| Abdomen 2 views (74019) |
$83.40 |
$417 |
0.8× |
| Acute gastrointestinal blood loss imaging (78278) |
$470 |
$2,474 |
1.2× |
| Angiography extremity unilateral rs&i (75710) |
$1,107.60 |
$5,538 |
0.3× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$1,121.40 |
$5,607 |
0.4× |
Angiography visceral slctv/supraslctv rs&i (75726)
likely a partial charge, not the full procedure |
$1,303 |
$6,515 |
0.2× |
| Ankle 2 views (73600) |
$67 |
$335 |
0.8× |
| Arthrogram shoulder (73040) |
$440 |
$1,365 |
1.3× |
| Bone &/joint imaging whole body (78306) |
$470 |
$1,894 |
1.2× |
| Bone age studies (77072) |
$39 |
$195 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$80.20 |
$401 |
0.9× |
| Chest 1 view (71045) |
$51.40 |
$257 |
0.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$210 |
$1,371 |
1.2× |
| Clavicle complete (73000) |
$72 |
$360 |
0.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$194.80 |
$974 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,063.80 |
$5,319 |
3.0× |
| CT abdomen and pelvis without contrast (74176) |
$668.80 |
$3,344 |
2.8× |
| CT abdomen w contrast (74160) |
$450 |
$2,410 |
2.6× |
| CT abdomen w wo contrast (74170) |
$550 |
$2,614 |
3.1× |
| CT abdomen w/o contrast (74150) |
$450 |
$1,671 |
4.3× |
| CT angio hrt w/3d image (75574) |
$421.60 |
$2,108 |
1.2× |
| CT c-spine w/o contrast (72125) |
$450 |
$1,638 |
4.3× |
| CT chest w/wo contrast (71270) |
$450 |
$2,543 |
2.6× |
| CT chest with contrast (71260) |
$450 |
$2,340 |
2.6× |
| CT head/brain with contrast (70460) |
$468 |
$2,340 |
2.7× |
| CT head/brain without and with contrast (70470) |
$450 |
$2,543 |
2.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$143.80 |
$719 |
1.6× |
| CT limited/localized follow up study (76380) |
$450 |
$828 |
5.1× |
| CT lower ext w/o (73700) |
$450 |
$1,530 |
4.3× |
| CT lower extremity with contrast (73701) |
$210 |
$2,377 |
1.2× |
| CT lumbar spine w/o contrast (72131) |
$450 |
$1,638 |
4.3× |
| CT maxillofacial w contrast (70487) |
$450 |
$2,377 |
2.6× |
| CT maxillofacial w/o contrast (70486) |
$450 |
$1,638 |
4.3× |
| CT neck soft tissue w contrast (70491) |
$450 |
$2,591 |
2.6× |
| CT orbits w/o contrast (70480) |
$450 |
$1,530 |
4.3× |
| CT pelvis w & w/o contrast (72194) |
$550 |
$2,704 |
3.1× |
| CT pelvis w/o contrast (72192) |
$450 |
$1,671 |
4.3× |
| CT soft tissue neck w/o contrast (70490) |
$450 |
$1,754 |
4.3× |
| CT thoracic spine w/contrast (72129) |
$450 |
$2,377 |
2.6× |
| CT thoracic spine w/o contrast (72128) |
$450 |
$1,530 |
4.3× |
| CT thorax w/o contrast (71250) |
$450 |
$1,524 |
4.3× |
| CT upper extremity w/o contrast rt (73200) |
$130 |
$1,530 |
1.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$450 |
$2,178 |
2.6× |
| Cta Abdomen (74175) |
$450 |
$2,215 |
2.6× |
| CTA abdomen pelvis (74174) |
$608.20 |
$3,041 |
1.7× |
| CTA chest (71275) |
$450 |
$2,195 |
2.6× |
| Cta Head (70496) |
$210 |
$1,940 |
1.2× |
| CTA lwr ext w&w/o contrast (73706) |
$210 |
$3,249 |
1.2× |
| Cta Neck (70498) |
$450 |
$1,919 |
2.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$130 |
$549 |
1.2× |
| Esophagus (74220) |
$210 |
$695 |
1.2× |
| Foot 2 views (73620) |
$67 |
$335 |
0.8× |
| Forearm 2 views (73090) |
$70 |
$350 |
0.8× |
| Hand 2 views (73120) |
$62.80 |
$314 |
0.6× |
| Hand 3 views (73130) |
$72 |
$360 |
0.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$497.80 |
$2,489 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$70 |
$350 |
0.8× |
| Hysterosalpingogram (74740) |
$280 |
$2,053 |
1.2× |
| Knee 3 views (73562) |
$77.81 |
$389.05 |
0.9× |
| MRA head w/o contrast (70544) |
$600 |
$1,603 |
2.5× |
| MRA head with contrast (70545) |
$600 |
$2,310 |
1.7× |
| MRA neck w/o contrast (70547) |
$600 |
$1,603 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$700 |
$3,239 |
2.0× |
| MRI abdomen w/o contrast (74181) |
$600 |
$2,189 |
2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$920 |
$2,858 |
1.2× |
| MRI cervical spine w/o contrast (72141) |
$500 |
$2,021 |
2.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$500 |
$2,155 |
2.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$700 |
$3,239 |
2.0× |
| MRI pelvis w/o contrast (72195) |
$500 |
$2,323 |
2.1× |
