| Abdomen 2 views (74019) |
$304.20 |
$507 |
3.0× |
| Ankle 2 views (73600) |
$210.60 |
$351 |
2.5× |
| Bone &/joint imaging whole body (78306) |
$1,268.40 |
$2,114 |
3.3× |
| Bone age studies (77072) |
$230.40 |
$384 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$1,170 |
$1,950 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$260.40 |
$434 |
3.1× |
| Chest 1 view (71045) |
$213.60 |
$356 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$553.20 |
$922 |
3.3× |
| Clavicle complete (73000) |
$230.40 |
$384 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,773 |
$2,955 |
17.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,948.20 |
$8,247 |
14.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,231 |
$5,385 |
14.1× |
| CT abdomen w contrast (74160) |
$1,892.40 |
$3,154 |
11.2× |
| CT abdomen w wo contrast (74170) |
$2,256.60 |
$3,761 |
13.4× |
| CT abdomen w/o contrast (74150) |
$1,533 |
$2,555 |
15.3× |
| CT c-spine w/contrast (72126) |
$2,272.80 |
$3,788 |
6.8× |
| CT c-spine w/o contrast (72125) |
$1,969.80 |
$3,283 |
19.6× |
| CT chest w contrast (71260) |
$2,422.80 |
$4,038 |
14.4× |
| CT chest w/wo contrast (71270) |
$2,899.80 |
$4,833 |
17.2× |
| CT head/brain with contrast (70460) |
$1,577.40 |
$2,629 |
9.4× |
| CT head/brain without and with contrast (70470) |
$2,240.40 |
$3,734 |
13.3× |
| CT lower ext w/o (73700) |
$1,463.40 |
$2,439 |
14.6× |
| CT lower extremity w wo contrast (73702) |
$3,146.70 |
$5,244.50 |
18.7× |
| CT lower extremity w/contrast material (73701) |
$1,846.80 |
$3,078 |
11.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,693.40 |
$4,489 |
16.0× |
| CT lumbar spine w/contrast (72132) |
$2,272.80 |
$3,788 |
6.8× |
| CT lumbar spine w/o contrast (72131) |
$1,869 |
$3,115 |
18.6× |
| CT maxillofacial w contrast (70487) |
$1,846.80 |
$3,078 |
11.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,098.20 |
$3,497 |
12.5× |
| CT maxillofacial wo contrast (70486) |
$1,463.40 |
$2,439 |
14.6× |
| CT orbits w/o contrast (70480) |
$1,463.40 |
$2,439 |
14.6× |
| CT pelvis w/o contrast (72192) |
$1,700.40 |
$2,834 |
17.0× |
| CT pelvis w/wo contrast (72194) |
$2,693.40 |
$4,489 |
16.0× |
| CT scan of arm combo (73202) |
$2,098.20 |
$3,497 |
12.5× |
| CT soft tissue neck w contrast (70491) |
$1,846.80 |
$3,078 |
11.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,098.20 |
$3,497 |
12.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,463.40 |
$2,439 |
14.6× |
| CT thoracic spine w/o contrast (72128) |
$2,010 |
$3,350 |
20.0× |
| CT thoracic spine w/wo contrast (72130) |
$2,693.40 |
$4,489 |
16.0× |
| CT thorax w/o contrast (71250) |
$1,773 |
$2,955 |
17.7× |
| CT upper ext wo (73200) |
$1,463.40 |
$2,439 |
14.6× |
| CT upper extremity with contrast (73201) |
$1,846.80 |
$3,078 |
5.5× |
| CTA abdomen pelvis (74174) |
$4,842 |
$8,070 |
14.5× |
| CTA chest (71275) |
$2,693.40 |
$4,489 |
16.0× |
| Cta Head (70496) |
$2,098.20 |
$3,497 |
12.5× |
| Cta Neck (70498) |
$2,098.20 |
$3,497 |
12.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$544.80 |
$908 |
5.4× |
| Esophagus (74220) |
$549.60 |
$916 |
3.3× |
| Facial bones min 3 views (70150) |
$336.60 |
$561 |
3.4× |
| Fluoroscopy up to 1 hr (76000) |
$374.40 |
$624 |
1.6× |
| Foot 2 views (73620) |
$209.40 |
$349 |
2.5× |
| Forearm 2 views (73090) |
$220.80 |
$368 |
2.6× |
| Hand 2 views (73120) |
$192.60 |
$321 |
1.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,268.40 |
$2,114 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$664.20 |
$1,107 |
1.7× |
| Knee 3 views (73562) |
$243.60 |
$406 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,010.20 |
$5,017 |
9.0× |
| MRA head w & w/o contrast (70546) |
$2,418.60 |
$4,031 |
7.2× |
| MRA head w/o contrast (70544) |
$2,485.20 |
$4,142 |
10.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,505 |
$4,175 |
7.5× |
| MRI abdomen w/o contrast (74181) |
$2,386.20 |
$3,977 |
10.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,277.20 |
$5,462 |
9.8× |
| MRI cervical spine w/o contrast (72141) |
$2,866.80 |
$4,778 |
12.5× |
| MRI chest w/o & w/contrast material (71552) |
$3,205.20 |
$5,342 |
9.6× |
| MRI chest w/o contrast (71550) |
$3,010.20 |
$5,017 |
13.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,866.80 |
$4,778 |
8.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,277.20 |
$5,462 |
9.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,033.40 |
$3,389 |
8.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,010.20 |
$5,017 |
13.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,010.20 |
$5,017 |
9.0× |
| MRI pelvis w/o contrast (72195) |
$2,866.80 |
$4,778 |
12.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,568.40 |
$7,614 |
13.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,754.80 |
$6,258 |
11.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,568.40 |
$7,614 |
13.7× |
| MRI thoracic spine w/o contrast (72146) |
$3,205.20 |
$5,342 |
14.0× |
| MRI up ext w/o contrast (73218) |
$2,167.80 |
$3,613 |
9.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,866.80 |
$4,778 |
12.5× |
| MRI, joint upper extrem combo (73223) |
$3,010.20 |
$5,017 |
9.0× |
| Myocardial Spect Multiple Studies (78452) |
$2,353.20 |
$3,922 |
1.9× |
| Neck soft tissue (70360) |
