| Abdomen 2 views (74019) |
$264.60 |
$441 |
2.5× |
| Ankle 2 views (73600) |
$221.40 |
$369 |
2.5× |
| Arthrogram elbow (73085) |
$291 |
$485 |
0.8× |
| Arthrogram hip (73525) |
$357.60 |
$596 |
1.0× |
| Arthrogram shoulder (73040) |
$357.60 |
$596 |
1.0× |
| Arthrogram wrist (73115) |
$266.40 |
$444 |
0.8× |
| Arthrography knee lt (73580) |
$357.60 |
$596 |
1.0× |
| Bone age studies (77072) |
$111.60 |
$186 |
1.1× |
| Bone survey complete (77075) |
$498 |
$830 |
4.7× |
| Cervical spine 2 or 3 views (72040) |
$276 |
$460 |
3.2× |
| Chest 1 view (71045) |
$221.40 |
$369 |
2.5× |
| Chest 3 views (71047) |
$191.40 |
$319 |
2.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$307.20 |
$512 |
1.7× |
| Clavicle complete (73000) |
$191.40 |
$319 |
2.2× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$169.20 |
$282 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,714.20 |
$2,857 |
4.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,714.20 |
$2,857 |
7.1× |
| CT abdomen w contrast (74160) |
$2,391.60 |
$3,986 |
13.6× |
| CT abdomen w wo contrast (74170) |
$2,160.30 |
$3,600.50 |
12.2× |
| CT abdomen w/o contrast (74150) |
$2,030.40 |
$3,384 |
19.3× |
| CT angiography upper extremity lt (73206) |
$1,714.20 |
$2,857 |
9.7× |
| CT c-spine w/o contrast (72125) |
$2,116.20 |
$3,527 |
20.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,116.20 |
$3,527 |
12.0× |
| CT cervical spine with contrast (72126) |
$1,884.60 |
$3,141 |
5.4× |
| CT chest w/wo contrast (71270) |
$2,443.20 |
$4,072 |
13.8× |
| CT chest with contrast (71260) |
$1,955.40 |
$3,259 |
11.1× |
| CT head/brain with contrast (70460) |
$1,884.60 |
$3,141 |
10.7× |
| CT head/brain without and with contrast (70470) |
$2,211.60 |
$3,686 |
12.5× |
| CT iac w contrast (70481) |
$1,884.60 |
$3,141 |
10.7× |
| CT limited/localized follow up study (76380) |
$1,141.80 |
$1,903 |
13.0× |
| CT lower ext w/o (73700) |
$1,714.20 |
$2,857 |
16.3× |
| CT lower extremity w wo contrast (73702) |
$2,116.20 |
$3,527 |
12.0× |
| CT lower extremity with contrast (73701) |
$1,884.60 |
$3,141 |
10.7× |
| CT lumbar spine w & w/o contrast (72133) |
$2,116.20 |
$3,527 |
12.0× |
| CT lumbar spine w/o contrast (72131) |
$2,157.60 |
$3,596 |
20.5× |
| CT lumbar spine with contrast (72132) |
$2,030.40 |
$3,384 |
5.8× |
| CT maxillofacial w contrast (70487) |
$1,884.60 |
$3,141 |
10.7× |
| CT maxillofacial w/o contrast (70486) |
$1,714.20 |
$2,857 |
16.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,078.40 |
$3,464 |
11.8× |
| CT neck soft tissue w contrast (70491) |
$1,884.60 |
$3,141 |
10.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,116.20 |
$3,527 |
12.0× |
| CT orbits w/o contrast (70480) |
$1,714.20 |
$2,857 |
16.3× |
| CT pelvis w & w/o contrast (72194) |
$2,116.20 |
$3,527 |
12.0× |
| CT pelvis w/o contrast (72192) |
$1,777.80 |
$2,963 |
16.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,116.20 |
$3,527 |
12.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,714.20 |
$2,857 |
16.3× |
| CT thoracic spine w/contrast (72129) |
$1,884.60 |
$3,141 |
10.7× |
| CT thoracic spine w/o contrast (72128) |
$1,714.20 |
$2,857 |
16.3× |
| CT thoracic spine w/wo contrast (72130) |
$2,116.20 |
$3,527 |
12.0× |
| CT thorax w/o contrast (71250) |
$2,020.80 |
$3,368 |
19.2× |
| CT unlisted procedure (76497) |
$1,205.10 |
$2,008.50 |
13.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,116.20 |
$3,527 |
12.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,714.20 |
$2,857 |
16.3× |
| CT upper extremity with contrast (73201) |
$1,884.60 |
$3,141 |
5.4× |
| Cta Abdomen (74175) |
$2,053.50 |
$3,422.50 |
11.6× |
| CTA abdomen pelvis (74174) |
$1,714.20 |
$2,857 |
4.9× |
| CTA chest (71275) |
$1,714.20 |
$2,857 |
9.7× |
| Cta Head (70496) |
$1,714.20 |
$2,857 |
9.7× |
| CTA lwr ext w&w/o contrast (73706) |
$2,085.60 |
$3,476 |
11.8× |
| Cta Neck (70498) |
$1,714.20 |
$2,857 |
9.7× |
| Cta Pelvis (72191) |
$1,714.20 |
$2,857 |
9.7× |
| Diskogram cervical (72285) |
$1,733.40 |
$2,889 |
0.9× |
| Diskography lumbar (72295) |
$1,733.40 |
$2,889 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$497.40 |
$829 |
4.7× |
| Esophagus (74220) |
$307.20 |
$512 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$972.60 |
$1,621 |
4.1× |
| Foot 2 views (73620) |
$221.40 |
$369 |
2.5× |
| Forearm 2 views (73090) |
$221.40 |
$369 |
2.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$379.20 |
$632 |
1.6× |
| Hand 2 views (73120) |
$212.40 |
$354 |
2.0× |
| Hand 3 views (73130) |
$243.60 |
$406 |
2.8× |
| Humerus Min 2 Views Left (73060) |
$221.40 |
$369 |
2.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$497.40 |
$829 |
4.7× |
| Knee 3 views (73562) |
$307.20 |
$512 |
3.5× |
| MRA head w & w/o contrast (70546) |
$2,973.60 |
