| Abdomen 2 views (74019) |
$293.80 |
$452 |
2.8× |
| Ankle 2 views (73600) |
$195 |
$300 |
2.2× |
| Bone age studies (77072) |
$276.25 |
$425 |
2.6× |
| Bone survey complete (77075) |
$712.40 |
$1,096 |
6.8× |
| Cervical spine 2 or 3 views (72040) |
$310.05 |
$477 |
3.6× |
| Chest 1 view (71045) |
$165.75 |
$255 |
1.9× |
| Chest 3 views (71047) |
$271.70 |
$418 |
3.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$431.60 |
$664 |
2.5× |
| Clavicle complete (73000) |
$239.85 |
$369 |
2.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,914.95 |
$6,023 |
11.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,580.50 |
$3,970 |
10.8× |
| CT abdomen w contrast (74160) |
$1,958.45 |
$3,013 |
11.1× |
| CT abdomen w wo contrast (74170) |
$2,382.25 |
$3,665 |
13.6× |
| CT abdomen w/o contrast (74150) |
$1,508 |
$2,320 |
14.4× |
| CT angiography upper extremity lt (73206) |
$2,112.50 |
$3,250 |
12.0× |
| CT c-spine w/o contrast (72125) |
$1,626.30 |
$2,502 |
15.5× |
| CT cervical spine w&w/o contrast (72127) |
$2,611.70 |
$4,018 |
14.9× |
| CT cervical spine with contrast (72126) |
$2,106 |
$3,240 |
6.0× |
| CT chest w/wo contrast (71270) |
$1,981.85 |
$3,049 |
11.3× |
| CT chest with contrast (71260) |
$1,904.50 |
$2,930 |
10.8× |
| CT head/brain with contrast (70460) |
$1,543.10 |
$2,374 |
8.8× |
| CT head/brain without and with contrast (70470) |
$1,918.80 |
$2,952 |
10.9× |
| CT iac w contrast (70481) |
$1,665.30 |
$2,562 |
9.5× |
| CT limited/localized follow up study (76380) |
$695.50 |
$1,070 |
8.0× |
| CT lower ext w/o (73700) |
$1,281.15 |
$1,971 |
12.2× |
| CT lower extremity w wo contrast (73702) |
$1,737.45 |
$2,673 |
9.9× |
| CT lower extremity with contrast (73701) |
$1,543.75 |
$2,375 |
8.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,050.75 |
$3,155 |
11.7× |
| CT lumbar spine w/o contrast (72131) |
$1,660.10 |
$2,554 |
15.9× |
| CT lumbar spine with contrast (72132) |
$2,195.70 |
$3,378 |
6.3× |
| CT maxillofacial w contrast (70487) |
$1,701.05 |
$2,617 |
9.7× |
| CT maxillofacial w/o contrast (70486) |
$1,324.38 |
$2,037.50 |
12.6× |
| CT maxillofacial w/wo contrast (70488) |
$2,224.30 |
$3,422 |
12.7× |
| CT neck soft tissue w contrast (70491) |
$1,793.35 |
$2,759 |
10.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,010.45 |
$3,093 |
11.4× |
| CT orbits w/o contrast (70480) |
$1,476.15 |
$2,271 |
14.1× |
| CT pelvis w & w/o contrast (72194) |
$2,172.30 |
$3,342 |
12.4× |
| CT pelvis w/o contrast (72192) |
$1,577.55 |
$2,427 |
15.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,018.90 |
$3,106 |
11.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,472.90 |
$2,266 |
14.1× |
| CT thoracic spine w/contrast (72129) |
$2,143.70 |
$3,298 |
12.2× |
| CT thoracic spine w/o contrast (72128) |
$1,691.95 |
$2,603 |
16.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,998.75 |
$3,075 |
11.4× |
| CT thorax w/o contrast (71250) |
$1,587.30 |
$2,442 |
15.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,855.75 |
$2,855 |
10.6× |
| CT upper extremity w/o contrast rt (73200) |
$1,265.55 |
$1,947 |
12.1× |
| CT upper extremity with contrast (73201) |
$1,420.90 |
$2,186 |
4.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,717 |
$4,180 |
15.5× |
| Cta Abdomen (74175) |
$2,399.80 |
$3,692 |
13.7× |
| CTA abdomen pelvis (74174) |
$3,270.15 |
$5,031 |
9.4× |
| CTA chest (71275) |
$2,356.90 |
$3,626 |
13.4× |
| Cta Head (70496) |
$2,011.10 |
$3,094 |
11.4× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,670.85 |
$4,109 |
7.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,942.85 |
$2,989 |
11.1× |
| Cta Neck (70498) |
$2,011.10 |
$3,094 |
11.4× |
| Cta Pelvis (72191) |
$1,949.35 |
$2,999 |
11.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$353.60 |
$544 |
3.4× |
| Esophagus (74220) |
$436.15 |
$671 |
2.5× |
| Fluoroscopy up to 1 hr (76000) |
$550.55 |
$847 |
2.3× |
| Foot 2 views (73620) |
$227.18 |
$349.50 |
2.6× |
| Forearm 2 views (73090) |
$230.10 |
$354 |
2.6× |
| Hand 2 views (73120) |
$202.15 |
$311 |
1.9× |
| Hand 3 views (73130) |
$260.65 |
$401 |
3.0× |
| Humerus Min 2 Views Left (73060) |
$251.55 |
$387 |
2.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$168.35 |
$259 |
1.6× |
| Knee 3 views (73562) |
