| Abdomen 2 views (74019) |
$316.55 |
$487 |
3.1× |
| Ankle 2 views (73600) |
$255.45 |
$393 |
3.0× |
| Arthrogram elbow (73085) |
$670.80 |
$1,032 |
2.0× |
| Arthrogram hip (73525) |
$741 |
$1,140 |
2.2× |
| Arthrogram shoulder (73040) |
$960.70 |
$1,478 |
2.8× |
| Arthrogram wrist (73115) |
$696.15 |
$1,071 |
2.0× |
| Arthrography knee lt (73580) |
$891.15 |
$1,371 |
2.6× |
| Bone age studies (77072) |
$152.10 |
$234 |
1.5× |
| Bone survey complete (77075) |
$637.65 |
$981 |
6.2× |
| Cervical spine 2 or 3 views (72040) |
$283.40 |
$436 |
3.3× |
| Chest 1 view (71045) |
$217.10 |
$334 |
2.6× |
| Clavicle complete (73000) |
$258.05 |
$397 |
3.0× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$480.35 |
$739 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,251.65 |
$6,541 |
12.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,120 |
$4,800 |
13.4× |
| CT abdomen w contrast (74160) |
$2,055.95 |
$3,163 |
12.0× |
| CT abdomen w wo contrast (74170) |
$2,297.75 |
$3,535 |
13.4× |
| CT abdomen w/o contrast (74150) |
$1,753.05 |
$2,697 |
17.1× |
| CT c-spine w/o contrast (72125) |
$1,133.60 |
$1,744 |
11.1× |
| CT cervical spine w&w/o contrast (72127) |
$2,583.10 |
$3,974 |
15.1× |
| CT cervical spine with contrast (72126) |
$2,136.55 |
$3,287 |
6.3× |
| CT chest w/wo contrast (71270) |
$2,166.45 |
$3,333 |
12.6× |
| CT chest with contrast (71260) |
$1,941.55 |
$2,987 |
11.3× |
| CT head/brain with contrast (70460) |
$1,712.75 |
$2,635 |
10.0× |
| CT head/brain without and with contrast (70470) |
$2,133.30 |
$3,282 |
12.4× |
| CT iac w contrast (70481) |
$1,795.30 |
$2,762 |
10.5× |
| CT lower ext w/o (73700) |
$1,417 |
$2,180 |
13.9× |
| CT lower extremity w wo contrast (73702) |
$1,713.40 |
$2,636 |
10.0× |
| CT lower extremity with contrast (73701) |
$1,626.30 |
$2,502 |
9.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,267.85 |
$3,489 |
13.2× |
| CT lumbar spine w/o contrast (72131) |
$1,133.60 |
$1,744 |
11.1× |
| CT lumbar spine with contrast (72132) |
$2,016.30 |
$3,102 |
5.9× |
| CT maxillofacial w contrast (70487) |
$1,676.35 |
$2,579 |
9.8× |
| CT maxillofacial w/o contrast (70486) |
$1,327.95 |
$2,043 |
13.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,174.90 |
$3,346 |
12.7× |
| CT neck soft tissue w contrast (70491) |
$1,972.75 |
$3,035 |
11.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,961.70 |
$3,018 |
11.4× |
| CT orbits w/o contrast (70480) |
$1,668.55 |
$2,567 |
16.3× |
| CT pelvis w & w/o contrast (72194) |
$1,885 |
$2,900 |
11.0× |
| CT pelvis w/o contrast (72192) |
$1,691.95 |
$2,603 |
16.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,167.75 |
$3,335 |
12.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,537.90 |
$2,366 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$2,078.05 |
$3,197 |
12.1× |
| CT thoracic spine w/o contrast (72128) |
$1,780.35 |
$2,739 |
17.4× |
| CT thoracic spine w/wo contrast (72130) |
$2,086.50 |
$3,210 |
12.2× |
| CT thorax w/o contrast (71250) |
$1,771.90 |
$2,726 |
17.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,790.10 |
$2,754 |
10.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,038.05 |
$1,597 |
10.2× |
| CT upper extremity with contrast (73201) |
$1,532.05 |
$2,357 |
4.5× |
| Cta Abdomen (74175) |
$2,282.80 |
$3,512 |
13.3× |
| CTA abdomen pelvis (74174) |
$3,917.55 |
$6,027 |
11.5× |
| CTA chest (71275) |
$2,253.55 |
$3,467 |
13.1× |
| Cta Head (70496) |
$2,193.75 |
$3,375 |
12.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,819.70 |
$4,338 |
8.3× |
| Cta Neck (70498) |
$2,193.75 |
$3,375 |
12.8× |
| Cta Pelvis (72191) |
$1,979.90 |
$3,046 |
11.5× |
| Diskogram cervical (72285) |
$4,155.45 |
$6,393 |
2.2× |
| Diskography lumbar (72295) |
$4,700.15 |
$7,231 |
2.5× |
| Esophagus (74220) |
$449.80 |
$692 |
2.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$455.65 |
$701 |
4.5× |
| Fluoroscopy up to 1 hr (76000) |
$215.80 |
$332 |
0.9× |
| Foot 2 views (73620) |
$222.95 |
$343 |
2.6× |
| Forearm 2 views (73090) |
$231.40 |
$356 |
2.7× |
| Hand 2 views (73120) |
$189.80 |
$292 |
1.9× |
| Hand 3 views (73130) |
$220.35 |
$339 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$246.35 |
$379 |
2.9× |
| Knee 3 views (73562) |
$290.55 |
$447 |
3.4× |
| MRA head w & w/o contrast (70546) |
$2,814.50 |
$4,330 |
8.2× |
| MRA head w/o contrast (70544) |
$1,710.80 |
$2,632 |
7.3× |
| MRA head with contrast (70545) |
$2,342.60 |
