| Abdomen 2 views (74019) |
$237.30 |
$395.50 |
2.3× |
| Ankle 2 views (73600) |
$193.50 |
$322.50 |
2.2× |
| Bone age studies (77072) |
$204.60 |
$341 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$237.30 |
$395.50 |
2.7× |
| Chest 1 view (71045) |
$143.40 |
$239 |
1.6× |
| Chest 3 views (71047) |
$329.40 |
$549 |
3.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$816.30 |
$1,360.50 |
4.6× |
| Clavicle complete (73000) |
$198.30 |
$330.50 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$318.30 |
$530.50 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,226.30 |
$3,710.50 |
6.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,585.80 |
$2,643 |
6.6× |
| CT abdomen w contrast (74160) |
$1,488 |
$2,480 |
8.5× |
| CT abdomen w wo contrast (74170) |
$1,692 |
$2,820 |
9.6× |
| CT abdomen w/o contrast (74150) |
$906.60 |
$1,511 |
8.7× |
| CT c-spine w/o contrast (72125) |
$1,113.75 |
$1,856.25 |
10.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,087.80 |
$1,813 |
6.2× |
| CT cervical spine with contrast (72126) |
$998.10 |
$1,663.50 |
2.9× |
| CT chest w/wo contrast (71270) |
$1,304.40 |
$2,174 |
7.4× |
| CT chest with contrast (71260) |
$1,134.90 |
$1,891.50 |
6.5× |
| CT head/brain with contrast (70460) |
$1,059.30 |
$1,765.50 |
6.0× |
| CT head/brain without and with contrast (70470) |
$1,241.70 |
$2,069.50 |
7.1× |
| CT iac w contrast (70481) |
$998.10 |
$1,663.50 |
5.7× |
| CT lower ext w/o (73700) |
$1,161.30 |
$1,935.50 |
11.1× |
| CT lower extremity w wo contrast (73702) |
$1,087.80 |
$1,813 |
6.2× |
| CT lower extremity with contrast (73701) |
$1,454.70 |
$2,424.50 |
8.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,087.80 |
$1,813 |
6.2× |
| CT lumbar spine w/o contrast (72131) |
$1,161.30 |
$1,935.50 |
11.1× |
| CT maxillofacial w contrast (70487) |
$1,085.70 |
$1,809.50 |
6.2× |
| CT maxillofacial w/o contrast (70486) |
$900.30 |
$1,500.50 |
8.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,087.80 |
$1,813 |
6.2× |
| CT neck soft tissue w contrast (70491) |
$1,317.60 |
$2,196 |
7.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,932.60 |
$3,221 |
11.0× |
| CT orbits w/o contrast (70480) |
$906.60 |
$1,511 |
8.7× |
| CT pelvis w & w/o contrast (72194) |
$1,087.80 |
$1,813 |
6.2× |
| CT pelvis w/o contrast (72192) |
$949.20 |
$1,582 |
9.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,587 |
$2,645 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,095 |
$1,825 |
10.5× |
| CT thoracic spine w/o contrast (72128) |
$1,165.50 |
$1,942.50 |
11.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,087.80 |
$1,813 |
6.2× |
| CT thorax w/o contrast (71250) |
$982.35 |
$1,637.25 |
9.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,087.80 |
$1,813 |
6.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,159.50 |
$1,932.50 |
11.1× |
| CT upper extremity with contrast (73201) |
$1,216.20 |
$2,027 |
3.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,993.20 |
$3,322 |
11.3× |
| Cta Abdomen (74175) |
$1,985.10 |
$3,308.50 |
11.3× |
| CTA abdomen pelvis (74174) |
$2,481.30 |
$4,135.50 |
7.1× |
| CTA chest (71275) |
$1,939.80 |
$3,233 |
11.0× |
| Cta Neck (70498) |
$1,889.10 |
$3,148.50 |
10.8× |
| Cta Pelvis (72191) |
$1,087.80 |
$1,813 |
6.2× |
| Cystography minimum 3 views rs&i (74430) |
$453.60 |
$756 |
1.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$297.30 |
$495.50 |
2.8× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$295.50 |
$492.50 |
3.4× |
| Esophagus (74220) |
$626.70 |
$1,044.50 |
3.6× |
| Fluoroscopy up to 1 hr (76000) |
$394.95 |
$658.25 |
1.7× |
| Foot 2 views (73620) |
$187.20 |
$312 |
2.1× |
| Forearm 2 views (73090) |
$184.20 |
$307 |
2.1× |
| Hand 2 views (73120) |
$193.50 |
$322.50 |
1.8× |
| Hand 3 views (73130) |
$225.60 |
$376 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$205.80 |
$343 |
2.4× |
| Knee 3 views (73562) |
$253.50 |
$422.50 |
2.9× |
| Mammary ductogram or galactogram multiple (77054) |
$408.60 |
$681 |
1.7× |
| Mammary ductogram or galactogram single (77053) |
$318.30 |
$530.50 |
