| Abdomen 2 views (74019) |
$234.65 |
$361 |
2.2× |
| Ankle 2 views (73600) |
$117.65 |
$181 |
1.3× |
| Bone age studies (77072) |
$130 |
$200 |
1.2× |
| Bone survey complete (77075) |
$567.45 |
$873 |
5.3× |
| Cervical spine 2 or 3 views (72040) |
$227.50 |
$350 |
2.5× |
| Chest 1 view (71045) |
$183.95 |
$283 |
2.0× |
| Chest xray 3 views (71047) |
$215.80 |
$332 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$466.05 |
$717 |
2.6× |
| Clavicle complete (73000) |
$111.15 |
$171 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,462.50 |
$2,250 |
13.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,730 |
$4,200 |
7.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,275 |
$3,500 |
9.2× |
| CT abdomen w wo contrast (74170) |
$1,657.50 |
$2,550 |
9.2× |
| CT abdomen w/o contrast (74150) |
$1,267.50 |
$1,950 |
11.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,975.35 |
$3,039 |
10.9× |
| CT angiography upper extremity lt (73206) |
$1,722.50 |
$2,650 |
9.5× |
| CT c-spine w/o contrast (72125) |
$1,917.50 |
$2,950 |
17.8× |
| CT chest w contrast (71260) |
$1,722.50 |
$2,650 |
9.5× |
| CT chest w/wo contrast (71270) |
$1,852.50 |
$2,850 |
10.2× |
| CT head/brain with contrast (70460) |
$1,527.50 |
$2,350 |
8.4× |
| CT head/brain without and with contrast (70470) |
$1,657.50 |
$2,550 |
9.2× |
| CT iac w contrast (70481) |
$1,527.50 |
$2,350 |
8.4× |
| CT lower ext w/o (73700) |
$1,267.50 |
$1,950 |
11.7× |
| CT lower extremity w wo contrast (73702) |
$1,657.50 |
$2,550 |
9.2× |
| CT lower extremity w/contrast material (73701) |
$1,527.50 |
$2,350 |
8.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,307.50 |
$3,550 |
12.7× |
| CT lumbar spine w/contrast (72132) |
$2,112.50 |
$3,250 |
5.9× |
| CT lumbar spine w/o contrast (72131) |
$1,917.50 |
$2,950 |
17.8× |
| CT maxillofacial w contrast (70487) |
$1,527.50 |
$2,350 |
8.4× |
| CT maxillofacial wo contrast (70486) |
$1,267.50 |
$1,950 |
11.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,657.50 |
$2,550 |
9.2× |
| CT orbits w/o contrast (70480) |
$1,267.50 |
$1,950 |
11.7× |
| CT pelvis w/o contrast (72192) |
$1,267.50 |
$1,950 |
11.7× |
| CT pelvis w/wo contrast (72194) |
$1,657.50 |
$2,550 |
9.2× |
| CT scan of arm combo (73202) |
$1,657.50 |
$2,550 |
9.2× |
| CT soft tissue neck w contrast (70491) |
$1,527.50 |
$2,350 |
8.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,267.50 |
$1,950 |
11.7× |
| CT thoracic spine w/contrast (72129) |
$2,112.50 |
$3,250 |
11.7× |
| CT thoracic spine w/o contrast (72128) |
$1,917.50 |
$2,950 |
17.8× |
| CT thorax w/o contrast (71250) |
$1,462.50 |
$2,250 |
13.6× |
| CT upper ext wo (73200) |
$1,267.50 |
$1,950 |
11.7× |
| CT upper extremity with contrast (73201) |
$1,527.50 |
$2,350 |
4.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,243.15 |
$3,451 |
12.4× |
| Cta Abdomen (74175) |
$1,917.50 |
$2,950 |
10.6× |
| CTA abdomen pelvis (74174) |
$2,372.50 |
$3,650 |
6.6× |
| CTA chest (71275) |
$1,917.50 |
$2,950 |
10.6× |
| Cta Head (70496) |
$1,722.50 |
$2,650 |
9.5× |
| Cta Neck (70498) |
$1,722.50 |
$2,650 |
9.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$313.95 |
$483 |
2.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$109.85 |
$169 |
1.2× |
| Esophagus (74220) |
$334.75 |
$515 |
1.8× |
| Facial bones min 3 views (70150) |
$189.48 |
$291.50 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$578.50 |
$890 |
5.4× |
| Fluoroscopy up to 1 hr (76000) |
$194.35 |
$299 |
0.8× |
| Foot 2 views (73620) |
$121.88 |
$187.50 |
1.4× |
| Forearm 2 views (73090) |
$183.95 |
$283 |
2.0× |
| Hand 2 views (73120) |
$183.95 |
$283 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,580.15 |
$2,431 |
2.8× |
| Knee 3 views (73562) |
$217.75 |
$335 |
2.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,776.15 |
$4,271 |
7.7× |
| MRA head w & w/o contrast (70546) |
$2,776.15 |
$4,271 |
7.7× |
| MRA head w/o contrast (70544) |
$2,122.90 |
$3,266 |
8.6× |
| MRA head with contrast (70545) |
$2,384.20 |
