| Abdomen 2 views (74019) |
$174 |
$232 |
1.8× |
| Bone age studies (77072) |
$177.71 |
$236.95 |
1.8× |
| Bone survey complete (77075) |
$645.68 |
$860.90 |
6.7× |
| Cervical spine 2 or 3 views (72040) |
$224.25 |
$299 |
2.8× |
| Chest 1 view (71045) |
$157.57 |
$210.09 |
2.0× |
| Chest 3 views (71047) |
$200.12 |
$266.82 |
2.5× |
| Clavicle complete (73000) |
$145.72 |
$194.29 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,237.50 |
$1,650 |
12.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,743.75 |
$2,325 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,162.50 |
$1,550 |
5.3× |
| CT abdomen w contrast (74160) |
$1,743.75 |
$2,325 |
10.8× |
| CT abdomen w wo contrast (74170) |
$1,584.38 |
$2,112.50 |
9.8× |
| CT abdomen w/o contrast (74150) |
$1,490.62 |
$1,987.50 |
15.5× |
| CT c-spine w/o contrast (72125) |
$1,743.75 |
$2,325 |
18.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,743.75 |
$2,325 |
10.8× |
| CT cervical spine with contrast (72126) |
$1,282.50 |
$1,710 |
4.0× |
| CT chest w/wo contrast (71270) |
$1,680.75 |
$2,241 |
10.4× |
| CT chest with contrast (71260) |
$1,171.88 |
$1,562.50 |
7.3× |
| CT head/brain with contrast (70460) |
$1,237.50 |
$1,650 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,240.50 |
$1,654 |
7.7× |
| CT iac w contrast (70481) |
$1,201.50 |
$1,602 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,364.25 |
$1,819 |
8.5× |
| CT lumbar spine w/o contrast (72131) |
$1,743.75 |
$2,325 |
18.1× |
| CT lumbar spine with contrast (72132) |
$1,743.75 |
$2,325 |
5.4× |
| CT maxillofacial w contrast (70487) |
$1,743.75 |
$2,325 |
10.8× |
| CT maxillofacial w/o contrast (70486) |
$1,200 |
$1,600 |
12.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,240.50 |
$1,654 |
7.7× |
| CT neck soft tissue w contrast (70491) |
$1,181.25 |
$1,575 |
7.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,332.75 |
$1,777 |
8.3× |
| CT orbits w/o contrast (70480) |
$1,201.50 |
$1,602 |
12.5× |
| CT pelvis w & w/o contrast (72194) |
$1,282.50 |
$1,710 |
8.0× |
| CT pelvis w/o contrast (72192) |
$1,237.50 |
$1,650 |
12.9× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$238.24 |
$317.65 |
3.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,240.50 |
$1,654 |
7.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,162.50 |
$1,550 |
12.1× |
| CT thoracic spine w/contrast (72129) |
$1,323 |
$1,764 |
8.2× |
| CT thoracic spine w/o contrast (72128) |
$1,263.75 |
$1,685 |
13.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,743.75 |
$2,325 |
10.8× |
| CT thorax w/o contrast (71250) |
$1,237.50 |
$1,650 |
12.9× |
| CT upper extremity with contrast (73201) |
$1,490.62 |
$1,987.50 |
4.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,593.46 |
$2,124.61 |
9.9× |
| Cta Abdomen (74175) |
$1,162.50 |
$1,550 |
7.2× |
| CTA abdomen pelvis (74174) |
$2,172.80 |
$2,897.06 |
6.8× |
| CTA chest (71275) |
$1,458.41 |
$1,944.55 |
9.0× |
| Cta Head (70496) |
$1,477.36 |
$1,969.81 |
9.2× |
| Cta Neck (70498) |
$1,478.54 |
$1,971.39 |
9.2× |
| Cystography minimum 3 views rs&i (74430) |
$569.18 |
$758.90 |
1.8× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$347.25 |
$463 |
3.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$252.40 |
$336.53 |
2.6× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$140.33 |
$187.10 |
1.8× |
| Esophagus (74220) |
$344.76 |
$459.68 |
2.1× |
| Fetal biophysical profile non-stress testing (76818) |
$180.41 |
$240.55 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$326.25 |
$435 |
3.4× |
| Forearm 2 views (73090) |
$158.75 |
$211.67 |
2.0× |
| Humerus Min 2 Views Left (73060) |
$175.34 |
$233.78 |
2.2× |
| MRA head w & w/o contrast (70546) |
$2,613.75 |
$3,485 |
8.1× |
| MRA head w/o contrast (70544) |
$1,743.75 |
$2,325 |
7.9× |
| MRA head with contrast (70545) |
$1,818.75 |
$2,425 |
5.7× |
| MRA neck w contrast (70548) |
$1,818.75 |
$2,425 |
5.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,613.75 |
$3,485 |
8.1× |
| MRA neck w/o contrast (70547) |
$1,743.75 |
$2,325 |
7.9× |
| MRI abdomen w contrast (74182) |
$1,818.75 |
$2,425 |
5.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,613.75 |
$3,485 |
8.1× |
| MRI abdomen w/o contrast (74181) |
$1,743.75 |
$2,325 |
7.9× |
| MRI any jnt lwr ext with con lt (73722) |
$1,818.75 |
$2,425 |
2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,818.75 |
$2,425 |
2.5× |
| MRI c-spine with contrast (72142) |
$1,818.75 |
$2,425 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,743.75 |
$2,325 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,613.75 |
$3,485 |
8.1× |
| MRI chest w/o contrast (71550) |
$1,743.75 |
$2,325 |
7.9× |
| MRI chest with contrast (71551) |
$1,818.75 |
$2,425 |
2.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,818.75 |
$2,425 |
5.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,818.75 |
$2,425 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,743.75 |
$2,325 |
7.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,743.75 |
$2,325 |
7.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,613.75 |
$3,485 |
8.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,818.75 |
$2,425 |
5.7× |
| MRI pelvis w contrast (72196) |
$1,818.75 |
$2,425 |
5.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,613.75 |
$3,485 |
8.1× |
| MRI pelvis w/o contrast (72195) |
$1,743.75 |
$2,325 |
7.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,613.75 |
$3,485 |
8.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,613.75 |
$3,485 |
8.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,613.75 |
$3,485 |
