| Abdomen 2 views (74019) |
$193.70 |
$298 |
1.9× |
| Ankle 2 views (73600) |
$174.85 |
$269 |
2.1× |
| Bone survey complete (77075) |
$833.30 |
$1,282 |
8.3× |
| Cervical spine 2 or 3 views (72040) |
$193.70 |
$298 |
2.3× |
| Chest 1 view (71045) |
$158.60 |
$244 |
1.9× |
| Chest 3 views (71047) |
$287.30 |
$442 |
3.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$532.35 |
$819 |
3.2× |
| Clavicle complete (73000) |
$174.85 |
$269 |
2.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$447.20 |
$688 |
4.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,286.70 |
$3,518 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,977.30 |
$3,042 |
8.6× |
| CT abdomen w contrast (74160) |
$1,318.20 |
$2,028 |
7.8× |
| CT abdomen w wo contrast (74170) |
$2,154.10 |
$3,314 |
12.8× |
| CT abdomen w/o contrast (74150) |
$982.80 |
$1,512 |
9.8× |
| CT c-spine w/o contrast (72125) |
$1,090.05 |
$1,677 |
10.8× |
| CT cervical spine with contrast (72126) |
$1,831.05 |
$2,817 |
5.5× |
| CT chest w/wo contrast (71270) |
$2,193.10 |
$3,374 |
13.0× |
| CT chest with contrast (71260) |
$1,658.80 |
$2,552 |
9.8× |
| CT head/brain with contrast (70460) |
$1,937 |
$2,980 |
11.5× |
| CT head/brain without and with contrast (70470) |
$2,351.70 |
$3,618 |
13.9× |
| CT iac w contrast (70481) |
$2,206.75 |
$3,395 |
13.1× |
| CT lower ext w/o (73700) |
$1,079.65 |
$1,661 |
10.7× |
| CT lower extremity with contrast (73701) |
$1,817.40 |
$2,796 |
10.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,507.05 |
$3,857 |
14.9× |
| CT lumbar spine w/o contrast (72131) |
$1,444.30 |
$2,222 |
14.4× |
| CT lumbar spine with contrast (72132) |
$1,844.70 |
$2,838 |
5.5× |
| CT maxillofacial w contrast (70487) |
$1,935.05 |
$2,977 |
11.5× |
| CT maxillofacial w/o contrast (70486) |
$1,116.05 |
$1,717 |
11.1× |
| CT maxillofacial w/wo contrast (70488) |
$2,081.95 |
$3,203 |
12.3× |
| CT neck soft tissue w contrast (70491) |
$1,285.05 |
$1,977 |
7.6× |
| CT orbits w/o contrast (70480) |
$1,656.85 |
$2,549 |
16.5× |
| CT pelvis w & w/o contrast (72194) |
$2,148.25 |
$3,305 |
12.7× |
| CT pelvis w/o contrast (72192) |
$971.10 |
$1,494 |
9.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,132.65 |
$3,281 |
12.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,121.25 |
$1,725 |
11.2× |
| CT thoracic spine w/contrast (72129) |
$1,784.90 |
$2,746 |
10.6× |
| CT thoracic spine w/o contrast (72128) |
$1,097.20 |
$1,688 |
10.9× |
| CT thorax w/o contrast (71250) |
$917.80 |
$1,412 |
9.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,846 |
$2,840 |
10.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,079.65 |
$1,661 |
10.7× |
| CT upper extremity with contrast (73201) |
$1,442.35 |
$2,219 |
4.3× |
| Cta Abdomen (74175) |
$2,396.55 |
$3,687 |
14.2× |
| CTA abdomen pelvis (74174) |
$3,069.95 |
$4,723 |
9.1× |
| CTA chest (71275) |
$1,869.40 |
$2,876 |
11.1× |
| Cta Head (70496) |
$2,027.35 |
$3,119 |
12.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,027.35 |
$3,119 |
6.0× |
| Cta Neck (70498) |
$2,017.60 |
$3,104 |
12.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$98.15 |
$151 |
1.0× |
| Esophagus (74220) |
$525.85 |
$809 |
3.1× |
| Foot 2 views (73620) |
$193.70 |
$298 |
2.3× |
| Forearm 2 views (73090) |
$193.70 |
$298 |
2.3× |
| Hand 2 views (73120) |
$251.55 |
$387 |
2.5× |
| Hand 3 views (73130) |
$274.30 |
$422 |
3.3× |
| Humerus Min 2 Views Left (73060) |
$184.28 |
$283.50 |
2.2× |
| Knee 3 views (73562) |
$193.70 |
$298 |
2.3× |
| MRA head w/o contrast (70544) |
$2,216.50 |
$3,410 |
9.7× |
| MRA neck w/o contrast (70547) |
$2,293.85 |
$3,529 |
10.0× |
| MRI abdomen w contrast (74182) |
$1,558.05 |
$2,397 |
4.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,694.25 |
$4,145 |
8.0× |
| MRI abdomen w/o contrast (74181) |
$2,451.80 |
$3,772 |
10.7× |
| MRI any jnt lwr ext with con lt (73722) |
$2,113.15 |
$3,251 |
2.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,292.55 |
$3,527 |
3.0× |
| MRI c-spine with contrast (72142) |
$2,531.10 |
$3,894 |
7.5× |
| MRI cervical spine w/o contrast (72141) |
$2,152.80 |
$3,312 |
9.4× |
| MRI chest w/o contrast (71550) |
$1,720.55 |
$2,647 |
7.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,992.25 |
$3,065 |
5.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,996.15 |
$3,071 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,886.95 |
$2,903 |
8.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,092.35 |
$3,219 |
9.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,353.65 |
$3,621 |
7.0× |
| MRI pelvis w contrast (72196) |
$2,169.70 |
$3,338 |
6.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,155.10 |
$4,854 |
9.4× |
| MRI pelvis w/o contrast (72195) |
$1,929.85 |
$2,969 |
8.4× |
| MRI scan of arm joint before and after contrast (73223) |
$2,821.65 |
$4,341 |
8.4× |
| MRI scan of leg joint before and after contrast (73723) |
$2,592.20 |
$3,988 |
7.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,889.25 |
$4,445 |
8.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,499.25 |
$3,845 |
7.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,889.25 |
$4,445 |
8.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,645.50 |
$4,070 |
7.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,889.25 |
$4,445 |
8.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,152.80 |
$3,312 |
9.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,795.30 |
$2,762 |
7.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,733.25 |
$4,205 |
