| Abdomen 2 views (74019) |
$381.60 |
$477 |
4.0× |
| Angiography extremity unilateral rs&i (75710) |
$1,531.20 |
$1,914 |
0.5× |
| Bone survey complete (77075) |
$1,156.80 |
$1,446 |
12.2× |
| Cervical spine 2 or 3 views (72040) |
$388 |
$485 |
4.9× |
| Chest 1 view (71045) |
$200 |
$250 |
2.5× |
| Chest 3 views (71047) |
$339.20 |
$424 |
4.3× |
| Clavicle complete (73000) |
$275.20 |
$344 |
3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$280.80 |
$351 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,492.80 |
$4,366 |
11.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,135.20 |
$1,419 |
5.3× |
| CT abdomen w contrast (74160) |
$2,514.40 |
$3,143 |
15.8× |
| CT abdomen w wo contrast (74170) |
$2,858.40 |
$3,573 |
18.0× |
| CT abdomen w/o contrast (74150) |
$1,713.60 |
$2,142 |
18.1× |
| CT c-spine w/o contrast (72125) |
$1,832.80 |
$2,291 |
19.4× |
| CT cervical spine w&w/o contrast (72127) |
$2,881.60 |
$3,602 |
18.1× |
| CT cervical spine with contrast (72126) |
$2,287.20 |
$2,859 |
7.2× |
| CT chest w/wo contrast (71270) |
$2,888 |
$3,610 |
18.2× |
| CT chest with contrast (71260) |
$2,282.40 |
$2,853 |
14.4× |
| CT head/brain with contrast (70460) |
$1,844 |
$2,305 |
11.6× |
| CT head/brain without and with contrast (70470) |
$2,200.80 |
$2,751 |
13.9× |
| CT iac w contrast (70481) |
$2,817.60 |
$3,522 |
17.7× |
| CT lower ext w/o (73700) |
$1,953.60 |
$2,442 |
20.6× |
| CT lower extremity w wo contrast (73702) |
$3,046.40 |
$3,808 |
19.2× |
| CT lower extremity with contrast (73701) |
$2,270.40 |
$2,838 |
14.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,214 |
$2,767.50 |
13.9× |
| CT lumbar spine w/o contrast (72131) |
$1,823.20 |
$2,279 |
19.3× |
| CT lumbar spine with contrast (72132) |
$2,100 |
$2,625 |
6.6× |
| CT maxillofacial w contrast (70487) |
$2,357.60 |
$2,947 |
14.8× |
| CT maxillofacial w/o contrast (70486) |
$1,915.20 |
$2,394 |
20.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,949.60 |
$3,687 |
18.6× |
| CT neck soft tissue w contrast (70491) |
$2,257.60 |
$2,822 |
14.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,248.80 |
$4,061 |
20.5× |
| CT orbits w/o contrast (70480) |
$2,384.80 |
$2,981 |
25.2× |
| CT pelvis w & w/o contrast (72194) |
$2,922.40 |
$3,653 |
18.4× |
| CT pelvis w/o contrast (72192) |
$1,716.80 |
$2,146 |
18.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,850.40 |
$3,563 |
17.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,811.20 |
$2,264 |
19.1× |
| CT thoracic spine w/o contrast (72128) |
$1,830.40 |
$2,288 |
19.3× |
| CT thorax w/o contrast (71250) |
$1,830.40 |
$2,288 |
19.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,984.80 |
$3,731 |
18.8× |
| CT upper extremity w/o contrast rt (73200) |
$1,801.60 |
$2,252 |
19.0× |
| CT upper extremity with contrast (73201) |
$2,251.20 |
$2,814 |
7.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,097.60 |
$2,622 |
13.2× |
| CTA abdomen pelvis (74174) |
$3,024 |
$3,780 |
9.6× |
| CTA chest (71275) |
$2,373.20 |
$2,966.50 |
14.9× |
| Cta Head (70496) |
$1,648.80 |
$2,061 |
10.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,680 |
$2,100 |
5.3× |
| Cta Neck (70498) |
$1,648.80 |
$2,061 |
10.4× |
| Cystography minimum 3 views rs&i (74430) |
$1,072.80 |
$1,341 |
3.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$250.40 |
$313 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$248.80 |
$311 |
3.2× |
| Forearm 2 views (73090) |
$275.20 |
$344 |
3.5× |
| Hand 3 views (73130) |
$330.40 |
$413 |
4.2× |
| Humerus Min 2 Views Left (73060) |
$292.80 |
$366 |
3.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$210.40 |
$263 |
2.2× |
| Knee 3 views (73562) |
$372.80 |
$466 |
4.7× |
| MRA head w & w/o contrast (70546) |
$4,074.40 |
$5,093 |
12.9× |
| MRA head w/o contrast (70544) |
$2,724 |
$3,405 |
12.6× |
| MRA head with contrast (70545) |
$2,706.40 |
$3,383 |
8.6× |
| MRA neck w contrast (70548) |
$2,858.40 |
$3,573 |
9.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,078.40 |
$5,098 |
12.9× |
| MRA neck w/o contrast (70547) |
$2,714.40 |
$3,393 |
12.6× |
| MRI abdomen w contrast (74182) |
$2,944.80 |
$3,681 |
9.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,245.60 |
$4,057 |
10.3× |
| MRI abdomen w/o contrast (74181) |
$3,360 |
$4,200 |
15.6× |
| MRI any jnt lwr ext with con lt (73722) |
$2,446.40 |
$3,058 |
3.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,417.60 |
$3,022 |
3.4× |
| MRI breast w/o contrast bilateral (77047) |
$788 |
$985 |
3.6× |
| MRI breast w/o contrast unilat (77046) |
$648.80 |
$811 |
3.0× |
| MRI c-spine with contrast (72142) |
$2,662.40 |
$3,328 |
8.4× |
| MRI cervical spine w/o contrast (72141) |
$2,126.40 |
$2,658 |
9.8× |
| MRI chest w/o & w/contrast material (71552) |
$3,805.60 |
$4,757 |
12.0× |
| MRI chest w/o contrast (71550) |
$2,769.60 |
$3,462 |
12.8× |
| MRI chest with contrast (71551) |
$3,028 |
$3,785 |
4.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,609.60 |
$3,262 |
8.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,570.40 |
$3,213 |
8.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,414.40 |
$3,018 |
11.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,397.60 |
$2,997 |
