| Abdomen 2 views (74019) |
$225 |
$300 |
2.4× |
| Angiography extremity unilateral rs&i (75710) |
$5,343.75 |
$7,125 |
1.9× |
| Angiography pulmonary unilateral slctv rs&i (75741) |
$5,493.75 |
$7,325 |
1.9× |
| Antegrade urography radiological supvj & interpj (74425) |
$772.50 |
$1,030 |
2.4× |
| Arthrogram elbow (73085) |
$772.50 |
$1,030 |
2.4× |
| Arthrogram hip (73525) |
$772.50 |
$1,030 |
2.4× |
| Arthrogram shoulder (73040) |
$772.50 |
$1,030 |
2.4× |
| Arthrogram wrist (73115) |
$772.50 |
$1,030 |
2.4× |
| Arthrography knee lt (73580) |
$772.50 |
$1,030 |
2.4× |
| Bone Imaging 3 Phase (78315) |
$1,328.25 |
$1,771 |
3.6× |
| Bone survey complete (77075) |
$225 |
$300 |
2.4× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$810 |
$1,080 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$161.25 |
$215 |
2.0× |
| Chest 1 view (71045) |
$149.25 |
$199 |
1.9× |
| Chest 3 views (71047) |
$198.75 |
$265 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$161.25 |
$215 |
1.7× |
| CT abdomen and pelvis without contrast (74176) |
$480 |
$640 |
2.2× |
| CT angio hrt w/3d image (75574) |
$367.50 |
$490 |
1.2× |
| CT c-spine w/o contrast (72125) |
$1,375.50 |
$1,834 |
14.5× |
| CT heart contrast eval cardiac structure&morph (75572) |
$367.50 |
$490 |
1.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$161.25 |
$215 |
2.0× |
| CT iac w contrast (70481) |
$367.50 |
$490 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$367.50 |
$490 |
2.3× |
| CTA abdomen pelvis (74174) |
$772.50 |
$1,030 |
2.4× |
| CTA lwr ext w&w/o contrast (73706) |
$405 |
$540 |
2.5× |
| Cystography minimum 3 views rs&i (74430) |
$772.50 |
$1,030 |
2.4× |
| Diskogram cervical (72285) |
$3,480 |
$4,640 |
2.0× |
| Echoencephalography real time imaging (76506) |
$217.50 |
$290 |
2.3× |
| Esophagus (74220) |
$371.25 |
$495 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$225 |
$300 |
2.4× |
| Gated Heart Planar Single (78472) |
$746.25 |
$995 |
2.1× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$956.25 |
$1,275 |
1.9× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$746.25 |
$995 |
2.1× |
| Hysterosalpingogram (74740) |
$472.50 |
$630 |
2.2× |
| Lung perf&ventilat diferentl (78598) |
$956.25 |
$1,275 |
1.9× |
| Meckels Diverticulum (78290) |
$746.25 |
$995 |
2.1× |
| MRA head w & w/o contrast (70546) |
$772.50 |
$1,030 |
2.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$772.50 |
$1,030 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$810 |
$1,080 |
2.5× |
| MRI abdomen w/o contrast (74181) |
$472.50 |
$630 |
2.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,380 |
$1,840 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,380 |
$1,840 |
1.9× |
| MRI breast w/o contrast bilateral (77047) |
$472.50 |
$630 |
2.2× |
| MRI breast w/o contrast unilat (77046) |
$472.50 |
$630 |
2.2× |
| MRI cardiac w/o contrast (75557) |
$472.50 |
$630 |
2.2× |
| MRI cervical spine w/o contrast (72141) |
$472.50 |
$630 |
2.2× |
| MRI chest w/o & w/contrast material (71552) |
$810 |
$1,080 |
2.5× |
| MRI chest w/o contrast (71550) |
$472.50 |
$630 |
2.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,105.25 |
$2,807 |
6.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$772.50 |
$1,030 |
2.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$472.50 |
$630 |
2.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$772.50 |
$1,030 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$810 |
$1,080 |
2.5× |
| MRI scan of arm joint before and after contrast (73223) |
$810 |
$1,080 |
2.5× |
| MRI scan of leg joint before and after contrast (73723) |
$810 |
$1,080 |
2.5× |
| MRI spectroscopy (76390) |
$452.62 |
$603.50 |
5.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$810 |
$1,080 |
2.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$772.50 |
$1,030 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$810 |
$1,080 |
2.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$772.50 |
