| Abdomen 2 views (74019) |
$122.50 |
$245 |
1.3× |
| Ankle 2 views (73600) |
$97.75 |
$195.50 |
1.2× |
| Arthrogram shoulder (73040) |
$239.50 |
$479 |
0.8× |
| Bone &/joint imaging whole body (78306) |
$1,523 |
$3,046 |
4.2× |
| Bone age studies (77072) |
$18.75 |
$37.50 |
0.2× |
| Bone survey complete (77075) |
$145 |
$290 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$110.50 |
$221 |
1.4× |
| Chest 1 view (71045) |
$76.50 |
$153 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$743 |
$1,486 |
4.7× |
| Clavicle complete (73000) |
$160 |
$320 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$212.50 |
$425 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$705.50 |
$1,411 |
2.2× |
| CT abdomen and pelvis without contrast (74176) |
$438.75 |
$877.50 |
2.0× |
| CT abdomen w contrast (74160) |
$514.50 |
$1,029 |
3.2× |
| CT abdomen w wo contrast (74170) |
$758 |
$1,516 |
4.8× |
| CT abdomen w/o contrast (74150) |
$439 |
$878 |
4.6× |
| CT c-spine w/o contrast (72125) |
$393 |
$786 |
4.2× |
| CT cervical spine w&w/o contrast (72127) |
$616 |
$1,232 |
3.9× |
| CT cervical spine with contrast (72126) |
$428.75 |
$857.50 |
1.4× |
| CT chest w/wo contrast (71270) |
$885.75 |
$1,771.50 |
5.6× |
| CT chest with contrast (71260) |
$745.25 |
$1,490.50 |
4.7× |
| CT head/brain with contrast (70460) |
$411.12 |
$822.25 |
2.6× |
| CT head/brain without and with contrast (70470) |
$456.75 |
$913.50 |
2.9× |
| CT iac w contrast (70481) |
$400 |
$800 |
2.5× |
| CT lower ext w/o (73700) |
$346.12 |
$692.25 |
3.7× |
| CT lower extremity w wo contrast (73702) |
$597.25 |
$1,194.50 |
3.8× |
| CT lower extremity with contrast (73701) |
$371.50 |
$743 |
2.3× |
| CT lumbar spine w & w/o contrast (72133) |
$608.50 |
$1,217 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$393 |
$786 |
4.2× |
| CT lumbar spine with contrast (72132) |
$440.62 |
$881.25 |
1.4× |
| CT maxillofacial w contrast (70487) |
$541.25 |
$1,082.50 |
3.4× |
| CT maxillofacial w/o contrast (70486) |
$461 |
$922 |
4.9× |
| CT maxillofacial w/wo contrast (70488) |
$684.25 |
$1,368.50 |
4.3× |
| CT neck soft tissue w contrast (70491) |
$466.96 |
$933.92 |
2.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$771.50 |
$1,543 |
4.9× |
| CT orbits w/o contrast (70480) |
$364.12 |
$728.25 |
3.8× |
| CT pelvis w & w/o contrast (72194) |
$628.75 |
$1,257.50 |
4.0× |
| CT pelvis w/o contrast (72192) |
$398.25 |
$796.50 |
4.2× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$225 |
$450 |
2.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$624 |
$1,248 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$379 |
$758 |
4.0× |
| CT thoracic spine w/contrast (72129) |
$444.38 |
$888.75 |
2.8× |
| CT thoracic spine w/o contrast (72128) |
$395.25 |
$790.50 |
4.2× |
| CT thoracic spine w/wo contrast (72130) |
$617 |
$1,234 |
3.9× |
| CT thorax w/o contrast (71250) |
$596.25 |
$1,192.50 |
6.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$582.50 |
$1,165 |
3.7× |
| CT upper extremity w/o contrast rt (73200) |
$400.25 |
$800.50 |
4.2× |
| CT upper extremity with contrast (73201) |
$432.38 |
$864.75 |
1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$716.75 |
$1,433.50 |
4.5× |
| Cta Abdomen (74175) |
$669.75 |
$1,339.50 |
4.2× |
| CTA abdomen pelvis (74174) |
$966.75 |
$1,933.50 |
3.1× |
| CTA chest (71275) |
$884.24 |
$1,768.48 |
5.6× |
| Cta Head (70496) |
$669.75 |
$1,339.50 |
4.2× |
| Cta Neck (70498) |
$669.75 |
$1,339.50 |
4.2× |
| Cta Pelvis (72191) |
$669.75 |
$1,339.50 |
4.2× |
| Echoencephalography real time imaging (76506) |
$350.50 |
$701 |
3.7× |
| Esophagus (74220) |
$1,031.30 |
$2,062.60 |
6.5× |
| Foot 2 views (73620) |
$151.50 |
$303 |
1.9× |
| Forearm 2 views (73090) |
$149.50 |
$299 |
1.9× |
| Hand 2 views (73120) |
$151.50 |
$303 |
1.6× |
| Hand 3 views (73130) |
$178.50 |
$357 |
2.3× |
| Humerus Min 2 Views Left (73060) |
$168 |
$336 |
2.1× |
| Knee 3 views (73562) |
