| Abdomen 2 views (74019) |
$131.95 |
$203 |
1.5× |
| Ankle 2 views (73600) |
$78 |
$120 |
1.0× |
| Arthrogram shoulder (73040) |
$269.75 |
$415 |
0.9× |
| Bone &/joint imaging whole body (78306) |
$227.50 |
$350 |
0.7× |
| Bone age studies (77072) |
$68.90 |
$106 |
0.8× |
| Bone survey complete (77075) |
$266.50 |
$410 |
3.0× |
| Cervical spine 2 or 3 views (72040) |
$102.70 |
$158 |
1.4× |
| Chest 1 view (71045) |
$86.45 |
$133 |
1.2× |
| Clavicle complete (73000) |
$87.10 |
$134 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,686.75 |
$2,595 |
5.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,397.50 |
$2,150 |
6.8× |
| CT abdomen w contrast (74160) |
$804.70 |
$1,238 |
5.3× |
| CT abdomen w wo contrast (74170) |
$908.70 |
$1,398 |
6.0× |
| CT abdomen w/o contrast (74150) |
$695.50 |
$1,070 |
7.7× |
| CT c-spine w/o contrast (72125) |
$643.50 |
$990 |
7.1× |
| CT cervical spine w&w/o contrast (72127) |
$838.50 |
$1,290 |
5.5× |
| CT cervical spine with contrast (72126) |
$746.85 |
$1,149 |
2.5× |
| CT chest w/wo contrast (71270) |
$973.05 |
$1,497 |
6.4× |
| CT chest with contrast (71260) |
$2,275 |
$3,500 |
15.0× |
| CT head/brain with contrast (70460) |
$719.55 |
$1,107 |
4.8× |
| CT head/brain without and with contrast (70470) |
$838.50 |
$1,290 |
5.5× |
| CT iac w contrast (70481) |
$819 |
$1,260 |
5.4× |
| CT lower ext w/o (73700) |
$654.55 |
$1,007 |
7.3× |
| CT lower extremity w wo contrast (73702) |
$750.75 |
$1,155 |
5.0× |
| CT lower extremity with contrast (73701) |
$666.25 |
$1,025 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$838.50 |
$1,290 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$643.50 |
$990 |
7.1× |
| CT lumbar spine with contrast (72132) |
$768.30 |
$1,182 |
2.6× |
| CT maxillofacial w contrast (70487) |
$627.25 |
$965 |
4.1× |
| CT maxillofacial w/o contrast (70486) |
$585 |
$900 |
6.5× |
| CT maxillofacial w/wo contrast (70488) |
$719.55 |
$1,107 |
4.8× |
| CT neck soft tissue w contrast (70491) |
$773.50 |
$1,190 |
5.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$962 |
$1,480 |
6.4× |
| CT orbits w/o contrast (70480) |
$680.55 |
$1,047 |
7.6× |
| CT pelvis w & w/o contrast (72194) |
$869.70 |
$1,338 |
5.8× |
| CT pelvis w/o contrast (72192) |
$700.05 |
$1,077 |
7.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$865.15 |
$1,331 |
5.7× |
| CT soft tissue neck w/o contrast (70490) |
$679.90 |
$1,046 |
7.5× |
| CT thoracic spine w/contrast (72129) |
$746.85 |
$1,149 |
4.9× |
| CT thoracic spine w/o contrast (72128) |
$643.50 |
$990 |
7.1× |
| CT thoracic spine w/wo contrast (72130) |
$838.50 |
$1,290 |
5.5× |
| CT thorax w/o contrast (71250) |
$1,316.58 |
$2,025.50 |
14.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$768.30 |
$1,182 |
5.1× |
| CT upper extremity w/o contrast rt (73200) |
$564.85 |
$869 |
6.3× |
| CT upper extremity with contrast (73201) |
$658.45 |
$1,013 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,560 |
$2,400 |
10.3× |
| Cta Abdomen (74175) |
$1,487.85 |
$2,289 |
9.8× |
| CTA abdomen pelvis (74174) |
$1,480.70 |
$2,278 |
4.9× |
| CTA chest (71275) |
$1,049.10 |
$1,614 |
6.9× |
| Cta Head (70496) |
$1,495 |
$2,300 |
9.9× |
| CTA lwr ext w&w/o contrast (73706) |
$1,495 |
$2,300 |
9.9× |
| Cta Neck (70498) |
$1,495 |
$2,300 |
9.9× |
| Cystography minimum 3 views rs&i (74430) |
$185.25 |
$285 |
0.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$227.50 |
$350 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$96.85 |
$149 |
1.3× |
| Esophagus (74220) |
$166.40 |
$256 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$227.50 |
$350 |
1.1× |
| Foot 2 views (73620) |
$72.80 |
$112 |
1.0× |
| Forearm 2 views (73090) |
$88.40 |
$136 |
1.2× |
| Hand 3 views (73130) |
$92.30 |
$142 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$86.45 |
$133 |
1.2× |
| Knee 3 views (73562) |
$102.70 |
$158 |
1.4× |
| MRA head w/o contrast (70544) |
$1,079 |
$1,660 |
5.2× |
| MRA head with contrast (70545) |
