| Abdomen 2 views (74019) |
$280.50 |
$280.50 |
2.6× |
| Ankle 2 views (73600) |
$190 |
$190 |
2.1× |
| Arthrogram hip (73525) |
$568.50 |
$568.50 |
1.6× |
| Arthrogram shoulder (73040) |
$666.50 |
$666.50 |
1.9× |
| Bone age studies (77072) |
$215 |
$215 |
2.0× |
| Bone survey complete (77075) |
$261.50 |
$261.50 |
2.4× |
| Cervical spine 2 or 3 views (72040) |
$292 |
$292 |
3.3× |
| Chest 1 view (71045) |
$162 |
$162 |
1.8× |
| Chest 3 views (71047) |
$341 |
$341 |
3.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$343 |
$343 |
1.9× |
| Clavicle complete (73000) |
$200 |
$200 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$323.50 |
$323.50 |
3.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,689.50 |
$2,689.50 |
7.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,296 |
$2,296 |
9.4× |
| CT abdomen w contrast (74160) |
$1,533.50 |
$1,533.50 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,449 |
$1,449 |
8.1× |
| CT abdomen w/o contrast (74150) |
$1,181 |
$1,181 |
11.1× |
| CT angiography upper extremity lt (73206) |
$1,647.50 |
$1,647.50 |
9.2× |
| CT c-spine w/o contrast (72125) |
$1,326 |
$1,326 |
12.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,380 |
$1,380 |
7.7× |
| CT cervical spine with contrast (72126) |
$1,242.50 |
$1,242.50 |
3.5× |
| CT chest w/wo contrast (71270) |
$1,696 |
$1,696 |
9.5× |
| CT chest with contrast (71260) |
$1,617 |
$1,617 |
9.0× |
| CT head/brain with contrast (70460) |
$1,231 |
$1,231 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,382 |
$1,382 |
7.7× |
| CT iac w contrast (70481) |
$1,099 |
$1,099 |
6.1× |
| CT limited/localized follow up study (76380) |
$750.50 |
$750.50 |
8.4× |
| CT lower ext w/o (73700) |
$1,088 |
$1,088 |
10.2× |
| CT lower extremity w wo contrast (73702) |
$2,603 |
$2,603 |
14.5× |
| CT lower extremity with contrast (73701) |
$1,287.50 |
$1,287.50 |
7.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,452 |
$1,452 |
8.1× |
| CT lumbar spine w/o contrast (72131) |
$1,334 |
$1,334 |
12.5× |
| CT lumbar spine with contrast (72132) |
$1,471.50 |
$1,471.50 |
4.1× |
| CT maxillofacial w contrast (70487) |
$1,551.50 |
$1,551.50 |
8.7× |
| CT maxillofacial w/o contrast (70486) |
$1,185.50 |
$1,185.50 |
11.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,706 |
$1,706 |
9.5× |
| CT neck soft tissue w contrast (70491) |
$1,482.50 |
$1,482.50 |
8.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,353.50 |
$1,353.50 |
7.6× |
| CT orbits w/o contrast (70480) |
$835.50 |
$835.50 |
7.8× |
| CT pelvis w & w/o contrast (72194) |
$1,358.50 |
$1,358.50 |
7.6× |
| CT pelvis w/o contrast (72192) |
$1,160 |
$1,160 |
10.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,548 |
$1,548 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,232.50 |
$1,232.50 |
11.5× |
| CT thoracic spine w/contrast (72129) |
$1,474.50 |
$1,474.50 |
8.2× |
| CT thoracic spine w/o contrast (72128) |
$1,462 |
$1,462 |
13.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,499.50 |
$1,499.50 |
8.4× |
| CT thorax w/o contrast (71250) |
$1,899 |
$1,899 |
17.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,461 |
$2,461 |
13.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,040 |
$1,040 |
9.7× |
| CT upper extremity with contrast (73201) |
$1,131 |
$1,131 |
3.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,809 |
$3,809 |
21.3× |
| Cta Abdomen (74175) |
$1,600.50 |
$1,600.50 |
8.9× |
| CTA abdomen pelvis (74174) |
$2,418.50 |
$2,418.50 |
6.8× |
| CTA chest (71275) |
$3,101 |
$3,101 |
17.3× |
| Cta Head (70496) |
$2,644 |
$2,644 |
14.8× |
| CTA lwr ext w&w/o contrast (73706) |
$2,919 |
$2,919 |
16.3× |
| Cta Neck (70498) |
$1,662 |
$1,662 |
9.3× |
| Cta Pelvis (72191) |
$1,520 |
$1,520 |
8.5× |
| Cystography minimum 3 views rs&i (74430) |
$428.50 |
$428.50 |
1.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$652 |
$652 |
6.1× |
| Echoencephalography real time imaging (76506) |
$583.50 |
$583.50 |
5.5× |
| Esophagus (74220) |
$395 |
$395 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$472.50 |
$472.50 |
4.4× |
| Fluoroscopy up to 1 hr (76000) |
$415.50 |
$415.50 |
1.7× |
| Foot 2 views (73620) |
$173.50 |
$173.50 |
2.0× |
| Forearm 2 views (73090) |
$193 |
$193 |
2.2× |
| Hand 2 views (73120) |
$203.50 |
$203.50 |
1.9× |
| Hand 3 views (73130) |
$205.50 |
$205.50 |
2.3× |
| Humerus Min 2 Views Left (73060) |
$190.50 |
$190.50 |
2.1× |
| Hysterosalpingogram (74740) |
$357.50 |
$357.50 |
1.5× |
| Knee 3 views (73562) |
$221 |
$221 |
2.5× |
| Mammary ductogram or galactogram single (77053) |
$671 |
$671 |
2.8× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$240 |
$240 |
2.7× |
| MRA head w & w/o contrast (70546) |