$207.50 |
$415 |
2.6× |
| MRA head w & w/o contrast (70546) |
$825 |
$1,650 |
2.6× |
| MRA head w/o contrast (70544) |
$750 |
$1,500 |
3.5× |
| MRA head with contrast (70545) |
$825 |
$1,650 |
2.6× |
| MRA neck w contrast (70548) |
$825 |
$1,650 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$825 |
$1,650 |
2.6× |
| MRA neck w/o contrast (70547) |
$750 |
$1,500 |
3.5× |
| MRI abdomen w contrast (74182) |
$825 |
$1,650 |
2.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$825 |
$1,650 |
2.6× |
| MRI abdomen w/o contrast (74181) |
$1,250 |
$2,500 |
5.8× |
| MRI any jnt lwr ext with con lt (73722) |
$825 |
$1,650 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$825 |
$1,650 |
1.2× |
| MRI c-spine with contrast (72142) |
$825 |
$1,650 |
2.6× |
| MRI cervical spine w/o contrast (72141) |
$750 |
$1,500 |
3.5× |
| MRI chest w/o & w/contrast material (71552) |
$825 |
$1,650 |
2.6× |
| MRI chest w/o contrast (71550) |
$750 |
$1,500 |
3.5× |
| MRI chest with contrast (71551) |
$825 |
$1,650 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$825 |
$1,650 |
2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$825 |
$1,650 |
2.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$750 |
$1,500 |
3.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$750 |
$1,500 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$825 |
$1,650 |
2.6× |
| MRI orbit/face/neck w/contrast (70542) |
$825 |
$1,650 |
2.6× |
| MRI pelvis w contrast (72196) |
$825 |
$1,650 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$825 |
$1,650 |
2.6× |
| MRI pelvis w/o contrast (72195) |
$750 |
$1,500 |
3.5× |
| MRI scan of arm joint before and after contrast (73223) |
$825 |
$1,650 |
2.6× |
| MRI scan of leg joint before and after contrast (73723) |
$825 |
$1,650 |
2.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$825 |
$1,650 |
2.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$825 |
$1,650 |
2.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$825 |
$1,650 |
2.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$825 |
$1,650 |
2.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$825 |
$1,650 |
2.6× |
| MRI thoracic spine w/o contrast (72146) |
$750 |
$1,500 |
3.5× |
| MRI tmj (70336) |
$750 |
$1,500 |
3.5× |
| MRI upper ext joint w/o contrast (73221) |
$750 |
$1,500 |
3.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$825 |
$1,650 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$750 |
$1,500 |
3.5× |
| Neck soft tissue (70360) |
$93.25 |
$186.50 |
1.2× |
| Osseous survey infant (77076) |
$150.75 |
$301.50 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$103 |
$206 |
1.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$825 |
$1,650 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$29.84 |
$59.67 |
0.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$232.50 |
$465 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$105.25 |
$210.50 |
1.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$125.50 |
$251 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$79.75 |
$159.50 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$33 |
$66 |
0.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$94.50 |
$189 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$371.92 |
$743.83 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$189 |
$378 |
2.4× |
| Ribs bilateral 3 views (71110) |
$162.20 |
$324.40 |
1.7× |
| Scapula complete (73010) |
$174.50 |
$349 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$25 |
$50 |
1.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$75.75 |
$151.50 |
0.8× |
| Spine thoracic 3 views (72072) |
$129 |
$258 |
1.4× |
| Tmj unilateral (70328) |
$178.50 |
$357 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$271 |
$542 |
2.9× |
| Upper Extremity Infant (73092) |
$86.50 |
$173 |
0.9× |
| Us breast unilateral complete (76641) |
$319 |
$638 |
3.4× |
| Us breast unilateral limited (76642) |
$262.50 |
