| Abdomen 1 View (74018) |
$162 |
$216 |
1.9× |
| Abdomen 2 views (74019) |
$197 |
$262 |
1.9× |
| Ankle 2 views (73600) |
$162 |
$216 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$4,722 |
$6,296 |
11.8× |
| Chest 1 view (71045) |
$162 |
$216 |
1.9× |
| Chest 2 views (71046) |
$162 |
$216 |
1.9× |
| Chest 3 views (71047) |
$169 |
$225 |
1.9× |
| Chest 4 or more views (71048) |
$169 |
$225 |
1.6× |
| Clavicle complete (73000) |
$162 |
$216 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,103 |
$2,804 |
6.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,298 |
$1,731 |
5.4× |
| CT abdomen w contrast (74160) |
$974 |
$1,299 |
5.5× |
| CT abdomen w wo contrast (74170) |
$1,218 |
$1,624 |
6.9× |
| CT abdomen w/o contrast (74150) |
$783 |
$1,044 |
7.5× |
| CT Angio Abdomen and Pelvis (74174) |
$1,675 |
$2,233 |
4.8× |
| CT Angio Chest (71275) |
$1,088 |
$1,450 |
6.2× |
| CT Angio Head (70496) |
$1,088 |
$1,450 |
6.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$334 |
$445 |
1.9× |
| CT Angio Neck (70498) |
$1,088 |
$1,450 |
6.2× |
| CT cervical spine w/ contrast (72126) |
$1,001 |
$1,334 |
2.9× |
| CT cervical spine w/o contrast (72125) |
$831 |
$1,108 |
7.9× |
| CT chest w contrast (71260) |
$988 |
$1,317 |
5.6× |
| CT chest w/wo contrast (71270) |
$1,231 |
$1,641 |
7.0× |
| CT head/brain with contrast (70460) |
$822 |
$1,096 |
4.7× |
| CT head/brain without and with contrast (70470) |
$1,053 |
$1,404 |
6.0× |
| CT l-spine w&w/o contrast (72133) |
$1,566 |
$2,088 |
8.9× |
| CT lower ext w/o (73700) |
$740 |
$986 |
7.0× |
| CT lower extremity w/contrast material (73701) |
$848 |
$1,131 |
4.8× |
| CT lumbar spine w/o contrast (72131) |
$836 |
$1,114 |
8.0× |
| CT maxillofacial w contrast (70487) |
$822 |
$1,096 |
4.7× |
| CT maxillofacial wo contrast (70486) |
$709 |
$945 |
6.8× |
| CT neck tissue combo (70492) |
$1,053 |
$1,404 |
6.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,053 |
$1,404 |
6.0× |
| CT orbits w/o contrast (70480) |
$709 |
$945 |
6.8× |
| CT pelvis w&w/o contrast (72194) |
$1,196 |
$1,595 |
6.8× |
| CT pelvis w/o contrast (72192) |
$848 |
$1,131 |
8.1× |
| CT scans face/jaw combo (70488) |
$1,053 |
$1,404 |
6.0× |
| CT soft tissue neck w contrast (70491) |
$822 |
$1,096 |
4.7× |
| CT soft tissue neck w/o contrast (70490) |
$709 |
$945 |
6.8× |
| CT thoracic spine w/o contrast (72128) |
$836 |
$1,114 |
8.0× |
| CT thorax w/o contrast (71250) |
$844 |
$1,125 |
8.0× |
| CT upper ext wo (73200) |
$740 |
$986 |
7.0× |
| CT upper extremity with contrast (73201) |
$848 |
$1,131 |
2.4× |
| Cta Abdomen (74175) |
$1,088 |
$1,450 |
6.2× |
| Dxa Bone Density Axial (77080) |
$221 |
$295 |
2.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$317 |
$423 |
3.0× |
| Foot 2 views (73620) |
$162 |
$216 |
1.9× |
| Forearm 2 views (73090) |
$162 |
$216 |
1.9× |
| Hand 2 views (73120) |
$197 |
$262 |
1.9× |
| Knee 3 Views (73562) |
$162 |
$216 |
1.9× |
| MRA head w/o contrast (70544) |
$1,316 |
$1,755 |
5.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,609 |
$2,145 |
4.6× |
| MRA neck w/o contrast (70547) |
$1,316 |
$1,755 |
5.5× |
| MRI abdomen w contrast (74182) |
$1,463 |
$1,950 |
4.2× |
| MRI abdomen w/o contrast (74181) |
$1,316 |
$1,755 |
5.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,430 |
$1,907 |
1.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,609 |
$2,145 |
4.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,316 |
$1,755 |
1.7× |
| MRI cervical spine w contrast (72142) |
$1,463 |
$1,950 |
4.2× |
| MRI cervical spine w/o cont (72141) |
$1,316 |
$1,755 |
5.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,609 |
$2,145 |
4.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,316 |
$1,755 |
5.5× |
| MRI lumbar spine w contrast (72149) |
$1,463 |
$1,950 |
4.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,609 |
$2,145 |
4.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,316 |
$1,755 |
5.5× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,609 |
$2,145 |
4.6× |
| MRI pelvis w/o & w contrast (72197) |
$1,609 |
$2,145 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$1,316 |
$1,755 |
5.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,316 |
$1,755 |
5.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,316 |
$1,755 |
5.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,609 |
$2,145 |
4.6× |
| MRI, abdomen, combo (74183) |
$1,609 |
$2,145 |
4.6× |
| MRI, dorsal spine combo (72157) |
$1,609 |
$2,145 |
4.6× |
| MRI, joint upper extrem (73221) |
$1,316 |
$1,755 |
5.5× |
| MRI, lumbar spine combo (72158) |
$1,609 |
$2,145 |
4.6× |
| Neck soft tissue (70360) |
$162 |
$216 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$197 |
$262 |
1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$197 |
