| Abdomen 2 views (74019) |
$214 |
$214 |
2.2× |
| Ankle 2 views (73600) |
$167 |
$167 |
2.1× |
| Arthrogram shoulder (73040) |
$485 |
$485 |
1.5× |
| Arthrogram wrist (73115) |
$550 |
$550 |
1.7× |
| Arthrography knee lt (73580) |
$714 |
$714 |
2.2× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$643.80 |
$643.80 |
1.8× |
| Bone &/joint imaging whole body (78306) |
$765 |
$765 |
2.1× |
| Bone age studies (77072) |
$207 |
$207 |
2.2× |
| Bone Imaging 3 Phase (78315) |
$737.80 |
$737.80 |
2.0× |
| Bone survey complete (77075) |
$800 |
$800 |
8.3× |
| Cervical spine 2 or 3 views (72040) |
$233 |
$233 |
2.9× |
| Chest 1 view (71045) |
$213.50 |
$213.50 |
2.7× |
| Chest 3 views (71047) |
$240 |
$240 |
3.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$430 |
$430 |
2.7× |
| Clavicle complete (73000) |
$174 |
$174 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$663 |
$663 |
6.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$667 |
$667 |
2.1× |
| CT abdomen and pelvis without contrast (74176) |
$666 |
$666 |
3.0× |
| CT abdomen w contrast (74160) |
$879.50 |
$879.50 |
5.5× |
| CT abdomen w wo contrast (74170) |
$667 |
$667 |
4.1× |
| CT abdomen w/o contrast (74150) |
$885 |
$885 |
9.2× |
| CT c-spine w/o contrast (72125) |
$663 |
$663 |
6.9× |
| CT cervical spine w&w/o contrast (72127) |
$663 |
$663 |
4.1× |
| CT cervical spine with contrast (72126) |
$663 |
$663 |
2.1× |
| CT chest w/wo contrast (71270) |
$663 |
$663 |
4.1× |
| CT chest with contrast (71260) |
$899 |
$899 |
5.6× |
| CT head/brain with contrast (70460) |
$663 |
$663 |
4.1× |
| CT head/brain without and with contrast (70470) |
$663 |
$663 |
4.1× |
| CT iac w contrast (70481) |
$663 |
$663 |
4.1× |
| CT limited/localized follow up study (76380) |
$663 |
$663 |
8.3× |
| CT lower ext w/o (73700) |
$864 |
$864 |
9.0× |
| CT lower extremity w wo contrast (73702) |
$859.50 |
$859.50 |
5.3× |
| CT lower extremity with contrast (73701) |
$852.50 |
$852.50 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$663 |
$663 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$663 |
$663 |
6.9× |
| CT lumbar spine with contrast (72132) |
$663 |
$663 |
2.1× |
| CT maxillofacial w contrast (70487) |
$663 |
$663 |
4.1× |
| CT maxillofacial w/o contrast (70486) |
$663 |
$663 |
6.9× |
| CT maxillofacial w/wo contrast (70488) |
$663 |
$663 |
4.1× |
| CT neck soft tissue w contrast (70491) |
$663 |
$663 |
4.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$663 |
$663 |
4.1× |
| CT orbits w/o contrast (70480) |
$663 |
$663 |
6.9× |
| CT pelvis w & w/o contrast (72194) |
$663 |
$663 |
4.1× |
| CT pelvis w/o contrast (72192) |
$663 |
$663 |
6.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$663 |
$663 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$663 |
$663 |
6.9× |
| CT thoracic spine w/contrast (72129) |
$663 |
$663 |
4.1× |
| CT thoracic spine w/o contrast (72128) |
$866 |
$866 |
9.0× |
| CT thoracic spine w/wo contrast (72130) |
$663 |
$663 |
4.1× |
| CT thorax w/o contrast (71250) |
$663 |
$663 |
6.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$851 |
$851 |
5.3× |
| CT upper extremity w/o contrast rt (73200) |
$836 |
$836 |
8.7× |
| CT upper extremity with contrast (73201) |
$841.50 |
$841.50 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,725 |
$1,725 |
10.7× |
| Cta Abdomen (74175) |
$1,637 |
$1,637 |
10.1× |
| CTA abdomen pelvis (74174) |
$2,415 |
$2,415 |
7.5× |
| CTA chest (71275) |
$1,579 |
$1,579 |
9.8× |
| Cta Head (70496) |
$1,599 |
$1,599 |
9.9× |
| Cta Neck (70498) |
$1,700.50 |
$1,700.50 |
10.5× |
| Cystography minimum 3 views rs&i (74430) |
$478 |
$478 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$276.79 |
$276.79 |
2.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$109 |
$109 |
1.4× |
| Esophagus (74220) |
$376 |
$376 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$308.50 |
$308.50 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$211.29 |
$211.29 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$250.59 |
$250.59 |
1.1× |
| Foot 2 views (73620) |
$154 |
$154 |
1.9× |
| Forearm 2 views (73090) |
$194 |
$194 |
2.4× |
| Hand 2 views (73120) |
$168 |
$168 |
1.7× |
| Hand 3 views (73130) |
$210 |
$210 |
2.6× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$794.50 |
$794.50 |
1.6× |
| Ht muscle image spect sing (78451) |
$816 |
$816 |
0.7× |
| Humerus Min 2 Views Left (73060) |
$211 |
$211 |
2.6× |
| Hysterosalpingogram (74740) |
$574 |
$574 |
2.6× |
| Knee 3 views (73562) |
$227 |
$227 |
