| Abdomen 2 views (74019) |
$143.50 |
$205 |
1.3× |
| Ankle 2 views (73600) |
$148.05 |
$211.50 |
1.6× |
| Antegrade urography radiological supvj & interpj (74425) |
$195.30 |
$279 |
0.5× |
| Arthrogram elbow (73085) |
$35 |
$50 |
0.1× |
| Arthrogram hip (73525) |
$611.45 |
$873.50 |
1.7× |
| Arthrogram shoulder (73040) |
$430.15 |
$614.50 |
1.2× |
| Arthrogram wrist (73115) |
$193.90 |
$277 |
0.5× |
| Arthrography knee lt (73580) |
$158.20 |
$226 |
0.4× |
| Bone age studies (77072) |
$203 |
$290 |
1.8× |
| Bone survey complete (77075) |
$446.95 |
$638.50 |
4.1× |
| Cervical spine 2 or 3 views (72040) |
$143.50 |
$205 |
1.6× |
| Chest 1 view (71045) |
$119.35 |
$170.50 |
1.3× |
| Chest 3 views (71047) |
$170.10 |
$243 |
1.9× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$360.50 |
$515 |
1.9× |
| Clavicle complete (73000) |
$148.40 |
$212 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$265.30 |
$379 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,796.55 |
$2,566.50 |
4.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,139.25 |
$1,627.50 |
4.5× |
| CT abdomen w contrast (74160) |
$929.60 |
$1,328 |
5.0× |
| CT abdomen w wo contrast (74170) |
$1,116.85 |
$1,595.50 |
6.0× |
| CT abdomen w/o contrast (74150) |
$664.30 |
$949 |
6.0× |
| CT angiography upper extremity lt (73206) |
$1,258.60 |
$1,798 |
6.8× |
| CT c-spine w/o contrast (72125) |
$720.65 |
$1,029.50 |
6.5× |
| CT cervical spine with contrast (72126) |
$882.70 |
$1,261 |
2.4× |
| CT chest w/wo contrast (71270) |
$288.40 |
$412 |
1.6× |
| CT chest with contrast (71260) |
$881.65 |
$1,259.50 |
4.8× |
| CT head/brain with contrast (70460) |
$795.90 |
$1,137 |
4.3× |
| CT head/brain without and with contrast (70470) |
$1,198.40 |
$1,712 |
6.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$392.35 |
$560.50 |
4.3× |
| CT iac w contrast (70481) |
$614.60 |
$878 |
3.3× |
| CT limited/localized follow up study (76380) |
$775.60 |
$1,108 |
8.4× |
| CT lower ext w/o (73700) |
$658 |
$940 |
6.0× |
| CT lower extremity w wo contrast (73702) |
$1,110.90 |
$1,587 |
6.0× |
| CT lower extremity with contrast (73701) |
$881.30 |
$1,259 |
4.8× |
| CT lumbar spine w & w/o contrast (72133) |
$82.60 |
$118 |
0.4× |
| CT lumbar spine w/o contrast (72131) |
$658 |
$940 |
6.0× |
| CT lumbar spine with contrast (72132) |
$883.05 |
$1,261.50 |
2.4× |
| CT maxillofacial w contrast (70487) |
$870.45 |
$1,243.50 |
4.7× |
| CT maxillofacial w/o contrast (70486) |
$653.45 |
$933.50 |
5.9× |
| CT neck soft tissue w contrast (70491) |
$894.25 |
$1,277.50 |
4.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,226.05 |
$1,751.50 |
6.6× |
| CT orbits w/o contrast (70480) |
$667.45 |
$953.50 |
6.1× |
| CT pelvis w & w/o contrast (72194) |
$1,148 |
$1,640 |
6.2× |
| CT pelvis w/o contrast (72192) |
$660.80 |
$944 |
6.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,233.40 |
$1,762 |
6.7× |
| CT soft tissue neck w/o contrast (70490) |
$735 |
$1,050 |
6.7× |
| CT thoracic spine w/contrast (72129) |
$249.20 |
$356 |
1.3× |
| CT thoracic spine w/o contrast (72128) |
$720.30 |
$1,029 |
6.5× |
| CT thorax w/o contrast (71250) |
$722.75 |
$1,032.50 |
6.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$79.10 |
$113 |
0.4× |
| CT upper extremity w/o contrast rt (73200) |
$735 |
$1,050 |
6.7× |
| CT upper extremity with contrast (73201) |
$796.95 |
$1,138.50 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,148.35 |
$1,640.50 |
6.2× |
| Cta Abdomen (74175) |
$1,259.30 |
$1,799 |
6.8× |
| CTA abdomen pelvis (74174) |
$1,142.40 |
$1,632 |
3.1× |
| CTA chest (71275) |
$1,259.65 |
$1,799.50 |
6.8× |
| Cta Head (70496) |
$1,257.55 |
$1,796.50 |
6.8× |
| CTA lwr ext w&w/o contrast (73706) |
$1,261.40 |
$1,802 |
6.8× |
| Cta Neck (70498) |
$1,257.55 |
$1,796.50 |
6.8× |
| Cta Pelvis (72191) |
$1,129.45 |
$1,613.50 |
6.1× |
| Cystography minimum 3 views rs&i (74430) |
$21 |
$30 |
0.1× |
| Diskogram cervical (72285) |
$77 |
$110 |
0.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$168.35 |
$240.50 |
1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$110.95 |
$158.50 |
1.2× |
| Echoencephalography real time imaging (76506) |
$161.70 |
$231 |
1.5× |
| Esophagus (74220) |
$314.30 |
$449 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$270.20 |
$386 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$308.70 |
$441 |
1.2× |
| Foot 2 views (73620) |
$130.20 |
$186 |
1.4× |
| Forearm 2 views (73090) |
$130.20 |
$186 |
1.4× |
| Hand 2 views (73120) |
$130.55 |
$186.50 |
1.2× |
| Hand 3 views (73130) |
$162.75 |
$232.50 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$147.70 |
$211 |
1.6× |
| Hysterosalpingogram (74740) |
$470.40 |
$672 |
1.9× |
| Knee 3 views (73562) |
$165.55 |
$236.50 |
1.8× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$78.40 |
$112 |
0.9× |
| MRA head w & w/o contrast (70546) |
$96.60 |
$138 |
0.3× |
| MRA head w/o contrast (70544) |
$1,146.25 |
$1,637.50 |
4.6× |
