| Abdomen 2 views (74019) |
$243.44 |
$608.60 |
2.4× |
| Ankle 2 views (73600) |
$171.84 |
$429.60 |
2.1× |
| Arthrogram wrist (73115) |
$1,157.29 |
$2,893.22 |
3.5× |
| Bone age studies (77072) |
$101 |
$252.51 |
1.0× |
| Bone survey complete (77075) |
$169.24 |
$423.09 |
1.7× |
| Brain Imaging Pet Metabolic Evaluation (78608) |
$2,198.81 |
$5,497.02 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$101 |
$252.51 |
1.2× |
| Chest 1 view (71045) |
$166.96 |
$417.39 |
2.0× |
| Chest 3 views (71047) |
$166.96 |
$417.39 |
2.0× |
| Clavicle complete (73000) |
$257.78 |
$644.44 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$210.60 |
$526.49 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,500.02 |
$3,750.06 |
4.5× |
| CT abdomen and pelvis without contrast (74176) |
$877.46 |
$2,193.64 |
3.8× |
| CT abdomen w contrast (74160) |
$667.99 |
$1,669.97 |
4.0× |
| CT abdomen w wo contrast (74170) |
$667.99 |
$1,669.97 |
4.0× |
| CT abdomen w/o contrast (74150) |
$438.75 |
$1,096.88 |
4.4× |
| CT angiography upper extremity lt (73206) |
$1,134.95 |
$2,837.38 |
6.8× |
| CT c-spine w/o contrast (72125) |
$438.79 |
$1,096.97 |
4.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,167.27 |
$2,918.17 |
7.0× |
| CT cervical spine with contrast (72126) |
$935.48 |
$2,338.71 |
2.8× |
| CT chest w/wo contrast (71270) |
$750.03 |
$1,875.08 |
4.5× |
| CT chest with contrast (71260) |
$668.04 |
$1,670.10 |
4.0× |
| CT head/brain with contrast (70460) |
$668.04 |
$1,670.10 |
4.0× |
| CT head/brain without and with contrast (70470) |
$750.03 |
$1,875.08 |
4.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$141.46 |
$353.65 |
1.7× |
| CT iac w contrast (70481) |
$681.24 |
$1,703.10 |
4.1× |
| CT limited/localized follow up study (76380) |
$269.05 |
$672.63 |
3.2× |
| CT lower ext w/o (73700) |
$853.58 |
$2,133.95 |
8.5× |
| CT lower extremity w wo contrast (73702) |
$1,459.08 |
$3,647.68 |
8.7× |
| CT lower extremity with contrast (73701) |
$1,299.58 |
$3,248.94 |
7.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,111.65 |
$2,779.12 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
$438.79 |
$1,096.97 |
4.4× |
| CT lumbar spine with contrast (72132) |
$668.04 |
$1,670.10 |
2.0× |
| CT maxillofacial w contrast (70487) |
$799.06 |
$1,997.64 |
4.8× |
| CT maxillofacial w/o contrast (70486) |
$438.70 |
$1,096.75 |
4.4× |
| CT maxillofacial w/wo contrast (70488) |
$839.04 |
$2,097.61 |
5.0× |
| CT neck soft tissue w contrast (70491) |
$668.04 |
$1,670.10 |
4.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$839.04 |
$2,097.61 |
5.0× |
| CT orbits w/o contrast (70480) |
$438.79 |
$1,096.97 |
4.4× |
| CT pelvis w & w/o contrast (72194) |
$750.03 |
$1,875.08 |
4.5× |
| CT pelvis w/o contrast (72192) |
$438.70 |
$1,096.75 |
4.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$750.03 |
$1,875.08 |
4.5× |
| CT soft tissue neck w/o contrast (70490) |
$438.79 |
$1,096.97 |
4.4× |
| CT thoracic spine w/contrast (72129) |
$990.12 |
$2,475.31 |
5.9× |
| CT thoracic spine w/o contrast (72128) |
$438.79 |
$1,096.97 |
4.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,111.65 |
$2,779.12 |
6.6× |
| CT thorax w/o contrast (71250) |
$438.79 |
$1,096.97 |
4.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,459.08 |
$3,647.68 |
8.7× |
| CT upper extremity w/o contrast rt (73200) |
$853.58 |
$2,133.95 |
8.5× |
| CT upper extremity with contrast (73201) |
$1,299.58 |
$3,248.94 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,191.76 |
$2,979.39 |
7.1× |
| Cta Abdomen (74175) |
$765.75 |
$1,914.38 |
4.6× |
| CTA abdomen pelvis (74174) |
$1,431.18 |
$3,577.95 |
4.3× |
| CTA chest (71275) |
$765.75 |
$1,914.38 |
4.6× |
| Cta Head (70496) |
$839.04 |
$2,097.61 |
5.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,489.68 |
$3,724.20 |
8.9× |
| Cta Neck (70498) |
$839.04 |
$2,097.61 |
5.0× |
| Cta Pelvis (72191) |
$765.75 |
$1,914.38 |
4.6× |
| Cystography minimum 3 views rs&i (74430) |
$385.97 |
$964.92 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$163.17 |
$407.92 |
1.6× |
| Echoencephalography real time imaging (76506) |
$241.31 |
$603.27 |
2.4× |
| Esophagus (74220) |
$196.88 |
$492.21 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$192.46 |
$481.14 |
0.8× |
| Foot 2 views (73620) |
$171.84 |
$429.60 |
2.1× |
| Forearm 2 views (73090) |
$136.42 |
$341.06 |
1.6× |
| Hand 2 views (73120) |
$171.84 |
$429.60 |
1.7× |
| Hand 3 views (73130) |
$171.84 |
$429.60 |
2.1× |
| Humerus Min 2 Views Left (73060) |
$136.42 |
$341.06 |
1.6× |
| Knee 3 views (73562) |
$252.68 |
$631.70 |
3.0× |
| Neck soft tissue (70360) |
$101 |
$252.51 |
1.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$189.26 |
$473.14 |
1.9× |
| Osseous survey infant (77076) |
$169.24 |
$423.09 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$101 |
$252.51 |
1.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$472.86 |
$1,182.16 |
0.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$135.85 |
$339.62 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$203.07 |
$507.67 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$295.48 |
$738.68 |
3.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$580.75 |
$1,451.87 |
5.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$101 |
$252.51 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$166.96 |
$417.39 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$243.44 |
$608.60 |
2.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$166.96 |
$417.39 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$318.72 |
$796.80 |
1.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$351.38 |
$878.44 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$196.88 |
$492.21 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$275.84 |
$689.59 |
3.3× |