$3,668 |
6.6× |
| MRA neck w contrast (70548) |
$2,384.20 |
$3,668 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,776.15 |
$4,271 |
7.7× |
| MRI abdomen w contrast (74182) |
$2,538.90 |
$3,906 |
7.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,956.20 |
$4,548 |
8.2× |
| MRI abdomen w/o contrast (74181) |
$2,260.70 |
$3,478 |
9.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,384.20 |
$3,668 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,776.15 |
$4,271 |
7.7× |
| MRI c-spine with contrast (72142) |
$2,462.85 |
$3,789 |
6.8× |
| MRI cervical spine w/o contrast (72141) |
$2,122.90 |
$3,266 |
8.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,776.15 |
$4,271 |
7.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,776.15 |
$4,271 |
7.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,122.90 |
$3,266 |
8.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,776.15 |
$4,271 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,776.15 |
$4,271 |
7.7× |
| MRI pelvis w/o contrast (72195) |
$2,122.90 |
$3,266 |
8.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,776.15 |
$4,271 |
7.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,384.20 |
$3,668 |
6.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,776.15 |
$4,271 |
7.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,384.20 |
$3,668 |
6.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,776.15 |
$4,271 |
7.7× |
| MRI temporomandibular joint (70336) |
$2,122.90 |
$3,266 |
8.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,122.90 |
$3,266 |
8.6× |
| MRI up ext w/o contrast (73218) |
$2,122.90 |
$3,266 |
8.6× |
| MRI upper ext joint w/o contrast (73221) |
$2,122.90 |
$3,266 |
8.6× |
| MRI, joint upper extrem combo (73223) |
$2,776.15 |
$4,271 |
7.7× |
| Neck soft tissue (70360) |
$147.55 |
$227 |
1.6× |
| Nm gastric emptying study (78264) |
$1,292.20 |
$1,988 |
3.1× |
| Osseous survey limited (77074) |
$213.20 |
$328 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$183.95 |
$283 |
1.7× |
| PET image w/CT, skull-thigh (78815) |
$4,312.10 |
$6,634 |
2.9× |
| PET imaging for CT attenuation whole body (78816) |
$4,312.10 |
$6,634 |
2.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,307.15 |
$2,011 |
2.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$196.30 |
$302 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$147.55 |
$227 |
1.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$234.65 |
$361 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$123.50 |
$190 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$246.35 |
$379 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$143.65 |
$221 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$246.35 |
$379 |
2.7× |
| Radex Hand Minimum 3 Views (73130) |
$200.85 |
$309 |
2.2× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$246.35 |
$379 |
2.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$421.85 |
$649 |
3.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$513.50 |
$790 |
4.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$593.45 |
$913 |
5.5× |
| Radex Humerus Minimum 2 Views (73060) |
$183.95 |
$283 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$183.95 |
$283 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$313.95 |
$483 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$189.48 |
$291.50 |
1.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$189.48 |
$291.50 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$145.92 |
$224.50 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$234.65 |
$361 |
2.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$239.20 |
$368 |
2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$265.85 |
$409 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$144.30 |
$222 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$217.75 |
$335 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$160.55 |
$247 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$306.80 |
