$1,175 |
2.9× |
| MRI cardiac w/o contrast (75557) |
$787.50 |
$1,050 |
3.8× |
| MRI cervical spine w/o contrast (72141) |
$787.50 |
$1,050 |
3.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI chest w/o contrast (71550) |
$787.50 |
$1,050 |
3.8× |
| MRI chest with contrast (71551) |
$881.25 |
$1,175 |
1.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$881.25 |
$1,175 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$881.25 |
$1,175 |
2.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$787.50 |
$1,050 |
3.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$787.50 |
$1,050 |
3.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI orbit/face/neck w/contrast (70542) |
$881.25 |
$1,175 |
2.9× |
| MRI pelvis w contrast (72196) |
$881.25 |
$1,175 |
2.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI pelvis w/o contrast (72195) |
$787.50 |
$1,050 |
3.8× |
| MRI scan of arm joint before and after contrast (73223) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI scan of leg joint before and after contrast (73723) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$881.25 |
$1,175 |
2.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$881.25 |
$1,175 |
2.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI thoracic spine w/o contrast (72146) |
$787.50 |
$1,050 |
3.8× |
| MRI upper ext joint w/o contrast (73221) |
$787.50 |
$1,050 |
3.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,040.62 |
$1,387.50 |
3.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$787.50 |
$1,050 |
3.8× |
| Neck soft tissue (70360) |
$101.25 |
$135 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$121.12 |
$161.50 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,040.62 |
$1,387.50 |
3.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$91.88 |
$122.50 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$206.25 |
$275 |
2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$187.50 |
$250 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$82.50 |
$110 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$86.25 |
$115 |
1.1× |
| Radiologic exam colon single contrast study (74270) |
$230.62 |
$307.50 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$198.75 |
$265 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$82.50 |
$110 |
1.1× |
| Ribs bilateral 3 views (71110) |
$131.25 |
$175 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$121.88 |
$162.50 |
1.4× |
| Scapula complete (73010) |
$82.50 |
$110 |
0.9× |
| Small bowel series (74250) |
$155.62 |
$207.50 |
1.0× |
| Spine thoracic 3 views (72072) |
$176.25 |
$235 |
2.0× |
| Thoracolumbar 2 views (72080) |
$112.50 |
$150 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$211.88 |
$282.50 |
2.4× |
| Upper Extremity Infant (73092) |
$46.88 |
$62.50 |
0.5× |
| Urethrocystography voiding (74455) |
$187.50 |
$250 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$315 |
$420 |
2.1× |
| Us abdl aorta screen aaa (76706) |
$155.62 |
$207.50 |
1.7× |
| Us breast unilateral complete (76641) |
$153.75 |
$205 |
1.7× |
| Us chest (76604) |
$133.12 |
$177.50 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$187.50 |
$250 |
2.1× |
| Us pelvic non ob complete (76856) |
$187.50 |
$250 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$202.50 |
$270 |
2.2× |
| Us retroperitoneal complete (76770) |
$219.38 |
$292.50 |
2.4× |
| Us retroperitoneal limited (76775) |
$120 |
$160 |
1.3× |
| Us scrotum and contents (76870) |
$150 |
$200 |
1.7× |
| Us soft tissue head/neck (76536) |
$187.50 |
$250 |
2.1× |
| Us transrectal (76872) |
$215.62 |
$287.50 |
2.4× |
| Wrist 2 views (73100) |
$82.50 |
$110 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$168.75 |
$225 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$75 |
$100 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$123.75 |
$165 |
1.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$262.50 |
$350 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$82.50 |
$110 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$83.25 |
$111 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$81.75 |
$109 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$84.38 |
$112.50 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$150 |
$200 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$84.38 |
$112.50 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$82.50 |
$110 |
1.1× |
| X-ray IV pyelogram+drip infusn (74410) |
$157.50 |
$210 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$73.12 |
$97.50 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$131.25 |
$175 |
1.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$61.88 |
$82.50 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$112.50 |
$150 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$135 |
$180 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$80.62 |
$107.50 |
0.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$131.25 |
$175 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$83.25 |
$111 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$123.75 |
$165 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$213.75 |
$285 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$123.75 |
$165 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$82.50 |
$110 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$82.50 |
$110 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$131.25 |
$175 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$131.25 |
$175 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$112.50 |
$150 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$112.50 |
$150 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$112.50 |
$150 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$82.50 |
$110 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$84.38 |
$112.50 |
1.1× |
| Xr chest 4+ views (71048) |
$127.50 |
$170 |
1.4× |
| Xr Cholecystography Oral Contrast (74290) |
$105 |
$140 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$127.50 |
$170 |
1.7× |
| Xr optic foramina (70190) |
$54.38 |
$72.50 |
0.7× |
| Xr shoulder 1 view (73020) |
$81.75 |
$109 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$150 |
$200 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$84.38 |
$112.50 |
1.1× |
| Xr tmj bilateral (70330) |
$88.12 |
$117.50 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$82.50 |
$110 |
1.1× |