$525 |
3.3× |
| Us chest (76604) |
$166.50 |
$333 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$201.25 |
$402.50 |
2.1× |
| Us infant hips dynamic (76885) |
$147.25 |
$294.50 |
1.9× |
| Us ob transvaginal (76817) |
$197.24 |
$394.48 |
2.1× |
| Us pelvic non ob complete (76856) |
$205.50 |
$411 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$100.75 |
$201.50 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$253.24 |
$506.48 |
2.7× |
| Us retroperitoneal complete (76770) |
$213.25 |
$426.50 |
2.3× |
| Us retroperitoneal limited (76775) |
$72.40 |
$144.80 |
0.8× |
| Us scrotum and contents (76870) |
$139.50 |
$279 |
1.5× |
| Us soft tissue head/neck (76536) |
$207 |
$414 |
2.2× |
| Us xtr non-vasc lmtd (76882) |
$92.50 |
$185 |
1.0× |
| Wrist 2 views (73100) |
$170 |
$340 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$149.25 |
$298.50 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$207.50 |
$415 |
2.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$182.50 |
$365 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$160 |
$320 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$180.50 |
$361 |
2.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$54.58 |
$109.16 |
0.6× |
| X-ray exam hip uni 1 view (73501) |
$174.50 |
$349 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$240.50 |
$481 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$130.25 |
$260.50 |
1.4× |
| X-ray exam of femur 1 (73551) |
$232.50 |
$465 |
3.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$136.75 |
$273.50 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$106.50 |
$213 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$170 |
$340 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$157.50 |
$315 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$105.25 |
$210.50 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$167 |
$334 |
2.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$91.50 |
$183 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$115.75 |
$231.50 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$363 |
$726 |
3.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$132.50 |
$265 |
1.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$105.25 |
$210.50 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$133.25 |
$266.50 |
1.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$222 |
$444 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$191 |
$382 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$36.78 |
$73.56 |
0.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$73.62 |
$147.25 |
0.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$105.25 |
$210.50 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$92.75 |
$185.50 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$168 |
$336 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$123 |
$246 |
1.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$50.88 |
$101.75 |
0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$141.75 |
$283.50 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$117.25 |
$234.50 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$37.94 |
$75.88 |
0.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$97.86 |
$195.72 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$111 |
$222 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$164 |
$328 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$205.50 |
$411 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$192 |
$384 |
2.0× |
| Xr chest 4+ views (71048) |
$191 |
$382 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$182.50 |
$365 |
2.3× |
| Xr shoulder 1 view (73020) |
$76 |
$152 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$147.75 |
$295.50 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$166 |
$332 |
2.1× |
| Xr tmj bilateral (70330) |
$267.50 |
$535 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$180.50 |
$361 |
2.3× |