| Ribs bilateral 3 views (71110) |
$101 |
$252.51 |
1.0× |
| Sacroiliac Joints < 3 Views (72200) |
$101 |
$252.51 |
1.0× |
| Scapula complete (73010) |
$257.78 |
$644.44 |
2.6× |
| Screening digital breast tomosynthesis (77063) |
$72.30 |
$180.76 |
3.1× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$259.17 |
$647.92 |
2.6× |
| Sialogram (70390) |
$472.86 |
$1,182.16 |
2.1× |
| Small bowel series (74250) |
$334.66 |
$836.66 |
2.0× |
| Spine thoracic 3 views (72072) |
$101 |
$252.51 |
1.0× |
| Thoracolumbar 2 views (72080) |
$101 |
$252.51 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$218.85 |
$547.12 |
2.2× |
| Upper Extremity Infant (73092) |
$257.78 |
$644.44 |
2.6× |
| Urethrocystography retrograde rs&i (74450) |
$251.84 |
$629.60 |
1.1× |
| Urethrocystography voiding (74455) |
$385.97 |
$964.92 |
1.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$385.97 |
$964.92 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$229.83 |
$574.57 |
2.3× |
| Us breast unilateral complete (76641) |
$355.56 |
$888.90 |
3.6× |
| Us breast unilateral limited (76642) |
$403.78 |
$1,009.45 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$390.66 |
$976.64 |
3.9× |
| Us infant hips dynamic (76885) |
$250.91 |
$627.28 |
3.0× |
| Us ob transvaginal (76817) |
$140.51 |
$351.27 |
1.4× |
| Us pelvic non ob complete (76856) |
$218.81 |
$547.03 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$238.90 |
$597.24 |
2.4× |
| Us pregnancy ltd (76815) |
$140.51 |
$351.27 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$218.81 |
$547.03 |
2.2× |
| Us retroperitoneal complete (76770) |
$218.85 |
$547.12 |
2.2× |
| Us retroperitoneal limited (76775) |
$218.85 |
$547.12 |
2.2× |
| Us scrotum and contents (76870) |
$218.81 |
$547.03 |
2.2× |
| Us soft tissue head/neck (76536) |
$218.85 |
$547.12 |
2.2× |
| Us spinal canal and contents (76800) |
$218.85 |
$547.12 |
2.2× |
| Us xtr non-vasc lmtd (76882) |
$180.52 |
$451.30 |
1.8× |
| Wrist 2 views (73100) |
$171.84 |
$429.60 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$169.24 |
$423.09 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$101 |
$252.51 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$252.68 |
$631.70 |
3.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$515.32 |
$1,288.29 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$171.84 |
$429.60 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$171.84 |
$429.60 |
2.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$387.18 |
$967.94 |
3.9× |
| X-ray exam hip uni 1 view (73501) |
$203.78 |
$509.46 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$269.90 |
$674.76 |
3.2× |
| X-ray exam hip uni 4/> views (73503) |
$281.20 |
$703.02 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$380.18 |
$950.46 |
3.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$462.49 |
$1,156.22 |
4.6× |
| X-ray exam of femur 1 (73551) |
$183.89 |
$459.73 |
2.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$318.36 |
$795.90 |
1.9× |
| X-ray eye for foreign body (70030) |
$225.63 |
$564.08 |
2.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$101 |
$252.51 |
1.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$101 |
$252.51 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$257.78 |
$644.44 |
3.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$252.68 |
$631.70 |
3.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$101 |
$252.51 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$257.78 |
$644.44 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$101 |
$252.51 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$257.78 |
$644.44 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$101 |
$252.51 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$169.24 |
$423.09 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$101 |
$252.51 |
1.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$101 |
$252.51 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$101 |
$252.51 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$171.84 |
$429.60 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$171.84 |
$429.60 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$171.84 |
$429.60 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$169.24 |
$423.09 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$101 |
$252.51 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$101 |
$252.51 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$257.78 |
$644.44 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$101 |
$252.51 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$101 |
$252.51 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$169.24 |
$423.09 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$101 |
$252.51 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$136.42 |
$341.06 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$156.94 |
$392.34 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$101 |
$252.51 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$101 |
$252.51 |
1.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$259.17 |
$647.92 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$257.78 |
$644.44 |
3.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$171.84 |
$429.60 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$169.24 |
$423.09 |
1.7× |
| Xr chest 4+ views (71048) |
$243.44 |
$608.60 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$257.78 |
$644.44 |
3.1× |
| Xr shoulder 1 view (73020) |
$171.84 |
$429.60 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$169.24 |
$423.09 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$136.42 |
$341.06 |
1.6× |
| Xr tmj bilateral (70330) |
$163.67 |
$409.18 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$257.78 |
$644.44 |
3.1× |