| Ankle 2 views (73600) |
$80.10 |
$133.50 |
1.0× |
| Bone age studies (77072) |
$154.80 |
$258 |
1.6× |
| Bone survey complete (77075) |
$118.50 |
$197.50 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$83.70 |
$139.50 |
1.1× |
| Chest 1 view (71045) |
$140.40 |
$234 |
1.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$287.40 |
$479 |
1.8× |
| Clavicle complete (73000) |
$80.10 |
$133.50 |
1.0× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$164.40 |
$274 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$285 |
$475 |
0.9× |
| CT abdomen and pelvis without contrast (74176) |
$238.80 |
$398 |
1.1× |
| CT abdomen w contrast (74160) |
$406.50 |
$677.50 |
2.5× |
| CT abdomen w wo contrast (74170) |
$670.20 |
$1,117 |
4.2× |
| CT abdomen w/o contrast (74150) |
$424.20 |
$707 |
4.5× |
| CT c-spine w/o contrast (72125) |
$414.90 |
$691.50 |
4.4× |
| CT cervical spine w&w/o contrast (72127) |
$662.40 |
$1,104 |
4.1× |
| CT cervical spine with contrast (72126) |
$568.20 |
$947 |
1.8× |
| CT chest w/wo contrast (71270) |
$669.60 |
$1,116 |
4.2× |
| CT chest with contrast (71260) |
$569.70 |
$949.50 |
3.6× |
| CT head/brain with contrast (70460) |
$441.90 |
$736.50 |
2.8× |
| CT head/brain without and with contrast (70470) |
$519.30 |
$865.50 |
3.3× |
| CT lower ext w/o (73700) |
$414.90 |
$691.50 |
4.4× |
| CT lower extremity with contrast (73701) |
$565.20 |
$942 |
3.5× |
| CT lumbar spine w & w/o contrast (72133) |
$663.30 |
$1,105.50 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$414.90 |
$691.50 |
4.4× |
| CT lumbar spine with contrast (72132) |
$569.10 |
$948.50 |
1.8× |
| CT maxillofacial w contrast (70487) |
$451.20 |
$752 |
2.8× |
| CT maxillofacial w/o contrast (70486) |
$145.80 |
$243 |
1.5× |
| CT maxillofacial w/wo contrast (70488) |
$527.10 |
$878.50 |
3.3× |
| CT neck soft tissue w contrast (70491) |
$456 |
$760 |
2.9× |
| CT orbits w/o contrast (70480) |
$249 |
$415 |
2.6× |
| CT pelvis w & w/o contrast (72194) |
$1,183.80 |
$1,973 |
7.4× |
| CT pelvis w/o contrast (72192) |
$136.20 |
$227 |
1.4× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$148.80 |
$248 |
1.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$528.60 |
$881 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$342.30 |
$570.50 |
3.6× |
| CT thoracic spine w/contrast (72129) |
$569.10 |
$948.50 |
3.6× |
| CT thoracic spine w/o contrast (72128) |
$414.90 |
$691.50 |
4.4× |
| CT thorax w/o contrast (71250) |
$414.90 |
$691.50 |
4.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$312.30 |
$520.50 |
2.0× |
| CT upper extremity w/o contrast rt (73200) |
$208.50 |
$347.50 |
2.2× |
| CT upper extremity with contrast (73201) |
$273.90 |
$456.50 |
0.9× |
| CTA chest (71275) |
$241.80 |
$403 |
1.5× |
| Cta Head (70496) |
$664.20 |
$1,107 |
4.2× |
| Fluoroscopy up to 1 hr (76000) |
$286.20 |
$477 |
1.3× |
| Foot 2 views (73620) |
$78.90 |
$131.50 |
1.0× |
| Forearm 2 views (73090) |
$80.10 |
$133.50 |
1.0× |
| Hand 2 views (73120) |
$80.10 |
$133.50 |
0.8× |
| Hand 3 views (73130) |
$80.10 |
$133.50 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$80.70 |
$134.50 |
1.0× |
| Knee 3 views (73562) |
$81.30 |
$135.50 |
1.0× |
| MRA head w/o contrast (70544) |
$399.60 |
$666 |
1.8× |
| MRA head with contrast (70545) |
$419.10 |
$698.50 |
1.3× |
| MRA neck w/o contrast (70547) |
$272.70 |
$454.50 |
1.3× |
| MRI abdomen w contrast (74182) |
$302.10 |
$503.50 |
1.0× |
| MRI abdomen w/o contrast (74181) |
$286.50 |
$477.50 |
1.3× |
| MRI any jnt lwr ext with con lt (73722) |
$406.20 |
$677 |
0.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$406.20 |
$677 |
0.6× |
| MRI c-spine with contrast (72142) |
$803.10 |
$1,338.50 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$737.70 |
$1,229.50 |
3.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$406.20 |
$677 |
1.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$438.90 |
$731.50 |
2.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$371.40 |
$619 |
1.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$412.50 |
$687.50 |
1.3× |
| MRI orbit/face/neck w/contrast (70542) |
$483 |
$805 |
1.5× |
| MRI pelvis w contrast (72196) |
$792 |
$1,320 |
2.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$581.40 |
$969 |
1.8× |
| MRI pelvis w/o contrast (72195) |
$729.60 |
$1,216 |
3.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,879.80 |
$3,133 |
5.9× |
| MRI scan of leg joint before and after contrast (73723) |
$241.20 |
$402 |
0.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,083.90 |
$1,806.50 |
3.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$795 |
$1,325 |
2.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,072.80 |
$1,788 |
3.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$803.10 |
$1,338.50 |
2.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,083.90 |
$1,806.50 |
3.4× |
| MRI thoracic spine w/o contrast (72146) |
$737.70 |
$1,229.50 |
3.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,206 |
$2,010 |
5.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,060.50 |
