| Abdomen 2 views (74019) |
$97.35 |
$324.50 |
1.0× |
| Acute gastrointestinal blood loss imaging (78278) |
$588 |
$1,960 |
1.6× |
| Ankle 2 views (73600) |
$107.70 |
$359 |
1.4× |
| Bone &/Joint Imaging Limited Area (78300) |
$367.50 |
$1,225 |
1.0× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$396 |
$1,320 |
1.1× |
| Bone &/joint imaging whole body (78306) |
$437.70 |
$1,459 |
1.2× |
| Bone age studies (77072) |
$86.85 |
$289.50 |
0.9× |
| Bone Imaging 3 Phase (78315) |
$578.10 |
$1,927 |
1.6× |
| Bone survey complete (77075) |
$330 |
$1,100 |
3.5× |
| Cervical spine 2 or 3 views (72040) |
$137.25 |
$457.50 |
1.7× |
| Chest 1 view (71045) |
$82.50 |
$275 |
1.0× |
| Chest 3 views (71047) |
$131.70 |
$439 |
1.7× |
| Clavicle complete (73000) |
$127.95 |
$426.50 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$198 |
$660 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,856.85 |
$6,189.50 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,666.95 |
$5,556.50 |
7.7× |
| CT abdomen w contrast (74160) |
$805.20 |
$2,684 |
5.1× |
| CT abdomen w wo contrast (74170) |
$995.10 |
$3,317 |
6.3× |
| CT abdomen w/o contrast (74150) |
$805.20 |
$2,684 |
8.5× |
| CT angiography upper extremity lt (73206) |
$990 |
$3,300 |
6.2× |
| CT c-spine w/o contrast (72125) |
$1,035.60 |
$3,452 |
10.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,851.30 |
$6,171 |
11.7× |
| CT cervical spine with contrast (72126) |
$925.65 |
$3,085.50 |
2.9× |
| CT chest w/wo contrast (71270) |
$1,081.65 |
$3,605.50 |
6.8× |
| CT chest with contrast (71260) |
$861.75 |
$2,872.50 |
5.4× |
| CT head/brain with contrast (70460) |
$613.50 |
$2,045 |
3.9× |
| CT head/brain without and with contrast (70470) |
$805.20 |
$2,684 |
5.1× |
| CT iac w contrast (70481) |
$497.85 |
$1,659.50 |
3.1× |
| CT lower ext w/o (73700) |
$613.65 |
$2,045.50 |
6.5× |
| CT lower extremity w wo contrast (73702) |
$805.20 |
$2,684 |
5.1× |
| CT lower extremity with contrast (73701) |
$646.65 |
$2,155.50 |
4.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,851.30 |
$6,171 |
11.7× |
| CT lumbar spine w/o contrast (72131) |
$925.65 |
$3,085.50 |
9.8× |
| CT lumbar spine with contrast (72132) |
$925.65 |
$3,085.50 |
2.9× |
| CT maxillofacial w contrast (70487) |
$497.85 |
$1,659.50 |
3.1× |
| CT maxillofacial w/o contrast (70486) |
$497.85 |
$1,659.50 |
5.3× |
| CT maxillofacial w/wo contrast (70488) |
$805.20 |
$2,684 |
5.1× |
| CT neck soft tissue w contrast (70491) |
$861.75 |
$2,872.50 |
5.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$738.75 |
$2,462.50 |
4.7× |
| CT orbits w/o contrast (70480) |
$497.85 |
$1,659.50 |
5.3× |
| CT pelvis w & w/o contrast (72194) |
$1,081.65 |
$3,605.50 |
6.8× |
| CT pelvis w/o contrast (72192) |
$861.75 |
$2,872.50 |
9.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$898.80 |
$2,996 |
5.7× |
| CT soft tissue neck w/o contrast (70490) |
$861.75 |
$2,872.50 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$925.65 |
$3,085.50 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$925.65 |
$3,085.50 |
9.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,851.30 |
$6,171 |
11.7× |
| CT thorax w/o contrast (71250) |
$861.75 |
$2,872.50 |
9.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$805.20 |
$2,684 |
5.1× |
| CT upper extremity w/o contrast rt (73200) |
$820.50 |
$2,735 |
8.7× |
| CT upper extremity with contrast (73201) |
$646.65 |
$2,155.50 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$990 |
$3,300 |
6.2× |
| Cta Abdomen (74175) |
$990 |
$3,300 |
6.2× |
| CTA abdomen pelvis (74174) |
$990 |
$3,300 |
3.1× |
| CTA chest (71275) |
$990 |
$3,300 |
6.2× |
| Cta Head (70496) |
$990 |
$3,300 |
6.2× |
| CTA lwr ext w&w/o contrast (73706) |
$990 |
$3,300 |
6.2× |
| Cta Neck (70498) |
$990 |
$3,300 |
6.2× |
| Cta Pelvis (72191) |
$1,081.65 |
$3,605.50 |
6.8× |
| Foot 2 views (73620) |
$107.70 |
$359 |
1.4× |
| Forearm 2 views (73090) |
$97.35 |
$324.50 |
1.2× |
| Gated Heart Planar Single (78472) |
$770.85 |
$2,569.50 |
2.1× |
| Hand 2 views (73120) |
$90 |
$300 |
1.0× |
| Hand 3 views (73130) |
$82.50 |
$275 |
1.0× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$665.85 |
$2,219.50 |
1.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$665.85 |
$2,219.50 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$132 |
$440 |
1.7× |
| Knee 3 views (73562) |
$136.80 |
$456 |
1.7× |
| MRA head w/o contrast (70544) |
$536.25 |
$1,787.50 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$772.20 |
$2,574 |
2.4× |
| MRA neck w/o contrast (70547) |
$536.25 |
$1,787.50 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$772.20 |
$2,574 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$536.25 |
$1,787.50 |
2.5× |
| MRI any jnt lwr ext with con lt (73722) |
$536.25 |
$1,787.50 |
0.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$536.25 |
$1,787.50 |
0.8× |
| MRI cervical spine w/o contrast (72141) |
$536.25 |
$1,787.50 |
2.5× |
| MRI chest w/o & w/contrast material (71552) |
$772.20 |
$2,574 |
2.4× |
| MRI chest w/o contrast (71550) |
$536.25 |
$1,787.50 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$736.20 |
$2,454 |
2.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$536.25 |
$1,787.50 |
2.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$536.25 |
$1,787.50 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$772.20 |
$2,574 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$772.20 |
$2,574 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$536.25 |
$1,787.50 |
2.5× |
| MRI scan of arm joint before and after contrast (73223) |
$772.20 |
$2,574 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$772.20 |
$2,574 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$772.20 |
