| Abdomen 2 views (74019) |
$177.30 |
$591 |
1.8× |
| Ankle 2 views (73600) |
$303 |
$1,010 |
3.6× |
| Bone age studies (77072) |
$106.50 |
$355 |
1.1× |
| Bone survey complete (77075) |
$459.60 |
$1,532 |
4.6× |
| Cervical spine 2 or 3 views (72040) |
$334.80 |
$1,116 |
4.0× |
| Chest 1 view (71045) |
$117.90 |
$393 |
1.4× |
| Chest 3 views (71047) |
$194.70 |
$649 |
2.3× |
| Clavicle complete (73000) |
$244.20 |
$814 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$429.30 |
$1,431 |
4.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,433.40 |
$4,778 |
4.3× |
| CT abdomen and pelvis without contrast (74176) |
$879.30 |
$2,931 |
3.8× |
| CT abdomen w contrast (74160) |
$1,167.60 |
$3,892 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,176 |
$3,920 |
7.0× |
| CT abdomen w/o contrast (74150) |
$942.60 |
$3,142 |
9.4× |
| CT c-spine w/o contrast (72125) |
$1,054.20 |
$3,514 |
10.5× |
| CT cere prfuj alys c+ w/o CT/CTA same anatomy (70473) |
$161.40 |
$538 |
1.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,598.10 |
$5,327 |
9.5× |
| CT cervical spine with contrast (72126) |
$1,374.60 |
$4,582 |
4.1× |
| CT chest w/wo contrast (71270) |
$1,387.20 |
$4,624 |
8.2× |
| CT chest with contrast (71260) |
$1,196.70 |
$3,989 |
7.1× |
| CT head/brain with contrast (70460) |
$214.80 |
$716 |
1.3× |
| CT head/brain without and with contrast (70470) |
$1,395.60 |
$4,652 |
8.3× |
| CT iac w contrast (70481) |
$1,025.40 |
$3,418 |
6.1× |
| CT lower ext w/o (73700) |
$1,218 |
$4,060 |
12.1× |
| CT lower extremity w wo contrast (73702) |
$1,158.60 |
$3,862 |
6.9× |
| CT lower extremity with contrast (73701) |
$1,053.90 |
$3,513 |
6.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,284.30 |
$4,281 |
7.6× |
| CT lumbar spine w/o contrast (72131) |
$1,045.80 |
$3,486 |
10.4× |
| CT lumbar spine with contrast (72132) |
$1,167.60 |
$3,892 |
3.5× |
| CT maxillofacial w contrast (70487) |
$1,090.50 |
$3,635 |
6.5× |
| CT maxillofacial w/o contrast (70486) |
$772.50 |
$2,575 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,134.90 |
$3,783 |
6.7× |
| CT neck soft tissue w contrast (70491) |
$1,155.90 |
$3,853 |
6.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,353.60 |
$4,512 |
8.0× |
| CT orbits w/o contrast (70480) |
$917.40 |
$3,058 |
9.1× |
| CT pelvis w & w/o contrast (72194) |
$1,190.70 |
$3,969 |
7.1× |
| CT pelvis w/o contrast (72192) |
$670.50 |
$2,235 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,243.20 |
$4,144 |
7.4× |
| CT soft tissue neck w/o contrast (70490) |
$781.50 |
$2,605 |
7.8× |
| CT thoracic spine w/contrast (72129) |
$993.90 |
$3,313 |
5.9× |
| CT thoracic spine w/o contrast (72128) |
$903.60 |
$3,012 |
9.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,519.80 |
$5,066 |
9.0× |
| CT thorax w/o contrast (71250) |
$977.40 |
$3,258 |
9.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,004.40 |
$3,348 |
6.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,107 |
$3,690 |
11.0× |
| CT upper extremity with contrast (73201) |
$1,141.12 |
$3,803.75 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,414.80 |
$4,716 |
8.4× |
| Cta Abdomen (74175) |
$1,416.90 |
$4,723 |
8.4× |
| CTA abdomen pelvis (74174) |
$1,911.30 |
$6,371 |
5.7× |
| CTA chest (71275) |
$477 |
$1,590 |
2.8× |
| Cta Head (70496) |
$1,414.80 |
$4,716 |
8.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,670.70 |
$5,569 |
5.0× |
| CTA lwr ext w&w/o contrast (73706) |
$1,607.62 |
$5,358.75 |
9.5× |
| Cta Neck (70498) |
$1,454.40 |
$4,848 |
8.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$245.10 |
$817 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$156.60 |
$522 |
1.9× |
| Fetal biophysical profile non-stress testing (76818) |
$114.90 |
$383 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$248.40 |
$828 |
1.1× |
| Foot 2 views (73620) |
$312 |
$1,040 |
3.7× |
| Forearm 2 views (73090) |
$313.50 |
$1,045 |
3.7× |
| Hand 2 views (73120) |
$302.62 |
$1,008.75 |
3.0× |
| Hand 3 views (73130) |
$372 |
$1,240 |
