| Abdomen 2 views (74019) |
$128.70 |
$183.86 |
1.2× |
| Ankle 2 views (73600) |
$98.60 |
$140.86 |
1.1× |
| Bone age studies (77072) |
$188.18 |
$268.83 |
1.8× |
| Bone survey complete (77075) |
$340.68 |
$486.68 |
3.2× |
| Cervical spine 2 or 3 views (72040) |
$151.41 |
$216.30 |
1.7× |
| Chest 1 view (71045) |
$163.20 |
$233.15 |
1.9× |
| Chest 3 views (71047) |
$189.27 |
$270.38 |
2.2× |
| Clavicle complete (73000) |
$113.56 |
$162.23 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$525 |
$750 |
5.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,414.99 |
$3,449.99 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$961.46 |
$1,373.51 |
4.0× |
| CT abdomen w contrast (74160) |
$1,695.79 |
$2,422.56 |
9.6× |
| CT abdomen w wo contrast (74170) |
$2,119.74 |
$3,028.20 |
12.0× |
| CT abdomen w/o contrast (74150) |
$1,362.69 |
$1,946.70 |
13.0× |
| CT angiography upper extremity lt (73206) |
$1,985.63 |
$2,836.62 |
11.3× |
| CT c-spine w/o contrast (72125) |
$1,453.54 |
$2,076.48 |
13.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,435 |
$2,050 |
8.1× |
| CT cervical spine with contrast (72126) |
$1,395.80 |
$1,994 |
4.0× |
| CT chest w/wo contrast (71270) |
$2,142.46 |
$3,060.65 |
12.2× |
| CT chest with contrast (71260) |
$1,718.51 |
$2,455.01 |
9.8× |
| CT head/brain with contrast (70460) |
$1,367.23 |
$1,953.19 |
7.8× |
| CT head/brain without and with contrast (70470) |
$1,832.06 |
$2,617.23 |
10.4× |
| CT iac w contrast (70481) |
$1,234 |
$1,762.85 |
7.0× |
| CT lower ext w/o (73700) |
$416.38 |
$594.83 |
4.0× |
| CT lower extremity w wo contrast (73702) |
$1,318.71 |
$1,883.87 |
7.5× |
| CT lower extremity with contrast (73701) |
$805 |
$1,150 |
4.6× |
| CT lumbar spine w & w/o contrast (72133) |
$2,244.47 |
$3,206.39 |
12.7× |
| CT lumbar spine w/o contrast (72131) |
$1,453.54 |
$2,076.48 |
13.8× |
| CT lumbar spine with contrast (72132) |
$1,437.67 |
$2,053.82 |
4.1× |
| CT maxillofacial w contrast (70487) |
$1,430.83 |
$2,044.04 |
8.1× |
| CT maxillofacial w/o contrast (70486) |
$1,234 |
$1,762.85 |
11.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,832.06 |
$2,617.23 |
10.4× |
| CT neck soft tissue w contrast (70491) |
$1,191.09 |
$1,701.56 |
6.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,384.64 |
$1,978.06 |
7.9× |
| CT orbits w/o contrast (70480) |
$1,234 |
$1,762.85 |
11.8× |
| CT pelvis w & w/o contrast (72194) |
$2,081.89 |
$2,974.13 |
11.8× |
| CT pelvis w/o contrast (72192) |
$1,476.25 |
$2,108.93 |
14.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,832.06 |
$2,617.23 |
10.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,234 |
$1,762.85 |
11.8× |
| CT thoracic spine w/contrast (72129) |
$1,437.67 |
$2,053.82 |
8.2× |
| CT thoracic spine w/o contrast (72128) |
$1,453.54 |
$2,076.48 |
13.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,244.47 |
$3,206.39 |
12.7× |
| CT thorax w/o contrast (71250) |
$1,468.68 |
$2,098.11 |
14.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,517.13 |
$2,167.33 |
8.6× |
| CT upper extremity w/o contrast rt (73200) |
$416.38 |
$594.83 |
4.0× |
| CT upper extremity with contrast (73201) |
$1,108.90 |
$1,584.14 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,934.47 |
$4,192.10 |
16.7× |
| Cta Abdomen (74175) |
$2,614.35 |
$3,734.78 |
14.8× |
| CTA abdomen pelvis (74174) |
$3,736.59 |
$5,337.98 |
10.7× |
| CTA chest (71275) |
$2,541.42 |
$3,630.60 |
14.4× |
| Cta Head (70496) |
$2,187.50 |
$3,125 |
12.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,939.56 |
$2,770.80 |
11.0× |
| Cta Neck (70498) |
$2,187.50 |
$3,125 |
12.4× |
| Cta Pelvis (72191) |
$2,244.47 |
$3,206.39 |
12.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$140 |
$200 |
1.3× |
| Esophagus (74220) |
$315 |
$450 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$364 |
$520 |
3.5× |
| Fluoroscopy up to 1 hr (76000) |
$780.50 |
$1,115 |
3.3× |
| Foot 2 views (73620) |
$105.99 |
$151.41 |
1.2× |
| Forearm 2 views (73090) |
$113.56 |
$162.23 |
1.3× |
