| Abdomen 2 views (74019) |
$258 |
$322 |
2.6× |
| Ankle 2 views (73600) |
$183 |
$229 |
2.2× |
| Bone &/joint imaging whole body (78306) |
$687 |
$859 |
1.8× |
| Bone age studies (77072) |
$258 |
$322 |
2.6× |
| Bone survey complete (77075) |
$235.50 |
$294 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$370 |
$463 |
4.4× |
| Chest 1 view (71045) |
$143 |
$179 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$150 |
$188 |
0.9× |
| Clavicle complete (73000) |
$258 |
$322 |
3.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,932 |
$3,665 |
8.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,369 |
$1,711 |
6.0× |
| CT abdomen w contrast (74160) |
$776 |
$970 |
4.6× |
| CT abdomen w wo contrast (74170) |
$972.50 |
$1,215.50 |
5.8× |
| CT abdomen w/o contrast (74150) |
$346 |
$432 |
3.4× |
| CT c-spine w/o contrast (72125) |
$1,106 |
$1,382 |
11.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,274 |
$1,593 |
7.6× |
| CT cervical spine with contrast (72126) |
$1,225 |
$1,531 |
3.7× |
| CT chest w/wo contrast (71270) |
$1,274 |
$1,593 |
7.6× |
| CT chest with contrast (71260) |
$1,225 |
$1,531 |
7.3× |
| CT head/brain with contrast (70460) |
$1,082 |
$1,352 |
6.4× |
| CT head/brain without and with contrast (70470) |
$1,314 |
$1,642 |
7.8× |
| CT iac w contrast (70481) |
$1,082 |
$1,352 |
6.4× |
| CT limited/localized follow up study (76380) |
$488 |
$610 |
5.8× |
| CT lower ext w/o (73700) |
$1,106 |
$1,382 |
11.0× |
| CT lower extremity w wo contrast (73702) |
$1,159 |
$1,449 |
6.9× |
| CT lower extremity with contrast (73701) |
$1,067 |
$1,334 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,198 |
$1,497 |
7.1× |
| CT lumbar spine w/o contrast (72131) |
$1,106 |
$1,382 |
11.0× |
| CT lumbar spine with contrast (72132) |
$1,008 |
$1,260 |
3.0× |
| CT maxillofacial w contrast (70487) |
$920 |
$1,150 |
5.5× |
| CT maxillofacial w/o contrast (70486) |
$1,149 |
$1,436 |
11.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,198 |
$1,497 |
7.1× |
| CT neck soft tissue w contrast (70491) |
$1,067 |
$1,334 |
6.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,290 |
$1,612 |
7.6× |
| CT orbits w/o contrast (70480) |
$874 |
$1,092.50 |
8.7× |
| CT pelvis w & w/o contrast (72194) |
$1,466 |
$1,832 |
8.7× |
| CT pelvis w/o contrast (72192) |
$1,067 |
$1,334 |
10.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,198 |
$1,497 |
7.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,106 |
$1,382 |
11.0× |
| CT thoracic spine w/contrast (72129) |
$1,225 |
$1,531 |
7.3× |
| CT thoracic spine w/o contrast (72128) |
$1,067 |
$1,334 |
10.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,274 |
$1,593 |
7.6× |
| CT thorax w/o contrast (71250) |
$1,067 |
$1,334 |
10.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,159 |
$1,449 |
6.9× |
| CT upper extremity w/o contrast rt (73200) |
$920 |
$1,150 |
9.1× |
| CT upper extremity with contrast (73201) |
$1,067 |
$1,334 |
3.2× |
| Cta Abdomen (74175) |
$1,375 |
$1,719 |
8.2× |
| CTA abdomen pelvis (74174) |
$2,484 |
$3,105 |
7.4× |
| CTA chest (71275) |
$1,284 |
$1,605 |
7.6× |
| Cta Neck (70498) |
$428 |
$535 |
2.5× |
| Esophagus (74220) |
$188 |
$235 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$232 |
$290 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$113 |
$141 |
0.5× |
| Foot 2 views (73620) |
$183 |
$229 |
2.2× |
| Forearm 2 views (73090) |
$183 |
$229 |
2.2× |
| Hand 2 views (73120) |
$258 |
$322 |
2.6× |
| Hand 3 views (73130) |
$350 |
$437 |
4.2× |
| Humerus Min 2 Views Left (73060) |
$202 |
$253 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$258 |
$322 |
2.6× |
| Knee 3 views (73562) |
$276 |
$345 |
3.3× |
| MRI abdomen w contrast (74182) |
$1,793 |
$2,241 |
5.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,793 |
$2,241 |
5.3× |
| MRI abdomen w/o contrast (74181) |
$1,550 |
$1,938 |
6.8× |
| MRI c-spine with contrast (72142) |
$1,793 |
$2,241 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,550 |
$1,938 |
6.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,793 |
$2,241 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,793 |
$2,241 |
5.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,793 |
$2,241 |
5.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,793 |
$2,241 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,793 |
$2,241 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,550 |
$1,938 |
6.8× |
| MRI tmj (70336) |
$12 |
$15 |
0.1× |
| Neck soft tissue (70360) |
$74 |
$92.50 |
0.9× |
| Nm whole blood volume (78122) |
$7.50 |
$9 |
0.0× |
| Osseous survey infant (77076) |
$231 |
$288.50 |
2.3× |
| Osseous survey limited (77074) |
$258 |
$322 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$183 |
$229 |
1.8× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$2 |
$3 |
0.0× |
| Pr red cell survival study (78130) |
$30 |
$38 |
0.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$183 |
$229 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$94 |
$118 |
0.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$116 |
$145 |
1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$124 |
