| Abdomen 1 View (74018) |
$109 |
$109 |
1.4× |
| Abdomen 2 views (74019) |
$286.50 |
$286.50 |
3.1× |
| Ankle 2 views (73600) |
$109 |
$109 |
1.4× |
| Bone age studies (77072) |
$286.50 |
$286.50 |
3.1× |
| Bone Imaging 3 Phase (78315) |
$1,016.50 |
$1,016.50 |
2.9× |
| Bone Imaging Limited Area (78300) |
$404 |
$404 |
1.2× |
| Bone Imaging Whole Body (78306) |
$606 |
$606 |
1.7× |
| Chest 1 view (71045) |
$336 |
$336 |
4.4× |
| Chest 2 views (71046) |
$354 |
$354 |
4.6× |
| Clavicle complete (73000) |
$203.50 |
$203.50 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,150 |
$1,150 |
12.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,300 |
$1,300 |
4.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,468 |
$2,468 |
11.8× |
| CT abdomen w contrast (74160) |
$1,150 |
$1,150 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,300 |
$1,300 |
8.5× |
| CT abdomen w/o contrast (74150) |
$1,150 |
$1,150 |
12.6× |
| CT Angio Abdomen and Pelvis (74174) |
$1,382.50 |
$1,382.50 |
4.5× |
| CT Angio Chest (71275) |
$2,074 |
$2,074 |
13.5× |
| CT Angio Head (70496) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT Angio Neck (70498) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT cervical spine w/ contrast (72126) |
$1,152 |
$1,152 |
3.8× |
| CT cervical spine w/o contrast (72125) |
$1,150 |
$1,150 |
12.6× |
| CT chest w contrast (71260) |
$1,728 |
$1,728 |
11.2× |
| CT chest w/wo contrast (71270) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT head/brain with contrast (70460) |
$1,152 |
$1,152 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT lower ext w/o (73700) |
$1,150 |
$1,150 |
12.6× |
| CT lower extremity w/contrast material (73701) |
$1,152 |
$1,152 |
7.5× |
| CT lumbar spine w contrast (72132) |
$1,152 |
$1,152 |
3.8× |
| CT lumbar spine w/o contrast (72131) |
$1,150 |
$1,150 |
12.6× |
| CT maxillofacial w contrast (70487) |
$1,152 |
$1,152 |
7.5× |
| CT maxillofacial wo contrast (70486) |
$1,728 |
$1,728 |
18.9× |
| CT neck tissue combo (70492) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT orbits w/o contrast (70480) |
$1,152 |
$1,152 |
12.6× |
| CT pelvis w&w/o contrast (72194) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT pelvis w/o contrast (72192) |
$1,150 |
$1,150 |
12.6× |
| CT scan of leg combo (73702) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT soft tissue neck w contrast (70491) |
$1,150 |
$1,150 |
7.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,150 |
$1,150 |
12.6× |
| CT thoracic spine w/o contrast (72128) |
$1,150 |
$1,150 |
12.6× |
| CT thorax w/o contrast (71250) |
$1,186.56 |
$1,186.56 |
13.0× |
| CT upper ext wo (73200) |
$2,304 |
$2,304 |
25.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,382.50 |
$1,382.50 |
9.0× |
| CT upper extremity with contrast (73201) |
$1,152 |
$1,152 |
3.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,256.64 |
$1,256.64 |
8.2× |
| Dxa Bone Density Axial (77080) |
$205 |
$205 |
2.2× |
| Esophagram (74220) |
$250 |
$250 |
1.6× |
| Foot 2 views (73620) |
$203.50 |
$203.50 |
2.7× |
| Forearm 2 views (73090) |
$236.50 |
$236.50 |
3.1× |
| Gastric emptying imaging study (78264) |
$727 |
$727 |
2.1× |
| Hand 2 views (73120) |
$286.50 |
$286.50 |
3.1× |
| Hepatobil Syst Image W/Drug (78227) |
$666 |
$666 |
1.4× |
| Hepatobiliary System Imaging (78226) |
$813 |
$813 |
2.3× |
| Knee 3 Views (73562) |
$231 |
$231 |
3.0× |
| Lung Ventilat&Perfus Imaging (78582) |
$1,232 |
$1,232 |
2.6× |
| MRA head w/o contrast (70544) |
$2,000 |
$2,000 |
9.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,642 |
$3,642 |
11.9× |
| MRI cervical spine w contrast (72142) |
$2,895 |
$2,895 |
9.5× |
| MRI cervical spine w/o cont (72141) |
$4,193 |
$4,193 |
20.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,642 |
$3,642 |
11.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,795 |
$2,795 |
13.4× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,642 |
$3,642 |
11.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,795 |
$2,795 |
13.4× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,842 |
$3,842 |
12.6× |
| MRI pelvis w/o & w contrast (72197) |
$3,642 |
$3,642 |
11.9× |
| MRI pelvis w/o contrast (72195) |
$2,795 |
$2,795 |
13.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,998 |
$1,998 |
9.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$4,114 |
$4,114 |
19.7× |
| MRI, abdomen, combo (74183) |
$5,463 |
$5,463 |
17.9× |
| MRI, dorsal spine combo (72157) |
$3,642 |
$3,642 |
11.9× |
| MRI, joint upper extrem (73221) |
$4,114 |
$4,114 |
19.7× |
| MRI, joint upper extrem combo (73223) |
$3,642 |
$3,642 |
11.9× |
| MRI, lumbar spine combo (72158) |
$3,642 |
$3,642 |
11.9× |
| Myocardial Spect Multiple Studies (78452) |
$3,135 |
$3,135 |
2.8× |
| Neck soft tissue (70360) |
$553 |
$553 |
7.3× |
| Parathyroid Planar Imaging (78070) |
$1,230 |
$1,230 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$430 |
$430 |
