| Abdomen 2 views (74019) |
$208.40 |
$260.50 |
2.2× |
| Ankle 2 views (73600) |
$168 |
$210 |
2.1× |
| Bone age studies (77072) |
$219.20 |
$274 |
2.3× |
| Bone survey complete (77075) |
$736 |
$920 |
7.7× |
| Cervical spine 2 or 3 views (72040) |
$251.20 |
$314 |
3.1× |
| Chest 1 view (71045) |
$193.60 |
$242 |
2.4× |
| Clavicle complete (73000) |
$184.80 |
$231 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$718.40 |
$898 |
7.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$748 |
$935 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$704.80 |
$881 |
3.2× |
| CT abdomen w contrast (74160) |
$718.40 |
$898 |
4.5× |
| CT abdomen w wo contrast (74170) |
$748 |
$935 |
4.6× |
| CT abdomen w/o contrast (74150) |
$718.40 |
$898 |
7.5× |
| CT c-spine w/o contrast (72125) |
$691.20 |
$864 |
7.2× |
| CT cervical spine with contrast (72126) |
$691.20 |
$864 |
2.2× |
| CT chest w/wo contrast (71270) |
$733.20 |
$916.50 |
4.5× |
| CT chest with contrast (71260) |
$704 |
$880 |
4.4× |
| CT head/brain with contrast (70460) |
$704 |
$880 |
4.4× |
| CT head/brain without and with contrast (70470) |
$748 |
$935 |
4.6× |
| CT lower ext w/o (73700) |
$704.80 |
$881 |
7.3× |
| CT lower extremity w wo contrast (73702) |
$718.40 |
$898 |
4.5× |
| CT lower extremity with contrast (73701) |
$711.20 |
$889 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$748 |
$935 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$691.20 |
$864 |
7.2× |
| CT lumbar spine with contrast (72132) |
$691.20 |
$864 |
2.2× |
| CT maxillofacial w contrast (70487) |
$711.20 |
$889 |
4.4× |
| CT maxillofacial w/o contrast (70486) |
$704.80 |
$881 |
7.3× |
| CT neck soft tissue w contrast (70491) |
$711.20 |
$889 |
4.4× |
| CT orbits w/o contrast (70480) |
$691.20 |
$864 |
7.2× |
| CT pelvis w & w/o contrast (72194) |
$748 |
$935 |
4.6× |
| CT pelvis w/o contrast (72192) |
$691.20 |
$864 |
7.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$748 |
$935 |
4.6× |
| CT soft tissue neck w/o contrast (70490) |
$691.20 |
$864 |
7.2× |
| CT thoracic spine w/contrast (72129) |
$704 |
$880 |
4.4× |
| CT thoracic spine w/o contrast (72128) |
$691.20 |
$864 |
7.2× |
| CT thorax w/o contrast (71250) |
$704.80 |
$881 |
7.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$733.20 |
$916.50 |
4.5× |
| CT upper extremity w/o contrast rt (73200) |
$704.80 |
$881 |
7.3× |
| CT upper extremity with contrast (73201) |
$711.20 |
$889 |
2.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,920 |
$2,400 |
11.9× |
| Cta Abdomen (74175) |
$1,862.40 |
$2,328 |
11.5× |
| CTA abdomen pelvis (74174) |
$1,920 |
$2,400 |
6.0× |
| CTA chest (71275) |
$1,795.20 |
$2,244 |
11.1× |
| Cta Head (70496) |
$1,817.60 |
$2,272 |
11.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,612.80 |
$4,516 |
11.3× |
| CTA lwr ext w&w/o contrast (73706) |
$409.60 |
$512 |
2.5× |
| Cta Neck (70498) |
$1,795.20 |
$2,244 |
11.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$310.40 |
$388 |
3.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$75.20 |
$94 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$360 |
$450 |
1.6× |
| Foot 2 views (73620) |
$160.40 |
$200.50 |
2.0× |
| Forearm 2 views (73090) |
$195.20 |
$244 |
2.4× |
| Hand 2 views (73120) |
$168 |
$210 |
1.7× |
| Hand 3 views (73130) |
$214.40 |
$268 |
2.7× |
| Humerus Min 2 Views Left (73060) |
$216.80 |
$271 |
2.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$219.20 |
$274 |
2.3× |
| Knee 3 views (73562) |
$235.20 |
$294 |
2.9× |
| MRA head w & w/o contrast (70546) |
$880 |
$1,100 |
2.7× |
| MRA head w/o contrast (70544) |
$880 |
$1,100 |
4.0× |
| MRA head with contrast (70545) |
$880 |
$1,100 |
2.7× |
| MRA neck w contrast (70548) |
$880 |
$1,100 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$880 |
$1,100 |
2.7× |
| MRA neck w/o contrast (70547) |
$880 |
$1,100 |
4.0× |
| MRI abdomen w contrast (74182) |
$760 |
$950 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$760 |
$950 |
2.4× |
| MRI abdomen w/o contrast (74181) |
$760 |
$950 |
3.5× |
| MRI any jnt lwr ext with con lt (73722) |
$760 |
$950 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$760 |
$950 |
1.1× |
| MRI c-spine with contrast (72142) |
$760 |
$950 |
2.4× |
| MRI cervical spine w/o contrast (72141) |
$760 |
$950 |
3.5× |
| MRI chest w/o & w/contrast material (71552) |
$760 |
$950 |
2.4× |
| MRI chest w/o contrast (71550) |
$760 |
$950 |
3.5× |
| MRI chest with contrast (71551) |
$760 |
$950 |
1.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$760 |
$950 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$760 |
$950 |
2.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$760 |
$950 |
3.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$760 |
$950 |
3.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$760 |
$950 |
2.4× |
| MRI orbit/face/neck w/contrast (70542) |
$760 |
$950 |
2.4× |
| MRI pelvis w contrast (72196) |
$760 |
$950 |
2.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$760 |
$950 |
2.4× |
| MRI pelvis w/o contrast (72195) |
$760 |
$950 |
3.5× |
| MRI scan of arm joint before and after contrast (73223) |
$760 |
$950 |
2.4× |
| MRI scan of leg joint before and after contrast (73723) |
$760 |
$950 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$760 |
$950 |
2.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$760 |
$950 |
2.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$760 |