$155 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$311.50 |
$389.50 |
3.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$197 |
$246 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$218 |
$272 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$460 |
$575 |
5.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$2.50 |
$3 |
0.0× |
| Ribs bilateral 3 views (71110) |
$314 |
$393 |
3.1× |
| Sacroiliac Joints < 3 Views (72200) |
$195 |
$244 |
1.9× |
| Scapula complete (73010) |
$97 |
$121 |
1.0× |
| Sella turcica (70240) |
$85 |
$106 |
1.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$181 |
$226 |
1.8× |
| Small bowel series (74250) |
$304 |
$380 |
1.8× |
| Spine thoracic 3 views (72072) |
$438 |
$547 |
4.4× |
| Tmj unilateral (70328) |
$58 |
$72.50 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$352 |
$440 |
3.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$58 |
$72 |
0.7× |
| Unlisted Ultrasound Procedure (76999) |
$165 |
$206.50 |
2.0× |
| Urethrocystography voiding (74455) |
$2 |
$2 |
0.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$194 |
$243 |
1.1× |
| Us abdl aorta screen aaa (76706) |
$269 |
$336 |
2.7× |
| Us breast unilateral complete (76641) |
$170 |
$212 |
1.7× |
| Us breast unilateral limited (76642) |
$96 |
$120 |
1.1× |
| Us chest (76604) |
$188 |
$235 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$330 |
$413 |
3.3× |
| Us elastography parenchyma (76981) |
$224 |
$280 |
2.2× |
| Us guided compression repair (76936) |
$415 |
$519 |
2.0× |
| Us ob transvaginal (76817) |
$182 |
$228 |
1.8× |
| Us pelvic non ob complete (76856) |
$534 |
$668 |
5.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$194 |
$243 |
1.9× |
| Us pregnancy ltd (76815) |
$133.50 |
$167 |
1.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$231 |
$289 |
2.3× |
| Us retroperitoneal complete (76770) |
$341.50 |
$426.50 |
3.4× |
| Us retroperitoneal limited (76775) |
$307 |
$384 |
3.1× |
| Us scrotum and contents (76870) |
$592 |
$740 |
5.9× |
| Us soft tissue head/neck (76536) |
$474 |
$593 |
4.7× |
| Us xtr non-vasc lmtd (76882) |
$60 |
$75 |
0.6× |
| Wrist 2 views (73100) |
$258 |
$322 |
3.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$212.50 |
$265.50 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$183 |
$229 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$276 |
$345 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$310 |
$388 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$98 |
$122 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$760 |
$950 |
9.1× |
| X-ray exam hip uni 1 view (73501) |
$104 |
$130 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$183 |
$229 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$472 |
$590 |
4.7× |
| X-ray exam of femur 1 (73551) |
$230 |
$288 |
2.7× |
| X-ray eye for foreign body (70030) |
$368 |
$460 |
4.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$147 |
$184 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$80 |
$100 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$286 |
$357 |
3.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$50.50 |
$63 |
0.6× |
| X-ray IV pyelogram+drip infusn (74410) |
$200.50 |
$250.50 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$37 |
$46 |
0.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$261.50 |
$327 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$250 |
$312 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$290 |
$362 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$258 |
$322 |
2.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$258 |
$322 |
2.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$136 |
$170 |
1.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$116 |
$145 |
1.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$96 |
$120 |
1.0× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$158.50 |
$198.50 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$222 |
$278 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$12 |
$15 |
0.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$406 |
$508 |
4.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$222 |
$278 |
2.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$235 |
$294 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$146 |
$182 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$174 |
$218 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$78.50 |
$98 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$183 |
$229 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$117 |
$146 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$239 |
$299 |
2.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$350 |
$437 |
4.2× |
| Xr c-spine 6 or more views (72052) |
$163 |
$203.50 |
1.6× |
| Xr Cholecystography Oral Contrast (74290) |
$121 |
$151 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$120.50 |
$150.50 |
1.4× |
| Xr shoulder 1 view (73020) |
$143 |
$179 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$294 |
$368 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$239 |
$299 |
2.9× |
| Xr tmj bilateral (70330) |
$133 |
$166 |
1.6× |
| Xray knee 1 or 2 views rt (73560) |
$106 |
$132 |
1.3× |