| Abdomen 2 views (74019) |
$124 |
$309 |
1.2× |
| Ankle 2 views (73600) |
$82 |
$206 |
1.0× |
| Bone age studies (77072) |
$50 |
$125 |
0.5× |
| Bone survey complete (77075) |
$260 |
$650 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$177 |
$443 |
2.1× |
| Chest 1 view (71045) |
$66 |
$165 |
0.8× |
| Clavicle complete (73000) |
$103 |
$258 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,610 |
$4,025 |
4.8× |
| CT abdomen and pelvis without contrast (74176) |
$425 |
$1,062 |
1.9× |
| CT abdomen w contrast (74160) |
$651 |
$1,627 |
3.9× |
| CT abdomen w wo contrast (74170) |
$865 |
$2,163 |
5.1× |
| CT abdomen w/o contrast (74150) |
$534 |
$1,336 |
5.3× |
| CT c-spine w/o contrast (72125) |
$464 |
$1,160 |
4.6× |
| CT cervical spine w&w/o contrast (72127) |
$658 |
$1,646 |
3.9× |
| CT cervical spine with contrast (72126) |
$547 |
$1,367 |
1.6× |
| CT chest w/wo contrast (71270) |
$632 |
$1,579 |
3.7× |
| CT chest with contrast (71260) |
$510 |
$1,276 |
3.0× |
| CT head/brain with contrast (70460) |
$437 |
$1,092 |
2.6× |
| CT head/brain without and with contrast (70470) |
$543 |
$1,358 |
3.2× |
| CT iac w contrast (70481) |
$463 |
$1,157 |
2.7× |
| CT lower ext w/o (73700) |
$364 |
$911 |
3.6× |
| CT lower extremity with contrast (73701) |
$366 |
$916 |
2.2× |
| CT lumbar spine w & w/o contrast (72133) |
$628 |
$1,570 |
3.7× |
| CT lumbar spine w/o contrast (72131) |
$461 |
$1,152 |
4.6× |
| CT lumbar spine with contrast (72132) |
$532 |
$1,329 |
1.6× |
| CT maxillofacial w contrast (70487) |
$452 |
$1,130 |
2.7× |
| CT maxillofacial w/o contrast (70486) |
$398 |
$995 |
4.0× |
| CT maxillofacial w/wo contrast (70488) |
$546 |
$1,364 |
3.2× |
| CT neck soft tissue w contrast (70491) |
$457 |
$1,143 |
2.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$554 |
$1,385 |
3.3× |
| CT orbits w/o contrast (70480) |
$420 |
$1,049 |
4.2× |
| CT pelvis w & w/o contrast (72194) |
$557 |
$1,393 |
3.3× |
| CT pelvis w/o contrast (72192) |
$405 |
$1,013 |
4.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$551 |
$1,377 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$414 |
$1,036 |
4.1× |
| CT thoracic spine w/contrast (72129) |
$542 |
$1,355 |
3.2× |
| CT thoracic spine w/o contrast (72128) |
$463 |
$1,157 |
4.6× |
| CT thoracic spine w/wo contrast (72130) |
$648 |
$1,620 |
3.8× |
| CT thorax w/o contrast (71250) |
$462 |
$1,154 |
4.6× |
| CT upper extremity w/o contrast rt (73200) |
$363 |
$908 |
3.6× |
| CT upper extremity with contrast (73201) |
$408 |
$1,021 |
1.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$887.50 |
$2,218.50 |
5.3× |
| Cta Abdomen (74175) |
$975 |
$2,437 |
5.8× |
| CTA abdomen pelvis (74174) |
$920 |
$2,300 |
2.7× |
| CTA chest (71275) |
$789 |
$1,972 |
4.7× |
| Cta Head (70496) |
$755 |
$1,887.50 |
4.5× |
| Cta Neck (70498) |
$754.50 |
$1,886 |
4.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$140 |
$350 |
1.4× |
| Fluoroscopy up to 1 hr (76000) |
$330 |
$824 |
1.4× |
| Foot 2 views (73620) |
$82 |
$206 |
1.0× |
| Forearm 2 views (73090) |
$103 |
$258 |
1.2× |
| Hand 2 views (73120) |
$58 |
$144 |
0.6× |
| Hand 3 views (73130) |
$103 |
$258 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$82 |
$206 |
1.0× |
| Knee 3 views (73562) |
$113 |
$283 |
1.4× |
| MRA head w/o contrast (70544) |
$1,349 |
$3,373 |
5.9× |
| MRA head with contrast (70545) |
$1,499 |
$3,748 |
4.5× |
| MRA neck w contrast (70548) |
$1,518 |
$3,795 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,328 |
$3,321 |
5.8× |
| MRI abdomen w contrast (74182) |
$1,347 |
$3,367 |
4.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,608 |
$4,021 |
4.8× |
| MRI abdomen w/o contrast (74181) |
$1,154 |
$2,886 |
5.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,201 |
$3,002 |
1.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,199 |
$2,998 |
1.6× |
| MRI c-spine with contrast (72142) |
$1,331 |
$3,327 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$1,186 |
$2,965 |
5.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,943 |
$4,858 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,319 |
$3,297 |
5.7× |
| MRI chest with contrast (71551) |
$1,457 |
$3,644 |
1.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,537 |
