| Abdomen 2 views (74019) |
$260.40 |
$434 |
2.5× |
| Ankle 2 views (73600) |
$205.80 |
$343 |
2.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$509.40 |
$849 |
1.5× |
| Arthrogram elbow (73085) |
$261.60 |
$436 |
0.7× |
| Arthrogram hip (73525) |
$371.40 |
$619 |
1.1× |
| Arthrogram shoulder (73040) |
$528 |
$880 |
1.5× |
| Arthrogram wrist (73115) |
$228 |
$380 |
0.7× |
| Arthrography knee lt (73580) |
$412.20 |
$687 |
1.2× |
| Bone age studies (77072) |
$156 |
$260 |
1.5× |
| Bone survey complete (77075) |
$751.20 |
$1,252 |
7.2× |
| Cervical spine 2 or 3 views (72040) |
$270.60 |
$451 |
3.1× |
| Chest 1 view (71045) |
$238.20 |
$397 |
2.7× |
| Chest 3 views (71047) |
$228 |
$380 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$468 |
$780 |
2.7× |
| Clavicle complete (73000) |
$208.20 |
$347 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,791.40 |
$6,319 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,907 |
$4,845 |
12.1× |
| CT abdomen w contrast (74160) |
$1,857 |
$3,095 |
10.5× |
| CT abdomen w wo contrast (74170) |
$1,934.40 |
$3,224 |
11.0× |
| CT abdomen w/o contrast (74150) |
$1,510.20 |
$2,517 |
14.4× |
| CT angiography upper extremity lt (73206) |
$4,308.60 |
$7,181 |
24.5× |
| CT c-spine w/o contrast (72125) |
$1,758.60 |
$2,931 |
16.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,952.40 |
$3,254 |
11.1× |
| CT cervical spine with contrast (72126) |
$1,831.80 |
$3,053 |
5.2× |
| CT chest w/wo contrast (71270) |
$2,062.20 |
$3,437 |
11.7× |
| CT chest with contrast (71260) |
$1,821 |
$3,035 |
10.3× |
| CT head/brain with contrast (70460) |
$1,726.20 |
$2,877 |
9.8× |
| CT head/brain without and with contrast (70470) |
$1,934.40 |
$3,224 |
11.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,465.80 |
$2,443 |
16.8× |
| CT iac w contrast (70481) |
$1,726.20 |
$2,877 |
9.8× |
| CT limited/localized follow up study (76380) |
$1,465.80 |
$2,443 |
16.8× |
| CT lower ext w/o (73700) |
$1,590 |
$2,650 |
15.1× |
| CT lower extremity w wo contrast (73702) |
$2,972.10 |
$4,953.50 |
16.9× |
| CT lower extremity with contrast (73701) |
$1,908 |
$3,180 |
10.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,053.20 |
$3,422 |
11.7× |
| CT lumbar spine w/o contrast (72131) |
$1,620 |
$2,700 |
15.4× |
| CT lumbar spine with contrast (72132) |
$1,770 |
$2,950 |
5.1× |
| CT maxillofacial w contrast (70487) |
$1,726.20 |
$2,877 |
9.8× |
| CT maxillofacial w/o contrast (70486) |
$1,510.20 |
$2,517 |
14.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,934.40 |
$3,224 |
11.0× |
| CT neck soft tissue w contrast (70491) |
$1,726.20 |
$2,877 |
9.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,934.40 |
$3,224 |
11.0× |
| CT orbits w/o contrast (70480) |
$1,525.20 |
$2,542 |
14.5× |
| CT pelvis w & w/o contrast (72194) |
$1,934.40 |
$3,224 |
11.0× |
| CT pelvis w/o contrast (72192) |
$1,510.20 |
$2,517 |
14.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,934.40 |
$3,224 |
11.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,509.90 |
$2,516.50 |
14.4× |
| CT thoracic spine w/contrast (72129) |
$1,808.40 |
$3,014 |
10.3× |
| CT thoracic spine w/o contrast (72128) |
$1,672.80 |
$2,788 |
15.9× |
| CT thoracic spine w/wo contrast (72130) |
$2,053.20 |
$3,422 |
11.7× |
| CT thorax w/o contrast (71250) |
$1,527 |
$2,545 |
14.5× |
| CT unlisted procedure (76497) |
$1,465.80 |
$2,443 |
16.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,043.60 |
$3,406 |
11.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,679.40 |
$2,799 |
16.0× |
| CT upper extremity with contrast (73201) |
$2,699.10 |
$4,498.50 |
7.7× |
| Cta Abdomen (74175) |
$2,392.80 |
$3,988 |
13.6× |
| CTA abdomen pelvis (74174) |
$4,425.60 |
$7,376 |
12.6× |
| CTA chest (71275) |
$1,934.40 |
$3,224 |
11.0× |
| Cta Head (70496) |
$2,100.60 |
$3,501 |
11.9× |
| CTA lwr ext w&w/o contrast (73706) |
$1,934.40 |
$3,224 |
11.0× |
| Cta Neck (70498) |
$2,101.20 |
$3,502 |
11.9× |
| Cta Pelvis (72191) |
$2,032.80 |
$3,388 |
11.5× |
| Cystography minimum 3 views rs&i (74430) |
$382.80 |
$638 |
1.1× |
| Diskography lumbar (72295) |
$1,158.60 |
$1,931 |
0.6× |
| Esophagus (74220) |
$428.40 |
$714 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$805.80 |
$1,343 |
3.4× |
| Foot 2 views (73620) |
$266.40 |
$444 |
3.0× |
| Forearm 2 views (73090) |
$281.40 |
$469 |
3.2× |
| Hand 2 views (73120) |
$294.60 |
$491 |
2.8× |
| Hand 3 views (73130) |
$294.60 |
$491 |
3.4× |
| Humerus Min 2 Views Left (73060) |
$274.20 |
$457 |
3.1× |
| Hysterosalpingogram (74740) |
$474.60 |
$791 |
2.0× |
| Interstitial radiation source applic complex (77778) |
$3,773.40 |
$6,289 |
5.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$165.60 |
$276 |
1.6× |
| Knee 3 views (73562) |
$282.60 |
$471 |
3.2× |
| MRA head w & w/o contrast (70546) |
$2,697 |
$4,495 |
7.7× |
| MRA head w/o contrast (70544) |
