| Abdomen 2 views (74019) |
$196.80 |
$328 |
2.0× |
| Ankle 2 views (73600) |
$261.60 |
$436 |
3.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$618.60 |
$1,031 |
1.9× |
| Arthrogram shoulder (73040) |
$700.20 |
$1,167 |
2.2× |
| Bone age studies (77072) |
$159.60 |
$266 |
1.7× |
| Bone survey complete (77075) |
$402.60 |
$671 |
4.2× |
| Cervical spine 2 or 3 views (72040) |
$224.40 |
$374 |
2.8× |
| Chest 1 view (71045) |
$160.80 |
$268 |
2.0× |
| Chest 3 views (71047) |
$224.40 |
$374 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$334.20 |
$557 |
2.1× |
| Clavicle complete (73000) |
$183 |
$305 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$144 |
$240 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,346 |
$3,910 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,926 |
$3,210 |
8.8× |
| CT abdomen w contrast (74160) |
$1,416 |
$2,360 |
8.8× |
| CT abdomen w wo contrast (74170) |
$1,716 |
$2,860 |
10.6× |
| CT abdomen w/o contrast (74150) |
$1,236 |
$2,060 |
12.9× |
| CT angiography upper extremity lt (73206) |
$1,722 |
$2,870 |
10.7× |
| CT c-spine w/o contrast (72125) |
$1,257.60 |
$2,096 |
13.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,737.60 |
$2,896 |
10.8× |
| CT cervical spine with contrast (72126) |
$1,437.60 |
$2,396 |
4.5× |
| CT chest w/wo contrast (71270) |
$1,707.60 |
$2,846 |
10.6× |
| CT chest with contrast (71260) |
$1,407.60 |
$2,346 |
8.7× |
| CT head/brain with contrast (70460) |
$1,312.80 |
$2,188 |
8.1× |
| CT head/brain without and with contrast (70470) |
$1,612.80 |
$2,688 |
10.0× |
| CT iac w contrast (70481) |
$1,319.40 |
$2,199 |
8.2× |
| CT limited/localized follow up study (76380) |
$960 |
$1,600 |
12.0× |
| CT lower ext w/o (73700) |
$1,292.40 |
$2,154 |
13.4× |
| CT lower extremity w wo contrast (73702) |
$1,513.80 |
$2,523 |
9.4× |
| CT lower extremity with contrast (73701) |
$1,213.80 |
$2,023 |
7.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,737.60 |
$2,896 |
10.8× |
| CT lumbar spine w/o contrast (72131) |
$1,257.60 |
$2,096 |
13.1× |
| CT lumbar spine with contrast (72132) |
$1,437.60 |
$2,396 |
4.5× |
| CT maxillofacial w contrast (70487) |
$1,215 |
$2,025 |
7.5× |
| CT maxillofacial w/o contrast (70486) |
$1,035 |
$1,725 |
10.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,515 |
$2,525 |
9.4× |
| CT neck soft tissue w contrast (70491) |
$1,230 |
$2,050 |
7.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,619.40 |
$2,699 |
10.0× |
| CT orbits w/o contrast (70480) |
$1,139.40 |
$1,899 |
11.9× |
| CT pelvis w & w/o contrast (72194) |
$1,680 |
$2,800 |
10.4× |
| CT pelvis w/o contrast (72192) |
$1,200 |
$2,000 |
12.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,530 |
$2,550 |
9.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,050 |
$1,750 |
10.9× |
| CT thoracic spine w/contrast (72129) |
$1,437.60 |
$2,396 |
8.9× |
| CT thoracic spine w/o contrast (72128) |
$1,257.60 |
$2,096 |
13.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,737.60 |
$2,896 |
10.8× |
| CT thorax w/o contrast (71250) |
$1,227.60 |
$2,046 |
12.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,513.80 |
$2,523 |
9.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,033.80 |
$1,723 |
10.8× |
| CT upper extremity with contrast (73201) |
$1,213.80 |
$2,023 |
3.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,722 |
$2,870 |
10.7× |
| Cta Abdomen (74175) |
$1,722 |
$2,870 |
10.7× |
| CTA abdomen pelvis (74174) |
$2,583 |
$4,305 |
8.1× |
| CTA chest (71275) |
$1,722 |
$2,870 |
10.7× |
| Cta Head (70496) |
$1,722 |
$2,870 |
10.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,722 |
$2,870 |
10.7× |
| Cta Neck (70498) |
$1,722 |
$2,870 |
10.7× |
| Cystography minimum 3 views rs&i (74430) |
$521.40 |
$869 |
1.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$268.80 |
$448 |
2.8× |
| Esophagus (74220) |
$348.60 |
$581 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$664.80 |
$1,108 |
6.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$444 |
$740 |
4.6× |
| Fluoroscopy up to 1 hr (76000) |
$439.20 |
$732 |
2.0× |
| Foot 2 views (73620) |
$174 |
$290 |
2.2× |
| Forearm 2 views (73090) |
$180 |
$300 |
2.2× |
| Hand 2 views (73120) |
$192.60 |
$321 |
2.0× |
| Hand 3 views (73130) |
$193.80 |
$323 |
2.4× |
| Humerus Min 2 Views Left (73060) |
$180.60 |
$301 |
2.3× |
| Hysterosalpingogram (74740) |
$491.40 |
$819 |
2.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$223.20 |
$372 |
2.3× |
| Knee 3 views (73562) |
$212.40 |
$354 |
2.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$110.40 |
$184 |
1.3× |
| MRA head w & w/o contrast (70546) |
$2,001 |
$3,335 |
6.2× |
| MRA head w/o contrast (70544) |
$1,521 |
$2,535 |
6.9× |
| MRA head with contrast (70545) |
$1,701 |
$2,835 |
5.3× |
| MRA neck w contrast (70548) |