$3,843 |
6.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,135 |
$5,337 |
6.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,784 |
$4,459 |
5.3× |
| MRI pelvis w contrast (72196) |
$1,365 |
$3,412 |
4.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,663 |
$4,158 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$421 |
$1,053 |
1.8× |
| MRI scan of arm joint before and after contrast (73223) |
$1,475 |
$3,688 |
4.4× |
| MRI scan of leg joint before and after contrast (73723) |
$1,444 |
$3,609 |
4.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,647 |
$4,119 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,374 |
$3,435 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,707 |
$4,267 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,410 |
$3,526 |
4.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,736 |
$4,339 |
5.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,258 |
$3,146 |
5.5× |
| MRI tmj (70336) |
$1,003 |
$2,508 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,037 |
$2,593 |
4.5× |
| Neck soft tissue (70360) |
$177 |
$443 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$103 |
$258 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$142 |
$355 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$74 |
$185 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$140 |
$350 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$87 |
$216 |
1.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$103 |
$258 |
1.2× |
| Scanogram (77073) |
$480 |
$1,200 |
4.8× |
| Scapula complete (73010) |
$103 |
$258 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$174 |
$434 |
1.7× |
| Us breast unilateral complete (76641) |
$245 |
$611 |
2.4× |
| Us breast unilateral limited (76642) |
$201 |
$502 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$320 |
$800 |
3.2× |
| Us pelvic non ob complete (76856) |
$182 |
$456 |
1.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$250 |
$625 |
2.5× |
| Us pregnancy ltd (76815) |
$190 |
$475 |
1.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$261 |
$652 |
2.6× |
| Us retroperitoneal complete (76770) |
$232 |
$579 |
2.3× |
| Us scrotum and contents (76870) |
$191.50 |
$479.50 |
1.9× |
| Us soft tissue head/neck (76536) |
$209 |
$523 |
2.1× |
| Wrist 2 views (73100) |
$82 |
$206 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$103 |
$258 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$82 |
$206 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$103 |
$258 |
1.2× |
| X-ray exam hip uni 1 view (73501) |
$72 |
$180 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$132 |
$330 |
1.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$148 |
$371 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$140 |
$350 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$103 |
$258 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$103 |
$258 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$68 |
$170 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$144 |
$361 |
1.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$103 |
$258 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$124 |
$310 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$95 |
$237 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$155 |
$386 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$132 |
$330 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$132 |
$330 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$107 |
$268 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$140 |
$350 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$103 |
$258 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$124 |
$309 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$68 |
$170 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$91 |
$227 |
1.1× |
| Xr c-spine 6 or more views (72052) |
$216 |
$541 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$103 |
$258 |
1.2× |
| Xr shoulder 1 view (73020) |
$95 |
$237 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$196 |
$489 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$70 |
$175 |
0.8× |
| Xray knee 1 or 2 views rt (73560) |
$103 |
$258 |
1.2× |