| Abdomen 2 views (74019) |
$199.50 |
$266 |
2.1× |
| Ankle 2 views (73600) |
$154.50 |
$206 |
1.9× |
| Bone &/Joint Imaging Limited Area (78300) |
$510 |
$680 |
1.4× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$602.25 |
$803 |
1.6× |
| Bone &/joint imaging whole body (78306) |
$594.75 |
$793 |
1.6× |
| Bone age studies (77072) |
$223.50 |
$298 |
2.3× |
| Bone Imaging 3 Phase (78315) |
$517.50 |
$690 |
1.4× |
| Bone survey complete (77075) |
$749.25 |
$999 |
7.8× |
| Cervical spine 2 or 3 views (72040) |
$237.75 |
$317 |
3.0× |
| Chest 1 view (71045) |
$181.50 |
$242 |
2.3× |
| Chest 3 views (71047) |
$231.75 |
$309 |
2.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$463.50 |
$618 |
2.9× |
| Clavicle complete (73000) |
$170.25 |
$227 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$657 |
$876 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$657 |
$876 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$657 |
$876 |
3.0× |
| CT abdomen w contrast (74160) |
$657 |
$876 |
4.1× |
| CT abdomen w wo contrast (74170) |
$657 |
$876 |
4.1× |
| CT abdomen w/o contrast (74150) |
$657 |
$876 |
6.8× |
| CT c-spine w/o contrast (72125) |
$657 |
$876 |
6.8× |
| CT cervical spine with contrast (72126) |
$657 |
$876 |
2.0× |
| CT chest w/wo contrast (71270) |
$657 |
$876 |
4.1× |
| CT chest with contrast (71260) |
$657 |
$876 |
4.1× |
| CT head/brain with contrast (70460) |
$657 |
$876 |
4.1× |
| CT head/brain without and with contrast (70470) |
$657 |
$876 |
4.1× |
| CT iac w contrast (70481) |
$657 |
$876 |
4.1× |
| CT lower ext w/o (73700) |
$657 |
$876 |
6.8× |
| CT lower extremity with contrast (73701) |
$657 |
$876 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$657 |
$876 |
6.8× |
| CT lumbar spine with contrast (72132) |
$657 |
$876 |
2.0× |
| CT maxillofacial w contrast (70487) |
$657 |
$876 |
4.1× |
| CT maxillofacial w/o contrast (70486) |
$657 |
$876 |
6.8× |
| CT maxillofacial w/wo contrast (70488) |
$657 |
$876 |
4.1× |
| CT neck soft tissue w contrast (70491) |
$657 |
$876 |
4.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$657 |
$876 |
4.1× |
| CT orbits w/o contrast (70480) |
$657 |
$876 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$657 |
$876 |
4.1× |
| CT pelvis w/o contrast (72192) |
$657 |
$876 |
6.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$657 |
$876 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$657 |
$876 |
6.8× |
| CT thoracic spine w/o contrast (72128) |
$657 |
$876 |
6.8× |
| CT thorax w/o contrast (71250) |
$657 |
$876 |
6.8× |
| CT upper extremity w/o contrast rt (73200) |
$657 |
$876 |
6.8× |
| CT upper extremity with contrast (73201) |
$657 |
$876 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,510.50 |
$2,014 |
9.4× |
| Cta Abdomen (74175) |
$1,761 |
$2,348 |
10.9× |
| CTA abdomen pelvis (74174) |
$2,078.25 |
$2,771 |
6.5× |
| CTA chest (71275) |
$1,390.50 |
$1,854 |
8.6× |
| Cta Head (70496) |
$1,467.75 |
$1,957 |
9.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$657 |
$876 |
2.0× |
| Cta Neck (70498) |
$1,467.75 |
$1,957 |
9.1× |
| Cystography minimum 3 views rs&i (74430) |
$517.50 |
$690 |
1.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$293.25 |
$391 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$210 |
$280 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$210 |
$280 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$343.50 |
$458 |
1.6× |
| Foot 2 views (73620) |
$140.25 |
$187 |
1.8× |
| Forearm 2 views (73090) |
$184.50 |
$246 |
2.3× |
| Hand 2 views (73120) |
$154.50 |
$206 |
1.6× |
| Hand 3 views (73130) |
$202.50 |
$270 |
2.5× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$786.75 |
$1,049 |
1.6× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$786.75 |
$1,049 |
2.1× |
| Ht muscle image spect sing (78451) |
$1,498.50 |
$1,998 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$204 |
$272 |
2.5× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,259.25 |
$1,679 |
2.5× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,246.50 |
$1,662 |
2.5× |
| Knee 3 views (73562) |
$222 |
$296 |
2.8× |
| Lung Ventilation Imaging (78579) |
$587.25 |
$783 |
1.6× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$131.25 |
$175 |
1.6× |
| MRA head w/o contrast (70544) |
$873 |
$1,164 |
4.0× |
| MRA neck w/o contrast (70547) |
$873 |
$1,164 |
4.0× |
| MRI abdomen w contrast (74182) |
$772.50 |
$1,030 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$772.50 |
$1,030 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$772.50 |
$1,030 |
3.5× |
| MRI any jnt lwr ext with con lt (73722) |
$772.50 |
$1,030 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$772.50 |
$1,030 |
1.1× |
| MRI c-spine with contrast (72142) |
$772.50 |
$1,030 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$772.50 |
$1,030 |
3.5× |
| MRI chest w/o & w/contrast material (71552) |
$772.50 |
$1,030 |
2.4× |
| MRI chest w/o contrast (71550) |
$772.50 |
$1,030 |
3.5× |
| MRI chest with contrast (71551) |
$772.50 |
$1,030 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$772.50 |
$1,030 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$772.50 |
$1,030 |
2.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$772.50 |
$1,030 |
3.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$772.50 |
$1,030 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$772.50 |
$1,030 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$772.50 |
$1,030 |
2.4× |
| MRI pelvis w contrast (72196) |
$772.50 |
$1,030 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$772.50 |
$1,030 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$772.50 |
$1,030 |
3.5× |
| MRI scan of arm joint before and after contrast (73223) |
$772.50 |
$1,030 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$772.50 |
$1,030 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$772.50 |
$1,030 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$772.50 |
$1,030 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$772.50 |
$1,030 |
2.4× |
| 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) |
$772.50 |
$1,030 |
3.5× |
| MRI upper ext joint w/o contrast (73221) |
$772.50 |
$1,030 |
3.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$772.50 |
$1,030 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$772.50 |