4.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$316.23 |
$316.23 |
3.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$228 |
$228 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$152 |
$152 |
2.0× |
| Radex elbow complete minimum 3 views (73080) |
$304.08 |
$304.08 |
4.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$286.50 |
$286.50 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$203.50 |
$203.50 |
2.7× |
| Radex foot complete minimum 3 views (73630) |
$169 |
$169 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$228 |
$228 |
3.0× |
| Radex lower extremity infant minimum 2 views (73592) |
$237 |
$237 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$152 |
$152 |
2.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$109 |
$109 |
1.4× |
| Radex shoulder complete minimum 2 views (73030) |
$392 |
$392 |
5.1× |
| Radex Spine 1 View Specify Level (72020) |
$152 |
$152 |
2.0× |
| Radex Sternum Minimum 2 Views (71120) |
$203.50 |
$203.50 |
2.7× |
| Radex Toe Minimum 2 Views (73660) |
$152 |
$152 |
2.0× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$237 |
$237 |
3.1× |
| Radiologic exam colon double contrast study (74280) |
$601.50 |
$601.50 |
3.9× |
| Radiologic exam colon single contrast study (74270) |
$432 |
$432 |
2.8× |
| Radiologic exam knee complete 4/more views (73564) |
$312 |
$312 |
3.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$286.50 |
$286.50 |
3.1× |
| Radiologic exam swallow function contrast study (74230) |
$250 |
$250 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$355.50 |
$355.50 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$146 |
$146 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$169 |
$169 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$110 |
$110 |
1.4× |
| Ribs bilateral 3 views (71110) |
$286.50 |
$286.50 |
3.1× |
| Scapula (73010) |
$237 |
$237 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$101 |
$101 |
4.3× |
| Shoulder 1 view (73020) |
$203.50 |
$203.50 |
2.7× |
| Skull less than 4 views (70250) |
$205 |
$205 |
2.2× |
| Thoracic spine 2 views (72070) |
$205 |
$205 |
2.2× |
| Thoracic spine 3 views (72072) |
$205 |
$205 |
2.2× |
| Thoracolumbar 2 views (72080) |
$146 |
$146 |
1.9× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,309 |
$1,309 |
3.7× |
| Ultrasound Breast Limited (76642) |
$381 |
$381 |
5.0× |
| Ultrasound Exam Aaa Screen (76706) |
$291 |
$291 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$610 |
$610 |
6.7× |
| Upper gi w/o kub (74240) |
$178.55 |
$178.55 |
1.2× |
| Us breast unilateral complete (76641) |
$254 |
$254 |
2.8× |
| Us chest (76604) |
$351.51 |
$351.51 |
3.8× |
| Us complete joint (76881) |
$286.50 |
$286.50 |
3.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$254 |
$254 |
2.8× |
| Us ob limited 1 or more fetuses (76815) |
$242 |
$242 |
2.6× |
| Us ob transvaginal (76817) |
$291 |
$291 |
3.2× |
| Us pelvic non ob complete (76856) |
$610 |
$610 |
6.7× |
| Us retroperitoneal complete (76770) |
$291 |
$291 |
3.2× |
| Us retroperitoneal limited (76775) |
$242 |
$242 |
2.6× |
| Us scrotum and contents (76870) |
$291 |
$291 |
3.2× |
| Us thyroid (76536) |
$610 |
$610 |
6.7× |
| Wrist 2 views (73100) |
$203.50 |
$203.50 |
2.7× |
| X-Ray Bend Only L-S Spine (72120) |
$209 |
$209 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$203.50 |
$203.50 |
2.7× |
| X-Ray Exam Breast Specimen (76098) |
$482.89 |
$482.89 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$146 |
$146 |
1.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$203 |
$203 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$297 |
$297 |
3.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$205 |
$205 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$205 |
$205 |
2.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$218 |
$218 |
2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$146 |
$146 |
1.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$222 |
$222 |
2.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$205 |
$205 |
2.2× |
| X-ray humerus (73060) |
$237 |
$237 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$186.50 |
$186.50 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$228 |
$228 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$430 |
$430 |
4.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$205 |
$205 |
2.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$374.08 |
$374.08 |
4.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$146 |
$146 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$203.50 |
$203.50 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$286.50 |
$286.50 |
3.1× |
| X-ray thoracic spine 4 vw (72074) |
$305.50 |
$305.50 |
3.3× |
| X-Rays Bone Survey Complete (77075) |
$833.50 |
$833.50 |
9.1× |
| Xr c-spine 4 or 5 views (72050) |
$436 |
$436 |
4.8× |
| Xr facial bones less than 3 views (70140) |
$154 |
$154 |
2.0× |
| Xr orbits complete 4 views (70200) |
$286.50 |
$286.50 |
3.1× |