$1,404 |
$2,160 |
4.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,467.70 |
$2,258 |
4.9× |
| MRA neck w/o contrast (70547) |
$1,248 |
$1,920 |
6.1× |
| MRI abdomen w contrast (74182) |
$1,216.80 |
$1,872 |
4.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,376.70 |
$2,118 |
4.6× |
| MRI abdomen w/o contrast (74181) |
$1,045.20 |
$1,608 |
5.1× |
| MRI any jnt lwr ext with con lt (73722) |
$997.75 |
$1,535 |
1.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,015.30 |
$1,562 |
1.5× |
| MRI c-spine with contrast (72142) |
$1,199.25 |
$1,845 |
4.0× |
| MRI cervical spine w/o contrast (72141) |
$1,690 |
$2,600 |
8.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,055.60 |
$1,624 |
3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,007.50 |
$1,550 |
3.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$932.75 |
$1,435 |
4.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,527.50 |
$2,350 |
7.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,755 |
$2,700 |
5.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,105 |
$1,700 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,625 |
$2,500 |
5.4× |
| MRI pelvis w/o contrast (72195) |
$889.20 |
$1,368 |
4.3× |
| MRI scan of arm joint before and after contrast (73223) |
$1,469 |
$2,260 |
4.9× |
| MRI scan of leg joint before and after contrast (73723) |
$1,443.65 |
$2,221 |
4.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,430 |
$2,200 |
4.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,207.70 |
$1,858 |
4.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,428.05 |
$2,197 |
4.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,199.25 |
$1,845 |
4.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,446.90 |
$2,226 |
4.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,067.95 |
$1,643 |
5.2× |
| MRI upper ext joint w/o contrast (73221) |
$912.60 |
$1,404 |
4.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,218.75 |
$1,875 |
4.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$961.35 |
$1,479 |
4.7× |
| Neck soft tissue (70360) |
$84.50 |
$130 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$143.65 |
$221 |
1.6× |
| Osseous survey infant (77076) |
$173.55 |
$267 |
1.9× |
| Osseous survey limited (77074) |
$224.25 |
$345 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$86.45 |
$133 |
1.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,248 |
$1,920 |
4.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$162.50 |
$250 |
0.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$116.35 |
$179 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$144.30 |
$222 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$128.05 |
$197 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$114.40 |
$176 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$163.80 |
$252 |
1.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$107.25 |
$165 |
1.4× |
| Radiologic exam colon single contrast study (74270) |
$218.40 |
$336 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$227.50 |
$350 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$223.92 |
$344.50 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$102.70 |
$158 |
1.4× |
| Ribs bilateral 3 views (71110) |
$116.35 |
$179 |
1.3× |
| Scapula complete (73010) |
$92.30 |
$142 |
1.0× |
| Sella turcica (70240) |
$37.05 |
$57 |
0.5× |
| Small bowel series (74250) |
$111.15 |
$171 |
0.7× |
| Spine thoracic 3 views (72072) |
$126.75 |
$195 |
1.4× |
| Therapeutic Enema (74283) |
$93.28 |
$143.50 |
0.6× |
| Thoracolumbar 2 views (72080) |
$104 |
$160 |
1.4× |
| Tmj unilateral (70328) |
$102.70 |
$158 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$228.15 |
$351 |
2.5× |
| Upper Extremity Infant (73092) |
$81.25 |
$125 |
0.9× |
| Urethrocystography voiding (74455) |
$176.80 |
$272 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$287.95 |
$443 |
1.9× |
| Us breast unilateral complete (76641) |
$166.40 |
$256 |
1.8× |
