| Abdomen 2 views (74019) |
$442 |
$491 |
4.6× |
| Ankle 2 views (73600) |
$390 |
$433 |
4.9× |
| Bone age studies (77072) |
$447 |
$497 |
4.6× |
| Cervical spine 2 or 3 views (72040) |
$513 |
$570 |
6.4× |
| Chest 1 view (71045) |
$397 |
$441 |
5.0× |
| Clavicle complete (73000) |
$366 |
$407 |
4.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,625 |
$1,805 |
16.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,002 |
$4,447 |
12.5× |
| CT abdomen and pelvis without contrast (74176) |
$3,776 |
$4,195 |
17.2× |
| CT abdomen w contrast (74160) |
$2,000 |
$2,222 |
12.4× |
| CT abdomen w wo contrast (74170) |
$2,000 |
$2,222 |
12.4× |
| CT abdomen w/o contrast (74150) |
$2,000 |
$2,222 |
20.8× |
| CT angiography upper extremity lt (73206) |
$4,307 |
$4,785 |
26.7× |
| CT c-spine w/o contrast (72125) |
$2,000 |
$2,222 |
20.8× |
| CT cervical spine w&w/o contrast (72127) |
$2,000 |
$2,222 |
12.4× |
| CT cervical spine with contrast (72126) |
$2,000 |
$2,222 |
6.2× |
| CT chest w/wo contrast (71270) |
$2,000 |
$2,222 |
12.4× |
| CT chest with contrast (71260) |
$2,000 |
$2,222 |
12.4× |
| CT head/brain with contrast (70460) |
$2,000 |
$2,222 |
12.4× |
| CT head/brain without and with contrast (70470) |
$2,000 |
$2,222 |
12.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$1,608 |
$1,787 |
20.1× |
| CT iac w contrast (70481) |
$2,000 |
$2,222 |
12.4× |
| CT lower ext w/o (73700) |
$2,000 |
$2,222 |
20.8× |
| CT lower extremity w wo contrast (73702) |
$2,000 |
$2,222 |
12.4× |
| CT lower extremity with contrast (73701) |
$2,000 |
$2,222 |
12.4× |
| CT lumbar spine w & w/o contrast (72133) |
$2,000 |
$2,222 |
12.4× |
| CT lumbar spine w/o contrast (72131) |
$2,000 |
$2,222 |
20.8× |
| CT lumbar spine with contrast (72132) |
$2,000 |
$2,222 |
6.2× |
| CT maxillofacial w contrast (70487) |
$2,000 |
$2,222 |
12.4× |
| CT maxillofacial w/o contrast (70486) |
$2,000 |
$2,222 |
20.8× |
| CT maxillofacial w/wo contrast (70488) |
$2,000 |
$2,222 |
12.4× |
| CT neck soft tissue w contrast (70491) |
$2,000 |
$2,222 |
12.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,000 |
$2,222 |
12.4× |
| CT orbits w/o contrast (70480) |
$2,000 |
$2,222 |
20.8× |
| CT pelvis w & w/o contrast (72194) |
$2,000 |
$2,222 |
12.4× |
| CT pelvis w/o contrast (72192) |
$2,000 |
$2,222 |
20.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,000 |
$2,222 |
12.4× |
| CT soft tissue neck w/o contrast (70490) |
$2,000 |
$2,222 |
20.8× |
| CT thoracic spine w/contrast (72129) |
$2,000 |
$2,222 |
12.4× |
| CT thoracic spine w/o contrast (72128) |
$2,000 |
$2,222 |
20.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,000 |
$2,222 |
12.4× |
| CT thorax w/o contrast (71250) |
$2,000 |
$2,222 |
20.8× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,000 |
$2,222 |
12.4× |
| CT upper extremity w/o contrast rt (73200) |
$2,000 |
$2,222 |
20.8× |
| CT upper extremity with contrast (73201) |
$2,000 |
$2,222 |
6.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$4,529 |
$5,032 |
28.1× |
| Cta Abdomen (74175) |
$4,307 |
$4,785 |
26.7× |
| CTA abdomen pelvis (74174) |
$6,125 |
$6,806 |
19.1× |
| CTA chest (71275) |
$4,156 |
$4,618 |
25.8× |
| Cta Head (70496) |
$4,208 |
$4,676 |
26.1× |
| CTA lwr ext w&w/o contrast (73706) |
$4,307 |
$4,785 |
26.7× |
| Cta Neck (70498) |
$3,131 |
$3,479 |
19.4× |
| Foot 2 views (73620) |
$390 |
$433 |
4.9× |
| Forearm 2 views (73090) |
$400 |
$444 |
5.0× |
| Hand 2 views (73120) |
$334 |
$371 |
3.5× |
| Hand 3 views (73130) |
$438 |
$487 |
5.5× |
| Humerus Min 2 Views Left (73060) |
$441 |
$490 |
5.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$314 |
$349 |
3.3× |
| Knee 3 views (73562) |
$480 |
$533 |
6.0× |
| MRA head w & w/o contrast (70546) |
$2,764 |
$3,071 |
8.6× |
| MRA head w/o contrast (70544) |
$2,764 |
$3,071 |
12.6× |
| MRA head with contrast (70545) |
$2,764 |
$3,071 |
8.6× |
| MRA neck w contrast (70548) |
$2,764 |
$3,071 |
8.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,764 |
$3,071 |
8.6× |
| MRA neck w/o contrast (70547) |
$2,764 |
$3,071 |
12.6× |
| MRI abdomen w contrast (74182) |
$2,306 |
$2,562 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,306 |
$2,562 |
7.2× |
| MRI abdomen w/o contrast (74181) |
$2,306 |
$2,562 |
10.5× |
| MRI any jnt lwr ext with con lt (73722) |
$2,306 |
$2,562 |
3.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,306 |
$2,562 |
3.2× |
| MRI c-spine with contrast (72142) |
$2,306 |
$2,562 |
7.2× |
| MRI cervical spine w/o contrast (72141) |
$2,306 |
$2,562 |
10.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,306 |
$2,562 |
7.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,306 |
$2,562 |
7.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,306 |
$2,562 |
10.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,306 |
$2,562 |
10.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,306 |
$2,562 |
7.2× |
| MRI orbit/face/neck w/contrast (70542) |
$2,306 |
$2,562 |
7.2× |
| MRI pelvis w contrast (72196) |
$2,306 |
$2,562 |
7.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,306 |
$2,562 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$2,306 |
$2,562 |
10.5× |
| MRI scan of arm joint before and after contrast (73223) |
$2,306 |
$2,562 |
7.2× |
| MRI scan of leg joint before and after contrast (73723) |
$2,306 |
$2,562 |
7.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,306 |
