| Abdomen 2 views (74019) |
$145 |
$145 |
1.5× |
| Acute gastrointestinal blood loss imaging (78278) |
$379 |
$379 |
1.0× |
| Ankle 2 views (73600) |
$151 |
$151 |
1.9× |
| Arthrogram shoulder (73040) |
$490 |
$490 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$485 |
$485 |
1.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$946 |
$946 |
2.6× |
| Bone &/joint imaging whole body (78306) |
$551 |
$551 |
1.5× |
| Bone age studies (77072) |
$206 |
$206 |
2.1× |
| Bone survey complete (77075) |
$731 |
$731 |
7.6× |
| Cervical spine 2 or 3 views (72040) |
$228 |
$228 |
2.8× |
| Chest 1 view (71045) |
$168 |
$168 |
2.1× |
| Chest 3 views (71047) |
$221 |
$221 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$453 |
$453 |
2.8× |
| Clavicle complete (73000) |
$184 |
$184 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$800 |
$800 |
8.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$900 |
$900 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$800 |
$800 |
3.6× |
| CT abdomen w contrast (74160) |
$800 |
$800 |
5.0× |
| CT abdomen w wo contrast (74170) |
$875 |
$875 |
5.4× |
| CT abdomen w/o contrast (74150) |
$850 |
$850 |
8.8× |
| CT angiography upper extremity lt (73206) |
$1,750 |
$1,750 |
10.8× |
| CT c-spine w/o contrast (72125) |
$800 |
$800 |
8.3× |
| CT cervical spine w&w/o contrast (72127) |
$900 |
$900 |
5.6× |
| CT cervical spine with contrast (72126) |
$850 |
$850 |
2.6× |
| CT chest w/wo contrast (71270) |
$900 |
$900 |
5.6× |
| CT chest with contrast (71260) |
$850 |
$850 |
5.3× |
| CT head/brain with contrast (70460) |
$850 |
$850 |
5.3× |
| CT head/brain without and with contrast (70470) |
$900 |
$900 |
5.6× |
| CT iac w contrast (70481) |
$850 |
$850 |
5.3× |
| CT limited/localized follow up study (76380) |
$900 |
$900 |
11.2× |
| CT lower ext w/o (73700) |
$800 |
$800 |
8.3× |
| CT lower extremity w wo contrast (73702) |
$900 |
$900 |
5.6× |
| CT lower extremity with contrast (73701) |
$850 |
$850 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$900 |
$900 |
5.6× |
| CT lumbar spine w/o contrast (72131) |
$800 |
$800 |
8.3× |
| CT lumbar spine with contrast (72132) |
$850 |
$850 |
2.6× |
| CT maxillofacial w contrast (70487) |
$850 |
$850 |
5.3× |
| CT maxillofacial w/o contrast (70486) |
$800 |
$800 |
8.3× |
| CT maxillofacial w/wo contrast (70488) |
$900 |
$900 |
5.6× |
| CT neck soft tissue w contrast (70491) |
$850 |
$850 |
5.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$900 |
$900 |
5.6× |
| CT orbits w/o contrast (70480) |
$800 |
$800 |
8.3× |
| CT pelvis w & w/o contrast (72194) |
$900 |
$900 |
5.6× |
| CT pelvis w/o contrast (72192) |
$800 |
$800 |
8.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$900 |
$900 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$800 |
$800 |
8.3× |
| CT thoracic spine w/contrast (72129) |
$850 |
$850 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$800 |
$800 |
8.3× |
| CT thoracic spine w/wo contrast (72130) |
$900 |
$900 |
5.6× |
| CT thorax w/o contrast (71250) |
$800 |
$800 |
8.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$900 |
$900 |
5.6× |
| CT upper extremity w/o contrast rt (73200) |
$800 |
$800 |
8.3× |
| CT upper extremity with contrast (73201) |
$850 |
$850 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,325 |
$1,325 |
8.2× |
| Cta Abdomen (74175) |
$1,775 |
$1,775 |
11.0× |
| CTA abdomen pelvis (74174) |
$2,450 |
$2,450 |
7.6× |
| CTA chest (71275) |
$1,650 |
$1,650 |
10.2× |
| Cta Head (70496) |
$1,750 |
$1,750 |
10.8× |
| CTA lwr ext w&w/o contrast (73706) |
$1,750 |
$1,750 |
10.8× |
| Cta Neck (70498) |
$1,750 |
$1,750 |
10.8× |
| Cta Pelvis (72191) |
$1,750 |
$1,750 |
10.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$25 |
$25 |
0.3× |
| Esophagus (74220) |
$435 |
$435 |
2.7× |
| Fetal biophysical profile non-stress testing (76818) |
$198 |
$198 |
2.1× |
| Foot 2 views (73620) |
$151 |
$151 |
1.9× |
| Forearm 2 views (73090) |
$181 |
$181 |
2.3× |
| Hand 2 views (73120) |
$179 |
$179 |
1.9× |
| Hand 3 views (73130) |
$198 |
$198 |
2.5× |
| Humerus Min 2 Views Left (73060) |
$201 |
$201 |
2.5× |
| Knee 3 views (73562) |
$217 |
$217 |
2.7× |
| Liver & spleen imaging static only (78215) |
$403 |
$403 |
1.1× |
| Liver & Spleen Imaging W/Vascular Flow (78216) |
$403 |
$403 |
1.1× |
| MRI any jnt lwr ext with con lt (73722) |
$800 |
$800 |
1.1× |
| MRI cervical spine w/o contrast (72141) |
$1,131 |
$1,131 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,190 |
$2,190 |
10.0× |
| MRI scan of leg joint before and after contrast (73723) |
$750 |
$750 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,087 |
$1,087 |
3.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,305.20 |
$4,305.20 |
13.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,087 |
$1,087 |
5.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$770 |
$770 |
3.5× |
| Neck soft tissue (70360) |
$186 |
$186 |
2.3× |
| Nuclear medicine study of kidney and blood flow (78701) |
$403 |
$403 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$185 |
$185 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$700 |
$700 |
2.2× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$393 |
$393 |
1.1× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$2,851 |
$2,851 |
5.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$276 |
$276 |
