| Abdomen 2 views (74019) |
$254.62 |
$339.50 |
2.3× |
| Ankle 2 views (73600) |
$376.50 |
$502 |
4.1× |
| Arthrogram shoulder (73040) |
$588.38 |
$784.50 |
1.6× |
| Bone age studies (77072) |
$82.12 |
$109.50 |
0.7× |
| Bone survey complete (77075) |
$575.62 |
$767.50 |
5.2× |
| Cervical spine 2 or 3 views (72040) |
$204 |
$272 |
2.2× |
| Chest 1 view (71045) |
$209.62 |
$279.50 |
2.3× |
| Chest 3 views (71047) |
$247.88 |
$330.50 |
2.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$484.12 |
$645.50 |
2.6× |
| Clavicle complete (73000) |
$339 |
$452 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$894 |
$1,192 |
8.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,346.38 |
$3,128.50 |
6.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,119.12 |
$2,825.50 |
8.4× |
| CT abdomen w contrast (74160) |
$1,431.75 |
$1,909 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,485.38 |
$1,980.50 |
8.0× |
| CT abdomen w/o contrast (74150) |
$1,277.62 |
$1,703.50 |
11.6× |
| CT angiography upper extremity lt (73206) |
$1,453.50 |
$1,938 |
7.9× |
| CT c-spine w/o contrast (72125) |
$1,319.25 |
$1,759 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,515.75 |
$2,021 |
8.2× |
| CT cervical spine with contrast (72126) |
$1,486.50 |
$1,982 |
4.0× |
| CT chest w/wo contrast (71270) |
$1,463.62 |
$1,951.50 |
7.9× |
| CT chest with contrast (71260) |
$1,380 |
$1,840 |
7.5× |
| CT head/brain with contrast (70460) |
$1,244.25 |
$1,659 |
6.7× |
| CT head/brain without and with contrast (70470) |
$1,408.50 |
$1,878 |
7.6× |
| CT iac w contrast (70481) |
$1,329.75 |
$1,773 |
7.2× |
| CT lower ext w/o (73700) |
$1,036.50 |
$1,382 |
9.4× |
| CT lower extremity w wo contrast (73702) |
$953.25 |
$1,271 |
5.2× |
| CT lower extremity with contrast (73701) |
$1,133.25 |
$1,511 |
6.1× |
| CT lumbar spine w & w/o contrast (72133) |
$2,314.50 |
$3,086 |
12.5× |
| CT lumbar spine w/o contrast (72131) |
$1,323 |
$1,764 |
12.0× |
| CT lumbar spine with contrast (72132) |
$1,426.88 |
$1,902.50 |
3.9× |
| CT maxillofacial w contrast (70487) |
$1,503 |
$2,004 |
8.1× |
| CT maxillofacial w/o contrast (70486) |
$852.75 |
$1,137 |
7.7× |
| CT neck soft tissue w contrast (70491) |
$1,396.50 |
$1,862 |
7.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,782 |
$2,376 |
9.6× |
| CT orbits w/o contrast (70480) |
$1,338.38 |
$1,784.50 |
12.1× |
| CT pelvis w & w/o contrast (72194) |
$1,515.38 |
$2,020.50 |
8.2× |
| CT pelvis w/o contrast (72192) |
$1,327.50 |
$1,770 |
12.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,581.38 |
$2,108.50 |
8.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,243.88 |
$1,658.50 |
11.3× |
| CT thoracic spine w/contrast (72129) |
$1,192.88 |
$1,590.50 |
6.4× |
| CT thoracic spine w/o contrast (72128) |
$1,318.50 |
$1,758 |
12.0× |
| CT thorax w/o contrast (71250) |
$1,077.75 |
$1,437 |
9.8× |
| CT upper extremity w/o contrast rt (73200) |
$1,068.75 |
$1,425 |
9.7× |
| CT upper extremity with contrast (73201) |
$1,498.12 |
$1,997.50 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,681.12 |
$2,241.50 |
9.1× |
| Cta Abdomen (74175) |
$1,765.50 |
$2,354 |
9.5× |
| CTA abdomen pelvis (74174) |
$2,820.38 |
$3,760.50 |
7.7× |
| CTA chest (71275) |
$1,627.12 |
$2,169.50 |
8.8× |
| Cta Head (70496) |
$685.88 |
$914.50 |
3.7× |
| CTA lwr ext w&w/o contrast (73706) |
$340.88 |
$454.50 |
1.8× |
| Cta Neck (70498) |
$1,648.50 |
$2,198 |
8.9× |
| Cta Pelvis (72191) |
$1,792.12 |
$2,389.50 |
9.7× |
| Cystography minimum 3 views rs&i (74430) |
$60.75 |
$81 |
0.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$269.62 |
$359.50 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$131.25 |
$175 |
1.4× |
| Esophagus (74220) |
$448.12 |
$597.50 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$840.75 |
$1,121 |
7.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$462 |
$616 |
4.2× |
| Fluoroscopy up to 1 hr (76000) |
$683.25 |
$911 |
2.7× |
| Foot 2 views (73620) |
$348 |
$464 |
3.8× |
| Forearm 2 views (73090) |
$207.38 |
$276.50 |
2.3× |
| Hand 2 views (73120) |
$308.25 |
$411 |
2.8× |
| Hand 3 views (73130) |
$392.25 |
$523 |
4.3× |
| Humerus Min 2 Views Left (73060) |
$365.25 |
$487 |
4.0× |
| Hysterosalpingogram (74740) |
$1,258.50 |
$1,678 |
5.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$184.88 |
$246.50 |
1.7× |
| Knee 3 views (73562) |
$385.50 |
$514 |
4.2× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$146.25 |
$195 |
1.6× |
| MRA head w & w/o contrast (70546) |
$1,861.50 |
$2,482 |
5.1× |
| MRA head w/o contrast (70544) |
$2,531.62 |
$3,375.50 |
10.1× |
| MRA neck w contrast (70548) |
$322.88 |
$430.50 |
0.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,796.38 |
$3,728.50 |
7.6× |
| MRA neck w/o contrast (70547) |
$2,254.50 |
$3,006 |
9.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,515.75 |
