| Abdomen 2 views (74019) |
$409 |
$682 |
3.9× |
| Ankle 2 views (73600) |
$249 |
$415 |
2.8× |
| Bone age studies (77072) |
$172 |
$287 |
1.6× |
| Bone survey complete (77075) |
$272 |
$454 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$334 |
$557 |
3.8× |
| Chest 1 view (71045) |
$210 |
$350 |
2.4× |
| Chest 3 views (71047) |
$349 |
$582 |
4.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$706 |
$1,177 |
4.0× |
| Clavicle complete (73000) |
$266 |
$443 |
3.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$321 |
$535 |
3.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,100 |
$5,167 |
8.8× |
| CT abdomen and pelvis without contrast (74176) |
$2,383 |
$3,971 |
9.9× |
| CT abdomen w contrast (74160) |
$1,591 |
$2,651 |
9.0× |
| CT abdomen w wo contrast (74170) |
$1,666 |
$2,777 |
9.5× |
| CT abdomen w/o contrast (74150) |
$1,293 |
$2,155 |
12.3× |
| CT angiography upper extremity lt (73206) |
$880 |
$1,466 |
5.0× |
| CT c-spine w/o contrast (72125) |
$1,407 |
$2,345 |
13.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,338 |
$3,897 |
13.3× |
| CT cervical spine with contrast (72126) |
$2,629 |
$4,382 |
7.5× |
| CT chest w/wo contrast (71270) |
$1,835 |
$3,059 |
10.4× |
| CT chest with contrast (71260) |
$747 |
$1,245 |
4.2× |
| CT head/brain with contrast (70460) |
$1,742 |
$2,903 |
9.9× |
| CT head/brain without and with contrast (70470) |
$1,751 |
$2,918 |
9.9× |
| CT iac w contrast (70481) |
$1,591 |
$2,651 |
9.0× |
| CT lower ext w/o (73700) |
$1,313 |
$2,189 |
12.5× |
| CT lower extremity w wo contrast (73702) |
$1,975 |
$3,292 |
11.2× |
| CT lower extremity with contrast (73701) |
$1,388 |
$2,314 |
7.9× |
| CT lumbar spine w & w/o contrast (72133) |
$2,702 |
$4,503 |
15.3× |
| CT lumbar spine w/o contrast (72131) |
$1,818 |
$3,030 |
17.3× |
| CT lumbar spine with contrast (72132) |
$2,629 |
$4,382 |
7.5× |
| CT maxillofacial w contrast (70487) |
$1,649 |
$2,748 |
9.4× |
| CT maxillofacial w/o contrast (70486) |
$1,392 |
$2,320 |
13.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,015 |
$3,359 |
11.4× |
| CT neck soft tissue w contrast (70491) |
$1,588 |
$2,647 |
9.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,015 |
$3,359 |
11.4× |
| CT orbits w/o contrast (70480) |
$1,392 |
$2,320 |
13.3× |
| CT pelvis w & w/o contrast (72194) |
$1,843 |
$3,072 |
10.5× |
| CT pelvis w/o contrast (72192) |
$1,334 |
$2,223 |
12.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,015 |
$3,359 |
11.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,312 |
$2,187 |
12.5× |
| CT thoracic spine w/contrast (72129) |
$2,288 |
$3,814 |
13.0× |
| CT thoracic spine w/o contrast (72128) |
$1,859 |
$3,098 |
17.7× |
| CT thoracic spine w/wo contrast (72130) |
$2,381 |
$3,968 |
13.5× |
| CT thorax w/o contrast (71250) |
$1,182 |
$1,970 |
11.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,942 |
$3,236 |
11.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,313 |
$2,189 |
12.5× |
| CT upper extremity with contrast (73201) |
$1,667 |
$2,778 |
4.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,664 |
$2,774 |
9.4× |
| Cta Abdomen (74175) |
$1,432 |
$2,387 |
8.1× |
| CTA abdomen pelvis (74174) |
$1,798 |
$2,997 |
5.1× |
| CTA chest (71275) |
$1,713 |
$2,855 |
9.7× |
| Cta Head (70496) |
$609 |
$1,015 |
3.5× |
| CTA lwr ext w&w/o contrast (73706) |
$1,553 |
$2,589 |
8.8× |
| Cta Neck (70498) |
$1,358 |
$2,264 |
7.7× |
| Cta Pelvis (72191) |
$1,821 |
$3,035 |
10.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$262 |
$437 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$209 |
$348 |
2.4× |
| Esophagus (74220) |
$525 |
$875 |
3.0× |
| Fetal biophysical profile non-stress testing (76818) |
$534 |
$890 |
5.1× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$367.50 |
$612.50 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$787 |
$1,311 |
3.3× |
| Foot 2 views (73620) |
$256 |
$427 |
2.9× |
| Forearm 2 views (73090) |
$263 |
$439 |
3.0× |
| Hand 2 views (73120) |
$172 |
$287 |
1.6× |
| Hand 3 views (73130) |
$211 |
$352 |
2.4× |
| Humerus Min 2 Views Left (73060) |
