| Abdomen 2 views (74019) |
$209.40 |
$349 |
2.0× |
| Ankle 2 views (73600) |
$181.20 |
$302 |
2.1× |
| Arthrogram elbow (73085) |
$246.60 |
$411 |
0.7× |
| Arthrogram hip (73525) |
$181.80 |
$303 |
0.5× |
| Arthrogram shoulder (73040) |
$172.20 |
$287 |
0.5× |
| Arthrogram wrist (73115) |
$128.40 |
$214 |
0.4× |
| Arthrography knee lt (73580) |
$220.20 |
$367 |
0.6× |
| Bone age studies (77072) |
$130.80 |
$218 |
1.2× |
| Bone survey complete (77075) |
$706.80 |
$1,178 |
6.7× |
| Cervical spine 2 or 3 views (72040) |
$254.40 |
$424 |
2.9× |
| Chest 1 view (71045) |
$127.20 |
$212 |
1.5× |
| Chest 3 views (71047) |
$210 |
$350 |
2.4× |
| Clavicle complete (73000) |
$196.20 |
$327 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$192.60 |
$321 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,568.20 |
$5,947 |
10.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,735.40 |
$4,559 |
11.4× |
| CT abdomen w contrast (74160) |
$1,747.80 |
$2,913 |
9.9× |
| CT abdomen w wo contrast (74170) |
$1,779 |
$2,965 |
10.1× |
| CT abdomen w/o contrast (74150) |
$1,385.40 |
$2,309 |
13.2× |
| CT angio hrt w/3d image (75574) |
$1,382.40 |
$2,304 |
3.9× |
| CT angiography upper extremity lt (73206) |
$2,027.40 |
$3,379 |
11.5× |
| CT c-spine w/o contrast (72125) |
$1,358.40 |
$2,264 |
12.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,837.80 |
$3,063 |
10.4× |
| CT cervical spine with contrast (72126) |
$1,725 |
$2,875 |
4.9× |
| CT chest w/wo contrast (71270) |
$1,939.80 |
$3,233 |
11.0× |
| CT chest with contrast (71260) |
$1,713.60 |
$2,856 |
9.7× |
| CT head/brain with contrast (70460) |
$1,466.40 |
$2,444 |
8.3× |
| CT head/brain without and with contrast (70470) |
$1,780.80 |
$2,968 |
10.1× |
| CT iac w contrast (70481) |
$1,576.20 |
$2,627 |
8.9× |
| CT limited/localized follow up study (76380) |
$641.40 |
$1,069 |
7.3× |
| CT lower ext w/o (73700) |
$1,496.40 |
$2,494 |
14.2× |
| CT lower extremity w wo contrast (73702) |
$1,955.40 |
$3,259 |
11.1× |
| CT lower extremity with contrast (73701) |
$1,795.80 |
$2,993 |
10.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,931.40 |
$3,219 |
11.0× |
| CT lumbar spine w/o contrast (72131) |
$1,524.60 |
$2,541 |
14.5× |
| CT lumbar spine with contrast (72132) |
$1,666.20 |
$2,777 |
4.8× |
| CT maxillofacial w contrast (70487) |
$1,431.60 |
$2,386 |
8.1× |
| CT maxillofacial w/o contrast (70486) |
$1,130.40 |
$1,884 |
10.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,711.80 |
$2,853 |
9.7× |
| CT neck soft tissue w contrast (70491) |
$1,484.40 |
$2,474 |
8.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,750.80 |
$2,918 |
9.9× |
| CT orbits w/o contrast (70480) |
$1,435.80 |
$2,393 |
13.7× |
| CT pelvis w & w/o contrast (72194) |
$1,789.20 |
$2,982 |
10.2× |
| CT pelvis w/o contrast (72192) |
$1,350.60 |
$2,251 |
12.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,371 |
$2,285 |
7.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,257 |
$2,095 |
12.0× |
| CT thoracic spine w/contrast (72129) |
$1,701.60 |
$2,836 |
9.7× |
| CT thoracic spine w/o contrast (72128) |
$1,574.40 |
$2,624 |
15.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,931.40 |
$3,219 |
11.0× |
| CT thorax w/o contrast (71250) |
$1,437 |
$2,395 |
13.7× |
| CT unlisted procedure (76497) |
$528.60 |
$881 |
6.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,923 |
$3,205 |
10.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,579.80 |
$2,633 |
15.0× |
| CT upper extremity with contrast (73201) |
$1,830 |
$3,050 |
5.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,085.60 |
$3,476 |
11.8× |
| Cta Abdomen (74175) |
$2,251.80 |
$3,753 |
12.8× |
| CTA abdomen pelvis (74174) |
$4,165.20 |
$6,942 |
11.9× |
| CTA chest (71275) |
$1,713.60 |
$2,856 |
9.7× |
| Cta Head (70496) |
$1,976.40 |
$3,294 |
11.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,980 |
$3,300 |
5.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,297.80 |
$2,163 |
7.4× |
| Cta Neck (70498) |
$1,977.60 |
$3,296 |
11.2× |
| Cta Pelvis (72191) |
$1,913.40 |
$3,189 |
10.9× |
| Diskogram cervical (72285) |
$869.40 |
$1,449 |
0.4× |
| Diskography lumbar (72295) |
$1,091.40 |
$1,819 |
0.6× |
| Esophagus (74220) |
$447.60 |
$746 |
2.5× |
| Fetal biophysical profile non-stress testing (76818) |
$389.40 |
$649 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$370.20 |
$617 |
1.5× |
| Foot 2 views (73620) |
$250.80 |
$418 |
2.9× |
| Forearm 2 views (73090) |
$264.60 |
$441 |
3.0× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$162 |
$270 |
0.7× |
| Hand 2 views (73120) |
$277.80 |
$463 |
2.6× |
| Hand 3 views (73130) |
$277.20 |
$462 |
3.2× |