11.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,200.80 |
$4,001 |
10.1× |
| MRI orbit/face/neck w/contrast (70542) |
$2,567.20 |
$3,209 |
8.1× |
| MRI pelvis w contrast (72196) |
$2,442.40 |
$3,053 |
7.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,240.80 |
$4,051 |
10.3× |
| MRI pelvis w/o contrast (72195) |
$2,183.20 |
$2,729 |
10.1× |
| MRI scan of arm joint before and after contrast (73223) |
$3,013.60 |
$3,767 |
9.5× |
| MRI scan of leg joint before and after contrast (73723) |
$3,002.40 |
$3,753 |
9.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,158.40 |
$3,948 |
10.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,660 |
$3,325 |
8.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,089.60 |
$3,862 |
9.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,312.80 |
$2,891 |
7.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,825.60 |
$3,532 |
8.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,136 |
$2,670 |
9.9× |
| MRI tmj (70336) |
$1,016.80 |
$1,271 |
4.7× |
| MRI upper ext joint w/o contrast (73221) |
$2,288.80 |
$2,861 |
10.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,248.80 |
$4,061 |
10.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,481.60 |
$3,102 |
11.5× |
| Neck soft tissue (70360) |
$280.80 |
$351 |
3.6× |
| Osseous survey infant (77076) |
$1,070.40 |
$1,338 |
11.3× |
| Osseous survey limited (77074) |
$710.40 |
$888 |
7.5× |
| Pelvis 1 or 2 views (72170) |
$244 |
$305 |
2.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,244.80 |
$4,056 |
10.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$388 |
$485 |
4.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$257.60 |
$322 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$405.60 |
$507 |
4.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$216.80 |
$271 |
2.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$272.80 |
$341 |
3.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$280.80 |
$351 |
3.6× |
| Ribs bilateral 3 views (71110) |
$392.80 |
$491 |
4.1× |
| Sacroiliac Joints < 3 Views (72200) |
$298.40 |
$373 |
3.2× |
| Scapula complete (73010) |
$285.60 |
$357 |
3.0× |
| Screening digital breast tomosynthesis (77063) |
$60 |
$75 |
2.6× |
| Sella turcica (70240) |
$298.40 |
$373 |
3.8× |
| Spine thoracic 3 views (72072) |
$400 |
$500 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$567.20 |
$709 |
6.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,340 |
$1,675 |
8.4× |
| Us breast unilateral limited (76642) |
$508 |
$635 |
6.4× |
| Us chest (76604) |
$324 |
$405 |
3.4× |
| Us compl joint r-t w/image documentation (76881) |
$783.20 |
$979 |
8.3× |
| Us pelvic non ob complete (76856) |
$677.60 |
$847 |
7.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$612.80 |
$766 |
6.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$578.40 |
$723 |
6.1× |
| Us retroperitoneal complete (76770) |
$389.60 |
$487 |
4.1× |
| Us soft tissue head/neck (76536) |
$655.20 |
$819 |
6.9× |
| Us transrectal (76872) |
$822.40 |
$1,028 |
8.7× |
| Us xtr non-vasc lmtd (76882) |
$783.20 |
$979 |
8.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$490.40 |
$613 |
5.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$372.80 |
$466 |
4.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$227.20 |
$284 |
2.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$392.80 |
$491 |
5.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$392.80 |
$491 |
5.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$429.60 |
$537 |
4.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$227.20 |
$284 |
2.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$271.20 |
$339 |
3.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$429.60 |
$537 |
4.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$409.60 |
$512 |
4.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$356.80 |
$446 |
4.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$280.80 |
$351 |
3.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$429.60 |
$537 |
4.5× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$541.20 |
$676.50 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$313.60 |
$392 |
4.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$298.40 |
$373 |
3.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$292.80 |
$366 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$372.80 |
$466 |
4.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$462.40 |
$578 |
4.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$356.80 |
$446 |
3.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$232 |
$290 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$383.20 |
$479 |
4.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$317.60 |
$397 |
4.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$323.20 |
$404 |
3.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$323.20 |
$404 |
4.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$388 |
$485 |
4.9× |
| Xr c-spine 6 or more views (72052) |
$705.60 |
$882 |
7.5× |
| Xr Cholecystography Oral Contrast (74290) |
$227.20 |
$284 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$344.80 |
$431 |
4.4× |
| Xr tibia/fibula 2 views (73590) |
$264.80 |
$331 |
3.4× |
| Xr tmj bilateral (70330) |
$523.20 |
$654 |
6.6× |