$274 |
$456 |
3.1× |
| Hysterosalpingogram (74740) |
$610 |
$1,016 |
2.5× |
| Knee 3 views (73562) |
$308 |
$514 |
3.5× |
| MRA head w & w/o contrast (70546) |
$960 |
$1,600 |
2.7× |
| MRA head w/o contrast (70544) |
$617 |
$1,029 |
2.6× |
| MRA head with contrast (70545) |
$960 |
$1,600 |
2.7× |
| MRA neck w contrast (70548) |
$960 |
$1,600 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$960 |
$1,600 |
2.7× |
| MRA neck w/o contrast (70547) |
$617 |
$1,029 |
2.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$960 |
$1,600 |
2.7× |
| MRI abdomen w/o contrast (74181) |
$617 |
$1,029 |
2.6× |
| MRI bone marrow blood supply (77084) |
$617 |
$1,029 |
2.6× |
| MRI cervical spine w/o contrast (72141) |
$617 |
$1,029 |
2.6× |
| MRI chest w/o & w/contrast material (71552) |
$960 |
$1,600 |
2.7× |
| MRI chest w/o contrast (71550) |
$617 |
$1,029 |
2.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$617 |
$1,029 |
2.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,760 |
$2,933 |
7.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,317 |
$3,861 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$960 |
$1,600 |
2.7× |
| MRI pelvis w/o contrast (72195) |
$617 |
$1,029 |
2.6× |
| MRI scan of arm joint before and after contrast (73223) |
$960 |
$1,600 |
2.7× |
| MRI scan of leg joint before and after contrast (73723) |
$960 |
$1,600 |
2.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$960 |
$1,600 |
2.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$960 |
$1,600 |
2.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$960 |
$1,600 |
2.7× |
| MRI thoracic spine w/o contrast (72146) |
$617 |
$1,029 |
2.6× |
| MRI tmj (70336) |
$2,222 |
$3,703 |
9.3× |
| MRI upper ext joint w/o contrast (73221) |
$617 |
$1,029 |
2.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$960 |
$1,600 |
2.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$617 |
$1,029 |
2.6× |
| Neck soft tissue (70360) |
$263 |
$439 |
3.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$534 |
$890 |
5.1× |
| Osseous survey infant (77076) |
$272 |
$454 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$335 |
$559 |
3.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$960 |
$1,600 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$2,407 |
$4,011 |
4.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$656 |
$1,093 |
6.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$446 |
$743 |
4.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$427 |
$711 |
4.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$268 |
$447 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$302 |
$503 |
3.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$312 |
$520 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$302 |
$503 |
3.5× |
| Radiologic exam colon single contrast study (74270) |
$673 |
$1,122 |
3.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$1,201 |
$2,001 |
6.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$696 |
$1,160 |
4.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$290 |
$484 |
3.3× |
| Ribs bilateral 3 views (71110) |
$469 |
$782 |
4.5× |
| Sacroiliac Joints < 3 Views (72200) |
$328 |
$547 |
3.1× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$573 |
$955 |
2.4× |
| Scanogram (77073) |
$400 |
$667 |
3.8× |
| Scapula complete (73010) |
$257 |
$428 |
2.4× |
| Screening digital breast tomosynthesis (77063) |
$131 |
$218 |
5.6× |
| Sella turcica (70240) |
$242 |
$403 |
2.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,012 |
$1,687 |
9.6× |
| Small bowel series (74250) |
$702 |
$1,170 |
4.0× |
| Spine thoracic 3 views (72072) |
$454 |
$757 |
4.3× |
| Thoracolumbar 2 views (72080) |
$427 |
$711 |
4.9× |
| Tmj unilateral (70328) |
$305 |
$509 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$534 |
$890 |
5.1× |
| Upper Extremity Infant (73092) |
$272 |
$454 |
2.6× |
| Urethrocystography voiding (74455) |
$751 |
$1,251 |
3.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$821 |
$1,368 |
4.7× |
| Us breast unilateral complete (76641) |
$534 |
$890 |
5.1× |