| Humerus Min 2 Views Left (73060) |
$258 |
$430 |
3.0× |
| Knee 3 views (73562) |
$265.80 |
$443 |
3.0× |
| Lymphangiography extremity only bilateral rs&i (75803) |
$3,669 |
$6,115 |
2.3× |
| MRA head w & w/o contrast (70546) |
$2,532.60 |
$4,221 |
7.2× |
| MRA head w/o contrast (70544) |
$1,272.60 |
$2,121 |
5.3× |
| MRA head with contrast (70545) |
$1,310.40 |
$2,184 |
3.7× |
| MRA neck w contrast (70548) |
$1,675.20 |
$2,792 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,193.60 |
$3,656 |
6.3× |
| MRA neck w/o contrast (70547) |
$1,626.60 |
$2,711 |
6.8× |
| MRI abdomen w contrast (74182) |
$1,797.60 |
$2,996 |
5.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,400 |
$4,000 |
6.8× |
| MRI abdomen w/o contrast (74181) |
$1,737.60 |
$2,896 |
7.2× |
| MRI any jnt lwr ext with con lt (73722) |
$2,160 |
$3,600 |
2.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,545.60 |
$2,576 |
2.0× |
| MRI c-spine with contrast (72142) |
$1,905 |
$3,175 |
5.4× |
| MRI cervical spine w/o contrast (72141) |
$1,849.80 |
$3,083 |
7.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,951.80 |
$3,253 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,315.80 |
$2,193 |
5.5× |
| MRI chest with contrast (71551) |
$1,356 |
$2,260 |
1.7× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,669.20 |
$2,782 |
4.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,741.80 |
$2,903 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,726.80 |
$2,878 |
7.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,267.20 |
$2,112 |
5.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,192.40 |
$3,654 |
6.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,286.40 |
$2,144 |
3.7× |
| MRI pelvis w contrast (72196) |
$1,647.60 |
$2,746 |
4.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,047.80 |
$3,413 |
5.8× |
| MRI pelvis w/o contrast (72195) |
$1,518 |
$2,530 |
6.3× |
| MRI scan of arm joint before and after contrast (73223) |
$1,872 |
$3,120 |
5.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,904.40 |
$3,174 |
5.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,533.80 |
$4,223 |
7.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,862.40 |
$3,104 |
5.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,608.80 |
$4,348 |
7.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,933.80 |
$3,223 |
5.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,681.40 |
$4,469 |
7.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,660.20 |
$2,767 |
6.9× |
| MRI tmj (70336) |
$1,090.20 |
$1,817 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,985.40 |
$3,309 |
8.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,709.60 |
$4,516 |
7.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,782 |
$2,970 |
7.4× |
| Neck soft tissue (70360) |
$130.80 |
$218 |
1.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$87.60 |
$146 |
0.8× |
| Pelvis 1 or 2 views (72170) |
$223.80 |
$373 |
2.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,322 |
$3,870 |
6.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$153 |
$255 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$285 |
$475 |
2.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$213 |
$355 |
2.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$167.40 |
$279 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$562.80 |
$938 |
5.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$137.40 |
$229 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$160.20 |
$267 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$193.20 |
$322 |
1.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$171 |
$285 |
2.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$194.40 |
$324 |
2.2× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$90.60 |
$151 |
1.0× |
| Radiological examination surgical specimen (76098) |
$94.80 |
$158 |
0.2× |
| Ribs bilateral 3 views (71110) |
$342 |
$570 |
3.3× |
| Sacroiliac Joints < 3 Views (72200) |
$90.60 |
$151 |
0.9× |
| Scanogram (77073) |
$237 |
$395 |
2.3× |
| Scapula complete (73010) |
$195.60 |
$326 |
1.9× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$766.80 |
$1,278 |
7.3× |
| Spine thoracic 3 views (72072) |
$297.60 |
$496 |
2.8× |
| Thoracolumbar 2 views (72080) |
$234 |
$390 |
2.7× |
| Tmj unilateral (70328) |
$90.60 |
$151 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$445.80 |
$743 |
4.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$379.80 |
$633 |
4.3× |
| Unlisted fluoroscopic procedure (76496) |
$264 |
$440 |
3.0× |
| Unlisted Ultrasound Procedure (76999) |
$250.20 |
$417 |
2.9× |
| Upper Extremity Infant (73092) |
$103.20 |
$172 |
1.0× |
| Us breast unilateral complete (76641) |