8.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,807.65 |
$2,781 |
7.9× |
| Neck soft tissue (70360) |
$221 |
$340 |
2.6× |
| Osseous survey infant (77076) |
$349.70 |
$538 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$260.65 |
$401 |
2.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,770.95 |
$4,263 |
8.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$307.45 |
$473 |
3.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$442 |
$680 |
4.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$411.45 |
$633 |
4.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$662.35 |
$1,019 |
6.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$357.50 |
$550 |
3.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$174.85 |
$269 |
2.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$371.80 |
$572 |
3.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$184.60 |
$284 |
2.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$193.70 |
$298 |
2.3× |
| Ribs bilateral 3 views (71110) |
$391.30 |
$602 |
3.9× |
| Sacroiliac Joints < 3 Views (72200) |
$226.20 |
$348 |
2.2× |
| Scapula complete (73010) |
$174.85 |
$269 |
1.7× |
| Spine thoracic 3 views (72072) |
$193.70 |
$298 |
1.9× |
| Thoracolumbar 2 views (72080) |
$291.85 |
$449 |
3.5× |
| Tmj unilateral (70328) |
$206.05 |
$317 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$381.55 |
$587 |
3.8× |
| Upper Extremity Infant (73092) |
$161.85 |
$249 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$761.15 |
$1,171 |
4.5× |
| Us abdl aorta screen aaa (76706) |
$406.90 |
$626 |
4.0× |
| Us chest (76604) |
$416.65 |
$641 |
4.1× |
| Us compl joint r-t w/image documentation (76881) |
$397.15 |
$611 |
3.9× |
| Us ob transvaginal (76817) |
$460.20 |
$708 |
4.6× |
| Us pelvic non ob complete (76856) |
$363.35 |
$559 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$416.65 |
$641 |
4.1× |
| Us pregnancy ltd (76815) |
$318.50 |
$490 |
3.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$365.95 |
$563 |
3.6× |
| Us retroperitoneal complete (76770) |
$455 |
$700 |
4.5× |
| Us retroperitoneal limited (76775) |
$381.55 |
$587 |
3.8× |
| Us scrotum and contents (76870) |
$364 |
$560 |
3.6× |
| Us soft tissue head/neck (76536) |
$399.10 |
$614 |
4.0× |
| Us xtr non-vasc lmtd (76882) |
$350.35 |
$539 |
3.5× |
| Wrist 2 views (73100) |
$160.22 |
$246.50 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$375.70 |
$578 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$245.05 |
$377 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$221 |
$340 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$221.32 |
$340.50 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$239.85 |
$369 |
2.9× |
| X-ray exam entire spi 4/5 vw (72083) |
$529.10 |
$814 |
5.3× |
| X-ray exam hip uni 1 view (73501) |
$175.50 |
$270 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$193.70 |
$298 |
2.3× |
| X-ray exam hip uni 4/> views (73503) |
$302.25 |
$465 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$523.25 |
$805 |
5.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$577.85 |
$889 |
5.7× |
| X-ray exam of femur 1 (73551) |
$174.85 |
$269 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$300.30 |
$462 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$213.20 |
$328 |
2.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$222.30 |
$342 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$174.85 |
$269 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$274.30 |
$422 |
3.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$286.65 |
$441 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$222.30 |
$342 |
2.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$188.50 |
$290 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$193.70 |
$298 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$271.70 |
$418 |
3.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$222.30 |
$342 |
2.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$193.70 |
$298 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$174.85 |
$269 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$181.35 |
$279 |
1.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$442.65 |
$681 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$266.50 |
$410 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$174.85 |
$269 |
2.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$193.70 |
$298 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$337.35 |
$519 |
4.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$214.50 |
$330 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$382.20 |
$588 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$315.90 |
$486 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$301.60 |
$464 |
3.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$215.15 |
$331 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$243.75 |
$375 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$174.85 |
$269 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$208 |
$320 |
2.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$193.70 |
$298 |
2.3× |
| Xr c-spine 6 or more views (72052) |
$469.95 |
$723 |
4.7× |
| Xr chest 4+ views (71048) |
$365.95 |
$563 |
3.6× |
| Xr finger(s) 2+ views (73140) |
$174.85 |
$269 |
2.1× |
| Xr shoulder 1 view (73020) |
$174.85 |
$269 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$241.80 |
$372 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$193.70 |
$298 |
2.3× |
| Xray knee 1 or 2 views rt (73560) |
$174.85 |
$269 |
2.1× |