$262 |
1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$162 |
$216 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$162 |
$216 |
1.9× |
| Radex elbow complete minimum 3 views (73080) |
$162 |
$216 |
1.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$197 |
$262 |
1.9× |
| Radex fingr minimum 2 views (73140) |
$162 |
$216 |
1.9× |
| Radex foot complete minimum 3 views (73630) |
$162 |
$216 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$162 |
$216 |
1.9× |
| Radex lower extremity infant minimum 2 views (73592) |
$101 |
$135 |
1.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$135 |
$180 |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$197 |
$262 |
2.3× |
| Radex shoulder complete minimum 2 views (73030) |
$162 |
$216 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$162 |
$216 |
1.9× |
| Radex Spine 1 View Specify Level (72020) |
$162 |
$216 |
1.9× |
| Radex Sternum Minimum 2 Views (71120) |
$135 |
$180 |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$176 |
$234 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$162 |
$216 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$106 |
$141 |
1.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$162 |
$216 |
1.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$162 |
$216 |
1.5× |
| Radiologic exam knee complete 4/more views (73564) |
$197 |
$262 |
1.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$197 |
$262 |
1.9× |
| Radiologic examination femur 1 view (73551) |
$101 |
$135 |
1.2× |
| Radiologic examination femur minimum 2 views (73552) |
$162 |
$216 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$162 |
$216 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$162 |
$216 |
1.9× |
| Ribs bilateral 3 views (71110) |
$176 |
$234 |
1.7× |
| Scapula (73010) |
$162 |
$216 |
1.5× |
| Shoulder 1 view (73020) |
$162 |
$216 |
1.9× |
| Skull less than 4 views (70250) |
$197 |
$262 |
1.9× |
| Thoracic spine 2 views (72070) |
$197 |
$262 |
1.9× |
| Thoracic spine 3 views (72072) |
$197 |
$262 |
1.9× |
| Thoracolumbar 2 views (72080) |
$163 |
$217 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$284 |
$378 |
2.7× |
| Us breast unilateral complete (76641) |
$473 |
$630 |
4.5× |
| Us chest (76604) |
$270 |
$360 |
2.6× |
| Us complete joint (76881) |
$560 |
$747 |
5.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$231 |
$308 |
2.2× |
| Us ob limited 1 or more fetuses (76815) |
$290 |
$387 |
2.8× |
| Us ob transvaginal (76817) |
$405 |
$540 |
3.9× |
| Us pelvic non ob complete (76856) |
$338 |
$450 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$371 |
$495 |
3.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$216 |
$288 |
2.1× |
| Us retroperitoneal complete (76770) |
$378 |
$504 |
3.6× |
| Us scrotum and contents (76870) |
$304 |
$405 |
2.9× |
| Us thyroid (76536) |
$270 |
$360 |
2.6× |
| Vertebral fracture assessment via dxa (77086) |
$162 |
$216 |
1.9× |
| Wrist 2 views (73100) |
$162 |
$216 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$135 |
$180 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$162 |
$216 |
1.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$162 |
$216 |
1.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$270 |
$360 |
2.6× |
| X-Ray Exam Hip Uni 1 View (73501) |
$162 |
$216 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$162 |
$216 |
1.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$197 |
$262 |
1.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$230 |
$306 |
2.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$162 |
$216 |
1.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$270 |
$360 |
2.6× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$197 |
$262 |
1.9× |
| X-ray humerus (73060) |
$162 |
$216 |
1.9× |
| X-ray IV pyelogram (ivp) (74400) |
$338 |
$450 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$162 |
$216 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$162 |
$216 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$197 |
$262 |
1.9× |
| X-ray nose-rectum child f.b. (76010) |
$101 |
$135 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$197 |
$262 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$197 |
$262 |
1.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$115 |
$153 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$162 |
$216 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$162 |
$216 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$203 |
$270 |
1.9× |
| X-ray thoracic spine 4 vw (72074) |
$203 |
$270 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$209 |
$279 |
2.0× |
| Xr facial bones less than 3 views (70140) |
$162 |
$216 |
1.9× |
| Xr orbits complete 4 views (70200) |
$197 |
$262 |
1.9× |