| Abdomen 2 views (74019) |
$108.40 |
$271 |
1.1× |
| Ankle 2 views (73600) |
$83.20 |
$208 |
1.1× |
| Bone &/Joint Imaging Limited Area (78300) |
$236.80 |
$592 |
0.7× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$290.40 |
$726 |
0.8× |
| Bone &/joint imaging whole body (78306) |
$399.60 |
$999 |
1.1× |
| Bone age studies (77072) |
$100.40 |
$251 |
1.1× |
| Bone Imaging 3 Phase (78315) |
$459.60 |
$1,149 |
1.3× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$532.80 |
$1,332 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$103.60 |
$259 |
1.3× |
| Chest 1 view (71045) |
$93.20 |
$233 |
1.2× |
| Chest 3 views (71047) |
$66 |
$165 |
0.8× |
| Clavicle complete (73000) |
$88.80 |
$222 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,005.20 |
$2,513 |
3.2× |
| CT abdomen and pelvis without contrast (74176) |
$909.60 |
$2,274 |
4.2× |
| CT abdomen w contrast (74160) |
$639.20 |
$1,598 |
4.0× |
| CT abdomen w wo contrast (74170) |
$690.40 |
$1,726 |
4.4× |
| CT abdomen w/o contrast (74150) |
$583.20 |
$1,458 |
6.2× |
| CT c-spine w/o contrast (72125) |
$745.60 |
$1,864 |
7.9× |
| CT cervical spine w&w/o contrast (72127) |
$690.40 |
$1,726 |
4.4× |
| CT cervical spine with contrast (72126) |
$574.40 |
$1,436 |
1.8× |
| CT chest w/wo contrast (71270) |
$435.20 |
$1,088 |
2.7× |
| CT chest with contrast (71260) |
$435.20 |
$1,088 |
2.7× |
| CT head/brain with contrast (70460) |
$448 |
$1,120 |
2.8× |
| CT head/brain without and with contrast (70470) |
$586.40 |
$1,466 |
3.7× |
| CT iac w contrast (70481) |
$622.40 |
$1,556 |
3.9× |
| CT lower ext w/o (73700) |
$537.60 |
$1,344 |
5.7× |
| CT lower extremity w wo contrast (73702) |
$912 |
$2,280 |
5.8× |
| CT lower extremity with contrast (73701) |
$526.40 |
$1,316 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$559.60 |
$1,399 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$596.80 |
$1,492 |
6.3× |
| CT lumbar spine with contrast (72132) |
$536.40 |
$1,341 |
1.7× |
| CT maxillofacial w contrast (70487) |
$408 |
$1,020 |
2.6× |
| CT maxillofacial w/o contrast (70486) |
$350 |
$875 |
3.7× |
| CT maxillofacial w/wo contrast (70488) |
$444.80 |
$1,112 |
2.8× |
| CT neck soft tissue w contrast (70491) |
$701.60 |
$1,754 |
4.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$678.80 |
$1,697 |
4.3× |
| CT orbits w/o contrast (70480) |
$380 |
$950 |
4.0× |
| CT pelvis w & w/o contrast (72194) |
$690.40 |
$1,726 |
4.4× |
| CT pelvis w/o contrast (72192) |
$610.40 |
$1,526 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$527.60 |
$1,319 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$397.60 |
$994 |
4.2× |
| CT thoracic spine w/contrast (72129) |
$722 |
$1,805 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$696.40 |
$1,741 |
7.4× |
| CT thoracic spine w/wo contrast (72130) |
$581.60 |
$1,454 |
3.7× |
| CT thorax w/o contrast (71250) |
$224.40 |
$561 |
2.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$526.80 |
$1,317 |
3.3× |
| CT upper extremity w/o contrast rt (73200) |
$467.60 |
$1,169 |
5.0× |
| CT upper extremity with contrast (73201) |
$654.80 |
$1,637 |
2.1× |
| CTA chest (71275) |
$766 |
$1,915 |
4.8× |
| Cta Pelvis (72191) |
$690.40 |
$1,726 |
4.4× |
| Fetal biophysical profile non-stress testing (76818) |
$178.40 |
$446 |
1.9× |
| Foot 2 views (73620) |
$83.20 |
$208 |
1.1× |
| Forearm 2 views (73090) |
$77.20 |
$193 |
1.0× |
| Gated Heart Planar Single (78472) |
$326.40 |
$816 |
0.9× |
| Hand 2 views (73120) |
$92.40 |
$231 |
1.0× |
| Hand 3 views (73130) |
$88.80 |
$222 |
1.1× |
| Heart Infarct Image (78466) |
$331.60 |
$829 |
0.9× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$505.20 |
$1,263 |
1.0× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$388.80 |
$972 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$88.80 |
$222 |
1.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$80.40 |
$201 |
0.9× |
| Knee 3 views (73562) |
$98.40 |
$246 |
1.3× |
| Liver & spleen imaging static only (78215) |
$279.60 |
$699 |
0.8× |
| MRA head w/o contrast (70544) |
$202 |
$505 |
0.9× |
| MRA neck w/o contrast (70547) |
$629.20 |
$1,573 |
2.9× |
| MRI abdomen w contrast (74182) |
$920 |
$2,300 |
2.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,040.40 |
$2,601 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$862.80 |
$2,157 |
4.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,498 |
$3,745 |
2.1× |
| MRI breast w/o contrast bilateral (77047) |
$979.60 |
$2,449 |
4.5× |
| MRI breast w/o contrast unilat (77046) |
$772.80 |
$1,932 |
3.6× |
| MRI c-spine with contrast (72142) |
$1,017.60 |
$2,544 |
3.2× |
| MRI cardiac w/o contrast (75557) |
$161.60 |
$404 |
0.8× |
| MRI cervical spine w/o contrast (72141) |
$637 |
$1,592.50 |
3.0× |
| MRI chest w/o contrast (71550) |
$810.40 |
$2,026 |
3.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$344 |
$860 |
1.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$643.20 |
$1,608 |
3.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$732.40 |
$1,831 |
3.4× |
| MRI pelvis w contrast (72196) |
$778.80 |
$1,947 |
2.5× |
| MRI pelvis w/o contrast (72195) |
$723.60 |
$1,809 |
3.4× |
| MRI scan of arm joint before and after contrast (73223) |
$658.80 |
$1,647 |
2.1× |
| MRI scan of leg joint before and after contrast (73723) |
$818 |
$2,045 |
2.6× |
| MRI spectroscopy (76390) |
$289.60 |
$724 |
3.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,323.20 |
$3,308 |
4.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,169.60 |
$2,924 |
3.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,407.20 |