$2,562 |
7.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,306 |
$2,562 |
7.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,306 |
$2,562 |
7.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,306 |
$2,562 |
7.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,306 |
$2,562 |
7.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,306 |
$2,562 |
10.5× |
| MRI upper ext joint w/o contrast (73221) |
$2,306 |
$2,562 |
10.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,306 |
$2,562 |
7.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,306 |
$2,562 |
10.5× |
| Neck soft tissue (70360) |
$414 |
$460 |
5.2× |
| Pelvis 1 or 2 views (72170) |
$405 |
$450 |
4.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,306 |
$2,562 |
7.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$617 |
$686 |
7.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$626 |
$695 |
6.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$577 |
$641 |
6.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$704 |
$782 |
7.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$677 |
$752 |
7.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$432 |
$480 |
5.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$487 |
$541 |
6.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$377 |
$419 |
4.7× |
| Ribs bilateral 3 views (71110) |
$612 |
$680 |
6.4× |
| Sacroiliac Joints < 3 Views (72200) |
$459 |
$510 |
4.8× |
| Scapula complete (73010) |
$375 |
$417 |
3.9× |
| Spine thoracic 3 views (72072) |
$647 |
$719 |
6.7× |
| Thoracolumbar 2 views (72080) |
$617 |
$686 |
7.7× |
| Tmj unilateral (70328) |
$439 |
$488 |
5.5× |
| Ultrasound, abdomen limited (76705) |
$595 |
$661 |
6.2× |
| Unlisted Ultrasound Procedure (76999) |
$1,543 |
$1,714 |
19.3× |
| Upper Extremity Infant (73092) |
$403 |
$448 |
4.2× |
| Us abdl aorta screen aaa (76706) |
$486 |
$540 |
5.1× |
| Us breast unilateral complete (76641) |
$418 |
$464 |
4.3× |
| Us breast unilateral limited (76642) |
$418 |
$464 |
5.2× |
| Us chest (76604) |
$595 |
$661 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$451 |
$501 |
4.7× |
| Us retroperitoneal complete (76770) |
$587.50 |
$652.50 |
6.1× |
| Us retroperitoneal limited (76775) |
$376 |
$418 |
3.9× |
| Us soft tissue head/neck (76536) |
$1,543 |
$1,714 |
16.0× |
| Us xtr non-vasc lmtd (76882) |
$512 |
$569 |
5.3× |
| Wrist 2 views (73100) |
$362 |
$402 |
4.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$847 |
$941 |
8.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$447 |
$497 |
5.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$364 |
$404 |
4.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$486 |
$540 |
6.1× |
| X-ray exam hip uni 1 view (73501) |
$405 |
$450 |
5.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$436 |
$484 |
5.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$577 |
$641 |
6.0× |
| X-ray exam of femur 1 (73551) |
$314 |
$349 |
3.9× |
| X-ray eye for foreign body (70030) |
$314 |
$349 |
3.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$608 |
$676 |
6.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$311 |
$345 |
3.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$447 |
$497 |
5.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$366 |
$407 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$492 |
$547 |
6.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$695 |
$772 |
7.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$352 |
$391 |
4.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$445 |
$494 |
5.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$561 |
$623 |
5.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$959 |
$1,066 |
10.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$474 |
$527 |
5.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$361 |
$401 |
4.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$584 |
$649 |
6.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$436 |
$484 |
4.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$429 |
$477 |
5.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$641 |
$712 |
6.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$787 |
$874 |
8.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$459 |
$510 |
5.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$450 |
$500 |
5.6× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$343 |
$381 |
4.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$677 |
$752 |
7.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$459 |
$510 |
4.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$548 |
$609 |
6.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$626 |
$695 |
7.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$465 |
$517 |
5.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$429 |
$477 |
4.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$346 |
$384 |
4.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$459 |
$510 |
5.7× |
| Xr c-spine 6 or more views (72052) |
$870 |
$967 |
9.0× |
| Xr finger(s) 2+ views (73140) |
$340 |
$378 |
4.2× |
| Xr shoulder 1 view (73020) |
$340 |
$378 |
4.2× |
| Xr spine cervical 4 or 5 views (72050) |
$796 |
$884 |
8.3× |
| Xr tibia/fibula 2 views (73590) |
$456 |
$507 |
5.7× |
| Xr tmj bilateral (70330) |
$635 |
$705 |
7.9× |
| Xray knee 1 or 2 views rt (73560) |
$346 |
$384 |
4.3× |