| Abdomen 2 views (74019) |
$251 |
$334 |
2.4× |
| Ankle 2 views (73600) |
$186 |
$248 |
2.1× |
| Bone survey complete (77075) |
$251 |
$334 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$186 |
$248 |
2.1× |
| Chest 1 view (71045) |
$186 |
$248 |
2.1× |
| Clavicle complete (73000) |
$186 |
$248 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$251 |
$334 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,114 |
$1,485 |
3.2× |
| CT abdomen and pelvis without contrast (74176) |
$801 |
$1,067.50 |
3.3× |
| CT abdomen w contrast (74160) |
$784 |
$1,045 |
4.4× |
| CT abdomen w wo contrast (74170) |
$900 |
$1,200 |
5.1× |
| CT abdomen w/o contrast (74150) |
$660 |
$880 |
6.3× |
| CT angiography upper extremity lt (73206) |
$900 |
$1,200 |
5.1× |
| CT c-spine w/o contrast (72125) |
$715 |
$953 |
6.8× |
| CT cervical spine w&w/o contrast (72127) |
$849 |
$1,132 |
4.8× |
| CT cervical spine with contrast (72126) |
$848 |
$1,130 |
2.4× |
| CT chest w/wo contrast (71270) |
$919 |
$1,225 |
5.2× |
| CT chest with contrast (71260) |
$845 |
$1,127 |
4.8× |
| CT head/brain with contrast (70460) |
$609 |
$812 |
3.5× |
| CT head/brain without and with contrast (70470) |
$722 |
$962 |
4.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$186 |
$248 |
2.1× |
| CT iac w contrast (70481) |
$609 |
$812 |
3.5× |
| CT lower ext w/o (73700) |
$578 |
$770 |
5.5× |
| CT lower extremity w wo contrast (73702) |
$671 |
$894 |
3.8× |
| CT lower extremity with contrast (73701) |
$609 |
$812 |
3.5× |
| CT lumbar spine w & w/o contrast (72133) |
$849 |
$1,132 |
4.8× |
| CT lumbar spine w/o contrast (72131) |
$715 |
$953 |
6.8× |
| CT lumbar spine with contrast (72132) |
$848 |
$1,130 |
2.4× |
| CT maxillofacial w contrast (70487) |
$609 |
$812 |
3.5× |
| CT maxillofacial w/o contrast (70486) |
$557 |
$743 |
5.3× |
| CT maxillofacial w/wo contrast (70488) |
$724 |
$965 |
4.1× |
| CT neck soft tissue w contrast (70491) |
$609 |
$812 |
3.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$728 |
$970 |
4.1× |
| CT orbits w/o contrast (70480) |
$603 |
$804 |
5.7× |
| CT pelvis w & w/o contrast (72194) |
$881 |
$1,175 |
5.0× |
| CT pelvis w/o contrast (72192) |
$681 |
$908 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$727 |
$969 |
4.1× |
| CT soft tissue neck w/o contrast (70490) |
$578 |
$770 |
5.5× |
| CT thoracic spine w/contrast (72129) |
$702 |
$936 |
4.0× |
| CT thoracic spine w/o contrast (72128) |
$715 |
$953 |
6.8× |
| CT thoracic spine w/wo contrast (72130) |
$849 |
$1,132 |
4.8× |
| CT thorax w/o contrast (71250) |
$715 |
$953 |
6.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$671 |
$894 |
3.8× |
| CT upper extremity w/o contrast rt (73200) |
$525 |
$700 |
5.0× |
| CT upper extremity with contrast (73201) |
$847 |
$1,129 |
2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$780 |
$1,040 |
4.4× |
| Cta Abdomen (74175) |
$900 |
$1,200 |
5.1× |
| CTA abdomen pelvis (74174) |
$881 |
$1,175 |
2.5× |
| CTA chest (71275) |
$1,040 |
$1,386 |
5.9× |
| Cta Head (70496) |
$900 |
$1,200 |
5.1× |
| CTA lwr ext w&w/o contrast (73706) |
$900 |
$1,200 |
5.1× |
| Cta Neck (70498) |
$900 |
$1,200 |
5.1× |
| Cta Pelvis (72191) |
$900 |
$1,200 |
5.1× |
| Dxa bone density study axial skeleton (77085) |
$260 |
$347 |
2.5× |
| Esophagus (74220) |
$411 |
$548 |
2.3× |
| Foot 2 views (73620) |
$186 |
$248 |
2.1× |
| Forearm 2 views (73090) |
$186 |
$248 |
2.1× |
| Hand 2 views (73120) |
$251 |
$334 |
2.4× |
| Hand 3 views (73130) |
$186 |
$248 |
2.1× |
| Humerus Min 2 Views Left (73060) |
$186 |
$248 |
2.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$251 |
$334 |
2.4× |
| Knee 3 views (73562) |
$186 |
$248 |
2.1× |
| MRA head w & w/o contrast (70546) |
$1,922 |
$2,562 |
5.5× |
| MRA head w/o contrast (70544) |
$1,127 |
$1,502 |
4.7× |
| MRA head with contrast (70545) |
$1,022 |
$1,362 |
2.9× |
| MRA neck w contrast (70548) |
$1,022 |
$1,362 |
2.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,922 |
$2,562 |
5.5× |
| MRA neck w/o contrast (70547) |
$1,022 |
$1,362 |
4.3× |
| MRI abdomen w contrast (74182) |
$1,244 |
$1,659 |
3.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,218 |
$4,290 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$1,040 |
$1,386 |
4.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,645 |
$2,193 |
2.1× |
| MRI bone marrow blood supply (77084) |
$1,069 |
$1,425 |
4.5× |
| MRI c-spine with contrast (72142) |
$1,283 |
$1,710 |
3.7× |
| MRI cervical spine w/o contrast (72141) |
$1,325 |
$1,767 |
5.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,165 |
$2,886 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,040 |
$1,386 |
4.3× |
| MRI chest with contrast (71551) |
$1,645 |
$2,193 |
2.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,226 |
$1,635 |
3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,224 |
$1,632 |
3.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,525 |
$2,033 |
6.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,148 |
$1,530 |
4.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,209 |
$4,279 |
9.2× |
| MRI orbit/face/neck w/contrast (70542) |
$1,224 |
$1,632 |
3.5× |
| MRI scan of arm joint before and after contrast (73223) |
$2,169 |
$2,892 |
6.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,169 |
$2,892 |
6.2× |