$3,518 |
4.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$986.80 |
$2,467 |
3.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,260 |
$3,150 |
4.0× |
| MRI thoracic spine w/o contrast (72146) |
$620.60 |
$1,551.50 |
2.9× |
| MRI tmj (70336) |
$950.80 |
$2,377 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$652.40 |
$1,631 |
3.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$659.20 |
$1,648 |
2.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$652 |
$1,630 |
3.0× |
| Neck soft tissue (70360) |
$56.80 |
$142 |
0.7× |
| Osseous survey limited (77074) |
$51.20 |
$128 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$92 |
$230 |
1.0× |
| Pr heart first pass single,planar (78481) |
$178.40 |
$446 |
0.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$818 |
$2,045 |
2.6× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$298.80 |
$747 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$509.60 |
$1,274 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$150.40 |
$376 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$138.40 |
$346 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$76.80 |
$192 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$80.40 |
$201 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$112.40 |
$281 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$165.20 |
$413 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$92 |
$230 |
1.2× |
| Ribs bilateral 3 views (71110) |
$127.20 |
$318 |
1.3× |
| Scapula complete (73010) |
$76 |
$190 |
0.8× |
| Small bowel series (74250) |
$108 |
$270 |
0.7× |
| Spine thoracic 3 views (72072) |
$115.60 |
$289 |
1.2× |
| Thyroid Imaging With Vascular Flow (78013) |
$158.70 |
$396.75 |
0.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$299.20 |
$748 |
11.5× |
| Ultrasound, abdomen limited (76705) |
$238 |
$595 |
2.5× |
| Unlisted Ultrasound Procedure (76999) |
$134.40 |
$336 |
1.7× |
| Upper Extremity Infant (73092) |
$63.60 |
$159 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$164.40 |
$411 |
1.0× |
| Us chest (76604) |
$134.80 |
$337 |
1.4× |
| Us compl joint r-t w/image documentation (76881) |
$160 |
$400 |
1.7× |
| Us ob transvaginal (76817) |
$268.80 |
$672 |
2.8× |
| Us pelvic non ob complete (76856) |
$247.20 |
$618 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$106.80 |
$267 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$318.40 |
$796 |
3.4× |
| Us retroperitoneal complete (76770) |
$358.80 |
$897 |
3.8× |
| Us retroperitoneal limited (76775) |
$206.80 |
$517 |
2.2× |
| Us scrotum and contents (76870) |
$328.40 |
$821 |
3.5× |
| Us soft tissue head/neck (76536) |
$186.80 |
$467 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$132 |
$330 |
1.4× |
| Wrist 2 views (73100) |
$86.80 |
$217 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$180.80 |
$452 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$97.60 |
$244 |
1.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$90 |
$225 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$83.20 |
$208 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$79.60 |
$199 |
1.0× |
| X-ray exam hip uni 1 view (73501) |
$77.20 |
$193 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$116 |
$290 |
1.5× |
| X-ray exam hip uni 4/> views (73503) |
$266.80 |
$667 |
2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$160 |
$400 |
1.7× |
| X-ray exam of femur 1 (73551) |
$54 |
$135 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$138.40 |
$346 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$88.80 |
$222 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$83.20 |
$208 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$166.40 |
$416 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$119.60 |
$299 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$72.40 |
$181 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$63.60 |
$159 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$111.20 |
$278 |
1.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$167.60 |
$419 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$118.80 |
$297 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$154 |
$385 |
1.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$122.40 |
$306 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$111.20 |
$278 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$111.20 |
$278 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$92.40 |
$231 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$90 |
$225 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$93.20 |
$233 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$157.20 |
$393 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$160 |
$400 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$85.60 |
$214 |
0.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$75.60 |
$189 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$95.60 |
$239 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$98.40 |
$246 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$72.40 |
$181 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$100.80 |
$252 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$132.40 |
$331 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$83.20 |
$208 |
1.1× |
| Xr shoulder 1 view (73020) |
$73.60 |
$184 |
0.9× |
| Xr spine cervical 4 or 5 views (72050) |
$138.80 |
$347 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$92 |
$230 |
1.2× |
| Xr tmj bilateral (70330) |
$104.80 |
$262 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$83.20 |
$208 |
1.1× |