| Abdomen 2 views (74019) |
$271 |
$301 |
2.5× |
| Ankle 2 views (73600) |
$240 |
$267 |
2.7× |
| Arthrogram shoulder (73040) |
$819 |
$910 |
2.3× |
| Bone survey complete (77075) |
$825 |
$917 |
7.6× |
| Cervical spine 2 or 3 views (72040) |
$335 |
$372 |
3.7× |
| Chest 1 view (71045) |
$260 |
$289 |
2.9× |
| Clavicle complete (73000) |
$284 |
$316 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$296 |
$329 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,199 |
$5,777 |
14.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,749 |
$4,166 |
15.1× |
| CT abdomen w contrast (74160) |
$2,552 |
$2,836 |
14.0× |
| CT abdomen w wo contrast (74170) |
$2,756 |
$3,062 |
15.1× |
| CT abdomen w/o contrast (74150) |
$2,137 |
$2,374 |
19.7× |
| CT c-spine w/o contrast (72125) |
$2,356 |
$2,618 |
21.7× |
| CT cervical spine with contrast (72126) |
$2,404 |
$2,671 |
6.6× |
| CT chest w/wo contrast (71270) |
$2,817 |
$3,130 |
15.5× |
| CT chest with contrast (71260) |
$2,504 |
$2,782 |
13.7× |
| CT head/brain with contrast (70460) |
$2,097 |
$2,330 |
11.5× |
| CT head/brain without and with contrast (70470) |
$2,129 |
$2,366 |
11.7× |
| CT iac w contrast (70481) |
$2,378 |
$2,642 |
13.1× |
| CT lower ext w/o (73700) |
$2,093 |
$2,325 |
19.3× |
| CT lower extremity w wo contrast (73702) |
$2,489 |
$2,766 |
13.7× |
| CT lower extremity with contrast (73701) |
$2,209 |
$2,454 |
12.1× |
| CT lumbar spine w & w/o contrast (72133) |
$2,602 |
$2,891 |
14.3× |
| CT lumbar spine w/o contrast (72131) |
$2,307 |
$2,563 |
21.3× |
| CT lumbar spine with contrast (72132) |
$2,687 |
$2,986 |
7.4× |
| CT maxillofacial w contrast (70487) |
$1,752 |
$1,947 |
9.6× |
| CT maxillofacial w/o contrast (70486) |
$1,825 |
$2,028 |
16.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,174 |
$2,416 |
11.9× |
| CT neck soft tissue w contrast (70491) |
$2,346 |
$2,607 |
12.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,457 |
$2,730 |
13.5× |
| CT orbits w/o contrast (70480) |
$1,874 |
$2,082 |
17.3× |
| CT pelvis w & w/o contrast (72194) |
$2,515 |
$2,794 |
13.8× |
| CT pelvis w/o contrast (72192) |
$2,144 |
$2,382 |
19.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,684 |
$2,982 |
14.7× |
| CT soft tissue neck w/o contrast (70490) |
$2,109 |
$2,343 |
19.4× |
| CT thoracic spine w/o contrast (72128) |
$2,307 |
$2,563 |
21.3× |
| CT thoracic spine w/wo contrast (72130) |
$2,083 |
$2,314 |
11.4× |
| CT thorax w/o contrast (71250) |
$2,172 |
$2,413 |
20.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,484 |
$1,649 |
8.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,862 |
$2,069 |
17.2× |
| CT upper extremity with contrast (73201) |
$2,222 |
$2,469 |
6.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,418 |
$3,798 |
18.8× |
| Cta Abdomen (74175) |
$3,082 |
$3,424 |
16.9× |
| CTA abdomen pelvis (74174) |
$5,054 |
$5,616 |
14.0× |
| CTA chest (71275) |
$3,141 |
$3,490 |
17.2× |
| Cta Head (70496) |
$2,808 |
$3,120 |
15.4× |
| Cta Neck (70498) |
$2,714 |
$3,016 |
14.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$452 |
$502 |
4.2× |
| Esophagus (74220) |
$604 |
$671 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$483 |
$537 |
4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$476 |
$529 |
4.4× |
| Foot 2 views (73620) |
$218 |
$242 |
2.4× |
| Forearm 2 views (73090) |
$254 |
$282 |
2.8× |
| Hand 2 views (73120) |
$242 |
$269 |
2.2× |
| Hand 3 views (73130) |
$311 |
$346 |
3.4× |
| Humerus Min 2 Views Left (73060) |
$285 |
$317 |
3.2× |
| Knee 3 views (73562) |
$342 |
$380 |
3.8× |
| MRA head w & w/o contrast (70546) |
$2,882 |
$3,202 |
8.0× |
| MRA head w/o contrast (70544) |
$3,148 |
$3,498 |
12.7× |
| MRA head with contrast (70545) |
$2,534 |
$2,816 |
7.0× |
| MRI abdomen w contrast (74182) |
$2,669 |
$2,966 |
7.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,038 |
$4,487 |
11.1× |
| MRI abdomen w/o contrast (74181) |
$3,074 |
$3,416 |
12.4× |
| MRI any jnt lwr ext with con lt (73722) |
$3,226 |
$3,584 |
4.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,011 |
$3,346 |
3.7× |
| MRI c-spine with contrast (72142) |
$3,114 |
$3,460 |
8.6× |
| MRI cervical spine w/o contrast (72141) |
$3,310 |
$3,678 |
13.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,436 |
$3,818 |
9.5× |
| MRI chest w/o contrast (71550) |
$2,358 |
$2,620 |
9.5× |
| MRI chest with contrast (71551) |
$2,669 |
$2,966 |
3.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,343 |
$2,603 |
6.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,327 |
$2,585 |
6.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,630 |
$2,922 |
10.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,895 |
$3,217 |
11.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,361 |
$3,734 |
9.3× |
| MRI orbit/face/neck w/contrast (70542) |
$2,345 |
$2,605 |
6.5× |
| MRI pelvis w contrast (72196) |
$2,802 |
$3,113 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,824 |
$4,249 |
10.6× |
| MRI pelvis w/o contrast (72195) |
$3,006 |
$3,340 |
12.1× |
| MRI scan of arm joint before and after contrast (73223) |
$3,549 |
$3,943 |
9.8× |
| MRI scan of leg joint before and after contrast (73723) |
$3,457 |
$3,841 |
9.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,003 |
$4,448 |
11.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,975 |
$3,305 |