$2,021 |
4.1× |
| MRI abdomen w/o contrast (74181) |
$1,745.62 |
$2,327.50 |
6.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,514.62 |
$2,019.50 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,514.62 |
$2,019.50 |
1.8× |
| MRI breast w/o contrast bilateral (77047) |
$2,120.25 |
$2,827 |
8.4× |
| MRI cervical spine w/o contrast (72141) |
$1,524.75 |
$2,033 |
6.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,258.25 |
$3,011 |
6.1× |
| MRI chest w/o contrast (71550) |
$1,756.50 |
$2,342 |
7.0× |
| MRI chest with contrast (71551) |
$1,773.38 |
$2,364.50 |
2.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,513.88 |
$2,018.50 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,454.25 |
$1,939 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,827.75 |
$2,437 |
7.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,522.62 |
$3,363.50 |
6.9× |
| MRI orbit/face/neck w/contrast (70542) |
$1,845.75 |
$2,461 |
5.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,702.62 |
$3,603.50 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$2,145 |
$2,860 |
8.5× |
| MRI scan of arm joint before and after contrast (73223) |
$2,222.62 |
$2,963.50 |
6.0× |
| MRI scan of leg joint before and after contrast (73723) |
$2,161.50 |
$2,882 |
5.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,900.12 |
$2,533.50 |
5.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,950.75 |
$2,601 |
5.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,230.88 |
$2,974.50 |
6.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,891.12 |
$2,521.50 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,744.50 |
$2,326 |
6.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,515 |
$2,020 |
6.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,222.62 |
$2,963.50 |
6.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,498.50 |
$1,998 |
6.0× |
| Neck soft tissue (70360) |
$380.25 |
$507 |
4.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$322.12 |
$429.50 |
2.9× |
| Ophthalmic biometry us echograpy a-scan (76516) |
$258 |
$344 |
2.3× |
| Osseous survey infant (77076) |
$322.12 |
$429.50 |
2.9× |
| Osseous survey limited (77074) |
$426.38 |
$568.50 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$369.75 |
$493 |
3.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,388.38 |
$3,184.50 |
6.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$220.50 |
$294 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$399.38 |
$532.50 |
3.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$259.12 |
$345.50 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$63.75 |
$85 |
0.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$213.75 |
$285 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$209.25 |
$279 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$285.38 |
$380.50 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$259.50 |
$346 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$447 |
$596 |
2.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$353.62 |
$471.50 |
1.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$550.50 |
$734 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$198 |
$264 |
2.2× |
| Radiological examination surgical specimen (76098) |
$266.62 |
$355.50 |
0.5× |
| Ribs bilateral 3 views (71110) |
$51 |
$68 |
0.5× |
| Sacroiliac Joints < 3 Views (72200) |
$184.12 |
$245.50 |
1.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$660 |
$880 |
2.6× |
| Scanogram (77073) |
$129.75 |
$173 |
1.2× |
| Scapula complete (73010) |
$155.25 |
$207 |
1.4× |
| Screening digital breast tomosynthesis (77063) |
$75.75 |
$101 |
3.2× |
| Sella turcica (70240) |
$36 |
$48 |
0.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$444 |
$592 |
4.0× |
| Small bowel series (74250) |
$451.12 |
$601.50 |
2.4× |
| Spine thoracic 3 views (72072) |
$238.88 |
$318.50 |
2.2× |
| Thoracolumbar 2 views (72080) |
$384.75 |
$513 |
4.2× |
| Tmj unilateral (70328) |
$120.38 |
$160.50 |
1.3× |
| Tomogram (76100) |
$111.75 |
$149 |
1.0× |
| Ultrasound scan of cornea to determine thickness (76514) |
$50.25 |
$67 |
1.6× |
| Ultrasound scan to determine eye length and lens power (76519) |
$279 |
$372 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$374.62 |
$499.50 |
3.4× |
| Umbilical-artery Doppler (OB) (76820) |
$186.75 |
$249 |
1.7× |
| Unlisted Ultrasound Procedure (76999) |
$60 |
$80 |
0.7× |
| Upper Extremity Infant (73092) |
$115.12 |
$153.50 |
1.0× |
| Urethrocystography retrograde rs&i (74450) |
$64.50 |
$86 |
0.3× |
| Urethrocystography voiding (74455) |
$381 |
$508 |
1.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$90.75 |
$121 |
0.5× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$90.75 |
$121 |
0.5× |
| Us abdl aorta screen aaa (76706) |
$495.75 |
$661 |
4.5× |
| Us breast unilateral complete (76641) |