$153 |
$255 |
1.5× |
| Us breast unilateral limited (76642) |
$153 |
$255 |
1.8× |
| Us chest (76604) |
$311.40 |
$519 |
3.0× |
| Us compl joint r-t w/image documentation (76881) |
$557.40 |
$929 |
5.3× |
| Us fetal nuchal translucency 1st gestation (76813) |
$392.40 |
$654 |
3.7× |
| Us ob detailed single fetus (76811) |
$398.40 |
$664 |
1.7× |
| Us ob transvaginal (76817) |
$206.40 |
$344 |
2.0× |
| Us pelvic non ob complete (76856) |
$527.40 |
$879 |
5.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$412.80 |
$688 |
3.9× |
| Us pregnancy ltd (76815) |
$125.40 |
$209 |
1.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$364.80 |
$608 |
3.5× |
| Us retroperitoneal complete (76770) |
$421.20 |
$702 |
4.0× |
| Us retroperitoneal limited (76775) |
$421.20 |
$702 |
4.0× |
| Us scrotum and contents (76870) |
$398.40 |
$664 |
3.8× |
| Us soft tissue head/neck (76536) |
$420.60 |
$701 |
4.0× |
| Us spinal canal and contents (76800) |
$252.60 |
$421 |
2.4× |
| Us transrectal (76872) |
$339 |
$565 |
3.2× |
| Us transrectal prostate volume (76873) |
$600.30 |
$1,000.50 |
5.7× |
| Us xtr non-vasc lmtd (76882) |
$278.40 |
$464 |
2.7× |
| Wrist 2 views (73100) |
$254.40 |
$424 |
2.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$398.40 |
$664 |
3.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94.20 |
$157 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$246.60 |
$411 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$254.40 |
$424 |
2.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$271.20 |
$452 |
3.1× |
| X-ray exam hip uni 1 view (73501) |
$112.20 |
$187 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$189 |
$315 |
2.2× |
| X-ray exam hip uni 4/> views (73503) |
$265.80 |
$443 |
2.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$318.60 |
$531 |
3.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$425.40 |
$709 |
4.1× |
| X-ray exam of femur 1 (73551) |
$126 |
$210 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$220.80 |
$368 |
2.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$93 |
$155 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$318.60 |
$531 |
3.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$100.80 |
$168 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$311.40 |
$519 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$261.60 |
$436 |
3.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$109.20 |
$182 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$265.20 |
$442 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$442.80 |
$738 |
4.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$399.60 |
$666 |
3.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$184.80 |
$308 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$99 |
$165 |
0.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$280.80 |
$468 |
2.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$538.80 |
$898 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$229.20 |
$382 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$352.80 |
$588 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$432.60 |
$721 |
4.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$130.20 |
$217 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$227.40 |
$379 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$255 |
$425 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$246 |
$410 |
2.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$114.60 |
$191 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$294 |
$490 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$207 |
$345 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$235.80 |
$393 |
2.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$216 |
$360 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$171.60 |
$286 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$234 |
$390 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$372 |
$620 |
3.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$159.60 |
$266 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$258 |
$430 |
3.0× |
| Xr arthrogram ankle (73615) |
$193.80 |
$323 |
0.6× |
| Xr c-spine 6 or more views (72052) |
$357.60 |
$596 |
3.4× |
| Xr chest 4+ views (71048) |
$291.60 |
$486 |
2.8× |
| Xr finger(s) 2+ views (73140) |
$180.60 |
$301 |
2.1× |
| Xr optic foramina (70190) |
$113.40 |
$189 |
1.3× |
| Xr shoulder 1 view (73020) |
$223.20 |
$372 |
2.6× |
| Xr spine cervical 4 or 5 views (72050) |
$342 |
$570 |
3.3× |
| Xr tibia/fibula 2 views (73590) |
$255 |
$425 |
2.9× |
| Xr tmj bilateral (70330) |
$181.20 |
$302 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$228 |
$380 |
2.6× |