| Abdomen 2 views (74019) |
$103.05 |
$171.75 |
1.1× |
| Ankle 2 views (73600) |
$100.50 |
$167.50 |
1.2× |
| Bone survey complete (77075) |
$824.40 |
$1,374 |
8.4× |
| Cervical spine 2 or 3 views (72040) |
$182.10 |
$303.50 |
2.2× |
| Chest 1 view (71045) |
$103.05 |
$171.75 |
1.3× |
| Chest 3 views (71047) |
$142.05 |
$236.75 |
1.7× |
| Clavicle complete (73000) |
$100.50 |
$167.50 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$129.15 |
$215.25 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,632.80 |
$4,388 |
8.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,570.05 |
$2,616.75 |
7.0× |
| CT abdomen w contrast (74160) |
$1,019.25 |
$1,698.75 |
6.2× |
| CT abdomen w wo contrast (74170) |
$1,700.70 |
$2,834.50 |
10.3× |
| CT abdomen w/o contrast (74150) |
$953.70 |
$1,589.50 |
9.7× |
| CT angio hrt w/3d image (75574) |
$182.10 |
$303.50 |
0.6× |
| CT angiography upper extremity lt (73206) |
$1,468.05 |
$2,446.75 |
8.9× |
| CT c-spine w/o contrast (72125) |
$1,395.30 |
$2,325.50 |
14.2× |
| CT cervical spine with contrast (72126) |
$1,433.40 |
$2,389 |
4.4× |
| CT chest w/wo contrast (71270) |
$1,700.70 |
$2,834.50 |
10.3× |
| CT chest with contrast (71260) |
$1,019.25 |
$1,698.75 |
6.2× |
| CT head/brain with contrast (70460) |
$899.25 |
$1,498.75 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,398.30 |
$2,330.50 |
8.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$59.40 |
$99 |
0.7× |
| CT iac w contrast (70481) |
$770.10 |
$1,283.50 |
4.7× |
| CT limited/localized follow up study (76380) |
$562.65 |
$937.75 |
6.9× |
| CT lower ext w/o (73700) |
$1,255.95 |
$2,093.25 |
12.8× |
| CT lower extremity w wo contrast (73702) |
$1,816.35 |
$3,027.25 |
11.0× |
| CT lower extremity with contrast (73701) |
$1,255.95 |
$2,093.25 |
7.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,646.02 |
$2,743.38 |
10.0× |
| CT lumbar spine w/o contrast (72131) |
$1,345.95 |
$2,243.25 |
13.7× |
| CT lumbar spine with contrast (72132) |
$1,333.95 |
$2,223.25 |
4.1× |
| CT maxillofacial w contrast (70487) |
$1,014.15 |
$1,690.25 |
6.2× |
| CT maxillofacial w/o contrast (70486) |
$1,023.60 |
$1,706 |
10.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,143 |
$1,905 |
6.9× |
| CT neck soft tissue w contrast (70491) |
$1,265.85 |
$2,109.75 |
7.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$792.75 |
$1,321.25 |
4.8× |
| CT orbits w/o contrast (70480) |
$663.15 |
$1,105.25 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$960.15 |
$1,600.25 |
5.8× |
| CT pelvis w/o contrast (72192) |
$617.25 |
$1,028.75 |
6.3× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$499.20 |
$832 |
6.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$848.85 |
$1,414.75 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,046.55 |
$1,744.25 |
10.7× |
| CT thoracic spine w/contrast (72129) |
$1,241.70 |
$2,069.50 |
7.5× |
| CT thoracic spine w/o contrast (72128) |
$1,194.75 |
$1,991.25 |
12.2× |
| CT thorax w/o contrast (71250) |
$852.22 |
$1,420.38 |
8.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,256.85 |
$2,094.75 |
7.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,329.60 |
$2,216 |
13.6× |
| CT upper extremity with contrast (73201) |
$1,098.75 |
$1,831.25 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,900.50 |
$3,167.50 |
11.5× |
| Cta Abdomen (74175) |
$1,440.45 |
$2,400.75 |
8.8× |
| CTA abdomen pelvis (74174) |
$1,901.10 |
$3,168.50 |
5.8× |
| CTA chest (71275) |
$1,452.30 |
$2,420.50 |
8.8× |
| Cta Head (70496) |
$1,440.45 |
$2,400.75 |
8.8× |
| CTA lwr ext w&w/o contrast (73706) |
$709.95 |
$1,183.25 |
4.3× |
| Cta Neck (70498) |
$1,440.45 |
$2,400.75 |
8.8× |
| Cta Pelvis (72191) |
$960.15 |
$1,600.25 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$592.05 |
$986.75 |
1.8× |
| Esophagus (74220) |
$279.45 |
$465.75 |
1.7× |
| Fluoroscopy up to 1 hr (76000) |
$253.65 |
$422.75 |
1.1× |
| Foot 2 views (73620) |
$109.95 |
$183.25 |
1.3× |
| Forearm 2 views (73090) |
$123.90 |
$206.50 |
1.5× |
| Gated Heart Planar Single (78472) |
$73.05 |
$121.75 |
0.2× |
| Hand 2 views (73120) |
$118.80 |
$198 |
1.2× |
| Hand 3 views (73130) |
$142.35 |
$237.25 |
1.7× |
| Humerus Min 2 Views Left (73060) |
$148.95 |
$248.25 |
1.8× |
| Knee 3 views (73562) |
$109.95 |
$183.25 |
1.3× |
| MRA head w & w/o contrast (70546) |
$1,524.45 |