| MRA neck w contrast (70548) |
$970.55 |
$1,386.50 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,639.40 |
$2,342 |
4.5× |
| MRA neck w/o contrast (70547) |
$317.80 |
$454 |
1.3× |
| MRI abdomen w contrast (74182) |
$112 |
$160 |
0.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,829.80 |
$2,614 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$1,131.20 |
$1,616 |
4.5× |
| MRI any jnt lwr ext with con lt (73722) |
$1,179.85 |
$1,685.50 |
1.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,174.25 |
$1,677.50 |
1.4× |
| MRI c-spine with contrast (72142) |
$1,179.50 |
$1,685 |
3.2× |
| MRI cervical spine w/o contrast (72141) |
$1,035.65 |
$1,479.50 |
4.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,468.95 |
$2,098.50 |
4.0× |
| MRI chest w/o contrast (71550) |
$1,207.15 |
$1,724.50 |
4.8× |
| MRI chest with contrast (71551) |
$112.70 |
$161 |
0.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,365.70 |
$1,951 |
3.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$387.80 |
$554 |
1.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,151.85 |
$1,645.50 |
4.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$333.20 |
$476 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,830.15 |
$2,614.50 |
5.0× |
| MRI orbit/face/neck w/contrast (70542) |
$395.50 |
$565 |
1.1× |
| MRI pelvis w contrast (72196) |
$1,177.05 |
$1,681.50 |
3.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,652.35 |
$2,360.50 |
4.5× |
| MRI pelvis w/o contrast (72195) |
$1,035.30 |
$1,479 |
4.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,866.55 |
$2,666.50 |
5.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,650.95 |
$2,358.50 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,816.15 |
$2,594.50 |
4.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,320.20 |
$1,886 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,655.85 |
$2,365.50 |
4.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$116.20 |
$166 |
0.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,655.85 |
$2,365.50 |
4.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,127 |
$1,610 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,136.45 |
$1,623.50 |
4.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,650.95 |
$2,358.50 |
4.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,031.80 |
$1,474 |
4.1× |
| Neck soft tissue (70360) |
$135.80 |
$194 |
1.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$141.40 |
$202 |
1.3× |
| Osseous survey infant (77076) |
$153.30 |
$219 |
1.4× |
| Osseous survey limited (77074) |
$93.10 |
$133 |
0.8× |
| Parathyroid imaging (78070) |
$387.80 |
$554 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$130.90 |
$187 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,829.10 |
$2,613 |
5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$117.95 |
$168.50 |
0.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$17.50 |
$25 |
0.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$146.65 |
$209.50 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$158.90 |
$227 |
1.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$27.30 |
$39 |
0.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$178.15 |
$254.50 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$119.35 |
$170.50 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$143.50 |
$205 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$474.60 |
$678 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$322.35 |
$460.50 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$343.70 |
$491 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$183.75 |
$262.50 |
2.0× |
| Radiological examination surgical specimen (76098) |
$51.80 |
$74 |
0.1× |
| Ribs bilateral 3 views (71110) |
$167.65 |
$239.50 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$148.75 |
$212.50 |
1.3× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$166.60 |
$238 |
0.7× |
| Scanogram (77073) |
$321.65 |
$459.50 |
2.9× |
| Scapula complete (73010) |
$130.90 |
$187 |
1.2× |
| Screening digital breast tomosynthesis (77063) |
$133.70 |
$191 |
5.7× |
| Small bowel series (74250) |
$438.20 |
$626 |
2.4× |
| Spine thoracic 3 views (72072) |
$143.50 |
$205 |
1.3× |
| Thoracolumbar 2 views (72080) |
$149.80 |
$214 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$263.90 |
$377 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$63.70 |
$91 |
0.6× |
| Upper Extremity Infant (73092) |
$10.50 |
$15 |
0.1× |
| Urethrocystography voiding (74455) |
$149.80 |
$214 |
0.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$193.90 |
$277 |
1.0× |
| Us abdl aorta screen aaa (76706) |
$351.05 |
$501.50 |
3.2× |
| Us breast unilateral complete (76641) |
$374.50 |
$535 |
3.4× |
| Us breast unilateral limited (76642) |
$301 |
$430 |
3.3× |
| Us chest (76604) |
$319.55 |
$456.50 |
2.9× |
| Us compl joint r-t w/image documentation (76881) |
$389.20 |
$556 |
3.5× |
| Us fetal nuchal translucency 1st gestation (76813) |