| Hand 2 views (73120) |
$105.99 |
$151.41 |
1.0× |
| Hand 3 views (73130) |
$136.27 |
$194.67 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$136.27 |
$194.67 |
1.6× |
| Knee 3 views (73562) |
$136.27 |
$194.67 |
1.6× |
| MRA head w/o contrast (70544) |
$1,789.52 |
$2,556.46 |
7.5× |
| MRA neck w contrast (70548) |
$1,138.46 |
$1,626.37 |
3.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,317.27 |
$1,881.81 |
3.8× |
| MRA neck w/o contrast (70547) |
$956.77 |
$1,366.81 |
4.0× |
| MRI abdomen w contrast (74182) |
$1,820 |
$2,600 |
5.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,023.15 |
$4,318.79 |
8.6× |
| MRI abdomen w/o contrast (74181) |
$1,814.04 |
$2,591.48 |
7.6× |
| MRI any jnt lwr ext with con lt (73722) |
$1,821.25 |
$2,601.78 |
2.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,662.63 |
$2,375.18 |
2.1× |
| MRI c-spine with contrast (72142) |
$1,664 |
$2,377.14 |
4.7× |
| MRI cervical spine w/o contrast (72141) |
$2,057.66 |
$2,939.52 |
8.6× |
| MRI chest w/o & w/contrast material (71552) |
$3,174.31 |
$4,534.73 |
9.1× |
| MRI chest w/o contrast (71550) |
$1,795.72 |
$2,565.32 |
7.5× |
| MRI chest with contrast (71551) |
$2,477.07 |
$3,538.67 |
3.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,031.16 |
$2,901.66 |
5.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,934.44 |
$2,763.49 |
5.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,559.52 |
$2,227.89 |
6.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,548.71 |
$2,212.44 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,138.51 |
$4,483.59 |
9.0× |
| MRI orbit/face/neck w/contrast (70542) |
$1,656.14 |
$2,365.91 |
4.7× |
| MRI pelvis w contrast (72196) |
$1,478.05 |
$2,111.50 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,824.56 |
$4,035.08 |
8.1× |
| MRI pelvis w/o contrast (72195) |
$1,333.16 |
$1,904.52 |
5.6× |
| MRI scan of arm joint before and after contrast (73223) |
$2,880.40 |
$4,114.85 |
8.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,630.21 |
$3,757.44 |
7.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,907.83 |
$4,154.04 |
8.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,107.63 |
$3,010.90 |
6.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,330.26 |
$4,757.52 |
9.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,690.50 |
$2,415 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,907.83 |
$4,154.04 |
8.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,057.66 |
$2,939.52 |
8.6× |
| MRI tmj (70336) |
$1,413.88 |
$2,019.83 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,560.24 |
$2,228.92 |
6.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,408.18 |
$3,440.25 |
6.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,637.50 |
$2,339.28 |
6.8× |
| Neck soft tissue (70360) |
$105.99 |
$151.41 |
1.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$464.32 |
$663.32 |
4.4× |
| Pelvis 1 or 2 views (72170) |
$151.41 |
$216.30 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$764.15 |
$1,091.64 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$129.93 |
$185.61 |
1.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$206.68 |
$295.25 |
2.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$189.27 |
$270.38 |
1.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$181.69 |
$259.56 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$121.13 |
$173.04 |
1.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$304.26 |
$434.66 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$192.50 |
$275 |
2.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$136.27 |
$194.67 |
1.6× |
| Ribs bilateral 3 views (71110) |
$196.83 |
$281.19 |
1.9× |
| Scapula complete (73010) |
$128.70 |
$183.86 |
1.2× |
| Tmj unilateral (70328) |
$154.44 |
$220.63 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$361.87 |
$516.96 |
3.4× |
| Unlisted Ultrasound Procedure (76999) |
$263.45 |
$376.36 |
3.0× |
| Upper Extremity Infant (73092) |
$364 |
$520 |
