| Abdomen 2 views (74019) |
$207.60 |
$346 |
2.3× |
| Ankle 2 views (73600) |
$274.20 |
$457 |
3.6× |
| Bone age studies (77072) |
$133.20 |
$222 |
1.5× |
| Bone survey complete (77075) |
$481.80 |
$803 |
5.3× |
| Cervical spine 2 or 3 views (72040) |
$310.20 |
$517 |
4.1× |
| Chest 1 view (71045) |
$123 |
$205 |
1.6× |
| Chest 3 views (71047) |
$387.60 |
$646 |
5.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$171.60 |
$286 |
1.1× |
| Clavicle complete (73000) |
$235.80 |
$393 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$70.80 |
$118 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,732.40 |
$4,554 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,548 |
$2,580 |
7.4× |
| CT abdomen w contrast (74160) |
$1,787.40 |
$2,979 |
11.6× |
| CT abdomen w wo contrast (74170) |
$2,031 |
$3,385 |
13.2× |
| CT abdomen w/o contrast (74150) |
$1,157.40 |
$1,929 |
12.6× |
| CT c-spine w/o contrast (72125) |
$1,701 |
$2,835 |
18.6× |
| CT cervical spine with contrast (72126) |
$2,449.80 |
$4,083 |
8.0× |
| CT chest w/wo contrast (71270) |
$1,583.40 |
$2,639 |
10.3× |
| CT chest with contrast (71260) |
$1,414.20 |
$2,357 |
9.2× |
| CT head/brain with contrast (70460) |
$1,425 |
$2,375 |
9.3× |
| CT head/brain without and with contrast (70470) |
$1,907.40 |
$3,179 |
12.4× |
| CT iac w contrast (70481) |
$586.80 |
$978 |
3.8× |
| CT lower ext w/o (73700) |
$1,067.40 |
$1,779 |
11.7× |
| CT lower extremity w wo contrast (73702) |
$1,633.20 |
$2,722 |
10.6× |
| CT lower extremity with contrast (73701) |
$1,345.20 |
$2,242 |
8.8× |
| CT lumbar spine w & w/o contrast (72133) |
$973.20 |
$1,622 |
6.3× |
| CT lumbar spine w/o contrast (72131) |
$457.20 |
$762 |
5.0× |
| CT lumbar spine with contrast (72132) |
$1,429.80 |
$2,383 |
4.7× |
| CT maxillofacial w contrast (70487) |
$1,411.20 |
$2,352 |
9.2× |
| CT maxillofacial w/o contrast (70486) |
$1,176 |
$1,960 |
12.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,729.20 |
$2,882 |
11.2× |
| CT neck soft tissue w contrast (70491) |
$1,288.80 |
$2,148 |
8.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$641.40 |
$1,069 |
4.2× |
| CT orbits w/o contrast (70480) |
$496.80 |
$828 |
5.4× |
| CT pelvis w & w/o contrast (72194) |
$3,414 |
$5,690 |
22.2× |
| CT pelvis w/o contrast (72192) |
$1,524 |
$2,540 |
16.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,521 |
$2,535 |
9.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,057.20 |
$1,762 |
11.5× |
| CT thoracic spine w/contrast (72129) |
$3,234.60 |
$5,391 |
21.0× |
| CT thoracic spine w/o contrast (72128) |
$1,617.60 |
$2,696 |
17.7× |
| CT thoracic spine w/wo contrast (72130) |
$3,622.80 |
$6,038 |
23.6× |
| CT thorax w/o contrast (71250) |
$707.40 |
$1,179 |
7.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,121.40 |
$1,869 |
12.2× |
| CT upper extremity with contrast (73201) |
$1,390.80 |
$2,318 |
4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,780.80 |
$2,968 |
11.6× |
| Cta Abdomen (74175) |
$2,433.60 |
$4,056 |
15.8× |
| CTA abdomen pelvis (74174) |
$3,080.40 |
$5,134 |
10.1× |
| CTA chest (71275) |
$2,538.60 |
$4,231 |
16.5× |
| Cta Head (70496) |
$1,308 |
$2,180 |
8.5× |
| Cta Neck (70498) |
$1,714.80 |
$2,858 |
11.2× |
| Cystography minimum 3 views rs&i (74430) |
$168.60 |
$281 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$298.20 |
$497 |
3.3× |
| Esophagus (74220) |
$350.40 |
$584 |
2.3× |
| Fetal biophysical profile non-stress testing (76818) |
$377.40 |
$629 |
4.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$275.40 |
$459 |
3.0× |
| Foot 2 views (73620) |
$87.60 |
$146 |
1.1× |
| Forearm 2 views (73090) |
$217.80 |
$363 |
2.9× |
| Hand 2 views (73120) |
$178.20 |
$297 |
1.9× |
| Hand 3 views (73130) |
$201.60 |
$336 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$171.60 |
$286 |
2.3× |
| Hysterosalpingogram (74740) |
$708.60 |
$1,181 |
3.4× |