2.8× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$74 |
$74 |
0.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$25 |
$25 |
0.9× |
| MRA head w & w/o contrast (70546) |
$1,448 |
$1,448 |
4.5× |
| MRA head w/o contrast (70544) |
$1,239 |
$1,239 |
5.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,283 |
$1,283 |
4.0× |
| MRA neck w/o contrast (70547) |
$1,239 |
$1,239 |
5.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,460 |
$1,460 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,210.70 |
$1,210.70 |
5.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,428 |
$1,428 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,199 |
$1,199 |
1.7× |
| MRI c-spine with contrast (72142) |
$1,300 |
$1,300 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,251.40 |
$1,251.40 |
5.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,460 |
$1,460 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,290 |
$1,290 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,102.35 |
$1,102.35 |
5.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,210.70 |
$1,210.70 |
5.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,460 |
$1,460 |
4.6× |
| MRI pelvis w contrast (72196) |
$1,325 |
$1,325 |
4.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,460 |
$1,460 |
4.6× |
| MRI pelvis w/o contrast (72195) |
$1,210.70 |
$1,210.70 |
5.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,276 |
$1,276 |
4.0× |
| MRI scan of leg joint before and after contrast (73723) |
$1,307.50 |
$1,307.50 |
4.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,435.70 |
$1,435.70 |
4.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,325 |
$1,325 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,460 |
$1,460 |
4.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,325 |
$1,325 |
4.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,460 |
$1,460 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,200 |
$1,200 |
5.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,100 |
$1,100 |
5.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,460 |
$1,460 |
4.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,102.35 |
$1,102.35 |
5.0× |
| Myocardial Spect Multiple Studies (78452) |
$1,768.36 |
$1,768.36 |
1.5× |
| Neck soft tissue (70360) |
$193 |
$193 |
2.4× |
| Nm gastric emptying study (78264) |
$929.40 |
$929.40 |
2.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$275.70 |
$275.70 |
2.9× |
| Osseous survey limited (77074) |
$383 |
$383 |
4.0× |
| Pelvis 1 or 2 views (72170) |
$189 |
$189 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,167 |
$1,167 |
3.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$170 |
$170 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$218 |
$218 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$240 |
$240 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$278 |
$278 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$340 |
$340 |
3.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$299 |
$299 |
3.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$193 |
$193 |
2.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$221 |
$221 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$1,324 |
$1,324 |
8.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$541.50 |
$541.50 |
3.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$550 |
$550 |
3.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$180 |
$180 |
2.2× |
| Radiological examination surgical specimen (76098) |
$108 |
$108 |
0.2× |
| Ribs bilateral 3 views (71110) |
$206 |
$206 |
2.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$635 |
$635 |
2.9× |
| Scapula complete (73010) |
$201 |
$201 |
2.1× |
| Screening digital breast tomosynthesis (77063) |
$121 |
$121 |
5.2× |
| Small bowel series (74250) |
$419 |
$419 |
2.6× |
| Spine thoracic 3 views (72072) |
$279 |
$279 |
2.9× |
| Thoracolumbar 2 views (72080) |
$284 |
$284 |
3.5× |
| Tomogram (76100) |
$445 |
$445 |
4.6× |
| Ultrasound, abdomen limited (76705) |
$399.70 |
$399.70 |
4.2× |
| Upper Extremity Infant (73092) |
$166 |
$166 |
1.7× |
| Urethrocystography retrograde rs&i (74450) |
$250 |
$250 |
1.1× |
| Urethrocystography voiding (74455) |
$606.35 |
$606.35 |
2.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$649 |
$649 |
4.0× |
| Us abdl aorta screen aaa (76706) |
$226.23 |
$226.23 |
2.4× |
| Us breast unilateral limited (76642) |
$182 |
$182 |
2.3× |
| Us chest (76604) |
$218 |
$218 |
2.3× |
| Us infant hips dynamic (76885) |
$650 |
$650 |
8.1× |