| Us breast unilateral limited (76642) |
$209 |
$348 |
2.4× |
| Us chest (76604) |
$534 |
$890 |
5.1× |
| Us ob detailed single fetus (76811) |
$490.50 |
$817.50 |
2.0× |
| Us ob transvaginal (76817) |
$534 |
$890 |
5.1× |
| Us pelvic non ob complete (76856) |
$534 |
$890 |
5.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$534 |
$890 |
5.1× |
| Us pregnancy ltd (76815) |
$402 |
$670 |
3.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$409.50 |
$682.50 |
3.9× |
| Us retroperitoneal complete (76770) |
$534 |
$890 |
5.1× |
| Us retroperitoneal limited (76775) |
$534 |
$890 |
5.1× |
| Us scrotum and contents (76870) |
$534 |
$890 |
5.1× |
| Us soft tissue head/neck (76536) |
$534 |
$890 |
5.1× |
| Us spinal canal and contents (76800) |
$534 |
$890 |
5.1× |
| Us transrectal (76872) |
$534 |
$890 |
5.1× |
| Us xtr non-vasc lmtd (76882) |
$534 |
$890 |
5.1× |
| Wrist 2 views (73100) |
$212 |
$353 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$478 |
$797 |
4.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$280 |
$467 |
3.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$286 |
$476 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$887 |
$1,478 |
5.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$265 |
$442 |
3.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$298 |
$497 |
3.4× |
| X-ray exam hip uni 1 view (73501) |
$172 |
$287 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$286 |
$476 |
3.3× |
| X-ray exam hip uni 4/> views (73503) |
$319 |
$532 |
3.0× |
| X-ray eye for foreign body (70030) |
$264 |
$440 |
3.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$394 |
$656 |
3.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$301 |
$501 |
3.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$268 |
$446 |
3.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$233 |
$388 |
2.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$383 |
$638 |
3.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$257 |
$428 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$314 |
$524 |
3.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$729 |
$1,215 |
6.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$334 |
$556 |
3.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$244 |
$407 |
2.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$279 |
$465 |
3.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$458 |
$763 |
4.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$370 |
$617 |
3.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$318 |
$530 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$381 |
$635 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$532 |
$887 |
5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$424 |
$707 |
4.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$273 |
$455 |
3.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$271 |
$451 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$351 |
$585 |
4.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$262 |
$436 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$451 |
$751 |
4.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$331 |
$552 |
3.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$278 |
$464 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$247 |
$411 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$358 |
$597 |
3.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$464 |
$773 |
4.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$260 |
$434 |
3.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$172 |
$287 |
2.0× |
| Xr c-spine 6 or more views (72052) |
$511 |
$852 |
4.9× |
| Xr chest 4+ views (71048) |
$629 |
$1,049 |
6.0× |
| Xr finger(s) 2+ views (73140) |
$232 |
$386 |
2.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$362 |
$604 |
3.4× |
| Xr shoulder 1 view (73020) |
$236 |
$393 |
2.7× |
| Xr spine cervical 4 or 5 views (72050) |
$449 |
$749 |
4.3× |
| Xr tibia/fibula 2 views (73590) |
$274 |
$457 |
3.1× |
| Xr tmj bilateral (70330) |
$334 |
$556 |
3.8× |
| Xray knee 1 or 2 views rt (73560) |
$262 |
$437 |
3.0× |