3.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$391 |
$391 |
4.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$276 |
$276 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$391 |
$391 |
4.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$305 |
$305 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$197 |
$197 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$214 |
$214 |
2.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$210 |
$210 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$276 |
$276 |
3.4× |
| Ribs bilateral 3 views (71110) |
$195 |
$195 |
2.0× |
| Sacroiliac Joints < 3 Views (72200) |
$200 |
$200 |
2.1× |
| Scapula complete (73010) |
$169 |
$169 |
1.8× |
| Small bowel series (74250) |
$448 |
$448 |
2.8× |
| Spine thoracic 3 views (72072) |
$291 |
$291 |
3.0× |
| Thoracolumbar 2 views (72080) |
$278 |
$278 |
3.5× |
| Tmj unilateral (70328) |
$192 |
$192 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$190 |
$190 |
2.0× |
| Upper Extremity Infant (73092) |
$179 |
$179 |
1.9× |
| Us abdl aorta screen aaa (76706) |
$207 |
$207 |
2.2× |
| Us breast unilateral complete (76641) |
$130 |
$130 |
1.4× |
| Us breast unilateral limited (76642) |
$130 |
$130 |
1.6× |
| Us chest (76604) |
$152 |
$152 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$160 |
$160 |
1.7× |
| Us pelvic non ob complete (76856) |
$175 |
$175 |
1.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$141 |
$141 |
1.5× |
| Us pregnancy ltd (76815) |
$198 |
$198 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$170 |
$170 |
1.8× |
| Us retroperitoneal complete (76770) |
$215 |
$215 |
2.2× |
| Us retroperitoneal limited (76775) |
$166 |
$166 |
1.7× |
| Us scrotum and contents (76870) |
$168 |
$168 |
1.7× |
| Us soft tissue head/neck (76536) |
$675 |
$675 |
7.0× |
| Us xtr non-vasc lmtd (76882) |
$166 |
$166 |
1.7× |
| Wrist 2 views (73100) |
$145 |
$145 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$370 |
$370 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$214 |
$214 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$203 |
$203 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$183 |
$183 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$227 |
$227 |
2.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$391 |
$391 |
4.1× |
| X-ray exam hip uni 1 view (73501) |
$198 |
$198 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$243 |
$243 |
3.0× |
| X-ray exam hip uni 4/> views (73503) |
$303 |
$303 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$391 |
$391 |
4.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$391 |
$391 |
4.1× |
| X-ray exam of femur 1 (73551) |
$254 |
$254 |
3.2× |
| X-ray eye for foreign body (70030) |
$122 |
$122 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$278 |
$278 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$260 |
$260 |
3.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$197 |
$197 |
2.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$224 |
$224 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$240 |
$240 |
3.0× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$314 |
$314 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$162 |
$162 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$200 |
$200 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$138.50 |
$138.50 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$437 |
$437 |
4.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$336 |
$336 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$212 |
$212 |
2.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$183 |
$183 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$254 |
$254 |
2.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$185 |
$185 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$194 |
$194 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$290 |
$290 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$355 |
$355 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$211 |
$211 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$206 |
$206 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$203 |
$203 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$290 |
$290 |
3.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$154 |
$154 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$305 |
$305 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$207 |
$207 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$248 |
$248 |
3.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$192 |
$192 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$211 |
$211 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$194 |
$194 |
2.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$151 |
$151 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$206 |
$206 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$382 |
$382 |
4.0× |
| Xr chest 4+ views (71048) |
$232 |
$232 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$152 |
$152 |
1.9× |
| Xr optic foramina (70190) |
$234 |
$234 |
2.9× |
| Xr shoulder 1 view (73020) |
$154 |
$154 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$330 |
$330 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$216 |
$216 |
2.7× |
| Xr tmj bilateral (70330) |
$258 |
$258 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$162 |
$162 |
2.0× |