$77.70 |
$111 |
0.7× |
| Us infant hips dynamic (76885) |
$402.85 |
$575.50 |
4.4× |
| Us infant hips limited static (76886) |
$40.60 |
$58 |
0.4× |
| Us ob detailed single fetus (76811) |
$1,099 |
$1,570 |
4.4× |
| Us ob transvaginal (76817) |
$311.15 |
$444.50 |
2.8× |
| Us pelvic non ob complete (76856) |
$389.55 |
$556.50 |
3.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$236.95 |
$338.50 |
2.1× |
| Us pregnancy ltd (76815) |
$302.75 |
$432.50 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$333.20 |
$476 |
3.0× |
| Us retroperitoneal complete (76770) |
$291.20 |
$416 |
2.6× |
| Us retroperitoneal limited (76775) |
$287.35 |
$410.50 |
2.6× |
| Us scrotum and contents (76870) |
$322 |
$460 |
2.9× |
| Us soft tissue head/neck (76536) |
$380.10 |
$543 |
3.4× |
| Us spinal canal and contents (76800) |
$84.70 |
$121 |
0.8× |
| Us transrectal (76872) |
$198.80 |
$284 |
1.8× |
| Us transrectal prostate volume (76873) |
$250.60 |
$358 |
2.3× |
| Us xtr non-vasc lmtd (76882) |
$267.40 |
$382 |
2.4× |
| Wrist 2 views (73100) |
$149.45 |
$213.50 |
1.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$171.85 |
$245.50 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$145.60 |
$208 |
1.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$162.40 |
$232 |
1.8× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$724.85 |
$1,035.50 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.55 |
$186.50 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$142.10 |
$203 |
1.5× |
| X-ray exam entire spi 4/5 vw (72083) |
$215.25 |
$307.50 |
2.0× |
| X-ray exam hip uni 1 view (73501) |
$136.85 |
$195.50 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$170.45 |
$243.50 |
1.9× |
| X-ray exam hip uni 4/> views (73503) |
$178.50 |
$255 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$208.25 |
$297.50 |
1.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$88.90 |
$127 |
0.8× |
| X-ray exam of femur 1 (73551) |
$42 |
$60 |
0.5× |
| X-ray eye for foreign body (70030) |
$119.35 |
$170.50 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$180.95 |
$258.50 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$13.30 |
$19 |
0.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$160.65 |
$229.50 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$130.20 |
$186 |
1.4× |
| X-ray IV pyelogram+drip infusn (74410) |
$31.50 |
$45 |
0.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$142.10 |
$203 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$180.95 |
$258.50 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$142.10 |
$203 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$154.35 |
$220.50 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$224.70 |
$321 |
2.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$132.30 |
$189 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$163.10 |
$233 |
1.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$119.35 |
$170.50 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$181.30 |
$259 |
1.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$166.60 |
$238 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$151.20 |
$216 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$196.35 |
$280.50 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$253.05 |
$361.50 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$143.50 |
$205 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$148.40 |
$212 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$161.35 |
$230.50 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$173.95 |
$248.50 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$154.35 |
$220.50 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$156.45 |
$223.50 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$142.10 |
$203 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$76.30 |
$109 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$59.50 |
$85 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$149.10 |
$213 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$131.60 |
$188 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$178.85 |
$255.50 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$140.70 |
$201 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$165.90 |
$237 |
1.8× |
| Xr arthrogram ankle (73615) |
$184.10 |
$263 |
0.5× |
| Xr c-spine 6 or more views (72052) |
$214.20 |
$306 |
1.9× |
| Xr chest 4+ views (71048) |
$20.30 |
$29 |
0.2× |
| Xr Cholecystography Oral Contrast (74290) |
$121.80 |
$174 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$163.80 |
$234 |
1.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$54.60 |
$78 |
0.5× |
| Xr shoulder 1 view (73020) |
$128.80 |
$184 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$196.70 |
$281 |
1.8× |
| Xr tibia/fibula 2 views (73590) |
$141.40 |
$202 |
1.5× |
| Xr tmj bilateral (70330) |
$174.30 |
$249 |
1.9× |
| Xray knee 1 or 2 views rt (73560) |
$149.45 |
$213.50 |
1.6× |