$2,540.75 |
4.7× |
| MRA head w/o contrast (70544) |
$1,200 |
$2,000 |
5.4× |
| MRA neck w contrast (70548) |
$1,259.70 |
$2,099.50 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,524.45 |
$2,540.75 |
4.7× |
| MRA neck w/o contrast (70547) |
$1,524.45 |
$2,540.75 |
6.8× |
| MRI abdomen w contrast (74182) |
$2,289.45 |
$3,815.75 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,398.95 |
$3,998.25 |
7.3× |
| MRI abdomen w/o contrast (74181) |
$1,391.02 |
$2,318.38 |
6.2× |
| MRI any jnt lwr ext with con lt (73722) |
$1,495.50 |
$2,492.50 |
2.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,591.35 |
$2,652.25 |
2.2× |
| MRI c-spine with contrast (72142) |
$1,570.95 |
$2,618.25 |
4.8× |
| MRI cervical spine w/o contrast (72141) |
$1,418.25 |
$2,363.75 |
6.3× |
| MRI chest w/o contrast (71550) |
$1,418.25 |
$2,363.75 |
6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,634.40 |
$2,724 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,250.70 |
$2,084.50 |
5.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,350.45 |
$2,250.75 |
4.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,300.05 |
$2,166.75 |
4.0× |
| MRI pelvis w contrast (72196) |
$1,418.25 |
$2,363.75 |
4.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,180.70 |
$3,634.50 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,569.30 |
$2,615.50 |
7.0× |
| MRI scan of arm joint before and after contrast (73223) |
$1,925.55 |
$3,209.25 |
5.9× |
| MRI scan of leg joint before and after contrast (73723) |
$2,180.70 |
$3,634.50 |
6.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,180.70 |
$3,634.50 |
6.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,587.75 |
$2,646.25 |
4.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,180.70 |
$3,634.50 |
6.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,570.05 |
$2,616.75 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,180.70 |
$3,634.50 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,418.25 |
$2,363.75 |
6.3× |
| MRI tmj (70336) |
$1,418.25 |
$2,363.75 |
6.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,925.55 |
$3,209.25 |
8.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,384.80 |
$2,308 |
4.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,558.50 |
$2,597.50 |
7.0× |
| Neck soft tissue (70360) |
$201.30 |
$335.50 |
2.5× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$289.20 |
$482 |
2.9× |
| Osseous survey infant (77076) |
$264.60 |
$441 |
2.7× |
| Osseous survey limited (77074) |
$441.30 |
$735.50 |
4.5× |
| Pelvis 1 or 2 views (72170) |
$157.20 |
$262 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,077.65 |
$3,462.75 |
6.3× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$225.75 |
$376.25 |
0.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$102.45 |
$170.75 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$254.40 |
$424 |
2.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$97.95 |
$163.25 |
1.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$115.05 |
$191.75 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$92.25 |
$153.75 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$142.35 |
$237.25 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$170.25 |
$283.75 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$212.40 |
$354 |
1.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$204.15 |
$340.25 |
1.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$219.90 |
$366.50 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$123.45 |
$205.75 |
1.5× |
| Radiological examination surgical specimen (76098) |
$76.65 |
$127.75 |
0.1× |
| Sacroiliac Joints < 3 Views (72200) |
$128.25 |
$213.75 |
1.3× |
| Scapula complete (73010) |
$112.65 |
$187.75 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$32.70 |
$54.50 |
1.4× |
| Small bowel series (74250) |
$194.25 |
$323.75 |
1.2× |
| Spine thoracic 3 views (72072) |
$115.05 |
$191.75 |
1.2× |
| Tmj unilateral (70328) |
$160.05 |
$266.75 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$246.30 |
$410.50 |
2.5× |
| Unlisted Ultrasound Procedure (76999) |
$253.65 |
$422.75 |
3.1× |
| Upper Extremity Infant (73092) |
$90.75 |
$151.25 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$172.20 |
$287 |
0.8× |
| Urethrocystography voiding (74455) |
$275.85 |