$2,604 |
$2,604 |
7.3× |
| MRA head w/o contrast (70544) |
$1,888.50 |
$1,888.50 |
7.7× |
| MRA neck w contrast (70548) |
$4,058 |
$4,058 |
11.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,421.50 |
$2,421.50 |
6.8× |
| MRA neck w/o contrast (70547) |
$2,003.50 |
$2,003.50 |
8.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,986.50 |
$1,986.50 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,617 |
$1,617 |
6.6× |
| MRI c-spine with contrast (72142) |
$1,814.50 |
$1,814.50 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,612.50 |
$1,612.50 |
6.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,545.50 |
$2,545.50 |
7.1× |
| MRI chest w/o contrast (71550) |
$2,172.50 |
$2,172.50 |
8.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,469 |
$2,469 |
10.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,058.50 |
$2,058.50 |
8.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,261.50 |
$2,261.50 |
6.3× |
| MRI orbit/face/neck w/contrast (70542) |
$2,057 |
$2,057 |
5.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,188 |
$2,188 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,689 |
$1,689 |
6.9× |
| MRI scan of arm joint before and after contrast (73223) |
$3,331 |
$3,331 |
9.3× |
| MRI scan of leg joint before and after contrast (73723) |
$3,953 |
$3,953 |
11.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,159 |
$2,159 |
6.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,999.50 |
$1,999.50 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,151.50 |
$2,151.50 |
6.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,839.50 |
$1,839.50 |
5.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,173.50 |
$2,173.50 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,637 |
$1,637 |
6.7× |
| MRI tmj (70336) |
$1,445.50 |
$1,445.50 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,685 |
$2,685 |
11.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,797 |
$3,797 |
10.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,469 |
$2,469 |
10.1× |
| Neck soft tissue (70360) |
$180 |
$180 |
2.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$134 |
$134 |
1.3× |
| Osseous survey infant (77076) |
$218 |
$218 |
2.0× |
| Osseous survey limited (77074) |
$123.50 |
$123.50 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$217.50 |
$217.50 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,758 |
$3,758 |
10.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$424 |
$424 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$348 |
$348 |
3.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,124 |
$1,124 |
10.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$240.50 |
$240.50 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$432.50 |
$432.50 |
4.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$270 |
$270 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$196.50 |
$196.50 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$306 |
$306 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$241 |
$241 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$450 |
$450 |
2.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$421 |
$421 |
2.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$463.50 |
$463.50 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$505.50 |
$505.50 |
2.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$219 |
$219 |
2.5× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$287.50 |
$287.50 |
3.2× |
| Radiological examination surgical specimen (76098) |
$63 |
$63 |
0.1× |
| Ribs bilateral 3 views (71110) |
$371 |
$371 |
3.5× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$433 |
$433 |
1.8× |
| Scanogram (77073) |
$116 |
$116 |
1.1× |
| Scapula complete (73010) |
$193.50 |
$193.50 |
1.8× |
| Screening digital breast tomosynthesis (77063) |
$125 |
$125 |
5.3× |
| Sella turcica (70240) |
$148 |
$148 |
1.7× |
| Sialogram (70390) |
$149 |
$149 |
0.6× |
| Small bowel series (74250) |
$204 |
$204 |
1.1× |
| Spine thoracic 3 views (72072) |
$277.50 |
$277.50 |
2.6× |
| Therapeutic Enema (74283) |
$520 |
$520 |
2.9× |
| Thoracolumbar 2 views (72080) |
$164.50 |
$164.50 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$554 |
$554 |
5.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$12.10 |
$12.10 |
0.1× |
| Unlisted Ultrasound Procedure (76999) |
$254.50 |
$254.50 |
2.9× |
| Upper Extremity Infant (73092) |
$176 |
$176 |
1.6× |
| Urethrocystography retrograde rs&i (74450) |
$349 |
$349 |
1.4× |
| Urethrocystography voiding (74455) |
$419.50 |
$419.50 |
1.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$513 |
$513 |
2.9× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$1,149 |
$1,149 |
6.4× |