$950 |
2.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$760 |
$950 |
2.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$760 |
$950 |
2.4× |
| MRI thoracic spine w/o contrast (72146) |
$760 |
$950 |
3.5× |
| MRI upper ext joint w/o contrast (73221) |
$760 |
$950 |
3.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$760 |
$950 |
2.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$760 |
$950 |
3.5× |
| Neck soft tissue (70360) |
$203.20 |
$254 |
2.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$158.40 |
$198 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$199.20 |
$249 |
2.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$760 |
$950 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$384 |
$480 |
4.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$178.40 |
$223 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$167.20 |
$209 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$278.40 |
$348 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$219.20 |
$274 |
2.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$242.40 |
$303 |
3.0× |
| Ribs bilateral 3 views (71110) |
$212 |
$265 |
2.2× |
| Sacroiliac Joints < 3 Views (72200) |
$223.20 |
$279 |
2.3× |
| Scanogram (77073) |
$376.80 |
$471 |
3.9× |
| Scapula complete (73010) |
$184.80 |
$231 |
1.9× |
| Small bowel series (74250) |
$341.60 |
$427 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$228.80 |
$286 |
2.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$96.80 |
$121 |
1.2× |
| Unlisted Ultrasound Procedure (76999) |
$228.80 |
$286 |
2.9× |
| Upper Extremity Infant (73092) |
$161.60 |
$202 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$281.60 |
$352 |
2.9× |
| Us breast unilateral complete (76641) |
$193.60 |
$242 |
2.0× |
| Us breast unilateral limited (76642) |
$228.80 |
$286 |
2.9× |
| Us chest (76604) |
$228.80 |
$286 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$228.80 |
$286 |
2.4× |
| Us fetal nuchal translucency 1st gestation (76813) |
$178.40 |
$223 |
1.9× |
| Us ob transvaginal (76817) |
$158.40 |
$198 |
1.6× |
| Us pelvic non ob complete (76856) |
$281.60 |
$352 |
2.9× |
| Us pregnancy ltd (76815) |
$158.40 |
$198 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$158.40 |
$198 |
1.6× |
| Us retroperitoneal complete (76770) |
$281.60 |
$352 |
2.9× |
| Us retroperitoneal limited (76775) |
$206.80 |
$258.50 |
2.2× |
| Us scrotum and contents (76870) |
$228.80 |
$286 |
2.4× |
| Us soft tissue head/neck (76536) |
$544.80 |
$681 |
5.7× |
| Us xtr non-vasc lmtd (76882) |
$228.80 |
$286 |
2.4× |
| Wrist 2 views (73100) |
$162 |
$202.50 |
2.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$414.40 |
$518 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$230.40 |
$288 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$219.20 |
$274 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$181.20 |
$226.50 |
2.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$237.60 |
$297 |
3.0× |
| X-ray exam hip uni 1 view (73501) |
$155.60 |
$194.50 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$180.40 |
$225.50 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$178.40 |
$223 |
1.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$358.40 |
$448 |
3.7× |
| X-ray exam of femur 1 (73551) |
$177.60 |
$222 |
2.2× |
| X-ray eye for foreign body (70030) |
$132 |
$165 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$270.40 |
$338 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$212 |
$265 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$182 |
$227.50 |
2.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$340 |
$425 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$178.80 |
$223.50 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$217.60 |
$272 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$274.40 |
$343 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$469.60 |
$587 |
4.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$231.20 |
$289 |
2.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$176 |
$220 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$220.80 |
$276 |
2.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$212.80 |
$266 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$210.40 |
$263 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$314.40 |
$393 |
3.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$225.60 |
$282 |
2.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$220.80 |
$276 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$224.80 |
$281 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$236 |
$295 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$210.40 |
$263 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$265.60 |
$332 |
2.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$166.40 |
$208 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$188.80 |
$236 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$425.60 |
$532 |
4.4× |
| Xr chest 4+ views (71048) |
$188 |
$235 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$166.40 |
$208 |
2.1× |
| Xr optic foramina (70190) |
$132 |
$165 |
1.6× |
| Xr shoulder 1 view (73020) |
$166.40 |
$208 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$361.60 |
$452 |
3.8× |
| Xr tibia/fibula 2 views (73590) |
$223.20 |
$279 |
2.8× |
| Xray knee 1 or 2 views rt (73560) |
$177.20 |
$221.50 |
2.2× |