$4,956 |
8.5× |
| MRA head w/o contrast (70544) |
$2,169.60 |
$3,616 |
9.0× |
| MRA head with contrast (70545) |
$2,517 |
$4,195 |
7.2× |
| MRA neck w contrast (70548) |
$2,517 |
$4,195 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,973.60 |
$4,956 |
8.5× |
| MRA neck w/o contrast (70547) |
$2,169.60 |
$3,616 |
9.0× |
| MRI abdomen w contrast (74182) |
$3,427.20 |
$5,712 |
9.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,693 |
$6,155 |
10.5× |
| MRI abdomen w/o contrast (74181) |
$2,856 |
$4,760 |
11.9× |
| MRI any jnt lwr ext with con lt (73722) |
$3,427.20 |
$5,712 |
4.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,427.20 |
$5,712 |
4.3× |
| MRI c-spine with contrast (72142) |
$3,427.20 |
$5,712 |
9.8× |
| MRI cervical spine w/o contrast (72141) |
$2,856 |
$4,760 |
11.9× |
| MRI chest w/o & w/contrast material (71552) |
$3,693 |
$6,155 |
10.5× |
| MRI chest w/o contrast (71550) |
$2,856 |
$4,760 |
11.9× |
| MRI chest with contrast (71551) |
$3,427.20 |
$5,712 |
4.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,427.20 |
$5,712 |
9.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,427.20 |
$5,712 |
9.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,856 |
$4,760 |
11.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,856 |
$4,760 |
11.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,693 |
$6,155 |
10.5× |
| MRI orbit/face/neck w/contrast (70542) |
$3,427.20 |
$5,712 |
9.8× |
| MRI pelvis w contrast (72196) |
$3,427.20 |
$5,712 |
9.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,693 |
$6,155 |
10.5× |
| MRI pelvis w/o contrast (72195) |
$2,856 |
$4,760 |
11.9× |
| MRI scan of arm joint before and after contrast (73223) |
$3,693 |
$6,155 |
10.5× |
| MRI scan of leg joint before and after contrast (73723) |
$3,693 |
$6,155 |
10.5× |
| MRI spectroscopy (76390) |
$2,517 |
$4,195 |
28.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,692.40 |
$6,154 |
10.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,427.20 |
$5,712 |
9.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,693 |
$6,155 |
10.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,297.84 |
$5,496.40 |
9.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,693 |
$6,155 |
10.5× |
| MRI thoracic spine w/o contrast (72146) |
$2,856 |
$4,760 |
11.9× |
| MRI tmj (70336) |
$1,246.80 |
$2,078 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$2,856 |
$4,760 |
11.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,693 |
$6,155 |
10.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,856 |
$4,760 |
11.9× |
| Myelogram Lumbar (72265) |
$997.20 |
$1,662 |
1.3× |
| Myelography 2 or more regions (72270) |
$1,074 |
$1,790 |
1.4× |
| Neck soft tissue (70360) |
$201 |
$335 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$200.40 |
$334 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,693 |
$6,155 |
10.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$190.20 |
$317 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$183 |
$305 |
1.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$266.40 |
$444 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$252.60 |
$421 |
2.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$190.20 |
$317 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$252.60 |
$421 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$264 |
$440 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$264.60 |
$441 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$252.60 |
$421 |
2.9× |
| Radiologic exam colon single contrast study (74270) |
$687.60 |
$1,146 |
3.9× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$307.20 |
$512 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$665.40 |
$1,109 |
3.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$307.20 |
$512 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$233.40 |
$389 |
2.7× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$200.40 |
$334 |
2.3× |
| Ribs bilateral 3 views (71110) |
$252.60 |
$421 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$221.40 |
$369 |
2.1× |
| Scanogram (77073) |
$497.40 |
$829 |
4.7× |
| Scapula complete (73010) |
$191.40 |
$319 |
1.8× |
| Sella turcica (70240) |
$191.40 |
$319 |
2.2× |
| Small bowel series (74250) |
$592.20 |
$987 |
3.4× |
| Spine thoracic 3 views (72072) |
$348.60 |
$581 |
3.3× |
| Thoracolumbar 2 views (72080) |
$191.40 |
$319 |
2.2× |
| Tmj unilateral (70328) |
$191.40 |
$319 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$449.40 |
$749 |
4.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$973.20 |
$1,622 |
11.1× |
| Unlisted fluoroscopic procedure (76496) |
$972.60 |
$1,621 |
11.1× |
| Unlisted Ultrasound Procedure (76999) |
$498 |
$830 |
5.7× |
| Upper Extremity Infant (73092) |
$200.40 |