| Knee 3 views (73562) |
$288.60 |
$481 |
3.8× |
| MRA head w & w/o contrast (70546) |
$1,989.60 |
$3,316 |
6.5× |
| MRA head w/o contrast (70544) |
$1,876.80 |
$3,128 |
9.0× |
| MRA neck w contrast (70548) |
$1,809.60 |
$3,016 |
5.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,900.20 |
$3,167 |
6.2× |
| MRA neck w/o contrast (70547) |
$1,138.20 |
$1,897 |
5.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,478 |
$4,130 |
8.1× |
| MRI abdomen w/o contrast (74181) |
$1,486.80 |
$2,478 |
7.1× |
| MRI any jnt lwr ext with con lt (73722) |
$4,142.40 |
$6,904 |
6.0× |
| MRI cervical spine w/o contrast (72141) |
$1,864.80 |
$3,108 |
8.9× |
| MRI chest with contrast (71551) |
$1,429.80 |
$2,383 |
2.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,953 |
$3,255 |
6.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,011.80 |
$3,353 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,273.80 |
$2,123 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,243.20 |
$2,072 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,071.80 |
$3,453 |
6.8× |
| MRI pelvis w contrast (72196) |
$1,944.60 |
$3,241 |
6.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,047.20 |
$3,412 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,228.20 |
$2,047 |
5.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,268.60 |
$3,781 |
7.4× |
| MRI scan of leg joint before and after contrast (73723) |
$2,473.80 |
$4,123 |
8.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,014.20 |
$3,357 |
6.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,566.80 |
$4,278 |
8.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,691.60 |
$4,486 |
8.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,611.60 |
$2,686 |
7.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,366.80 |
$2,278 |
6.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,056.20 |
$3,427 |
6.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,357.20 |
$2,262 |
6.5× |
| Myelography 2 or more regions (72270) |
$771.60 |
$1,286 |
1.1× |
| Neck soft tissue (70360) |
$151.80 |
$253 |
2.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$304.20 |
$507 |
3.3× |
| Osseous survey infant (77076) |
$530.40 |
$884 |
5.8× |
| Osseous survey limited (77074) |
$323.40 |
$539 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$153.60 |
$256 |
1.7× |
| Peritoneogram rs&i (74190) |
$466.20 |
$777 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,113.80 |
$3,523 |
6.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$134.40 |
$224 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$216.60 |
$361 |
2.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$130.20 |
$217 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$306 |
$510 |
3.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$83.40 |
$139 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$108 |
$180 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$334.80 |
$558 |
4.4× |
| Radiologic exam colon single contrast study (74270) |
$490.20 |
$817 |
3.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$273.60 |
$456 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$99.60 |
$166 |
1.3× |
| Scapula complete (73010) |
$136.80 |
$228 |
1.5× |
| Screening digital breast tomosynthesis (77063) |
$67.20 |
$112 |
2.9× |
| Small bowel series (74250) |
$138.60 |
$231 |
0.9× |
| Spine thoracic 3 views (72072) |
$363.60 |
$606 |
4.0× |
| Thoracolumbar 2 views (72080) |
$111.60 |
$186 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$618.60 |
$1,031 |
6.8× |
| Upper Extremity Infant (73092) |
$174.60 |
$291 |
1.9× |
| Urethrocystography voiding (74455) |
$434.40 |
$724 |
2.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,332 |
$2,220 |
8.7× |
| Us abdl aorta screen aaa (76706) |
$161.40 |
$269 |
1.8× |
| Us breast unilateral complete (76641) |
$172.20 |
$287 |
1.9× |
| Us breast unilateral limited (76642) |