| Us ob detailed single fetus (76811) |
$319 |
$319 |
1.5× |
| Us ob transvaginal (76817) |
$264.25 |
$264.25 |
2.7× |
| Us pelvic non ob complete (76856) |
$420 |
$420 |
4.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$403.90 |
$403.90 |
4.2× |
| Us pregnancy ltd (76815) |
$275.70 |
$275.70 |
2.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$300 |
$300 |
3.1× |
| Us retroperitoneal complete (76770) |
$513.80 |
$513.80 |
5.3× |
| Us retroperitoneal limited (76775) |
$414.60 |
$414.60 |
4.3× |
| Us scrotum and contents (76870) |
$310.70 |
$310.70 |
3.2× |
| Us soft tissue head/neck (76536) |
$717.89 |
$717.89 |
7.5× |
| Us spinal canal and contents (76800) |
$240 |
$240 |
2.5× |
| Us transrectal (76872) |
$457.30 |
$457.30 |
4.8× |
| Us xtr non-vasc lmtd (76882) |
$245 |
$245 |
2.5× |
| Venogram extremity bilateral (75822) |
$1,052 |
$1,052 |
0.7× |
| Venography extremity unilateral rs&i (75820) |
$578 |
$578 |
0.4× |
| Wrist 2 views (73100) |
$157 |
$157 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$368 |
$368 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$216 |
$216 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$216 |
$216 |
2.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,324 |
$1,324 |
8.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$176.50 |
$176.50 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$229 |
$229 |
2.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$265 |
$265 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$189 |
$189 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$239 |
$239 |
3.0× |
| X-ray exam hip uni 4/> views (73503) |
$289 |
$289 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$260 |
$260 |
2.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$299 |
$299 |
3.1× |
| X-ray exam of femur 1 (73551) |
$169 |
$169 |
2.1× |
| X-ray eye for foreign body (70030) |
$134 |
$134 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$272 |
$272 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$259 |
$259 |
3.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$208 |
$208 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$180 |
$180 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$232 |
$232 |
2.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$314 |
$314 |
3.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$212 |
$212 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$251 |
$251 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$433.60 |
$433.60 |
4.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$407 |
$407 |
4.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$217 |
$217 |
2.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$190 |
$190 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$262 |
$262 |
2.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$241 |
$241 |
2.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$513 |
$513 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$200 |
$200 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$284 |
$284 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$344 |
$344 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$214 |
$214 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$211 |
$211 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$222.50 |
$222.50 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$276 |
$276 |
3.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$166 |
$166 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$295 |
$295 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$211 |
$211 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$240 |
$240 |
3.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$180 |
$180 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$213 |
$213 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$154 |
$154 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$290 |
$290 |
3.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$165 |
$165 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$215.50 |
$215.50 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$377 |
$377 |
3.9× |
| Xr chest 4+ views (71048) |
$259 |
$259 |
2.7× |
| Xr finger(s) 2+ views (73140) |
$164 |
$164 |
2.0× |
| Xr shoulder 1 view (73020) |
$166 |
$166 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$324 |
$324 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$220 |
$220 |
2.7× |
| Xr tmj bilateral (70330) |
$256 |
$256 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$176 |
$176 |
2.2× |