8.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,818.75 |
$2,425 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,613.75 |
$3,485 |
8.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,818.75 |
$2,425 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,613.75 |
$3,485 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,743.75 |
$2,325 |
7.9× |
| MRI tmj (70336) |
$1,743.75 |
$2,325 |
7.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,743.75 |
$2,325 |
7.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,613.75 |
$3,485 |
8.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,743.75 |
$2,325 |
7.9× |
| Neck soft tissue (70360) |
$164.68 |
$219.57 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$326.25 |
$435 |
3.4× |
| Osseous survey infant (77076) |
$236.25 |
$315 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$169.49 |
$225.98 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,613.75 |
$3,485 |
8.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$169.49 |
$225.98 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$258 |
$344 |
2.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$171.78 |
$229.04 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$262.50 |
$350 |
2.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$192.23 |
$256.31 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$1,283.89 |
$1,711.85 |
8.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$453.75 |
$605 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$543.79 |
$725.05 |
3.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$146.25 |
$195 |
1.8× |
| Radiological examination surgical specimen (76098) |
$873.86 |
$1,165.15 |
1.7× |
| Ribs bilateral 3 views (71110) |
$171.78 |
$229.04 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$181.27 |
$241.69 |
1.9× |
| Screening digital breast tomosynthesis (77063) |
$102.13 |
$136.17 |
4.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$195 |
$260 |
2.0× |
| Small bowel series (74250) |
$396.89 |
$529.18 |
2.5× |
| Thoracolumbar 2 views (72080) |
$245.24 |
$326.98 |
3.1× |
| Ultrasound, abdomen limited (76705) |
$317.25 |
$423 |
3.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$140.33 |
$187.10 |
1.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$613.70 |
$818.26 |
3.8× |
| Us abdl aorta screen aaa (76706) |
$326.25 |
$435 |
3.4× |
| Us chest (76604) |
$317.25 |
$423 |
3.3× |
| Us compl joint r-t w/image documentation (76881) |
$169.49 |
$225.98 |
1.8× |
| Us infant hips limited static (76886) |
$140.33 |
$187.10 |
1.8× |
| Us ob detailed single fetus (76811) |
$385.25 |
$513.66 |
1.8× |
| Us ob transvaginal (76817) |
$391.50 |
$522 |
4.1× |
| Us pelvic non ob complete (76856) |
$326.25 |
$435 |
3.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$169.49 |
$225.98 |
1.8× |
| Us pregnancy ltd (76815) |
$326.25 |
$435 |
3.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$326.25 |
$435 |
3.4× |
| Us retroperitoneal complete (76770) |
$326.25 |
$435 |
3.4× |
| Us retroperitoneal limited (76775) |
$326.25 |
$435 |
3.4× |
| Us scrotum and contents (76870) |
$169.49 |
$225.98 |
1.8× |
| Us soft tissue head/neck (76536) |
$612.97 |
$817.29 |
6.4× |
| Us transrectal (76872) |
$240 |
$320 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$317.25 |
$423 |
3.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$336.46 |
$448.61 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$187.19 |
$249.58 |
2.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$177.71 |
$236.95 |
2.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,283.89 |
$1,711.85 |
8.0× |
| X-ray exam hip uni 1 view (73501) |
$181.07 |
$241.42 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$220.90 |
$294.53 |
2.8× |
| X-ray eye for foreign body (70030) |
$140.33 |
$187.10 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$241.69 |
$322.25 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$228.66 |
$304.88 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$140.33 |
$187.10 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$176.53 |
$235.37 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$222.73 |
$296.97 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$381.48 |
$508.64 |
4.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$188.37 |
$251.16 |
2.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$143.35 |
$191.13 |
1.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$172.97 |
$230.62 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$170.60 |
$227.46 |
2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$228 |
$304 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$182.45 |
$243.27 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$178.90 |
$238.53 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$247.61 |
$330.14 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$140.33 |
$187.10 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$268.94 |
$358.58 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$182.45 |
$243.27 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$217.99 |
$290.65 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$184.82 |
$246.43 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$170.60 |
$227.46 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$140.33 |
$187.10 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$345.95 |
$461.26 |
3.6× |
| Xr finger(s) 2+ views (73140) |
$140.33 |
$187.10 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$318.75 |
$425 |
3.3× |
| Xray knee 1 or 2 views rt (73560) |
$140.33 |
$187.10 |
1.8× |