$3,604 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,528.50 |
$3,890 |
7.4× |
| MRA neck w/o contrast (70547) |
$1,376.05 |
$2,117 |
5.9× |
| MRI abdomen w contrast (74182) |
$2,373.80 |
$3,652 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,107 |
$4,780 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$2,189.20 |
$3,368 |
9.4× |
| MRI any jnt lwr ext with con lt (73722) |
$2,399.15 |
$3,691 |
3.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,343.90 |
$3,606 |
3.1× |
| MRI c-spine with contrast (72142) |
$2,676.05 |
$4,117 |
7.8× |
| MRI cervical spine w/o contrast (72141) |
$1,292.20 |
$1,988 |
5.5× |
| MRI chest w/o & w/contrast material (71552) |
$3,074.50 |
$4,730 |
9.0× |
| MRI chest w/o contrast (71550) |
$1,880.45 |
$2,893 |
8.1× |
| MRI chest with contrast (71551) |
$2,670.85 |
$4,109 |
3.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,037.10 |
$3,134 |
6.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,304.90 |
$3,546 |
9.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,020.20 |
$3,108 |
8.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,120.98 |
$4,801.50 |
9.1× |
| MRI orbit/face/neck w/contrast (70542) |
$2,339.35 |
$3,599 |
6.9× |
| MRI pelvis w contrast (72196) |
$2,373.80 |
$3,652 |
7.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,108.95 |
$4,783 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$2,262 |
$3,480 |
9.7× |
| MRI scan of arm joint before and after contrast (73223) |
$2,648.10 |
$4,074 |
7.8× |
| MRI scan of leg joint before and after contrast (73723) |
$2,643.55 |
$4,067 |
7.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,090.75 |
$4,755 |
9.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,575.30 |
$3,962 |
7.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,053.70 |
$4,698 |
8.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,737.80 |
$4,212 |
8.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,409.90 |
$5,246 |
10.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,311.05 |
$2,017 |
5.6× |
| MRI tmj (70336) |
$1,890.20 |
$2,908 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,244.75 |
$1,915 |
5.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,494.70 |
$3,838 |
7.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,976 |
$3,040 |
8.5× |
| Myelogram Lumbar (72265) |
$1,135.55 |
$1,747 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,458.60 |
$2,244 |
1.9× |
| Neck soft tissue (70360) |
$252.85 |
$389 |
3.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$271.05 |
$417 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$236.60 |
$364 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,707.25 |
$4,165 |
7.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$269.75 |
$415 |
3.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$376.35 |
$579 |
3.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$388.70 |
$598 |
3.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$276.90 |
$426 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$341.90 |
$526 |
3.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$265.20 |
$408 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$375.70 |
$578 |
3.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$285.35 |
$439 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$724.75 |
$1,115 |
4.2× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$802.10 |
$1,234 |
4.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$690.30 |
$1,062 |
4.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$430.95 |
$663 |
2.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$295.75 |
$455 |
3.5× |
| Ribs bilateral 3 views (71110) |
$342.55 |
$527 |
3.4× |
| Sacroiliac Joints < 3 Views (72200) |
$226.85 |
$349 |
2.2× |
| Scanogram (77073) |
$280.15 |
$431 |
2.7× |
| Scapula complete (73010) |
$275.60 |
$424 |
2.7× |
| Small bowel series (74250) |
$636.35 |
$979 |
3.7× |
| Spine thoracic 3 views (72072) |
$321.75 |
$495 |
3.1× |
| Thoracolumbar 2 views (72080) |
$196.95 |
$303 |
2.3× |
| Tmj unilateral (70328) |
$208 |
$320 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$551.85 |
$849 |
5.4× |
| Us abdl aorta screen aaa (76706) |
$451.10 |
$694 |
4.4× |
| Us breast unilateral complete (76641) |
$147.55 |
$227 |
1.4× |
| Us breast unilateral limited (76642) |
$320.45 |
$493 |
3.8× |
| Us chest (76604) |
$450.45 |
$693 |
4.4× |
| Us compl joint r-t w/image documentation (76881) |
$391.95 |
$603 |
