| Abdomen 2 views (74019) |
$250.80 |
$456 |
2.3× |
| Ankle 2 views (73600) |
$161.15 |
$293 |
1.8× |
| Arthrogram hip (73525) |
$611.60 |
$1,112 |
1.7× |
| Arthrogram shoulder (73040) |
$764.50 |
$1,390 |
2.1× |
| Arthrogram wrist (73115) |
$611.60 |
$1,112 |
1.7× |
| Arthrography knee lt (73580) |
$611.60 |
$1,112 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,396.45 |
$2,539 |
3.3× |
| Bone &/joint imaging whole body (78306) |
$1,885.40 |
$3,428 |
4.5× |
| Bone age studies (77072) |
$161.15 |
$293 |
1.5× |
| Bone Imaging 3 Phase (78315) |
$883.85 |
$1,607 |
2.1× |
| Bone survey complete (77075) |
$435.05 |
$791 |
3.9× |
| Cervical spine 2 or 3 views (72040) |
$199.10 |
$362 |
2.2× |
| Chest 1 view (71045) |
$161.15 |
$293 |
1.8× |
| Chest 3 views (71047) |
$207.35 |
$377 |
2.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$328.90 |
$598 |
1.8× |
| Clavicle complete (73000) |
$161.15 |
$293 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,387 |
$4,340 |
6.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,758.35 |
$3,197 |
7.0× |
| CT abdomen w contrast (74160) |
$1,082.40 |
$1,968 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,249.60 |
$2,272 |
6.8× |
| CT abdomen w/o contrast (74150) |
$618.75 |
$1,125 |
5.6× |
| CT angio hrt w/3d image (75574) |
$1,119.25 |
$2,035 |
3.0× |
| CT angiography upper extremity lt (73206) |
$2,230.80 |
$4,056 |
12.1× |
| CT c-spine w/o contrast (72125) |
$818.95 |
$1,489 |
7.4× |
| CT cervical spine w&w/o contrast (72127) |
$933.35 |
$1,697 |
5.0× |
| CT chest w/wo contrast (71270) |
$1,255.65 |
$2,283 |
6.8× |
| CT chest with contrast (71260) |
$1,197.90 |
$2,178 |
6.5× |
| CT head/brain with contrast (70460) |
$1,333.75 |
$2,425 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,249.60 |
$2,272 |
6.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$567.60 |
$1,032 |
6.2× |
| CT iac w contrast (70481) |
$1,147.30 |
$2,086 |
6.2× |
| CT lower ext w/o (73700) |
$665.50 |
$1,210 |
6.0× |
| CT lower extremity w wo contrast (73702) |
$1,221 |
$2,220 |
6.6× |
| CT lower extremity with contrast (73701) |
$944.90 |
$1,718 |
5.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,197.35 |
$2,177 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$818.95 |
$1,489 |
7.4× |
| CT lumbar spine with contrast (72132) |
$1,073.60 |
$1,952 |
2.9× |
| CT maxillofacial w contrast (70487) |
$1,112.10 |
$2,022 |
6.0× |
| CT maxillofacial w/o contrast (70486) |
$810.15 |
$1,473 |
7.3× |
| CT neck soft tissue w contrast (70491) |
$917.95 |
$1,669 |
5.0× |
| CT orbits w/o contrast (70480) |
$730.95 |
$1,329 |
6.6× |
| CT pelvis w & w/o contrast (72194) |
$1,249.60 |
$2,272 |
6.8× |
| CT pelvis w/o contrast (72192) |
$730.95 |
$1,329 |
6.6× |
| CT soft tissue neck w/o contrast (70490) |
$618.75 |
$1,125 |
5.6× |
| CT thoracic spine w/contrast (72129) |
$871.20 |
$1,584 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$647.90 |
$1,178 |
5.9× |
| CT thoracic spine w/wo contrast (72130) |
$933.35 |
$1,697 |
5.0× |
| CT thorax w/o contrast (71250) |
$772.75 |
$1,405 |
7.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$892.65 |
$1,623 |
4.8× |
| CT upper extremity w/o contrast rt (73200) |
$693 |
$1,260 |
6.3× |
| CT upper extremity with contrast (73201) |
$983.95 |
$1,789 |
2.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,728.65 |
$3,143 |
9.3× |
| Cta Abdomen (74175) |
$2,230.80 |
$4,056 |
12.1× |
| CTA abdomen pelvis (74174) |
$2,230.80 |
$4,056 |
6.1× |
| CTA chest (71275) |
$2,341.90 |
$4,258 |
12.7× |
| Cta Head (70496) |
$2,339.70 |
$4,254 |
12.6× |
| CTA lwr ext w&w/o contrast (73706) |
$2,230.80 |
$4,056 |
12.1× |
| Cta Neck (70498) |
$2,341.90 |
$4,258 |
12.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$290.95 |
$529 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$290.95 |
$529 |
3.2× |
| Esophagus (74220) |
$328.90 |
$598 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$300.30 |
$546 |
2.7× |
| Fluoroscopy up to 1 hr (76000) |
$391.05 |
$711 |
1.6× |
| Foot 2 views (73620) |
$161.15 |
$293 |
1.8× |
| Forearm 2 views (73090) |