$141.60 |
$236 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$283.20 |
$472 |
3.1× |
| Us elastography parenchyma (76981) |
$190.20 |
$317 |
2.1× |
| Us ob detailed single fetus (76811) |
$293.40 |
$489 |
1.4× |
| Us ob transvaginal (76817) |
$472.80 |
$788 |
5.2× |
| Us pelvic non ob complete (76856) |
$180.60 |
$301 |
2.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$180.60 |
$301 |
2.0× |
| Us pregnancy ltd (76815) |
$411 |
$685 |
4.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$259.80 |
$433 |
2.8× |
| Us retroperitoneal limited (76775) |
$528.60 |
$881 |
5.8× |
| Us scrotum and contents (76870) |
$697.80 |
$1,163 |
7.6× |
| Us soft tissue head/neck (76536) |
$419.40 |
$699 |
4.6× |
| Us spinal canal and contents (76800) |
$120.60 |
$201 |
1.3× |
| Us xtr non-vasc lmtd (76882) |
$160.80 |
$268 |
1.8× |
| Wrist 2 views (73100) |
$93.60 |
$156 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$207.60 |
$346 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$291.60 |
$486 |
3.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$686.40 |
$1,144 |
4.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$199.20 |
$332 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$231 |
$385 |
3.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$142.20 |
$237 |
1.9× |
| X-ray exam hip uni 4/> views (73503) |
$177.60 |
$296 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$167.40 |
$279 |
1.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$176.40 |
$294 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$301.80 |
$503 |
3.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$280.80 |
$468 |
3.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$204.60 |
$341 |
2.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$320.40 |
$534 |
3.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$87 |
$145 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$360 |
$600 |
3.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$629.40 |
$1,049 |
6.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$414.60 |
$691 |
4.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$204 |
$340 |
2.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$51.60 |
$86 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$113.40 |
$189 |
1.2× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$183 |
$305 |
2.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$271.20 |
$452 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$311.40 |
$519 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$383.40 |
$639 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$235.80 |
$393 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$233.40 |
$389 |
3.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$249.60 |
$416 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$126.60 |
$211 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$267 |
$445 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$213.60 |
$356 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$87 |
$145 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$184.20 |
$307 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$150.60 |
$251 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$356.40 |
$594 |
3.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$205.20 |
$342 |
2.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$103.80 |
$173 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$521.40 |
$869 |
5.7× |
| Xr chest 4+ views (71048) |
$457.80 |
$763 |
5.0× |
| Xr finger(s) 2+ views (73140) |
$213.60 |
$356 |
2.8× |
| Xr shoulder 1 view (73020) |
$195 |
$325 |
2.6× |
| Xr spine cervical 4 or 5 views (72050) |
$422.40 |
$704 |
4.6× |
| Xr tibia/fibula 2 views (73590) |
$244.20 |
$407 |
3.2× |
| Xr tmj bilateral (70330) |
$62.40 |
$104 |
0.8× |
| Xray knee 1 or 2 views rt (73560) |
$251.40 |
$419 |
3.3× |