| MRI spectroscopy (76390) |
$1,033 |
$1,377 |
11.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,488 |
$3,317 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,267 |
$1,689 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,805 |
$3,740 |
8.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,283 |
$1,710 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,261 |
$3,015 |
6.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,473 |
$1,964 |
6.1× |
| MRI tmj (70336) |
$1,055 |
$1,407 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,325 |
$1,767 |
5.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,169 |
$2,892 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,325 |
$1,767 |
5.5× |
| Neck soft tissue (70360) |
$186 |
$248 |
2.1× |
| Nm whole blood volume (78122) |
$7 |
$9 |
0.0× |
| Osseous survey infant (77076) |
$251 |
$334 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$251 |
$334 |
2.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,167 |
$2,889 |
6.2× |
| Pr red cell survival study (78130) |
$49 |
$65 |
0.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$175 |
$233 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$251 |
$334 |
2.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$186 |
$248 |
2.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$186 |
$248 |
2.1× |
| Radiologic exam colon single contrast study (74270) |
$411 |
$548 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$186 |
$248 |
2.1× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$5 |
$6 |
0.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$11 |
$14 |
0.0× |
| Ribs bilateral 3 views (71110) |
$251 |
$334 |
2.4× |
| Scapula complete (73010) |
$251 |
$334 |
2.4× |
| Sialogram (70390) |
$36 |
$48 |
0.2× |
| Small bowel series (74250) |
$411 |
$548 |
2.3× |
| Spine thoracic 3 views (72072) |
$251 |
$334 |
2.4× |
| Thoracolumbar 2 views (72080) |
$186 |
$248 |
2.1× |
| Tmj unilateral (70328) |
$1,611 |
$2,148 |
18.4× |
| Tomogram (76100) |
$5 |
$6 |
0.0× |
| Ultrasound, abdomen limited (76705) |
$250 |
$333 |
2.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$186 |
$248 |
2.1× |
| Unlisted Ultrasound Procedure (76999) |
$186 |
$248 |
2.1× |
| Upper Extremity Infant (73092) |
$251 |
$334 |
2.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$411 |
$548 |
2.3× |
| Us pelvic non ob complete (76856) |
$250 |
$333 |
2.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$250 |
$333 |
2.4× |
| Us retroperitoneal complete (76770) |
$266 |
$354 |
2.5× |
| Us retroperitoneal limited (76775) |
$251 |
$334 |
2.4× |
| Us scrotum and contents (76870) |
$251 |
$334 |
2.4× |
| Us soft tissue head/neck (76536) |
$251 |
$334 |
2.4× |
| Wrist 2 views (73100) |
$186 |
$248 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$251 |
$334 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$186 |
$248 |
2.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$186 |
$248 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$186 |
$248 |
2.1× |
| X-ray exam hip uni 1 view (73501) |
$142.50 |
$190 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$186 |
$248 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$251 |
$334 |
2.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$164 |
$218 |
1.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$186 |
$248 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$186 |
$248 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$186 |
$248 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$186 |
$248 |
2.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$186 |
$248 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$251 |
$334 |
2.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$186 |
$248 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$251 |
$334 |
2.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$251 |
$334 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$186 |
$248 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$251 |
$334 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$251 |
$334 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$186 |
$248 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$213 |
$284 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$186 |
$248 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$251 |
$334 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$251 |
$334 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$186 |
$248 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$186 |
$248 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$186 |
$248 |
2.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$251 |
$334 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$251 |
$334 |
2.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$186 |
$248 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$186 |
$248 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$251 |
$334 |
2.4× |
| Xr chest 4+ views (71048) |
$251 |
$334 |
2.4× |
| Xr finger(s) 2+ views (73140) |
$186 |
$248 |
2.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$251 |
$334 |
2.4× |
| Xr spine cervical 4 or 5 views (72050) |
$251 |
$334 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$186 |
$248 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$186 |
$248 |
2.1× |