$161.15 |
$293 |
1.8× |
| Hand 2 views (73120) |
$161.15 |
$293 |
1.5× |
| Hand 3 views (73130) |
$201.85 |
$367 |
2.2× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,503.15 |
$2,733 |
2.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$883.85 |
$1,607 |
2.1× |
| Ht muscle image spect sing (78451) |
$2,129.05 |
$3,871 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$161.15 |
$293 |
1.8× |
| Hysterosalpingogram (74740) |
$590.70 |
$1,074 |
2.3× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$858.55 |
$1,561 |
1.5× |
| Knee 3 views (73562) |
$193.05 |
$351 |
2.1× |
| MRA head w/o contrast (70544) |
$1,997.60 |
$3,632 |
7.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,361.70 |
$4,294 |
6.4× |
| MRA neck w/o contrast (70547) |
$1,997.60 |
$3,632 |
7.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,060.85 |
$3,747 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,614.25 |
$2,935 |
6.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,593.90 |
$2,898 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,668.70 |
$3,034 |
2.0× |
| MRI c-spine with contrast (72142) |
$1,576.30 |
$2,866 |
4.3× |
| MRI cervical spine w/o contrast (72141) |
$1,291.40 |
$2,348 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,614.25 |
$2,935 |
6.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,473.45 |
$2,679 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,266.55 |
$4,121 |
6.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,389.75 |
$4,345 |
6.5× |
| MRI pelvis w/o contrast (72195) |
$1,614.25 |
$2,935 |
6.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,911.80 |
$3,476 |
5.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,180.75 |
$3,965 |
5.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,389.75 |
$4,345 |
6.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,939.30 |
$3,526 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,237.95 |
$4,069 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,291.40 |
$2,348 |
5.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,437.15 |
$2,613 |
5.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,911.80 |
$3,476 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,471.80 |
$2,676 |
5.8× |
| Myocardial Spect Multiple Studies (78452) |
$2,846.80 |
$5,176 |
2.1× |
| Neck soft tissue (70360) |
$161.15 |
$293 |
1.8× |
| Nm gastric emptying study (78264) |
$883.85 |
$1,607 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$218.90 |
$398 |
2.0× |
| Parathyrd planar w/wo subtrj (78071) |
$883.85 |
$1,607 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$201.85 |
$367 |
1.8× |
| PET image w/CT, skull-thigh (78815) |
$3,996.30 |
$7,266 |
2.6× |
| PET imaging for CT attenuation whole body (78816) |
$4,561.70 |
$8,294 |
3.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,333.10 |
$4,242 |
6.3× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$821.15 |
$1,493 |
1.9× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$883.85 |
$1,607 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$435.05 |
$791 |
3.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$469.15 |
$853 |
4.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$161.15 |
$293 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$199.65 |
$363 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$336.60 |
$612 |
3.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$184.80 |
$336 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$328.90 |
$598 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$328.90 |
$598 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$161.15 |
$293 |
1.8× |
| Radiological examination surgical specimen (76098) |
$312.95 |
$569 |
0.5× |
| Scapula complete (73010) |
$161.15 |
$293 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$56.65 |
$103 |
2.4× |
| Small bowel series (74250) |
$328.90 |
$598 |
1.8× |
| Spine thoracic 3 views (72072) |
$161.15 |
$293 |
1.5× |
| Thoracolumbar 2 views (72080) |
$161.15 |
$293 |
1.8× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$883.85 |
