| Ankle 2 views (73600) |
$70 |
$125 |
0.9× |
| Bone age studies (77072) |
$94.08 |
$168 |
1.0× |
| Bone survey complete (77075) |
$301.84 |
$539 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$92.40 |
$165 |
1.2× |
| Chest 1 view (71045) |
$81.20 |
$145 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$200.48 |
$358 |
1.3× |
| Clavicle complete (73000) |
$73.36 |
$131 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$616 |
$1,100 |
6.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$979.44 |
$1,749 |
3.2× |
| CT abdomen and pelvis without contrast (74176) |
$784.56 |
$1,401 |
3.8× |
| CT abdomen w contrast (74160) |
$855.68 |
$1,528 |
5.6× |
| CT abdomen w wo contrast (74170) |
$979.44 |
$1,749 |
6.4× |
| CT abdomen w/o contrast (74150) |
$766.08 |
$1,368 |
8.4× |
| CT angiography upper extremity lt (73206) |
$766.08 |
$1,368 |
5.0× |
| CT c-spine w/o contrast (72125) |
$784.56 |
$1,401 |
8.6× |
| CT cervical spine w&w/o contrast (72127) |
$938.56 |
$1,676 |
6.1× |
| CT cervical spine with contrast (72126) |
$873.04 |
$1,559 |
2.9× |
| CT chest w/wo contrast (71270) |
$1,006.32 |
$1,797 |
6.5× |
| CT chest with contrast (71260) |
$873.04 |
$1,559 |
5.7× |
| CT head/brain with contrast (70460) |
$766.08 |
$1,368 |
5.0× |
| CT head/brain without and with contrast (70470) |
$873.04 |
$1,559 |
5.7× |
| CT lower ext w/o (73700) |
$712.88 |
$1,273 |
7.8× |
| CT lower extremity w wo contrast (73702) |
$899.36 |
$1,606 |
5.9× |
| CT lower extremity with contrast (73701) |
$784.56 |
$1,401 |
5.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,006.32 |
$1,797 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$784.56 |
$1,401 |
8.6× |
| CT lumbar spine with contrast (72132) |
$873.04 |
$1,559 |
2.9× |
| CT maxillofacial w contrast (70487) |
$766.08 |
$1,368 |
5.0× |
| CT maxillofacial w/o contrast (70486) |
$696.08 |
$1,243 |
7.6× |
| CT maxillofacial w/wo contrast (70488) |
$873.04 |
$1,559 |
5.7× |
| CT neck soft tissue w contrast (70491) |
$766.08 |
$1,368 |
5.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,120 |
$2,000 |
7.3× |
| CT orbits w/o contrast (70480) |
$924 |
$1,650 |
10.1× |
| CT pelvis w & w/o contrast (72194) |
$979.44 |
$1,749 |
6.4× |
| CT pelvis w/o contrast (72192) |
$784.56 |
$1,401 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$696.08 |
$1,243 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$873.04 |
$1,559 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$784.56 |
$1,401 |
8.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,006.32 |
$1,797 |
6.5× |
| CT thorax w/o contrast (71250) |
$784.56 |
$1,401 |
8.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$899.36 |
$1,606 |
5.9× |
| CT upper extremity w/o contrast rt (73200) |
$712.88 |
$1,273 |
7.8× |
| CT upper extremity with contrast (73201) |
$784.56 |
$1,401 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$672 |
$1,200 |
4.4× |
| Cta Abdomen (74175) |
$766.08 |
$1,368 |
5.0× |
| CTA abdomen pelvis (74174) |
$896 |
$1,600 |
2.9× |
| CTA chest (71275) |
$766.08 |
$1,368 |
5.0× |
| Cta Head (70496) |
$766.08 |
$1,368 |
5.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,532.16 |
$2,736 |
5.0× |
| CTA lwr ext w&w/o contrast (73706) |
$766.08 |
$1,368 |
5.0× |
| Cta Neck (70498) |
$766.08 |
$1,368 |
5.0× |
| Cta Pelvis (72191) |
$766.08 |
$1,368 |
5.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$231.28 |
$413 |
2.5× |
| Fetal biophysical profile non-stress testing (76818) |
$349.44 |
$624 |
3.8× |
| Fluoroscopy up to 1 hr (76000) |
$209.44 |
$374 |
1.0× |
| Foot 2 views (73620) |
$70 |
$125 |
0.9× |
| Forearm 2 views (73090) |
$73.36 |
$131 |
1.0× |
| Hand 2 views (73120) |
$70 |
$125 |
0.8× |
| Hand 3 views (73130) |
$76.16 |
$136 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$80.08 |
$143 |
1.1× |
| MRA head w & w/o contrast (70546) |
$1,219.68 |
$2,178 |
4.0× |
| MRA head w/o contrast (70544) |
$948.64 |
$1,694 |
4.5× |
| MRA head with contrast (70545) |
$1,016.40 |
$1,815 |
3.3× |
| MRA neck w contrast (70548) |
$1,084.16 |
$1,936 |
3.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,219.68 |
$2,178 |
4.0× |
| MRA neck w/o contrast (70547) |
$948.64 |
$1,694 |
4.5× |
| MRI abdomen w contrast (74182) |
$1,151.92 |
$2,057 |
3.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,219.68 |
$2,178 |
4.0× |
| MRI abdomen w/o contrast (74181) |
$1,084.16 |
$1,936 |
5.2× |
| MRI c-spine with contrast (72142) |
$1,084.16 |
$1,936 |
3.5× |
| MRI cervical spine w/o contrast (72141) |
$1,016.40 |
$1,815 |
4.9× |
| MRI chest w/o & w/contrast material (71552) |
$1,219.68 |
$2,178 |
4.0× |
| MRI chest w/o contrast (71550) |
$948.64 |
$1,694 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,084.16 |
$1,936 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$948.64 |
$1,694 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,151.92 |
$2,057 |
3.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,016.40 |
$1,815 |
3.3× |
| MRI pelvis w contrast (72196) |
$1,084.16 |
$1,936 |
3.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,219.68 |
$2,178 |
4.0× |
| MRI pelvis w/o contrast (72195) |
$1,016.40 |
$1,815 |
4.9× |
| MRI scan of arm joint before and after contrast (73223) |
$1,219.68 |
$2,178 |
4.0× |
| MRI scan of leg joint before and after contrast (73723) |
