| Abdomen 2 views (74019) |
$77.50 |
$194 |
0.7× |
| Ankle 2 views (73600) |
$12 |
$30 |
0.1× |
| Bone age studies (77072) |
$10 |
$25 |
0.1× |
| Bone Imaging 3 Phase (78315) |
$500 |
$1,250 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$67 |
$167 |
0.8× |
| Chest 1 view (71045) |
$54.50 |
$136.50 |
0.6× |
| Chest 3 views (71047) |
$38 |
$95.50 |
0.4× |
| Clavicle complete (73000) |
$58 |
$145 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$212 |
$531 |
2.0× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$36 |
$90 |
0.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$648 |
$1,620 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$498 |
$1,245 |
2.1× |
| CT abdomen w contrast (74160) |
$334 |
$835 |
1.9× |
| CT abdomen w wo contrast (74170) |
$428 |
$1,070 |
2.4× |
| CT abdomen w/o contrast (74150) |
$278 |
$695 |
2.6× |
| CT c-spine w/o contrast (72125) |
$298 |
$745 |
2.8× |
| CT cervical spine w&w/o contrast (72127) |
$563 |
$1,407.50 |
3.2× |
| CT cervical spine with contrast (72126) |
$348 |
$870 |
1.0× |
| CT chest w/wo contrast (71270) |
$416 |
$1,040 |
2.4× |
| CT chest with contrast (71260) |
$368 |
$920 |
2.1× |
| CT head/brain with contrast (70460) |
$302 |
$755 |
1.7× |
| CT head/brain without and with contrast (70470) |
$391 |
$977.50 |
2.2× |
| CT lower ext w/o (73700) |
$277 |
$692.50 |
2.6× |
| CT lower extremity w wo contrast (73702) |
$374 |
$935 |
2.1× |
| CT lower extremity with contrast (73701) |
$326 |
$815 |
1.9× |
| CT lumbar spine w & w/o contrast (72133) |
$416 |
$1,040 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$298 |
$745 |
2.8× |
| CT lumbar spine with contrast (72132) |
$369 |
$922.50 |
1.1× |
| CT maxillofacial w contrast (70487) |
$303 |
$757.50 |
1.7× |
| CT maxillofacial w/o contrast (70486) |
$277 |
$692.50 |
2.6× |
| CT maxillofacial w/wo contrast (70488) |
$372 |
$930 |
2.1× |
| CT neck soft tissue w contrast (70491) |
$330 |
$825 |
1.9× |
| CT orbits w/o contrast (70480) |
$220 |
$550 |
2.1× |
| CT pelvis w & w/o contrast (72194) |
$426 |
$1,065 |
2.4× |
| CT pelvis w/o contrast (72192) |
$299 |
$747.50 |
2.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$418 |
$1,045 |
2.4× |
| CT soft tissue neck w/o contrast (70490) |
$281 |
$702.50 |
2.7× |
| CT thoracic spine w/contrast (72129) |
$369 |
$922.50 |
2.1× |
| CT thoracic spine w/o contrast (72128) |
$299 |
$747.50 |
2.8× |
| CT thoracic spine w/wo contrast (72130) |
$416 |
$1,040 |
2.4× |
| CT thorax w/o contrast (71250) |
$278 |
$695 |
2.6× |
| CT unlisted procedure (76497) |
$10 |
$26 |
0.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$376 |
$940 |
2.1× |
| CT upper extremity w/o contrast rt (73200) |
$282 |
$705 |
2.7× |
| CT upper extremity with contrast (73201) |
$332 |
$830 |
0.9× |
| Cta Abdomen (74175) |
$165 |
$412 |
0.9× |
| CTA abdomen pelvis (74174) |
$490 |
$1,225 |
1.4× |
| CTA chest (71275) |
$433 |
$1,082.50 |
2.5× |
| Cta Head (70496) |
$390 |
$975 |
2.2× |
| Cta Neck (70498) |
$432 |
$1,080 |
2.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$16 |
$40 |
0.2× |
| Fetal biophysical profile non-stress testing (76818) |
$136.50 |
$341.50 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$16 |
$40 |
0.1× |
| Foot 2 views (73620) |
$58 |
$145 |
0.7× |
| Forearm 2 views (73090) |
$61.50 |
$154 |
0.7× |
| Hand 2 views (73120) |
$76.50 |
$191.50 |
0.7× |
| Hand 3 views (73130) |
$82.50 |
$206.50 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$61.50 |
$154 |
0.7× |
| Knee 3 views (73562) |
$63.50 |
$159 |
0.7× |
| MRA head w/o contrast (70544) |
$756 |
$1,890 |
3.2× |
| MRI abdomen w contrast (74182) |
$756 |
$1,890 |
2.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$648 |
$1,620 |
1.8× |
| MRI abdomen w/o contrast (74181) |
$416 |
$1,040 |
1.7× |
| MRI c-spine with contrast (72142) |
$638 |
$1,595 |
1.8× |
| MRI cervical spine w/o contrast (72141) |
$415 |
$1,037.50 |
1.7× |
| MRI chest w/o contrast (71550) |
$342 |
$855 |
1.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$396 |
$990 |
1.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$376 |
$940 |
1.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$323.50 |
$809 |
1.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$648 |
$1,620 |
1.8× |
| MRI pelvis w contrast (72196) |
$470 |
$1,175 |
1.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$648 |
$1,620 |
1.8× |
| MRI scan of leg joint before and after contrast (73723) |
$474 |
$1,185 |
1.4× |
| MRI spectroscopy (76390) |
$320 |
$800 |
3.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$669 |
$1,672.50 |
1.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$578 |
$1,445 |
1.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$669 |
$1,672.50 |
1.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$473 |
$1,182.50 |
1.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$690 |
$1,725 |
2.0× |
| MRI thoracic spine w/o contrast (72146) |
$414 |
$1,035 |
1.7× |
| MRI tmj (70336) |
$407 |
$1,017.50 |
1.7× |
| MRI upper ext joint w/o contrast (73221) |
