| Abdomen 2 views (74019) |
$182 |
$260 |
1.7× |
| Ankle 2 views (73600) |
$151 |
$216 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$256 |
$366 |
2.9× |
| Chest 1 view (71045) |
$127.50 |
$182 |
1.5× |
| Chest 3 views (71047) |
$251 |
$359 |
2.9× |
| Clavicle complete (73000) |
$157 |
$224 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,160 |
$1,657 |
11.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,755 |
$5,365 |
10.7× |
| CT abdomen and pelvis without contrast (74176) |
$3,073 |
$4,390 |
12.8× |
| CT abdomen w contrast (74160) |
$1,684 |
$2,406 |
9.6× |
| CT abdomen w wo contrast (74170) |
$2,033 |
$2,905 |
11.5× |
| CT abdomen w/o contrast (74150) |
$1,437 |
$2,053 |
13.7× |
| CT angiography upper extremity lt (73206) |
$1,562 |
$2,231 |
8.9× |
| CT c-spine w/o contrast (72125) |
$1,474 |
$2,106 |
14.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,540 |
$2,200 |
8.7× |
| CT cervical spine with contrast (72126) |
$1,728 |
$2,468 |
4.9× |
| CT chest w/wo contrast (71270) |
$2,092 |
$2,988 |
11.9× |
| CT chest with contrast (71260) |
$1,718 |
$2,454 |
9.8× |
| CT head/brain with contrast (70460) |
$1,419 |
$2,027 |
8.1× |
| CT head/brain without and with contrast (70470) |
$1,728 |
$2,468 |
9.8× |
| CT heart no contrast quant eval coronry calcium (75571) |
$88 |
$125 |
1.0× |
| CT iac w contrast (70481) |
$1,294 |
$1,848 |
7.3× |
| CT limited/localized follow up study (76380) |
$917 |
$1,310 |
10.5× |
| CT lower ext w/o (73700) |
$1,237 |
$1,767 |
11.8× |
| CT lower extremity w wo contrast (73702) |
$1,483 |
$2,119 |
8.4× |
| CT lower extremity with contrast (73701) |
$1,718 |
$2,454 |
9.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,507 |
$2,153 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$1,474 |
$2,106 |
14.0× |
| CT lumbar spine with contrast (72132) |
$1,728 |
$2,468 |
4.9× |
| CT maxillofacial w/o contrast (70486) |
$1,266 |
$1,808 |
12.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,266 |
$1,808 |
7.2× |
| CT neck soft tissue w contrast (70491) |
$1,162 |
$1,659.50 |
6.6× |
| CT orbits w/o contrast (70480) |
$1,294 |
$1,848 |
12.3× |
| CT pelvis w & w/o contrast (72194) |
$1,973 |
$2,819 |
11.2× |
| CT pelvis w/o contrast (72192) |
$1,450 |
$2,071 |
13.8× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$190 |
$272 |
2.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,602 |
$2,288 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,294 |
$1,848 |
12.3× |
| CT thoracic spine w/contrast (72129) |
$1,540 |
$2,200 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$1,474 |
$2,106 |
14.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,540 |
$2,200 |
8.7× |
| CT thorax w/o contrast (71250) |
$1,160 |
$1,657 |
11.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,421 |
$2,030 |
8.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,237 |
$1,767 |
11.8× |
| CT upper extremity with contrast (73201) |
$1,365 |
$1,950 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,986 |
$2,837 |
11.3× |
| Cta Abdomen (74175) |
$2,426 |
$3,466 |
13.8× |
| CTA abdomen pelvis (74174) |
$2,091.50 |
$2,988 |
6.0× |
| CTA chest (71275) |
$2,570 |
$3,671 |
14.6× |
| Cta Head (70496) |
$1,771 |
$2,530 |
10.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,771 |
$2,530 |
5.1× |
| Cta Neck (70498) |
$1,896 |
$2,709 |
10.8× |
| Cta Pelvis (72191) |
$2,129 |
$3,042 |
12.1× |
| Cystography minimum 3 views rs&i (74430) |
$617 |
$881 |
1.8× |
| Fetal biophysical profile non-stress testing (76818) |
$744 |
$1,063 |
7.1× |
| Fluoroscopy up to 1 hr (76000) |
$464 |
$663 |
1.9× |
| Foot 2 views (73620) |
$129 |
$184 |
1.5× |
| Forearm 2 views (73090) |
$151 |
$215 |
1.7× |
| Hand 2 views (73120) |
$135 |
$193 |
1.3× |
| Hand 3 views (73130) |
$166 |
$237 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$154 |
$220 |
1.8× |
| Knee 3 views (73562) |
$174 |
$249 |
2.0× |
| MRA head w/o contrast (70544) |
$1,628 |
$2,325 |
6.8× |
| MRA neck w contrast (70548) |
$1,728 |
$2,468 |
4.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,127 |
$3,038 |
6.1× |
| MRA neck w/o contrast (70547) |
$1,628 |
$2,325 |
6.8× |
| MRI abdomen w contrast (74182) |
$1,628 |
$2,325 |
4.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,255 |
$4,650 |
9.3× |
| MRI abdomen w/o contrast (74181) |
$1,628 |
$2,325 |
6.8× |
| MRI any jnt lwr ext with con lt (73722) |
$2,538 |
$3,625 |
3.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,538 |
$3,625 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$1,628 |
$2,325 |
6.8× |
| MRI chest w/o & w/contrast material (71552) |
$3,255 |
$4,650 |
9.3× |
| MRI chest w/o contrast (71550) |
$1,628 |
$2,325 |
6.8× |
| MRI chest with contrast (71551) |
$2,538 |
$3,625 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,456 |
$3,509 |
7.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,628 |
$2,325 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,628 |
$2,325 |
6.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,255 |
$4,650 |
9.3× |
| MRI orbit/face/neck w/contrast (70542) |
$2,538 |
$3,625 |
7.2× |
| MRI pelvis w contrast (72196) |
$2,538 |
$3,625 |