$1,815.60 |
$3,026 |
7.6× |
| MRA head with contrast (70545) |
$2,263.20 |
$3,772 |
6.5× |
| MRA neck w contrast (70548) |
$2,263.20 |
$3,772 |
6.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,697 |
$4,495 |
7.7× |
| MRA neck w/o contrast (70547) |
$1,815.60 |
$3,026 |
7.6× |
| MRI abdomen w contrast (74182) |
$2,263.20 |
$3,772 |
6.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,697 |
$4,495 |
7.7× |
| MRI abdomen w/o contrast (74181) |
$1,846.20 |
$3,077 |
7.7× |
| MRI any jnt lwr ext with con lt (73722) |
$2,295.60 |
$3,826 |
2.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,263.20 |
$3,772 |
2.9× |
| MRI c-spine with contrast (72142) |
$2,263.20 |
$3,772 |
6.5× |
| MRI cervical spine w/o contrast (72141) |
$1,966.20 |
$3,277 |
8.2× |
| MRI chest w/o & w/contrast material (71552) |
$2,697 |
$4,495 |
7.7× |
| MRI chest w/o contrast (71550) |
$1,815.60 |
$3,026 |
7.6× |
| MRI chest with contrast (71551) |
$2,263.20 |
$3,772 |
2.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,815.60 |
$3,026 |
5.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,263.80 |
$3,773 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,834.80 |
$3,058 |
7.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,815.30 |
$3,025.50 |
7.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,697 |
$4,495 |
7.7× |
| MRI orbit/face/neck w/contrast (70542) |
$2,263.20 |
$3,772 |
6.5× |
| MRI pelvis w contrast (72196) |
$2,263.20 |
$3,772 |
6.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,697 |
$4,495 |
7.7× |
| MRI pelvis w/o contrast (72195) |
$1,815.60 |
$3,026 |
7.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,697 |
$4,495 |
7.7× |
| MRI scan of leg joint before and after contrast (73723) |
$2,697 |
$4,495 |
7.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,697 |
$4,495 |
7.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,263.20 |
$3,772 |
6.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,772.60 |
$4,621 |
7.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,263.20 |
$3,772 |
6.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,848.80 |
$4,748 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,815.60 |
$3,026 |
7.6× |
| MRI tmj (70336) |
$1,815.60 |
$3,026 |
7.6× |
| MRI upper ext joint w/o contrast (73221) |
$2,109.60 |
$3,516 |
8.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,880 |
$4,800 |
8.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,893.60 |
$3,156 |
7.9× |
| Neck soft tissue (70360) |
$228 |
$380 |
2.6× |
| Osseous survey infant (77076) |
$275.40 |
$459 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$237.60 |
$396 |
2.3× |
| Pr MRI brain w/o dye (70557) |
$2,263.20 |
$3,772 |
4.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,697 |
$4,495 |
7.7× |
| Pr sono bone density measure,peripheral (76977) |
$197.40 |
$329 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$156 |
$260 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$302.40 |
$504 |
2.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$300 |
$500 |
2.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$112.80 |
$188 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$598.20 |
$997 |
5.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$340.80 |
$568 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$259.20 |
$432 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$279.60 |
$466 |
2.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$228 |
$380 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$549.60 |
$916 |
3.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$459.60 |
$766 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$490.80 |
$818 |
2.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$207 |
$345 |
2.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$228 |
$380 |
2.6× |
| Ribs bilateral 3 views (71110) |
$363.60 |
$606 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$125.40 |
$209 |
1.2× |
| Scanogram (77073) |
$252 |
$420 |
2.4× |
| Scapula complete (73010) |
$207.60 |
$346 |
2.0× |
| Small bowel series (74250) |
$481.80 |
$803 |
2.7× |
| Spine thoracic 3 views (72072) |
$316.20 |
$527 |
3.0× |
| Thoracolumbar 2 views (72080) |
$240.30 |
$400.50 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$473.40 |
$789 |
4.5× |
| Unlisted fluoroscopic procedure (76496) |
$805.80 |
$1,343 |
9.2× |
| Unlisted Ultrasound Procedure (76999) |
$517.20 |
$862 |
5.9× |
| Urethrocystography retrograde rs&i (74450) |
$353.40 |
$589 |
1.5× |
| Urethrocystography voiding (74455) |
$382.80 |
$638 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$546.60 |
$911 |
3.1× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$765.60 |
$1,276 |
4.3× |
| Us breast unilateral complete (76641) |
$281.40 |
$469 |
2.7× |
| Us breast unilateral limited (76642) |
$281.40 |
$469 |
3.2× |
| Us chest (76604) |
$330.60 |