$1,767.50 |
3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$678.90 |
$1,131.50 |
3.1× |
| Neck soft tissue (70360) |
$80.10 |
$133.50 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$47.70 |
$79.50 |
0.5× |
| Pelvis 1 or 2 views (72170) |
$80.70 |
$134.50 |
0.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,060.50 |
$1,767.50 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$74.10 |
$123.50 |
0.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$85.20 |
$142 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$84.60 |
$141 |
0.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90 |
$150 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$86.40 |
$144 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$82.80 |
$138 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$19.80 |
$33 |
0.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$102 |
$170 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$76.80 |
$128 |
0.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$80.70 |
$134.50 |
1.0× |
| Ribs bilateral 3 views (71110) |
$85.20 |
$142 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$19.80 |
$33 |
0.2× |
| Scapula complete (73010) |
$80.70 |
$134.50 |
0.8× |
| Small bowel series (74250) |
$170.40 |
$284 |
1.1× |
| Spine thoracic 3 views (72072) |
$82.80 |
$138 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$41.10 |
$68.50 |
0.4× |
| Upper Extremity Infant (73092) |
$37.50 |
$62.50 |
0.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$286.50 |
$92 |
1.8× |
| Us breast unilateral complete (76641) |
$43.80 |
$73 |
0.5× |
| Us breast unilateral limited (76642) |
$61.20 |
$102 |
0.8× |
| Us chest (76604) |
$35.10 |
$58.50 |
0.4× |
| Us compl joint r-t w/image documentation (76881) |
$61.80 |
$103 |
0.6× |
| Us ob transvaginal (76817) |
$78.90 |
$131.50 |
0.8× |
| Us pelvic non ob complete (76856) |
$68.40 |
$114 |
0.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$29.10 |
$48.50 |
0.3× |
| Us pregnancy ltd (76815) |
$72.60 |
$121 |
0.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$67.20 |
$112 |
0.7× |
| Us retroperitoneal complete (76770) |
$80.70 |
$134.50 |
0.8× |
| Us retroperitoneal limited (76775) |
$66 |
$110 |
0.7× |
| Us scrotum and contents (76870) |
$44.40 |
$74 |
0.5× |
| Us soft tissue head/neck (76536) |
$41.70 |
$69.50 |
0.4× |
| Wrist 2 views (73100) |
$30.60 |
$51 |
0.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$169.20 |
$282 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$82.80 |
$138 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$80.10 |
$133.50 |
1.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$111 |
$185 |
0.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$78.90 |
$131.50 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$19.80 |
$33 |
0.2× |
| X-ray exam hip uni 1 view (73501) |
$80.70 |
$134.50 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$82.80 |
$138 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$85.20 |
$142 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$81.30 |
$135.50 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$80.10 |
$133.50 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$86.40 |
$144 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$80.70 |
$134.50 |
1.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$81.30 |
$135.50 |
1.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$80.10 |
$133.50 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$83.70 |
$139.50 |
0.9× |
| 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) |
$83.70 |
$139.50 |
0.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$80.10 |
$133.50 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$140.40 |
$234 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$82.80 |
$138 |
1.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$81.30 |
$135.50 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$105.60 |
$176 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$140.40 |
$234 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$84.60 |
$141 |
1.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$80.70 |
$134.50 |
1.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$140.70 |
$234.50 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$84.60 |
$141 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$82.80 |
$138 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$81.30 |
$135.50 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$82.80 |
$138 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$77.70 |
$129.50 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$30.90 |
$51.50 |
0.4× |
| Xr c-spine 6 or more views (72052) |
$142.20 |
$237 |
1.5× |
| Xr finger(s) 2+ views (73140) |
$80.70 |
$134.50 |
1.0× |
| Xr shoulder 1 view (73020) |
$78.90 |
$131.50 |
1.0× |
| Xr spine cervical 4 or 5 views (72050) |
$140.10 |
$233.50 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$80.10 |
$133.50 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$80.70 |
$134.50 |
1.0× |