$1,607 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$233.20 |
$424 |
2.1× |
| Umbilical-artery Doppler (OB) (76820) |
$202.40 |
$368 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$521.40 |
$948 |
2.1× |
| Urethrocystography voiding (74455) |
$521.40 |
$948 |
2.1× |
| Us abdl aorta screen aaa (76706) |
$300.30 |
$546 |
2.7× |
| Us breast unilateral complete (76641) |
$266.20 |
$484 |
2.4× |
| Us breast unilateral limited (76642) |
$232.10 |
$422 |
2.5× |
| Us ob detailed single fetus (76811) |
$350.35 |
$637 |
1.4× |
| Us ob transvaginal (76817) |
$202.40 |
$368 |
1.8× |
| Us pelvic non ob complete (76856) |
$315.70 |
$574 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$109.45 |
$199 |
1.0× |
| Us pregnancy ltd (76815) |
$175.45 |
$319 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$253 |
$460 |
2.3× |
| Us retroperitoneal complete (76770) |
$272.25 |
$495 |
2.5× |
| Us scrotum and contents (76870) |
$217.80 |
$396 |
2.0× |
| Us soft tissue head/neck (76536) |
$251.35 |
$457 |
2.3× |
| Us xtr non-vasc lmtd (76882) |
$198 |
$360 |
1.8× |
| Wrist 2 views (73100) |
$201.85 |
$367 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$336.60 |
$612 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$161.15 |
$293 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$201.85 |
$367 |
2.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$485.10 |
$882 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$161.15 |
$293 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$201.85 |
$367 |
2.2× |
| X-ray exam hip uni 1 view (73501) |
$393.80 |
$716 |
4.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$312.95 |
$569 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$534.60 |
$972 |
4.8× |
| X-ray exam of femur 1 (73551) |
$141.35 |
$257 |
1.5× |
| X-ray eye for foreign body (70030) |
$161.15 |
$293 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$161.15 |
$293 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$196.35 |
$357 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$161.15 |
$293 |
1.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$201.85 |
$367 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$161.15 |
$293 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$201.85 |
$367 |
1.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$269.50 |
$490 |
2.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$161.15 |
$293 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$161.15 |
$293 |
1.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$193.60 |
$352 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$165 |
$300 |
1.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$242 |
$440 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$240.90 |
$438 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$254.10 |
$462 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$161.15 |
$293 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$161.15 |
$293 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$226.05 |
$411 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$217.25 |
$395 |
2.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$161.15 |
$293 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$161.15 |
$293 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$161.15 |
$293 |
1.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$161.15 |
$293 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$161.15 |
$293 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$161.15 |
$293 |
1.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$161.15 |
$293 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$215.60 |
$392 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$394.35 |
$717 |
3.6× |
| Xr finger(s) 2+ views (73140) |
$161.15 |
$293 |
1.8× |
| Xr shoulder 1 view (73020) |
$161.15 |
$293 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$336.60 |
$612 |
3.1× |
| Xr tibia/fibula 2 views (73590) |
$201.85 |
$367 |
2.2× |
| Xr tmj bilateral (70330) |
$161.15 |
$293 |
1.8× |
| Xray knee 1 or 2 views rt (73560) |
$201.85 |
$367 |
2.2× |