$397 |
$992.50 |
1.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$689 |
$1,722.50 |
2.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$375 |
$937.50 |
1.6× |
| Neck soft tissue (70360) |
$65 |
$162 |
0.7× |
| Nuclear medicine study of kidney and blood flow (78701) |
$417 |
$1,043 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$48 |
$120 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$76.50 |
$191.50 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$606 |
$1,515 |
1.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$360 |
$900 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$133 |
$332.50 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$141 |
$353 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$58 |
$145 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$14 |
$35 |
0.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$64 |
$159.50 |
0.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$58 |
$145 |
0.7× |
| Ribs bilateral 3 views (71110) |
$87 |
$217 |
0.8× |
| Scapula complete (73010) |
$78.50 |
$196.50 |
0.7× |
| Sella turcica (70240) |
$30 |
$75.50 |
0.3× |
| Tmj unilateral (70328) |
$56 |
$140.50 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$121 |
$302.50 |
1.2× |
| Unlisted musculoskeletal procedure, diagnostic nuclear medicine UNSCHEDULED (78399) |
$462 |
$592.50 |
1.2× |
| Upper Extremity Infant (73092) |
$54 |
$134.50 |
0.5× |
| Urethrocystography voiding (74455) |
$40 |
$100 |
0.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$170 |
$425 |
1.0× |
| Us breast unilateral complete (76641) |
$103 |
$257.50 |
1.0× |
| Us chest (76604) |
$284 |
$710.50 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$110 |
$274.50 |
1.0× |
| Us ob detailed single fetus (76811) |
$182 |
$455 |
0.8× |
| Us pelvic non ob complete (76856) |
$135.50 |
$339 |
1.3× |
| Us pregnancy ltd (76815) |
$89.50 |
$224 |
0.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$104 |
$260 |
1.0× |
| Us retroperitoneal complete (76770) |
$125 |
$312.50 |
1.2× |
| Us scrotum and contents (76870) |
$200 |
$499 |
1.9× |
| Us soft tissue head/neck (76536) |
$125 |
$312.50 |
1.2× |
| Wrist 2 views (73100) |
$58 |
$145 |
0.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$83 |
$207.50 |
0.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$100.50 |
$251.50 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$59 |
$147 |
0.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$80 |
$200 |
0.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$58 |
$145 |
0.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$64 |
$159.50 |
0.7× |
| X-ray exam hip uni 1 view (73501) |
$56 |
$140.50 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$63.50 |
$159 |
0.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$20 |
$50 |
0.2× |
| X-ray exam of femur 1 (73551) |
$56 |
$140.50 |
0.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$69 |
$172.50 |
0.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$58 |
$145 |
0.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$56 |
$140.50 |
0.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$58 |
$145.50 |
0.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$18 |
$45 |
0.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$57.50 |
$144 |
0.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$56 |
$140.50 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$81.50 |
$204 |
0.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$70 |
$175 |
0.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$102.50 |
$256.50 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$79 |
$197.50 |
0.8× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$160 |
$400 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$59 |
$147.50 |
0.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$78.50 |
$196.50 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$58 |
$145 |
0.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$64 |
$159.50 |
0.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$58 |
$145 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$102.50 |
$256.50 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$80.50 |
$201.50 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$72 |
$180 |
0.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$64 |
$159.50 |
0.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$79.50 |
$199 |
0.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$81.50 |
$204 |
0.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$58 |
$145 |
0.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$16 |
$40 |
0.2× |
| Xr chest 4+ views (71048) |
$18 |
$45 |
0.2× |
| Xr finger(s) 2+ views (73140) |
$58 |
$145.50 |
0.7× |
| XR Mastoids < 3 Views Bilateral (70120) |
$78 |
$195 |
0.7× |
| Xr shoulder 1 view (73020) |
$34 |
$85.50 |
0.4× |
| Xr spine cervical 4 or 5 views (72050) |
$94 |
$235 |
0.9× |
| Xr tibia/fibula 2 views (73590) |
$104 |
$259 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$58 |
$145 |
0.7× |