1.3× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$271.80 |
$453 |
3.1× |
| MRA head w & w/o contrast (70546) |
$1,721.70 |
$2,869.50 |
4.9× |
| MRA head w/o contrast (70544) |
$1,784.10 |
$2,973.50 |
7.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,737.20 |
$4,562 |
7.8× |
| MRA neck w/o contrast (70547) |
$1,793.40 |
$2,989 |
7.5× |
| MRI abdomen w contrast (74182) |
$1,359.60 |
$2,266 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,340.30 |
$3,900.50 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$1,548 |
$2,580 |
6.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,812 |
$3,020 |
2.3× |
| MRI bone marrow blood supply (77084) |
$1,359.60 |
$2,266 |
5.7× |
| MRI c-spine with contrast (72142) |
$1,450.50 |
$2,417.50 |
4.2× |
| MRI cardiac w/o contrast (75557) |
$1,359.60 |
$2,266 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,239.60 |
$2,066 |
5.2× |
| MRI chest w/o & w/contrast material (71552) |
$3,158.70 |
$5,264.50 |
9.0× |
| MRI chest w/o contrast (71550) |
$2,258.70 |
$3,764.50 |
9.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,450.50 |
$2,417.50 |
4.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,631.25 |
$2,718.75 |
4.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,491.60 |
$2,486 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,191 |
$1,985 |
5.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,214.90 |
$3,691.50 |
6.3× |
| MRI orbit/face/neck w/contrast (70542) |
$1,450.50 |
$2,417.50 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,721.70 |
$2,869.50 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,545.30 |
$2,575.50 |
6.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,766.85 |
$2,944.75 |
5.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,145.30 |
$3,575.50 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,091.90 |
$3,486.50 |
6.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,450.50 |
$2,417.50 |
4.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,086.50 |
$3,477.50 |
6.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,450.50 |
$2,417.50 |
4.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,094.90 |
$3,491.50 |
6.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,242.30 |
$2,070.50 |
5.2× |
| MRI tmj (70336) |
$1,359.60 |
$2,266 |
5.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,305.90 |
$2,176.50 |
5.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,812 |
$3,020 |
5.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,678.80 |
$2,798 |
7.0× |
| Neck soft tissue (70360) |
$201 |
$335 |
2.3× |
| Osseous survey limited (77074) |
$460.50 |
$767.50 |
4.4× |
| Pelvis 1 or 2 views (72170) |
$225.60 |
$376 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,330.40 |
$3,884 |
6.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$295.50 |
$492.50 |
0.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$267 |
$445 |
2.5× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$204.60 |
$341 |
2.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$204.60 |
$341 |
2.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$194.10 |
$323.50 |
2.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$216.90 |
$361.50 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$1,058.70 |
$1,764.50 |
6.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$946.80 |
$1,578 |
5.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$408.60 |
$681 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$234.30 |
$390.50 |
2.7× |
| Radiological examination surgical specimen (76098) |
$123 |
$205 |
0.2× |
| Ribs bilateral 3 views (71110) |
$285 |
$475 |
2.7× |
| Scapula complete (73010) |
$216.30 |
$360.50 |
2.1× |
| Sella turcica (70240) |
$159.30 |
$265.50 |
1.8× |
| Small bowel series (74250) |
$534.90 |
$891.50 |
3.0× |
| Spine thoracic 3 views (72072) |
$247.20 |
$412 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$448.20 |
$747 |
4.3× |
| Us breast unilateral limited (76642) |
$433.20 |
$722 |
5.0× |
| Us chest (76604) |
$91.50 |
$152.50 |
0.9× |
| Us compl joint r-t w/image documentation (76881) |