$1,001.25 |
$1,335 |
9.1× |
| Us breast unilateral limited (76642) |
$552.75 |
$737 |
6.0× |
| Us chest (76604) |
$420.75 |
$561 |
3.8× |
| Us compl joint r-t w/image documentation (76881) |
$420 |
$560 |
3.8× |
| Us infant hips limited static (76886) |
$112.50 |
$150 |
1.2× |
| Us ob transvaginal (76817) |
$430.50 |
$574 |
3.9× |
| Us pelvic non ob complete (76856) |
$723 |
$964 |
6.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$341.25 |
$455 |
3.1× |
| Us pregnancy ltd (76815) |
$554.25 |
$739 |
5.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$530.62 |
$707.50 |
4.8× |
| Us retroperitoneal complete (76770) |
$446.25 |
$595 |
4.0× |
| Us retroperitoneal limited (76775) |
$611.25 |
$815 |
5.5× |
| Us scrotum and contents (76870) |
$429.75 |
$573 |
3.9× |
| Us soft tissue head/neck (76536) |
$425.62 |
$567.50 |
3.9× |
| Us xtr non-vasc lmtd (76882) |
$350.62 |
$467.50 |
3.2× |
| Venography extremity unilateral rs&i (75820) |
$134.25 |
$179 |
0.1× |
| Wrist 2 views (73100) |
$189.75 |
$253 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$646.50 |
$862 |
5.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$244.50 |
$326 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$402 |
$536 |
4.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$185.25 |
$247 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$350.25 |
$467 |
3.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$388.50 |
$518 |
4.2× |
| X-ray exam entire spi 4/5 vw (72083) |
$211.88 |
$282.50 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$169.12 |
$225.50 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$266.62 |
$355.50 |
2.9× |
| X-ray exam hip uni 4/> views (73503) |
$307.88 |
$410.50 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$396 |
$528 |
3.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$486.38 |
$648.50 |
4.4× |
| X-ray exam of femur 1 (73551) |
$144.38 |
$192.50 |
1.6× |
| X-ray eye for foreign body (70030) |
$171 |
$228 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$304.50 |
$406 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$132 |
$176 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$387.75 |
$517 |
4.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$154.88 |
$206.50 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$33.75 |
$45 |
0.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$431.25 |
$575 |
3.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$165 |
$220 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$146.62 |
$195.50 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$458.25 |
$611 |
4.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$454.88 |
$606.50 |
4.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$220.88 |
$294.50 |
2.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$177 |
$236 |
1.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$135.38 |
$180.50 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$52.50 |
$70 |
0.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$286.88 |
$382.50 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$205.50 |
$274 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$239.25 |
$319 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$711 |
$948 |
6.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$175.88 |
$234.50 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$196.50 |
$262 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$211.88 |
$282.50 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$230.25 |
$307 |
2.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$105 |
$140 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$320.25 |
$427 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$234 |
$312 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$334.88 |
$446.50 |
3.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$129.75 |
$173 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$198 |
$264 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$209.25 |
$279 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$409.50 |
$546 |
3.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$202.50 |
$270 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$213.75 |
$285 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$372 |
$496 |
3.4× |
| Xr chest 4+ views (71048) |
$319.88 |
$426.50 |
2.9× |
| Xr Cholecystography Oral Contrast (74290) |
$60.75 |
$81 |
0.3× |
| Xr finger(s) 2+ views (73140) |
$363 |
$484 |
4.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$33.75 |
$45 |
0.3× |
| Xr shoulder 1 view (73020) |
$142.50 |
$190 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$343.50 |
$458 |
3.1× |
| Xr tibia/fibula 2 views (73590) |
$197.25 |
$263 |
2.1× |
| Xr tmj bilateral (70330) |
$137.62 |
$183.50 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$348 |
$464 |
3.8× |