$2,574 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$536.25 |
$1,787.50 |
1.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$772.20 |
$2,574 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$772.20 |
$2,574 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$536.25 |
$1,787.50 |
2.5× |
| MRI upper ext joint w/o contrast (73221) |
$536.25 |
$1,787.50 |
2.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$772.20 |
$2,574 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$536.25 |
$1,787.50 |
2.5× |
| Myocardial Spect Multiple Studies (78452) |
$578.55 |
$1,928.50 |
0.5× |
| Neck soft tissue (70360) |
$96 |
$320 |
1.2× |
| Nuclear medicine study of stomach to assess emptying small bowel movement (78265) |
$420.75 |
$1,402.50 |
1.2× |
| Parathyroid imaging (78070) |
$391.80 |
$1,306 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$90.75 |
$302.50 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$772.20 |
$2,574 |
2.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$430.05 |
$1,433.50 |
1.2× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$828.30 |
$2,761 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$215.10 |
$717 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$197.25 |
$657.50 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$136.80 |
$456 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$82.50 |
$275 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$115.50 |
$385 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$82.50 |
$275 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$107.70 |
$359 |
1.4× |
| Ribs bilateral 3 views (71110) |
$182.40 |
$608 |
1.9× |
| Scapula complete (73010) |
$132.60 |
$442 |
1.4× |
| Small bowel series (74250) |
$188.10 |
$627 |
1.2× |
| Spine thoracic 3 views (72072) |
$155.70 |
$519 |
1.6× |
| Thyroid Imaging With Vascular Flow (78013) |
$477.75 |
$1,592.50 |
1.3× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$477.75 |
$1,592.50 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$283.95 |
$946.50 |
3.0× |
| Upper Extremity Infant (73092) |
$132.15 |
$440.50 |
1.4× |
| Us chest (76604) |
$340.35 |
$1,134.50 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$340.35 |
$1,134.50 |
3.6× |
| Us ob transvaginal (76817) |
$340.35 |
$1,134.50 |
3.6× |
| Us pelvic non ob complete (76856) |
$283.95 |
$946.50 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$217.95 |
$726.50 |
2.3× |
| Us pregnancy ltd (76815) |
$315.60 |
$1,052 |
3.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$315.60 |
$1,052 |
3.3× |
| Us retroperitoneal complete (76770) |
$283.95 |
$946.50 |
3.0× |
| Us retroperitoneal limited (76775) |
$188.40 |
$628 |
2.0× |
| Us scrotum and contents (76870) |
$283.95 |
$946.50 |
3.0× |
| Us soft tissue head/neck (76536) |
$277.20 |
$924 |
2.9× |
| Us xtr non-vasc lmtd (76882) |
$168.30 |
$561 |
1.8× |
| Wrist 2 views (73100) |
$82.50 |
$275 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$174.45 |
$581.50 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$92.55 |
$308.50 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$107.70 |
$359 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$136.80 |
$456 |
1.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$197.25 |
$657.50 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$107.70 |
$359 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$131.70 |
$439 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$148.50 |
$495 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$150.60 |
$502 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$97.35 |
$324.50 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$107.70 |
$359 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$145.65 |
$485.50 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$82.50 |
$275 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$132.15 |
$440.50 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$141.45 |
$471.50 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$136.80 |
$456 |
1.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$136.80 |
$456 |
1.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$149.70 |
$499 |
1.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$132 |
$440 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$158.70 |
$529 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$140.25 |
$467.50 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$165 |
$550 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$167.55 |
$558.50 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$118.65 |
$395.50 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$119.85 |
$399.50 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$155.25 |
$517.50 |
2.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$155.25 |
$517.50 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$155.25 |
$517.50 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$167.55 |
$558.50 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$79.50 |
$265 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$136.80 |
$456 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$107.70 |
$359 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$82.50 |
$275 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$182.40 |
$608 |
1.9× |
| Xr chest 4+ views (71048) |
$146.25 |
$487.50 |
1.5× |
| Xr finger(s) 2+ views (73140) |
$78.45 |
$261.50 |
1.0× |
| Xr shoulder 1 view (73020) |
$91.35 |
$304.50 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$178.05 |
$593.50 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$136.80 |
$456 |
1.7× |
| Xr tmj bilateral (70330) |
$167.55 |
$558.50 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$82.50 |
$275 |
1.0× |