| Us abdl aorta screen aaa (76706) |
$638 |
$638 |
6.0× |
| Us breast unilateral complete (76641) |
$311 |
$311 |
2.9× |
| Us breast unilateral limited (76642) |
$457 |
$457 |
5.1× |
| Us chest (76604) |
$405 |
$405 |
3.8× |
| Us ob transvaginal (76817) |
$413 |
$413 |
3.9× |
| Us pelvic non ob complete (76856) |
$448 |
$448 |
4.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$263 |
$263 |
2.5× |
| Us pregnancy ltd (76815) |
$262 |
$262 |
2.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$495 |
$495 |
4.6× |
| Us retroperitoneal complete (76770) |
$480.50 |
$480.50 |
4.5× |
| Us retroperitoneal limited (76775) |
$447 |
$447 |
4.2× |
| Us scrotum and contents (76870) |
$410 |
$410 |
3.8× |
| Us soft tissue head/neck (76536) |
$433 |
$433 |
4.1× |
| Us spinal canal and contents (76800) |
$358 |
$358 |
3.4× |
| Us xtr non-vasc lmtd (76882) |
$134 |
$134 |
1.3× |
| Wrist 2 views (73100) |
$147 |
$147 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$234 |
$234 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$211 |
$211 |
2.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$262 |
$262 |
2.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$706 |
$706 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$175 |
$175 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$239 |
$239 |
2.7× |
| X-ray exam hip uni 1 view (73501) |
$183.50 |
$183.50 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$152 |
$152 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$342 |
$342 |
3.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$300.50 |
$300.50 |
2.8× |
| X-ray exam of femur 1 (73551) |
$194.50 |
$194.50 |
2.2× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$119 |
$119 |
0.7× |
| X-ray eye for foreign body (70030) |
$46 |
$46 |
0.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$245.50 |
$245.50 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$180 |
$180 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$261.50 |
$261.50 |
2.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$172 |
$172 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$198.50 |
$198.50 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$534 |
$534 |
5.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$196 |
$196 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$174.50 |
$174.50 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$173 |
$173 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$427 |
$427 |
4.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$147.50 |
$147.50 |
1.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$191.50 |
$191.50 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$380 |
$380 |
3.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$259.50 |
$259.50 |
2.4× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$116 |
$116 |
0.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,017 |
$1,017 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$216 |
$216 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$77 |
$77 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$476.50 |
$476.50 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$279.50 |
$279.50 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$203.50 |
$203.50 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$266.50 |
$266.50 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$324.50 |
$324.50 |
3.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$176 |
$176 |
2.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$402 |
$402 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$255 |
$255 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$124.50 |
$124.50 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$239.50 |
$239.50 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$228.50 |
$228.50 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$193 |
$193 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$161 |
$161 |
1.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$207.50 |
$207.50 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$428.50 |
$428.50 |
4.0× |
| Xr chest 4+ views (71048) |
$411.50 |
$411.50 |
3.9× |
| Xr Cholecystography Oral Contrast (74290) |
$158 |
$158 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$43 |
$43 |
0.5× |
| XR Mastoids < 3 Views Bilateral (70120) |
$217.50 |
$217.50 |
2.0× |
| Xr optic foramina (70190) |
$360 |
$360 |
4.0× |
| Xr shoulder 1 view (73020) |
$176.50 |
$176.50 |
2.0× |
| Xr spine cervical 4 or 5 views (72050) |
$443.50 |
$443.50 |
4.2× |
| Xr tibia/fibula 2 views (73590) |
$204.50 |
$204.50 |
2.3× |
| Xr tmj bilateral (70330) |
$285 |
$285 |
3.2× |
| Xray knee 1 or 2 views rt (73560) |
$182.50 |
$182.50 |
2.1× |