$1,797 |
$2,995 |
5.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,073 |
$3,455 |
6.5× |
| MRA neck w/o contrast (70547) |
$1,593 |
$2,655 |
7.3× |
| MRI abdomen w contrast (74182) |
$1,830 |
$3,050 |
5.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,130 |
$3,550 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,650 |
$2,750 |
7.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,722 |
$2,870 |
2.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,722 |
$2,870 |
2.4× |
| MRI c-spine with contrast (72142) |
$1,908 |
$3,180 |
5.9× |
| MRI cervical spine w/o contrast (72141) |
$1,728 |
$2,880 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,130 |
$3,550 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,650 |
$2,750 |
7.5× |
| MRI chest with contrast (71551) |
$1,830 |
$3,050 |
2.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,722 |
$2,870 |
5.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,722 |
$2,870 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,542 |
$2,570 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,356 |
$2,260 |
6.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,836 |
$3,060 |
5.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,536 |
$2,560 |
4.8× |
| MRI pelvis w contrast (72196) |
$1,833 |
$3,055 |
5.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,133 |
$3,555 |
6.6× |
| MRI pelvis w/o contrast (72195) |
$1,653 |
$2,755 |
7.5× |
| MRI scan of arm joint before and after contrast (73223) |
$2,022 |
$3,370 |
6.3× |
| MRI scan of leg joint before and after contrast (73723) |
$2,022 |
$3,370 |
6.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,208 |
$3,680 |
6.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,908 |
$3,180 |
5.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,208 |
$3,680 |
6.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,908 |
$3,180 |
5.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,208 |
$3,680 |
6.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,728 |
$2,880 |
7.9× |
| MRI tmj (70336) |
$1,485 |
$2,475 |
6.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,542 |
$2,570 |
7.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,022 |
$3,370 |
6.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,542 |
$2,570 |
7.0× |
| Neck soft tissue (70360) |
$174.60 |
$291 |
2.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$366 |
$610 |
3.8× |
| Osseous survey infant (77076) |
$353.40 |
$589 |
3.7× |
| Osseous survey limited (77074) |
$420.60 |
$701 |
4.4× |
| Pelvis 1 or 2 views (72170) |
$179.40 |
$299 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,902 |
$3,170 |
5.9× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$534 |
$890 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$104.40 |
$174 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$208.80 |
$348 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$313.80 |
$523 |
3.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$228.60 |
$381 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$150.60 |
$251 |
1.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$192.60 |
$321 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$466.80 |
$778 |
2.9× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$348.60 |
$581 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$676.80 |
$1,128 |
4.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$550.80 |
$918 |
3.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$165 |
$275 |
2.1× |
| Ribs bilateral 3 views (71110) |
$269.40 |
$449 |
2.8× |
| Sacroiliac Joints < 3 Views (72200) |
$141.60 |
$236 |
1.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$726 |
$1,210 |
3.3× |
| Scanogram (77073) |
$288.60 |
$481 |
3.0× |
| Scapula complete (73010) |
$123.60 |
$206 |
1.3× |
| Screening digital breast tomosynthesis (77063) |
$36 |
$60 |
1.5× |
| Sialogram (70390) |
$280.20 |
$467 |
1.3× |
| Small bowel series (74250) |
$498.60 |
$831 |
3.1× |
| Spine thoracic 3 views (72072) |
$230.40 |
$384 |
2.4× |
| Thoracolumbar 2 views (72080) |
$233.40 |
$389 |
2.9× |
| Tmj unilateral (70328) |
$133.20 |
$222 |
1.7× |
| Tomogram (76100) |
$388.80 |
$648 |
4.0× |
| Ultrasound, abdomen limited (76705) |
$471 |
$785 |
4.9× |
| Upper Extremity Infant (73092) |
$146.40 |
$244 |
1.5× |
| Urethrocystography retrograde rs&i (74450) |
$622.80 |
$1,038 |
2.8× |
| Urethrocystography voiding (74455) |
$620.40 |
$1,034 |
2.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$481.20 |
$802 |
3.0× |
| Us abdl aorta screen aaa (76706) |
$360 |
$600 |
3.7× |
| Us breast unilateral complete (76641) |
$300 |
$500 |
3.1× |
| Us breast unilateral limited (76642) |
$270 |
$450 |
3.4× |
| Us chest (76604) |
$366 |
$610 |
3.8× |
| Us compl joint r-t w/image documentation (76881) |