8.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,770 |
$4,189 |
10.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,171 |
$2,412 |
6.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,051 |
$4,501 |
11.2× |
| MRI thoracic spine w/o contrast (72146) |
$3,231 |
$3,590 |
13.0× |
| MRI tmj (70336) |
$2,414 |
$2,682 |
9.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,462 |
$2,735 |
9.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,309 |
$3,677 |
9.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,561 |
$2,845 |
10.3× |
| Neck soft tissue (70360) |
$292 |
$324 |
3.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$472 |
$524 |
4.3× |
| Pelvis 1 or 2 views (72170) |
$297 |
$330 |
2.7× |
| Pr gi endoscopic ultrasound (76975) |
$581 |
$646 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,083 |
$3,426 |
8.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$430 |
$478 |
4.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$424 |
$471 |
3.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$289 |
$321 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$329 |
$366 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$291 |
$323 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$384 |
$427 |
3.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$327 |
$363 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$766 |
$851 |
4.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$323 |
$359 |
3.6× |
| Ribs bilateral 3 views (71110) |
$383 |
$426 |
3.5× |
| Scapula complete (73010) |
$267 |
$297 |
2.5× |
| Small bowel series (74250) |
$632 |
$702 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$650 |
$722 |
6.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$109 |
$121 |
1.2× |
| Unlisted Ultrasound Procedure (76999) |
$408 |
$453 |
4.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$689 |
$766 |
3.8× |
| Us abdl aorta screen aaa (76706) |
$570 |
$633 |
5.3× |
| Us compl joint r-t w/image documentation (76881) |
$483 |
$537 |
4.4× |
| Us ob transvaginal (76817) |
$545 |
$606 |
5.0× |
| Us pelvic non ob complete (76856) |
$772 |
$858 |
7.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$510 |
$567 |
4.7× |
| Us pregnancy ltd (76815) |
$472 |
$524 |
4.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$622 |
$691 |
5.7× |
| Us retroperitoneal complete (76770) |
$779 |
$866 |
7.2× |
| Us retroperitoneal limited (76775) |
$581 |
$645 |
5.4× |
| Us scrotum and contents (76870) |
$649 |
$721 |
6.0× |
| Us soft tissue head/neck (76536) |
$598 |
$664 |
5.5× |
| Us transrectal (76872) |
$711 |
$790 |
6.5× |
| Us xtr non-vasc lmtd (76882) |
$484 |
$538 |
4.5× |
| Venogram extremity bilateral (75822) |
$281 |
$312 |
0.2× |
| Venography extremity unilateral rs&i (75820) |
$281 |
$312 |
0.2× |
| Wrist 2 views (73100) |
$230 |
$256 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$271 |
$301 |
3.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$370 |
$411 |
4.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$789 |
$877 |
4.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$259 |
$288 |
2.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$317 |
$352 |
3.5× |
| X-ray exam hip uni 1 view (73501) |
$259 |
$288 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$327 |
$363 |
3.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$569 |
$632 |
5.2× |
| X-ray eye for foreign body (70030) |
$229 |
$254 |
2.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$416 |
$462 |
3.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$374.50 |
$416 |
4.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$207 |
$230 |
2.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$419.50 |
$466.50 |
3.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$400 |
$444 |
3.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$392 |
$436 |
3.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$314 |
$349 |
3.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$415 |
$461 |
3.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$383 |
$426 |
3.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$302 |
$336 |
3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$263 |
$292 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$334 |
$371 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$337 |
$374 |
3.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$424 |
$471 |
3.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$283 |
$314 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$256 |
$284 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$289 |
$321 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$325 |
$361 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$333 |
$370 |
3.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$215 |
$239 |
2.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$300 |
$333 |
3.3× |
| Xr c-spine 6 or more views (72052) |
$532 |
$591 |
4.9× |
| Xr chest 4+ views (71048) |
$305 |
$339 |
2.8× |
| Xr Cholecystography Oral Contrast (74290) |
$238 |
$264 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$224 |
$249 |
2.5× |
| Xr shoulder 1 view (73020) |
$206 |
$229 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$291 |
$323 |
3.2× |
| Xr tmj bilateral (70330) |
$247 |
$274 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$344.50 |
$382.50 |
3.8× |