$1,030 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$772.50 |
$1,030 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$472.50 |
$630 |
2.2× |
| MRI upper ext joint w/o contrast (73221) |
$472.50 |
$630 |
2.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$810 |
$1,080 |
2.5× |
| Neck soft tissue (70360) |
$161.25 |
$215 |
2.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$297.75 |
$397 |
3.1× |
| Osseous survey limited (77074) |
$225 |
$300 |
2.4× |
| PET image w/CT, skull-thigh (78815) |
$2,921.25 |
$3,895 |
2.2× |
| PET imaging for CT attenuation whole body (78816) |
$2,921.25 |
$3,895 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$810 |
$1,080 |
2.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$930 |
$1,240 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$161.25 |
$215 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$180 |
$240 |
2.3× |
| Radiologic exam colon single contrast study (74270) |
$371.25 |
$495 |
2.3× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$390 |
$520 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$390 |
$520 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$371.25 |
$495 |
2.3× |
| Radiological examination surgical specimen (76098) |
$975 |
$1,300 |
2.0× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$2,576.25 |
$3,435 |
5.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$450 |
$600 |
2.1× |
| Scanogram (77073) |
$225 |
$300 |
2.4× |
| Scapula complete (73010) |
$225 |
$300 |
2.4× |
| Screening digital breast tomosynthesis (77063) |
$52.50 |
$70 |
2.2× |
| Small bowel series (74250) |
$371.25 |
$495 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$217.50 |
$290 |
2.3× |
| Unlisted Ultrasound Procedure (76999) |
$371.25 |
$495 |
4.7× |
| Urethrocystography retrograde rs&i (74450) |
$450 |
$600 |
2.1× |
| Urethrocystography voiding (74455) |
$472.50 |
$630 |
2.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$371.25 |
$495 |
2.3× |
| Us breast unilateral limited (76642) |
$228.75 |
$305 |
2.9× |
| Us chest (76604) |
$217.50 |
$290 |
2.3× |
| Us elastography parenchyma (76981) |
$204.75 |
$273 |
2.2× |
| Us guided compression repair (76936) |
$510 |
$680 |
2.6× |
| Us ob detailed single fetus (76811) |
$472.50 |
$630 |
2.2× |
| Us pelvic non ob complete (76856) |
$225 |
$300 |
2.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$225 |
$300 |
2.4× |
| Us pregnancy ltd (76815) |
$225 |
$300 |
2.4× |
| Us retroperitoneal limited (76775) |
$285.75 |
$381 |
3.0× |
| Us scrotum and contents (76870) |
$225 |
$300 |
2.4× |
| Us soft tissue head/neck (76536) |
$217.50 |
$290 |
2.3× |
| Us spinal canal and contents (76800) |
$217.50 |
$290 |
2.3× |
| Us xtr non-vasc lmtd (76882) |
$225 |
$300 |
2.4× |
| Venography extremity unilateral rs&i (75820) |
$818.25 |
$1,091 |
0.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$225 |
$300 |
2.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$390 |
$520 |
2.4× |
| X-ray exam hip uni 4/> views (73503) |
$210 |
$280 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$225 |
$300 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$161.25 |
$215 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$161.25 |
$215 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$225 |
$300 |
2.4× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$772.50 |
$1,030 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$225 |
$300 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$180 |
$240 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$161.25 |
$215 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$243.75 |
$325 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$225 |
$300 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$225 |
$300 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$262.50 |
$350 |
2.8× |
| Xr arthrogram ankle (73615) |
$772.50 |
$1,030 |
2.4× |
| Xr chest 4+ views (71048) |
$225 |
$300 |
2.4× |
| Xr tmj bilateral (70330) |
$486 |
$648 |
6.1× |