$472 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$217.75 |
$335 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$586.30 |
$902 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$435.50 |
$670 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$167.70 |
$258 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$200.85 |
$309 |
2.2× |
| Radiological examination surgical specimen (76098) |
$142.35 |
$219 |
0.3× |
| Ribs bilateral 3 views (71110) |
$502.45 |
$773 |
4.7× |
| Sacroiliac Joints < 3 Views (72200) |
$200.85 |
$309 |
1.9× |
| Scapula (73010) |
$150.80 |
$232 |
1.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$79.95 |
$123 |
3.4× |
| Shoulder 1 view (73020) |
$119.28 |
$183.50 |
1.3× |
| Spine thoracic 3 views (72072) |
$265.85 |
$409 |
2.5× |
| Thoracolumbar 2 views (72080) |
$260.65 |
$401 |
2.9× |
| Ultrasound Exam Aaa Screen (76706) |
$589.55 |
$907 |
5.5× |
| Ultrasound, abdomen limited (76705) |
$499.85 |
$769 |
4.6× |
| Umbilical-artery Doppler (OB) (76820) |
$443.95 |
$683 |
4.1× |
| Us breast unilateral limited (76642) |
$448.50 |
$690 |
5.0× |
| Us chest (76604) |
$391.95 |
$603 |
3.6× |
| Us hips infant static (76886) |
$265.20 |
$408 |
3.0× |
| Us infant hips w manipulation (76885) |
$265.20 |
$408 |
3.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$253.50 |
$390 |
2.3× |
| Us ob limited (76815) |
$309.40 |
$476 |
2.9× |
| Us ob transvaginal (76817) |
$455.65 |
$701 |
4.2× |
| Us pelvic non ob complete (76856) |
$578.50 |
$890 |
5.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$209.30 |
$322 |
1.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$491.40 |
$756 |
4.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$325 |
$500 |
3.0× |
| Us retroperitoneal complete (76770) |
$603.85 |
$929 |
5.6× |
| Us retroperitoneal limited (76775) |
$534.95 |
$823 |
5.0× |
| Us scrotum and contents (76870) |
$534.95 |
$823 |
5.0× |
| Us soft tissue head/neck (76536) |
$534.95 |
$823 |
5.0× |
| Us transrectal (76872) |
$441.35 |
$679 |
4.1× |
| Wrist 2 views (73100) |
$115.70 |
$178 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$368.55 |
$567 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$140.08 |
$215.50 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$125.78 |
$193.50 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$316.55 |
$487 |
3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$554.45 |
$853 |
5.1× |
| X-ray exam of femur 2/> (73552) |
$221 |
$340 |
2.5× |
| X-ray eye for foreign body (70030) |
$139.10 |
$214 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$153.40 |
$236 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$167.70 |
$258 |
1.9× |
| X-ray leg, infant (73592) |
$197.60 |
$304 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$234.65 |
$361 |
2.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$397.15 |
$611 |
3.7× |
| X-ray nose-rectum child f.b. (76010) |
$113.10 |
$174 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$334.75 |
$515 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$206.05 |
$317 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$271.05 |
$417 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$319.15 |
$491 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$234.65 |
$361 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$214.50 |
$330 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$267.80 |
$412 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$223.60 |
$344 |
2.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$244.40 |
$376 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$115.38 |
$177.50 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$207.35 |
$319 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$224.25 |
$345 |
2.1× |
| Xr bone length studies (77073) |
$258.70 |
$398 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$331.50 |
$510 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$271.05 |
$417 |
2.5× |
| Xr chest 4+ views (71048) |
$250.90 |
$386 |
2.3× |