7.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,255 |
$4,650 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$1,628 |
$2,325 |
6.8× |
| MRI scan of arm joint before and after contrast (73223) |
$3,255 |
$4,650 |
9.3× |
| MRI scan of leg joint before and after contrast (73723) |
$3,255 |
$4,650 |
9.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,255 |
$4,650 |
9.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,538 |
$3,625 |
7.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,255 |
$4,650 |
9.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,538 |
$3,625 |
7.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,255 |
$4,650 |
9.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,628 |
$2,325 |
6.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,628 |
$2,325 |
6.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,255 |
$4,650 |
9.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,628 |
$2,325 |
6.8× |
| Neck soft tissue (70360) |
$122 |
$174 |
1.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$410 |
$585 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$138 |
$197 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,955 |
$4,222 |
8.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$249 |
$356 |
2.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$251 |
$359 |
2.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$225 |
$321 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$146 |
$209 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$151 |
$216 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$169 |
$242 |
1.9× |
| Ribs bilateral 3 views (71110) |
$232 |
$331 |
2.2× |
| Scapula complete (73010) |
$158 |
$226 |
1.5× |
| Sella turcica (70240) |
$158 |
$226 |
1.8× |
| Small bowel series (74250) |
$356 |
$508 |
2.0× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$205 |
$293 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$407 |
$581 |
3.9× |
| Unlisted fluoroscopic procedure (76496) |
$202 |
$288 |
2.3× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$571 |
$815 |
3.2× |
| Us breast unilateral complete (76641) |
$278 |
$397 |
2.6× |
| Us compl joint r-t w/image documentation (76881) |
$357.50 |
$511 |
3.4× |
| Us pelvic non ob complete (76856) |
$407 |
$581 |
3.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$114 |
$163 |
1.1× |
| Us pregnancy ltd (76815) |
$410 |
$585 |
3.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$706 |
$1,008 |
6.7× |
| Us retroperitoneal complete (76770) |
$421 |
$601 |
4.0× |
| Us scrotum and contents (76870) |
$447 |
$638 |
4.3× |
| Us soft tissue head/neck (76536) |
$335 |
$479 |
3.2× |
| Vertebral fracture assessment via dxa (77086) |
$81 |
$116 |
0.9× |
| Wrist 2 views (73100) |
$174 |
$249 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$348 |
$497 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$166 |
$237 |
1.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$166 |
$237 |
1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$143 |
$204 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$174 |
$249 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$115 |
$165 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$174 |
$248 |
2.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$193 |
$276 |
1.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$163 |
$233 |
1.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$137 |
$196 |
1.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$290 |
$414 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$290 |
$414 |
3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$214 |
$305.50 |
2.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$148 |
$212 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$199 |
$284 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$174 |
$249 |
2.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$208 |
$297 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$274 |
$392 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$190 |
$271 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$180 |
$257 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$167 |
$239 |
1.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$239 |
$341 |
2.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$297 |
$424 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$163 |
$233 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$165 |
$235 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$174 |
$249 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$160 |
$229 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$174 |
$249 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$273 |
$390 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$135 |
$193 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$174 |
$249 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$293 |
$419 |
2.8× |
| Xr finger(s) 2+ views (73140) |
$125 |
$179 |
1.4× |
| Xr shoulder 1 view (73020) |
$129 |
$184 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$160 |
$229 |
1.8× |
| Xr tmj bilateral (70330) |
$210 |
$300 |
2.4× |
| Xray knee 1 or 2 views rt (73560) |
$141 |
$202 |
1.6× |