$274.30 |
$422 |
3.1× |
| MRA head w/o contrast (70544) |
$1,721.85 |
$2,649 |
7.2× |
| MRA neck w contrast (70548) |
$2,411.50 |
$3,710 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,900.95 |
$4,463 |
8.3× |
| MRA neck w/o contrast (70547) |
$1,894.10 |
$2,914 |
7.9× |
| MRI abdomen w contrast (74182) |
$2,513.55 |
$3,867 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,897.70 |
$4,458 |
8.3× |
| MRI abdomen w/o contrast (74181) |
$2,087.15 |
$3,211 |
8.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,449.85 |
$3,769 |
3.1× |
| MRI cervical spine w/o contrast (72141) |
$2,003.95 |
$3,083 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,063.45 |
$4,713 |
8.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,161.90 |
$3,326 |
6.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,868.10 |
$2,874 |
7.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,009.15 |
$3,091 |
8.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,695.88 |
$4,147.50 |
7.7× |
| MRI pelvis w contrast (72196) |
$2,293.20 |
$3,528 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,603.90 |
$4,006 |
7.5× |
| MRI pelvis w/o contrast (72195) |
$1,879.80 |
$2,892 |
7.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,854.15 |
$4,391 |
8.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,624.38 |
$4,037.50 |
7.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,496.65 |
$3,841 |
7.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,652.65 |
$4,081 |
7.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,496.65 |
$3,841 |
7.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,496.65 |
$3,841 |
7.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,996.80 |
$3,072 |
8.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,065.70 |
$3,178 |
8.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,362.10 |
$3,634 |
6.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,920.75 |
$2,955 |
8.0× |
| Neck soft tissue (70360) |
$228.15 |
$351 |
2.6× |
| Osseous survey infant (77076) |
$403 |
$620 |
3.8× |
| Pelvis 1 or 2 views (72170) |
$214.50 |
$330 |
2.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,588.30 |
$3,982 |
7.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$280.15 |
$431 |
3.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$328.90 |
$506 |
3.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$329.55 |
$507 |
3.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$259.35 |
$399 |
2.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$644.80 |
$992 |
6.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$347.75 |
$535 |
3.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$207.35 |
$319 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$386.75 |
$595 |
3.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$207.35 |
$319 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$771.55 |
$1,187 |
4.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$666.25 |
$1,025 |
3.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$258.70 |
$398 |
3.0× |
| Radiological examination surgical specimen (76098) |
$217.10 |
$334 |
0.4× |
| Ribs bilateral 3 views (71110) |
$355.55 |
$547 |
3.4× |
| Sacroiliac Joints < 3 Views (72200) |
$224.25 |
$345 |
2.1× |
| Scapula complete (73010) |
$281.45 |
$433 |
2.7× |
| Screening digital breast tomosynthesis (77063) |
$68.90 |
$106 |
2.9× |
| Small bowel series (74250) |
$583.05 |
$897 |
3.3× |
| Spine thoracic 3 views (72072) |
$332.15 |
$511 |
3.2× |
| Thoracolumbar 2 views (72080) |
$306.15 |
$471 |
3.5× |
| Tmj unilateral (70328) |
$196.95 |
$303 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$494.65 |
$761 |
4.7× |
| Upper Extremity Infant (73092) |
$176.80 |
$272 |
1.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$682.50 |
$1,050 |
3.9× |
| Us abdl aorta screen aaa (76706) |
$377.65 |
$581 |
3.6× |
| Us chest (76604) |
$453.05 |
$697 |
4.3× |
| Us compl joint r-t w/image documentation (76881) |
$518.70 |
$798 |
5.0× |
| Us kidney transplant (76776) |
$657.80 |
$1,012 |
6.3× |
| Us ob transvaginal (76817) |
$412.10 |
$634 |
3.9× |
| Us pelvic non ob complete (76856) |
$650.65 |
$1,001 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$436.80 |
$672 |
4.2× |
| Us pregnancy ltd (76815) |