$334 |
1.9× |
| Us compl joint r-t w/image documentation (76881) |
$339.60 |
$566 |
3.2× |
| Us pelvic non ob complete (76856) |
$772.80 |
$1,288 |
7.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$389.40 |
$649 |
3.7× |
| Us retroperitoneal complete (76770) |
$772.80 |
$1,288 |
7.3× |
| Us retroperitoneal limited (76775) |
$772.80 |
$1,288 |
7.3× |
| Us scrotum and contents (76870) |
$449.40 |
$749 |
4.3× |
| Us soft tissue head/neck (76536) |
$449.40 |
$749 |
4.3× |
| Us spinal canal and contents (76800) |
$765.60 |
$1,276 |
7.3× |
| Us xtr non-vasc lmtd (76882) |
$339.60 |
$566 |
3.2× |
| Wrist 2 views (73100) |
$261.90 |
$436.50 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$361.80 |
$603 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$191.40 |
$319 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$243.60 |
$406 |
2.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$772.80 |
$1,288 |
4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$191.40 |
$319 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$200.40 |
$334 |
2.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$411 |
$685 |
3.9× |
| X-ray exam hip uni 1 view (73501) |
$190.20 |
$317 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$212.40 |
$354 |
2.4× |
| X-ray exam hip uni 4/> views (73503) |
$212.40 |
$354 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$266.40 |
$444 |
2.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$274.80 |
$458 |
2.6× |
| X-ray exam of femur 1 (73551) |
$236.40 |
$394 |
2.7× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$862.20 |
$1,437 |
4.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$200.40 |
$334 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$390.60 |
$651 |
4.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$221.40 |
$369 |
2.5× |
| X-ray head for orthodontia (70350) |
$191.40 |
$319 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$191.40 |
$319 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$205.20 |
$342 |
2.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$264.60 |
$441 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$191.40 |
$319 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$252.60 |
$421 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$296.40 |
$494 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$381 |
$635 |
3.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$296.40 |
$494 |
2.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$390.60 |
$651 |
4.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$368.86 |
$614.76 |
3.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$264.60 |
$441 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$317.40 |
$529 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$348.60 |
$581 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$296.40 |
$494 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$264.60 |
$441 |
2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$243.60 |
$406 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$285 |
$475 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$390.60 |
$651 |
4.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$200.40 |
$334 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$307.80 |
$513 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$285 |
$475 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$221.40 |
$369 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$169.20 |
$282 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$212.40 |
$354 |
2.4× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$276 |
$460 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$243.60 |
$406 |
2.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$296.40 |
$494 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$191.40 |
$319 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$221.40 |
$369 |
2.5× |
| Xr arthrogram ankle (73615) |
$266.40 |
$444 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$412.20 |
$687 |
3.9× |
| Xr chest 4+ views (71048) |
$243.30 |
$405.50 |
2.3× |
| Xr Cholecystography Oral Contrast (74290) |
$592.20 |
$987 |
3.4× |
| Xr finger(s) 2+ views (73140) |
$191.40 |
$319 |
2.2× |
| Xr internal auditory meati complete (70134) |
$243.60 |
$406 |
0.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$221.40 |
$369 |
2.1× |
| Xr myelogram posterior fossa (70010) |
$858 |
$1,430 |
2.4× |
| Xr optic foramina (70190) |
$191.40 |
$319 |
2.2× |
| Xr shoulder 1 view (73020) |
$212.40 |
$354 |
2.4× |
| Xr spine cervical 4 or 5 views (72050) |
$370.20 |
$617 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$252.60 |
$421 |
2.9× |
| Xr tmj bilateral (70330) |
$379.20 |
$632 |
4.3× |
| Xray knee 1 or 2 views rt (73560) |
$243.60 |
$406 |
2.8× |