$295.50 |
$492.50 |
2.8× |
| Us guided compression repair (76936) |
$346.50 |
$577.50 |
1.6× |
| Us ob detailed single fetus (76811) |
$453.60 |
$756 |
1.9× |
| Us pelvic non ob complete (76856) |
$836.10 |
$1,393.50 |
8.0× |
| Us pregnancy ltd (76815) |
$416.40 |
$694 |
4.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$385.50 |
$642.50 |
3.7× |
| Us retroperitoneal complete (76770) |
$554.40 |
$924 |
5.3× |
| Us retroperitoneal limited (76775) |
$288 |
$480 |
2.8× |
| Us scrotum and contents (76870) |
$335.70 |
$559.50 |
3.2× |
| Us soft tissue head/neck (76536) |
$566.10 |
$943.50 |
5.4× |
| Us xtr non-vasc lmtd (76882) |
$284.40 |
$474 |
2.7× |
| Vertebral fracture assessment via dxa (77086) |
$218.10 |
$363.50 |
2.5× |
| Wrist 2 views (73100) |
$223.20 |
$372 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$318.90 |
$531.50 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$254.10 |
$423.50 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$223.80 |
$373 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$566.70 |
$944.50 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$193.50 |
$322.50 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$223.80 |
$373 |
2.6× |
| X-ray exam entire spi 4/5 vw (72083) |
$530.10 |
$883.50 |
5.1× |
| X-ray exam hip uni 1 view (73501) |
$408.60 |
$681 |
4.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$248.70 |
$414.50 |
2.9× |
| X-ray exam of femur 1 (73551) |
$159.30 |
$265.50 |
1.8× |
| X-ray eye for foreign body (70030) |
$118.80 |
$198 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$294.30 |
$490.50 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$208.80 |
$348 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$193.50 |
$322.50 |
2.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$476.40 |
$794 |
2.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$281.10 |
$468.50 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$271.80 |
$453 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$385.50 |
$642.50 |
3.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$318.30 |
$530.50 |
3.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$233.70 |
$389.50 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$204.60 |
$341 |
2.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$268.80 |
$448 |
2.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$831.30 |
$1,385.50 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$237.30 |
$395.50 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$272.40 |
$454 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$335.70 |
$559.50 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$234.30 |
$390.50 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$201 |
$335 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$210 |
$350 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$267.60 |
$446 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$204.60 |
$341 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$259.50 |
$432.50 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$159.30 |
$265.50 |
1.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$257.10 |
$428.50 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$212.70 |
$354.50 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$242.40 |
$404 |
2.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$179.70 |
$299.50 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$247.80 |
$413 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$398.70 |
$664.50 |
3.8× |
| Xr chest 4+ views (71048) |
$385.50 |
$642.50 |
3.7× |
| Xr finger(s) 2+ views (73140) |
$227.40 |
$379 |
2.6× |
| Xr internal auditory meati complete (70134) |
$204.60 |
$341 |
0.4× |
| Xr optic foramina (70190) |
$204.60 |
$341 |
2.3× |
| Xr shoulder 1 view (73020) |
$136.50 |
$227.50 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$323.10 |
$538.50 |
3.1× |
| Xr tibia/fibula 2 views (73590) |
$204 |
$340 |
2.3× |
| Xr tmj bilateral (70330) |
$204.60 |
$341 |
2.3× |
| Xray knee 1 or 2 views rt (73560) |
$220.50 |
$367.50 |
2.5× |