4.4× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$417.60 |
$1,392 |
0.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$417.30 |
$1,391 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$330.38 |
$1,101.25 |
3.9× |
| Knee 3 views (73562) |
$351 |
$1,170 |
4.2× |
| MRA head w/o contrast (70544) |
$764.70 |
$2,549 |
3.3× |
| MRA head with contrast (70545) |
$844.80 |
$2,816 |
2.5× |
| MRA neck w/o contrast (70547) |
$764.70 |
$2,549 |
3.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,699.20 |
$5,664 |
2.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,698.30 |
$5,661 |
2.3× |
| MRI c-spine with contrast (72142) |
$1,306.20 |
$4,354 |
3.9× |
| MRI cervical spine w/o contrast (72141) |
$1,187.10 |
$3,957 |
5.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,471.20 |
$4,904 |
4.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,759.20 |
$5,864 |
5.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,599.90 |
$5,333 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$267.30 |
$891 |
1.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,409.70 |
$4,699 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,660.50 |
$5,535 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$245.70 |
$819 |
1.1× |
| MRI scan of arm joint before and after contrast (73223) |
$1,698.30 |
$5,661 |
5.1× |
| MRI scan of leg joint before and after contrast (73723) |
$1,869 |
$6,230 |
5.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,803.30 |
$6,011 |
5.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,698.30 |
$5,661 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,734.30 |
$5,781 |
5.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,736.40 |
$5,788 |
5.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,770.90 |
$5,903 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,578.30 |
$5,261 |
6.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,081.25 |
$6,937.50 |
9.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,449 |
$4,830 |
4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,420.80 |
$4,736 |
6.2× |
| Myocardial Spect Multiple Studies (78452) |
$1,541.40 |
$5,138 |
1.2× |
| Neck soft tissue (70360) |
$134.10 |
$447 |
1.6× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$281.70 |
$939 |
2.8× |
| Osseous survey infant (77076) |
$120 |
$400 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$273 |
$910 |
2.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,935.90 |
$6,453 |
5.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$257.40 |
$858 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$129.30 |
$431 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$272.70 |
$909 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$120 |
$400 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$110.10 |
$367 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$195 |
$650 |
1.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$177 |
$590 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$252.30 |
$841 |
3.0× |
| Ribs bilateral 3 views (71110) |
$354.30 |
$1,181 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$119.40 |
$398 |
1.2× |
| Scapula complete (73010) |
$248.40 |
$828 |
2.5× |
| Screening digital breast tomosynthesis (77063) |
$53.70 |
$179 |
2.3× |
| Spine thoracic 3 views (72072) |
$357.30 |
$1,191 |
3.6× |
| Thoracolumbar 2 views (72080) |
$242.10 |
$807 |
2.9× |
| Tmj unilateral (70328) |
$66.60 |
$222 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$380.40 |
$1,268 |
3.8× |
| Umbilical-artery Doppler (OB) (76820) |
$212.70 |
$709 |
2.1× |
| Upper Extremity Infant (73092) |
$127.50 |
$425 |
1.3× |
| Us abdl aorta screen aaa (76706) |
$256.80 |
$856 |
2.6× |
| Us breast unilateral complete (76641) |
$463.20 |
$1,544 |
4.6× |
| Us breast unilateral limited (76642) |
$337.80 |
$1,126 |
4.0× |
| Us chest (76604) |
$129.30 |
$431 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$337.80 |
$1,126 |
3.4× |
| Us ob detailed single fetus (76811) |
$573.90 |
$1,913 |
2.5× |
| Us ob transvaginal (76817) |
$207.30 |
$691 |
2.1× |