$1,219.68 |
$2,178 |
4.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,219.68 |
$2,178 |
4.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,084.16 |
$1,936 |
3.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,219.68 |
$2,178 |
4.0× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,219.68 |
$2,178 |
4.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,331.68 |
$2,378 |
4.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,084.16 |
$1,936 |
5.2× |
| MRI tmj (70336) |
$948.64 |
$1,694 |
4.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,084.16 |
$1,936 |
5.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,219.68 |
$2,178 |
4.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,084.16 |
$1,936 |
5.2× |
| Neck soft tissue (70360) |
$65.52 |
$117 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$82.32 |
$147 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,219.68 |
$2,178 |
4.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$160.72 |
$287 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$68.60 |
$122.50 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$75.04 |
$134 |
1.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$232.96 |
$416 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$92.40 |
$165 |
1.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$80.08 |
$143 |
1.1× |
| Scanogram (77073) |
$84 |
$150 |
0.9× |
| Scapula complete (73010) |
$81.20 |
$145 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$43.12 |
$77 |
1.8× |
| Small bowel series (74250) |
$213.92 |
$382 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$202.16 |
$361 |
2.2× |
| Unlisted Ultrasound Procedure (76999) |
$140 |
$250 |
1.8× |
| Upper Extremity Infant (73092) |
$36.40 |
$65 |
0.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$358.96 |
$641 |
2.3× |
| Us abdl aorta screen aaa (76706) |
$294 |
$525 |
3.2× |
| Us breast unilateral complete (76641) |
$202.16 |
$361 |
2.2× |
| Us breast unilateral limited (76642) |
$84 |
$150 |
1.1× |
| Us chest (76604) |
$215.60 |
$385 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$141.12 |
$252 |
1.5× |
| Us ob transvaginal (76817) |
$336 |
$600 |
3.7× |
| Us pelvic non ob complete (76856) |
$256.48 |
$458 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$172.48 |
$308 |
1.9× |
| Us pregnancy ltd (76815) |
$215.60 |
$385 |
2.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$277.48 |
$495.50 |
3.0× |
| Us retroperitoneal complete (76770) |
$309.12 |
$552 |
3.4× |
| Us retroperitoneal limited (76775) |
$294 |
$525 |
3.2× |
| Us scrotum and contents (76870) |
$369.04 |
$659 |
4.0× |
| Us soft tissue head/neck (76536) |
$320.32 |
$572 |
3.5× |
| Us xtr non-vasc lmtd (76882) |
$33.60 |
$60 |
0.4× |
| Wrist 2 views (73100) |
$70 |
$125 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$254.24 |
$454 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$75.04 |
$134 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$80.08 |
$143 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$100.24 |
$179 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$93.52 |
$167 |
1.2× |
| X-ray exam of femur 1 (73551) |
$50.40 |
$90 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$114.80 |
$205 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$89.60 |
$160 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$68.32 |
$122 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$103.04 |
$184 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$98.56 |
$176 |
1.1× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$42 |
$75 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$98.56 |
$176 |
1.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$47.60 |
$85 |
0.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$82.32 |
$147 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$36.40 |
$65 |
0.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$89.60 |
$160 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$110.32 |
$197 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$140.56 |
$251 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$80.08 |
$143 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$80.08 |
$143 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$90.72 |
$162 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$114.80 |
$205 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$137.76 |
$246 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$98.56 |
$176 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$98.56 |
$176 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$90.72 |
$162 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$93.52 |
$167 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$70 |
$125 |
0.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$76.16 |
$136 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$159.60 |
$285 |
1.7× |
| Xr chest 4+ views (71048) |
$87.36 |
$156 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$70 |
$125 |
0.9× |
| Xr optic foramina (70190) |
$89.60 |
$160 |
1.2× |
| Xr shoulder 1 view (73020) |
$67.20 |
$120 |
0.9× |
| Xr tibia/fibula 2 views (73590) |
$73.36 |
$131 |
1.0× |
| Xr tmj bilateral (70330) |
$117.04 |
$209 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$73.92 |
$132 |
1.0× |