$210.60 |
$351 |
2.5× |
| Nm gastric emptying study (78264) |
$1,293 |
$2,155 |
3.4× |
| Pelvis 1 or 2 views (72170) |
$230.40 |
$384 |
2.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$251.40 |
$419 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$220.80 |
$368 |
2.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$260.40 |
$434 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$462 |
$770 |
4.6× |
| Radex fingr minimum 2 views (73140) |
$186.60 |
$311 |
2.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$238.20 |
$397 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$231.60 |
$386 |
2.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$243 |
$405 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$452.40 |
$754 |
4.5× |
| Radex Humerus Minimum 2 Views (73060) |
$230.40 |
$384 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$218.40 |
$364 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$280.80 |
$468 |
2.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$374.40 |
$624 |
3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$230.40 |
$384 |
2.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$230.40 |
$384 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$230.40 |
$384 |
2.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$366 |
$610 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$374.40 |
$624 |
4.5× |
| Radex Toe Minimum 2 Views (73660) |
$172.80 |
$288 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$255 |
$425 |
3.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$668.40 |
$1,114 |
6.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$230.40 |
$384 |
2.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$307.80 |
$513 |
3.1× |
| Radiologic exam chest 2 views (71046) |
$251.40 |
$419 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,225.20 |
$2,042 |
7.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,149 |
$1,915 |
6.8× |
| Radiologic examination femur 1 view (73551) |
$117 |
$195 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$238.20 |
$397 |
2.9× |
| Ribs bilateral 3 views (71110) |
$454.20 |
$757 |
4.5× |
| Sacroiliac Joints < 3 Views (72200) |
$161.40 |
$269 |
1.6× |
| Scapula (73010) |
$230.40 |
$384 |
2.3× |
| Shoulder 1 view (73020) |
$199.80 |
$333 |
2.4× |
| Small bowel series (74250) |
$445.20 |
$742 |
2.6× |
| Spine thoracic 3 views (72072) |
$352.20 |
$587 |
3.5× |
| Ultrasound breast complete (76641) |
$538.80 |
$898 |
5.4× |
| Ultrasound Exam Aaa Screen (76706) |
$405 |
$675 |
4.0× |
| Ultrasound, abdomen limited (76705) |
$519 |
$865 |
5.2× |
| Us chest (76604) |
$898.80 |
$1,498 |
9.0× |
| Us compl joint r-t w/image documentation (76881) |
$230.40 |
$384 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$149.40 |
$249 |
1.5× |
| Us ob limited (76815) |
$643.20 |
$1,072 |
6.4× |
| Us pelvic non ob complete (76856) |
$715.80 |
$1,193 |
7.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$637.20 |
$1,062 |
6.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$809.40 |
$1,349 |
8.1× |
| Us retroperitoneal limited (76775) |
$137.40 |
$229 |
1.4× |
| Us scrotum and contents (76870) |
$809.40 |
$1,349 |
8.1× |
| Us soft tissue head/neck (76536) |
$643.20 |
$1,072 |
6.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$289.20 |
$482 |
2.9× |
| Wrist 2 views (73100) |
$209.40 |
$349 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$529.20 |
$882 |
5.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$304.20 |
$507 |
3.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$910.20 |
$1,517 |
5.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$199.20 |
$332 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$234 |
$390 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$446.40 |
$744 |
4.5× |
| X-ray exam of femur 2/> (73552) |
$230.40 |
$384 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$230.40 |
$384 |
2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$230.40 |
$384 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$427.20 |
$712 |
5.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$265.80 |
$443 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$648 |
$1,080 |
6.5× |
| X-ray nose-rectum child f.b. (76010) |
$230.40 |
$384 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$300 |
$500 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$364.80 |
$608 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$519 |
$865 |
5.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$333 |
$555 |
3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$260.40 |
$434 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$373.80 |
$623 |
4.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$374.40 |
$624 |
3.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$230.40 |
$384 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$230.40 |
$384 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$230.40 |
$384 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$315 |
$525 |
3.1× |
| Xr bone length studies (77073) |
$320.40 |
$534 |
3.2× |
| Xr c-spine 4 or 5 views (72050) |
$339 |
$565 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$454.20 |
$757 |
4.5× |
| Xr chest 4+ views (71048) |
$295.20 |
$492 |
2.9× |