$1,030 |
3.5× |
| Myocardial Spect Multiple Studies (78452) |
$2,178.75 |
$2,905 |
1.8× |
| Neck soft tissue (70360) |
$189 |
$252 |
2.4× |
| Nm gastric emptying study (78264) |
$402 |
$536 |
1.1× |
| Nuclear medicine study of heart muscle at rest with stress (78453) |
$1,437 |
$1,916 |
1.2× |
| Parathyrd planar w/wo subtrj (78071) |
$1,120.50 |
$1,494 |
3.0× |
| Parathyroid imaging (78070) |
$927 |
$1,236 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$185.25 |
$247 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$772.50 |
$1,030 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$602.25 |
$803 |
1.6× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,028.25 |
$1,371 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$258 |
$344 |
3.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$180.75 |
$241 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$324 |
$432 |
3.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$312.75 |
$417 |
3.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$199.50 |
$266 |
2.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$222 |
$296 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$223.50 |
$298 |
2.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$147 |
$196 |
1.8× |
| Ribs bilateral 3 views (71110) |
$197.25 |
$263 |
2.1× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,228.50 |
$1,638 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$208.50 |
$278 |
2.2× |
| Scanogram (77073) |
$355.50 |
$474 |
3.7× |
| Scapula complete (73010) |
$174 |
$232 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$114.75 |
$153 |
4.9× |
| Small bowel series (74250) |
$463.50 |
$618 |
2.9× |
| Spine thoracic 3 views (72072) |
$299.25 |
$399 |
3.1× |
| Thoracolumbar 2 views (72080) |
$282 |
$376 |
3.5× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$629.25 |
$839 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$174 |
$232 |
1.8× |
| Upper Extremity Infant (73092) |
$153 |
$204 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$714.75 |
$953 |
4.4× |
| Us abdl aorta screen aaa (76706) |
$225 |
$300 |
2.3× |
| Us breast unilateral complete (76641) |
$147.38 |
$196.50 |
1.5× |
| Us breast unilateral limited (76642) |
$186 |
$248 |
2.3× |
| Us chest (76604) |
$165.75 |
$221 |
1.7× |
| Us ob transvaginal (76817) |
$210 |
$280 |
2.2× |
| Us pelvic non ob complete (76856) |
$183 |
$244 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$153 |
$204 |
1.6× |
| Us pregnancy ltd (76815) |
$210 |
$280 |
2.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$181.50 |
$242 |
1.9× |
| Us retroperitoneal complete (76770) |
$225 |
$300 |
2.3× |
| Us retroperitoneal limited (76775) |
$174 |
$232 |
1.8× |
| Us scrotum and contents (76870) |
$183 |
$244 |
1.9× |
| Us soft tissue head/neck (76536) |
$714 |
$952 |
7.4× |
| Us spinal canal and contents (76800) |
$174 |
$232 |
1.8× |
| Us xtr non-vasc lmtd (76882) |
$174 |
$232 |
1.8× |
| Wrist 2 views (73100) |
$143.25 |
$191 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$391.50 |
$522 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$217.50 |
$290 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$207 |
$276 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168.75 |
$225 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$225 |
$300 |
2.8× |
| X-ray exam entire spi 4/5 vw (72083) |
$249.75 |
$333 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$210.75 |
$281 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$257.25 |
$343 |
3.2× |
| X-ray exam hip uni 4/> views (73503) |
$315.75 |
$421 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$225 |
$300 |
2.3× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$266.25 |
$355 |
2.8× |
| X-ray exam of femur 1 (73551) |
$123.75 |
$165 |
1.5× |
| X-ray eye for foreign body (70030) |
$132.75 |
$177 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$281.25 |
$375 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$266.25 |
$355 |
3.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$200.25 |
$267 |
2.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$169.50 |
$226 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$66 |
$88 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$321 |
$428 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$162 |
$216 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$205.50 |
$274 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$258.75 |
$345 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$444 |
$592 |
4.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$343.50 |
$458 |
3.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$216 |
$288 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$270.75 |
$361 |
2.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$201 |
$268 |
2.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$198.75 |
$265 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$297.75 |
$397 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$363 |
$484 |
3.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$216 |
$288 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$212.25 |
$283 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$208.50 |
$278 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$285.75 |
$381 |
3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$312.75 |
$417 |
3.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$212.25 |
$283 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$251.25 |
$335 |
3.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$162 |
$216 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$214.50 |
$286 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$197.25 |
$263 |
2.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$159.75 |
$213 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$212.25 |
$283 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$402 |
$536 |
4.2× |
| Xr chest 4+ views (71048) |
$243 |
$324 |
2.5× |
| Xr finger(s) 2+ views (73140) |
$157.50 |
$210 |
2.0× |
| Xr shoulder 1 view (73020) |
$156.75 |
$209 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$339.75 |
$453 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$210.75 |
$281 |
2.6× |
| Xray knee 1 or 2 views rt (73560) |
$159.75 |
$213 |
2.0× |