| Us breast unilateral limited (76642) |
$306.15 |
$471 |
4.1× |
| Us chest (76604) |
$162.50 |
$250 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$153.40 |
$236 |
1.7× |
| Us ob detailed single fetus (76811) |
$261.95 |
$403 |
1.3× |
| Us ob transvaginal (76817) |
$181.35 |
$279 |
2.0× |
| Us pelvic non ob complete (76856) |
$231.40 |
$356 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$115.05 |
$177 |
1.3× |
| Us pregnancy ltd (76815) |
$152.10 |
$234 |
1.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$216.45 |
$333 |
2.4× |
| Us retroperitoneal complete (76770) |
$487.50 |
$750 |
5.4× |
| Us retroperitoneal limited (76775) |
$208.65 |
$321 |
2.3× |
| Us scrotum and contents (76870) |
$223.60 |
$344 |
2.5× |
| Us soft tissue head/neck (76536) |
$211.25 |
$325 |
2.3× |
| Us transrectal (76872) |
$307.45 |
$473 |
3.4× |
| Us xtr non-vasc lmtd (76882) |
$102.05 |
$157 |
1.1× |
| Venogram extremity bilateral (75822) |
$487.50 |
$750 |
0.4× |
| Venography extremity unilateral rs&i (75820) |
$487.50 |
$750 |
0.4× |
| Vertebral fracture assessment via dxa (77086) |
$146.25 |
$225 |
2.0× |
| Wrist 2 views (73100) |
$78 |
$120 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$100.75 |
$155 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$94.25 |
$145 |
1.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$278.85 |
$429 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$127.40 |
$196 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$98.80 |
$152 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$84.50 |
$130 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$100.10 |
$154 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$120.25 |
$185 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$94.90 |
$146 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$92.95 |
$143 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$79.30 |
$122 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$79.30 |
$122 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$117 |
$180 |
1.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$81.25 |
$125 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$119.60 |
$184 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$215.15 |
$331 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$98.15 |
$151 |
1.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$75.40 |
$116 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$117.65 |
$181 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$108.55 |
$167 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$125.45 |
$193 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$141.70 |
$218 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$98.15 |
$151 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$99.45 |
$153 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$96.85 |
$149 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$124.80 |
$192 |
1.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$83.20 |
$128 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$133.90 |
$206 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$90.35 |
$139 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$81.90 |
$126 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$97.50 |
$150 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$102.05 |
$157 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$80.60 |
$124 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$95.55 |
$147 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$178.10 |
$274 |
2.0× |
| Xr Cholecystography Oral Contrast (74290) |
$70.20 |
$108 |
0.5× |
| Xr finger(s) 2+ views (73140) |
$77.35 |
$119 |
1.0× |
| Xr shoulder 1 view (73020) |
$73.45 |
$113 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$146.25 |
$225 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$93.60 |
$144 |
1.2× |
| Xr tmj bilateral (70330) |
$109.20 |
$168 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$90.35 |
$139 |
1.2× |