3.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$386.40 |
$552 |
2.2× |
| Us abdl aorta screen aaa (76706) |
$303.30 |
$433.29 |
2.9× |
| Us breast unilateral limited (76642) |
$315 |
$450 |
3.6× |
| Us chest (76604) |
$493.50 |
$705 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$628.36 |
$897.65 |
6.0× |
| Us ob detailed single fetus (76811) |
$899.50 |
$1,285 |
3.8× |
| Us ob transvaginal (76817) |
$403.20 |
$576 |
3.8× |
| Us pelvic non ob complete (76856) |
$378.53 |
$540.75 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$196.11 |
$280.16 |
1.9× |
| Us pregnancy ltd (76815) |
$387.18 |
$553.11 |
3.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$416.38 |
$594.83 |
4.0× |
| Us retroperitoneal complete (76770) |
$423.95 |
$605.64 |
4.0× |
| Us retroperitoneal limited (76775) |
$310.39 |
$443.42 |
3.0× |
| Us scrotum and contents (76870) |
$340.68 |
$486.68 |
3.2× |
| Us soft tissue head/neck (76536) |
$376.26 |
$537.51 |
3.6× |
| Us xtr non-vasc lmtd (76882) |
$227.12 |
$324.45 |
2.2× |
| Wrist 2 views (73100) |
$113.56 |
$162.23 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$304.26 |
$434.66 |
2.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$151.41 |
$216.30 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$136.27 |
$194.67 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$175 |
$250 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$128.70 |
$183.86 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$151.41 |
$216.30 |
1.7× |
| X-ray exam of femur 1 (73551) |
$136.27 |
$194.67 |
1.6× |
| X-ray eye for foreign body (70030) |
$137.71 |
$196.73 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$196.83 |
$281.19 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196.83 |
$281.19 |
2.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$121.13 |
$173.04 |
1.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$113.56 |
$162.23 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$163.67 |
$233.81 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$147.81 |
$211.15 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$266 |
$380 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$151.41 |
$216.30 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$503.30 |
$719 |
4.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$503.30 |
$719 |
4.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$151.41 |
$216.30 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$196.83 |
$281.19 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$152.13 |
$217.33 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$151.41 |
$216.30 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$227.84 |
$325.48 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$445.90 |
$637 |
4.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$224 |
$320 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$128.70 |
$183.86 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$130.21 |
$186.02 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$174.13 |
$248.75 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$227.12 |
$324.45 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$151.41 |
$216.30 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$95.17 |
$135.96 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$180.97 |
$258.53 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$151.41 |
$216.30 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$151.41 |
$216.30 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$99.18 |
$141.68 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$121.13 |
$173.04 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$378.53 |
$540.75 |
3.6× |
| Xr finger(s) 2+ views (73140) |
$99.18 |
$141.68 |
1.1× |
| Xr shoulder 1 view (73020) |
$105.99 |
$151.41 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$206.68 |
$295.25 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$128.70 |
$183.86 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$121.13 |
$173.04 |
1.4× |