$358.80 |
$552 |
3.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$527.80 |
$812 |
5.0× |
| Us retroperitoneal complete (76770) |
$681.20 |
$1,048 |
6.5× |
| Us retroperitoneal limited (76775) |
$484.90 |
$746 |
4.6× |
| Us scrotum and contents (76870) |
$581.75 |
$895 |
5.6× |
| Us soft tissue head/neck (76536) |
$566.15 |
$871 |
5.4× |
| Us xtr non-vasc lmtd (76882) |
$364 |
$560 |
3.5× |
| Wrist 2 views (73100) |
$206.05 |
$317 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$372.45 |
$573 |
3.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$256.10 |
$394 |
2.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$289.25 |
$445 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$878.15 |
$1,351 |
5.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$213.85 |
$329 |
2.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$293.15 |
$451 |
3.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$482.95 |
$743 |
4.6× |
| X-ray exam hip uni 1 view (73501) |
$182 |
$280 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$238.55 |
$367 |
2.7× |
| X-ray exam hip uni 4/> views (73503) |
$271.05 |
$417 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$420.55 |
$647 |
4.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$497.25 |
$765 |
4.7× |
| X-ray exam of femur 1 (73551) |
$196.95 |
$303 |
2.3× |
| X-ray eye for foreign body (70030) |
$143.65 |
$221 |
1.6× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$313.30 |
$482 |
3.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$210.60 |
$324 |
2.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$274.30 |
$422 |
3.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$185.25 |
$285 |
2.1× |
| X-ray IV pyelogram+drip infusn (74410) |
$625.95 |
$963 |
3.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$252.85 |
$389 |
2.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$354.25 |
$545 |
3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$245.70 |
$378 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$178.10 |
$274 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$276.25 |
$425 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$582.40 |
$896 |
5.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$364 |
$560 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$259.35 |
$399 |
3.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$227.50 |
$350 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$349.70 |
$538 |
3.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$319.15 |
$491 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$235.95 |
$363 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$274.30 |
$422 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$417.95 |
$643 |
4.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$274.30 |
$422 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$263.25 |
$405 |
3.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$263.90 |
$406 |
3.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$339.95 |
$523 |
3.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$201.50 |
$310 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$377.65 |
$581 |
3.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$235.95 |
$363 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$180.70 |
$278 |
2.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$269.10 |
$414 |
3.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$262.60 |
$404 |
2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$371.80 |
$572 |
3.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$199.55 |
$307 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$251.55 |
$387 |
2.9× |
| Xr c-spine 6 or more views (72052) |
$492.05 |
$757 |
4.7× |
| Xr chest 4+ views (71048) |
$325.65 |
$501 |
3.1× |
| Xr finger(s) 2+ views (73140) |
$206.05 |
$317 |
2.4× |
| XR Mastoids < 3 Views Bilateral (70120) |
$201.50 |
$310 |
1.9× |
| Xr optic foramina (70190) |
$167.70 |
$258 |
1.9× |
| Xr shoulder 1 view (73020) |
$187.20 |
$288 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$414.70 |
$638 |
4.0× |
| Xr tibia/fibula 2 views (73590) |
$258.05 |
$397 |
3.0× |
| Xr tmj bilateral (70330) |
$336.05 |
$517 |
3.9× |
| Xray knee 1 or 2 views rt (73560) |
$210.60 |
$324 |
2.4× |