| Us pelvic non ob complete (76856) |
$462.60 |
$1,542 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$240.60 |
$802 |
2.4× |
| Us pregnancy ltd (76815) |
$304.20 |
$1,014 |
3.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$369.90 |
$1,233 |
3.7× |
| Us retroperitoneal complete (76770) |
$481.20 |
$1,604 |
4.8× |
| Us retroperitoneal limited (76775) |
$463.50 |
$1,545 |
4.6× |
| Us scrotum and contents (76870) |
$345 |
$1,150 |
3.4× |
| Us soft tissue head/neck (76536) |
$308.70 |
$1,029 |
3.1× |
| Us xtr non-vasc lmtd (76882) |
$305.62 |
$1,018.75 |
3.0× |
| Wrist 2 views (73100) |
$292.88 |
$976.25 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$287.10 |
$957 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$374.25 |
$1,247.50 |
4.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$246.30 |
$821 |
2.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$281.70 |
$939 |
3.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$318 |
$1,060 |
3.2× |
| X-ray exam hip uni 1 view (73501) |
$163.20 |
$544 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$247.80 |
$826 |
3.0× |
| X-ray exam hip uni 4/> views (73503) |
$272.70 |
$909 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$294 |
$980 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$350.70 |
$1,169 |
3.5× |
| X-ray exam of femur 1 (73551) |
$111.30 |
$371 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$522 |
$1,740 |
5.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$213.90 |
$713 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$377.25 |
$1,257.50 |
4.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$277.50 |
$925 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$78.90 |
$263 |
0.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$405.38 |
$1,351.25 |
4.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$168.60 |
$562 |
2.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$66.60 |
$222 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$330.30 |
$1,101 |
3.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$377.10 |
$1,257 |
3.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$120 |
$400 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$218.40 |
$728 |
2.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$121.50 |
$405 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$210.30 |
$701 |
2.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$300.90 |
$1,003 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$70.20 |
$234 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$350.70 |
$1,169 |
3.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$358.50 |
$1,195 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$141.90 |
$473 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$246.90 |
$823 |
2.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$348 |
$1,160 |
4.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$342 |
$1,140 |
4.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$70.20 |
$234 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$129.30 |
$431 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$211.80 |
$706 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$70.20 |
$234 |
0.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$232.50 |
$775 |
2.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$301.50 |
$1,005 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$393 |
$1,310 |
3.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$212.40 |
$708 |
2.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$361.12 |
$1,203.75 |
4.3× |
| Xr c-spine 6 or more views (72052) |
$420.60 |
$1,402 |
4.2× |
| Xr chest 4+ views (71048) |
$120 |
$400 |
1.2× |
| Xr finger(s) 2+ views (73140) |
$231.90 |
$773 |
2.8× |
| Xr shoulder 1 view (73020) |
$240 |
$800 |
2.9× |
| Xr spine cervical 4 or 5 views (72050) |
$412.80 |
$1,376 |
4.1× |
| Xr tibia/fibula 2 views (73590) |
$264 |
$880 |
3.2× |
| Xr tmj bilateral (70330) |
$227.70 |
$759 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$336.38 |
$1,121.25 |
4.0× |