$551 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$591.60 |
$986 |
5.6× |
| Us ob detailed single fetus (76811) |
$466.20 |
$777 |
1.9× |
| Us ob transvaginal (76817) |
$465.60 |
$776 |
4.4× |
| Us pelvic non ob complete (76856) |
$539.14 |
$898.57 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$439.20 |
$732 |
4.2× |
| Us pregnancy ltd (76815) |
$490.20 |
$817 |
4.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$465.60 |
$776 |
4.4× |
| Us retroperitoneal complete (76770) |
$558 |
$930 |
5.3× |
| Us retroperitoneal limited (76775) |
$448.20 |
$747 |
4.3× |
| Us scrotum and contents (76870) |
$424.20 |
$707 |
4.0× |
| Us soft tissue head/neck (76536) |
$447.60 |
$746 |
4.3× |
| Us spinal canal and contents (76800) |
$465.60 |
$776 |
4.4× |
| Us transrectal (76872) |
$363.60 |
$606 |
3.5× |
| Us transrectal prostate volume (76873) |
$333.60 |
$556 |
3.2× |
| Us xtr non-vasc lmtd (76882) |
$296.40 |
$494 |
2.8× |
| Wrist 2 views (73100) |
$271.20 |
$452 |
3.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$423 |
$705 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$528 |
$880 |
6.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$262.20 |
$437 |
3.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$625.20 |
$1,042 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$270.60 |
$451 |
3.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$288 |
$480 |
3.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$450.60 |
$751 |
4.3× |
| X-ray exam hip uni 1 view (73501) |
$165.60 |
$276 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$216.60 |
$361 |
2.5× |
| X-ray exam hip uni 4/> views (73503) |
$282.60 |
$471 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$381 |
$635 |
3.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$451.80 |
$753 |
4.3× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$693.60 |
$1,156 |
3.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$321.60 |
$536 |
3.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$331.20 |
$552 |
3.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$339 |
$565 |
3.9× |
| X-ray guide gu dilation - ir nephrostomy dilation (74485) |
$1,255.20 |
$2,092 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$107.40 |
$179 |
1.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$450 |
$750 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$134.40 |
$224 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$330.60 |
$551 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$278.40 |
$464 |
3.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$282 |
$470 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$570.60 |
$951 |
5.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$423.60 |
$706 |
4.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$238.20 |
$397 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$260.40 |
$434 |
2.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$298.20 |
$497 |
2.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$571.80 |
$953 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$244.20 |
$407 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$374.40 |
$624 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$459 |
$765 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$216.60 |
$361 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$241.20 |
$402 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$271.80 |
$453 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$271.80 |
$453 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$165.60 |
$276 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$353.40 |
$589 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$219.60 |
$366 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$250.20 |
$417 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$236.70 |
$394.50 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$238.20 |
$397 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$269.40 |
$449 |
2.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$394.80 |
$658 |
3.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$169.20 |
$282 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$274.20 |
$457 |
3.1× |
| Xr arthrogram ankle (73615) |
$228 |
$380 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$412.20 |
$687 |
3.9× |
| Xr chest 4+ views (71048) |
$331.20 |
$552 |
3.2× |
| Xr Cholecystography Oral Contrast (74290) |
$246.60 |
$411 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$197.40 |
$329 |
2.3× |
| Xr optic foramina (70190) |
$156 |
$260 |
1.8× |
| Xr shoulder 1 view (73020) |
$237.60 |
$396 |
2.7× |
| Xr spine cervical 4 or 5 views (72050) |
$363.60 |
$606 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$271.20 |
$452 |
3.1× |
| Xr tmj bilateral (70330) |
$192.60 |
$321 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$241.20 |
$402 |
2.8× |