$414 |
$690 |
4.3× |
| Us kidney transplant (76776) |
$600 |
$1,000 |
6.2× |
| Us ob transvaginal (76817) |
$363 |
$605 |
3.8× |
| Us pelvic non ob complete (76856) |
$510 |
$850 |
5.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$213 |
$355 |
2.2× |
| Us pregnancy ltd (76815) |
$327 |
$545 |
3.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$405 |
$675 |
4.2× |
| Us retroperitoneal complete (76770) |
$489 |
$815 |
5.1× |
| Us retroperitoneal limited (76775) |
$405 |
$675 |
4.2× |
| Us scrotum and contents (76870) |
$426 |
$710 |
4.4× |
| Us soft tissue head/neck (76536) |
$504 |
$840 |
5.2× |
| Us spinal canal and contents (76800) |
$291 |
$485 |
3.0× |
| Us transrectal (76872) |
$492 |
$820 |
5.1× |
| Us xtr non-vasc lmtd (76882) |
$297 |
$495 |
3.1× |
| Venogram extremity bilateral (75822) |
$2,668.80 |
$4,448 |
1.8× |
| Venography extremity unilateral rs&i (75820) |
$1,779 |
$2,965 |
1.2× |
| Wrist 2 views (73100) |
$176.40 |
$294 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$357.60 |
$596 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$223.20 |
$372 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$273.60 |
$456 |
3.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$538.20 |
$897 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$174.60 |
$291 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$198 |
$330 |
2.5× |
| X-ray exam entire spi 4/5 vw (72083) |
$313.20 |
$522 |
3.3× |
| X-ray exam hip uni 1 view (73501) |
$154.80 |
$258 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$192 |
$320 |
2.4× |
| X-ray exam hip uni 4/> views (73503) |
$288 |
$480 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$355.80 |
$593 |
3.7× |
| X-ray exam of femur 1 (73551) |
$118.80 |
$198 |
1.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$552.60 |
$921 |
3.4× |
| X-ray eye for foreign body (70030) |
$124.80 |
$208 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$254.40 |
$424 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$163.20 |
$272 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$193.20 |
$322 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$142.20 |
$237 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$220.20 |
$367 |
2.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$238.20 |
$397 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$130.20 |
$217 |
1.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$146.40 |
$244 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$241.20 |
$402 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$432 |
$720 |
4.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$121.80 |
$203 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$208.20 |
$347 |
2.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$106.20 |
$177 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$190.80 |
$318 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$243 |
$405 |
2.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$769.20 |
$1,282 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$189 |
$315 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$275.40 |
$459 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$390 |
$650 |
4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$180 |
$300 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$205.80 |
$343 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$209.40 |
$349 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$261.60 |
$436 |
3.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$132.60 |
$221 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$277.20 |
$462 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$168 |
$280 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$164.40 |
$274 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$216 |
$360 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$206.40 |
$344 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$198.60 |
$331 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$262.20 |
$437 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$161.40 |
$269 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$190.80 |
$318 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$401.40 |
$669 |
4.2× |
| Xr chest 4+ views (71048) |
$256.20 |
$427 |
2.7× |
| Xr finger(s) 2+ views (73140) |
$152.40 |
$254 |
1.9× |
| Xr internal auditory meati complete (70134) |
$405.60 |
$676 |
0.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$129 |
$215 |
1.3× |
| Xr shoulder 1 view (73020) |
$154.80 |
$258 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$328.20 |
$547 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$195.60 |
$326 |
2.4× |
| Xr tmj bilateral (70330) |
$206.40 |
$344 |
2.6× |
| Xray knee 1 or 2 views rt (73560) |
$186.60 |
$311 |
2.3× |