3.8× |
| Us ob transvaginal (76817) |
$382.20 |
$588 |
3.7× |
| Us pelvic non ob complete (76856) |
$553.80 |
$852 |
5.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$423.15 |
$651 |
4.1× |
| Us pregnancy ltd (76815) |
$367.25 |
$565 |
3.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$590.85 |
$909 |
5.8× |
| Us retroperitoneal complete (76770) |
$438.10 |
$674 |
4.3× |
| Us retroperitoneal limited (76775) |
$389.35 |
$599 |
3.8× |
| Us scrotum and contents (76870) |
$594.75 |
$915 |
5.8× |
| Us soft tissue head/neck (76536) |
$599.95 |
$923 |
5.9× |
| Us transrectal (76872) |
$504.40 |
$776 |
4.9× |
| Us xtr non-vasc lmtd (76882) |
$378.30 |
$582 |
3.7× |
| Wrist 2 views (73100) |
$224.25 |
$345 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$478.40 |
$736 |
4.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$234.65 |
$361 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$279.50 |
$430 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,028.95 |
$1,583 |
6.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$207.35 |
$319 |
2.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$280.15 |
$431 |
3.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$473.20 |
$728 |
4.6× |
| X-ray exam hip uni 1 view (73501) |
$204.75 |
$315 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$279.50 |
$430 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$509.60 |
$784 |
5.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$488.80 |
$752 |
4.8× |
| X-ray exam of femur 1 (73551) |
$226.85 |
$349 |
2.7× |
| X-ray eye for foreign body (70030) |
$187.20 |
$288 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$338.65 |
$521 |
3.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$234.65 |
$361 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$272.35 |
$419 |
3.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$212.55 |
$327 |
2.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$239.20 |
$368 |
2.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$377 |
$580 |
3.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$184.60 |
$284 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$276.90 |
$426 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$541.45 |
$833 |
5.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$309.40 |
$476 |
3.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$257.40 |
$396 |
3.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$345.15 |
$531 |
3.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$306.80 |
$472 |
3.0× |
| X-Ray Renal Cyst Xlumbar+Contrst - Xr Renal Cyst Lumbar W Contrast (74470) |
$841.75 |
$1,295 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$273 |
$420 |
3.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$335.40 |
$516 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$482.95 |
$743 |
4.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$316.55 |
$487 |
3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$316.55 |
$487 |
3.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$267.15 |
$411 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$347.10 |
$534 |
4.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$207.35 |
$319 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$388.70 |
$598 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$267.15 |
$411 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$194.35 |
$299 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$275.60 |
$424 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$248.30 |
$382 |
2.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$196.30 |
$302 |
1.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$373.75 |
$575 |
3.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$224.25 |
$345 |
2.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$257.40 |
$396 |
3.0× |
| Xr arthrogram ankle (73615) |
$807.95 |
$1,243 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$529.10 |
$814 |
5.2× |
| Xr finger(s) 2+ views (73140) |
$202.15 |
$311 |
2.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$157.95 |
$243 |
1.5× |
| Xr optic foramina (70190) |
$154.05 |
$237 |
1.8× |
| Xr shoulder 1 view (73020) |
$235.95 |
$363 |
2.8× |
| Xr spine cervical 4 or 5 views (72050) |
$524.55 |
$807 |
5.1× |
| Xr tibia/fibula 2 views (73590) |
$248.95 |
$383 |
2.9× |
| Xr tmj bilateral (70330) |
$331.50 |
$510 |
3.9× |
| Xray knee 1 or 2 views rt (73560) |
$254.80 |
$392 |
3.0× |