$459.75 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$327.60 |
$546 |
2.0× |
| Us abdl aorta screen aaa (76706) |
$335.55 |
$559.25 |
3.4× |
| Us breast unilateral complete (76641) |
$202.80 |
$338 |
2.1× |
| Us breast unilateral limited (76642) |
$202.80 |
$338 |
2.5× |
| Us chest (76604) |
$295.65 |
$492.75 |
3.0× |
| Us ob transvaginal (76817) |
$289.20 |
$482 |
2.9× |
| Us pelvic non ob complete (76856) |
$349.65 |
$582.75 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$282.82 |
$471.38 |
2.9× |
| Us pregnancy ltd (76815) |
$289.20 |
$482 |
2.9× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$289.20 |
$482 |
2.9× |
| Us retroperitoneal complete (76770) |
$673.95 |
$1,123.25 |
6.9× |
| Us retroperitoneal limited (76775) |
$335.55 |
$559.25 |
3.4× |
| Us scrotum and contents (76870) |
$349.65 |
$582.75 |
3.6× |
| Us soft tissue head/neck (76536) |
$349.65 |
$582.75 |
3.6× |
| Us spinal canal and contents (76800) |
$273.60 |
$456 |
2.8× |
| Us xtr non-vasc lmtd (76882) |
$263.10 |
$438.50 |
2.7× |
| Venography caval inferior serialography rs&i (75825) |
$1,139.40 |
$1,899 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$949.80 |
$1,583 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$276.60 |
$461 |
0.2× |
| Wrist 2 views (73100) |
$87 |
$145 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$197.25 |
$328.75 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$78.15 |
$130.25 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$142.35 |
$237.25 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$249.15 |
$415.25 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$123.90 |
$206.50 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$142.35 |
$237.25 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$97.35 |
$162.25 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$113.70 |
$189.50 |
1.4× |
| X-ray exam of femur 1 (73551) |
$105.75 |
$176.25 |
1.3× |
| X-ray eye for foreign body (70030) |
$71.70 |
$119.50 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$196.80 |
$328 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$183.75 |
$306.25 |
2.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$142.35 |
$237.25 |
1.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$123.90 |
$206.50 |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$153.45 |
$255.75 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$129 |
$215 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$82.65 |
$137.75 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$90.75 |
$151.25 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$129.60 |
$216 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$137.10 |
$228.50 |
1.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$78.90 |
$131.50 |
0.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$168.15 |
$280.25 |
2.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$168.15 |
$280.25 |
1.7× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$191.40 |
$319 |
0.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$156.30 |
$260.50 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$194.25 |
$323.75 |
2.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$116.40 |
$194 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$123.90 |
$206.50 |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$168.15 |
$280.25 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$223.20 |
$372 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$97.95 |
$163.25 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$63.45 |
$105.75 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$103.05 |
$171.75 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$137.85 |
$229.75 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$65.55 |
$109.25 |
0.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$170.25 |
$283.75 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$123.90 |
$206.50 |
1.5× |
| Xr c-spine 6 or more views (72052) |
$233.25 |
$388.75 |
2.4× |
| Xr chest 4+ views (71048) |
$213 |
$355 |
2.2× |
| Xr finger(s) 2+ views (73140) |
$123.90 |
$206.50 |
1.5× |
| Xr shoulder 1 view (73020) |
$117 |
$195 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$199.95 |
$333.25 |
2.0× |
| Xr tibia/fibula 2 views (73590) |
$123.90 |
$206.50 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$87 |
$145 |
1.1× |