| MRI scan of leg joint before and after contrast (73723) |
$700 |
$3,112 |
2.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$700 |
$3,112 |
2.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$600 |
$2,858 |
1.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$700 |
$3,112 |
2.0× |
| MRI thoracic spine w/o contrast (72146) |
$500 |
$2,021 |
2.1× |
| MRI upper ext joint w/o contrast (73221) |
$500 |
$2,155 |
2.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$500 |
$2,155 |
2.1× |
| Neck soft tissue (70360) |
$67 |
$335 |
0.8× |
| Nm gastric emptying study (78264) |
$470 |
$1,962 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$62.80 |
$314 |
0.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$700 |
$3,112 |
2.0× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$712.80 |
$3,564 |
1.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$630 |
$941 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$117.40 |
$587 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$62.80 |
$314 |
0.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$74.80 |
$374 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$74.80 |
$374 |
0.9× |
| Scapula complete (73010) |
$70 |
$350 |
0.7× |
| Screening digital breast tomosynthesis (77063) |
$29.80 |
$149 |
1.3× |
| Small bowel series (74250) |
$210 |
$941 |
1.2× |
| Spine thoracic 3 views (72072) |
$139 |
$695 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$150 |
$850 |
1.4× |
| Us breast unilateral complete (76641) |
$102 |
$510 |
1.0× |
| Us breast unilateral limited (76642) |
$58.60 |
$293 |
0.7× |
| Us chest (76604) |
$130 |
$521 |
1.2× |
| Us compl joint r-t w/image documentation (76881) |
$168.60 |
$843 |
1.6× |
| Us ob transvaginal (76817) |
$170 |
$850 |
1.6× |
| Us pelvic non ob complete (76856) |
$150 |
$908 |
1.4× |
| Us pregnancy ltd (76815) |
$129.60 |
$648 |
1.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$150 |
$850 |
1.4× |
| Us retroperitoneal complete (76770) |
$150 |
$918 |
1.4× |
| Us scrotum and contents (76870) |
$150 |
$1,056 |
1.4× |
| Us soft tissue head/neck (76536) |
$150 |
$1,010 |
1.4× |
| Wrist 2 views (73100) |
$67 |
$335 |
0.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$74.80 |
$374 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$72 |
$360 |
0.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$74.80 |
$374 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$62.80 |
$314 |
0.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$74.80 |
$374 |
0.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$105.40 |
$527 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$59.60 |
$298 |
0.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$74.80 |
$374 |
0.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$87.60 |
$438 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$109.60 |
$548 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$74.80 |
$374 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$57.40 |
$287 |
0.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$94.80 |
$474 |
0.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$62.80 |
$314 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$105.40 |
$527 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$72.40 |
$362 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$90.20 |
$451 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$122.80 |
$614 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$72.40 |
$362 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$72 |
$360 |
0.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$88.13 |
$440.64 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$109.60 |
$548 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$67 |
$335 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$83.80 |
$419 |
0.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$70 |
$350 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$74.80 |
$374 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$62.80 |
$314 |
0.7× |
| Xr shoulder 1 view (73020) |
$64.20 |
$321 |
0.7× |
| Xr spine cervical 4 or 5 views (72050) |
$139 |
$695 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$72.12 |
$360.61 |
0.8× |
| Xray knee 1 or 2 views rt (73560) |
$72.88 |
$364.38 |
0.8× |