| Abdomen 2 views (74019) |
$275.25 |
$367 |
2.9× |
| Ankle 2 views (73600) |
$141.22 |
$188 |
1.8× |
| Bone age studies (77072) |
$172.50 |
$230 |
1.8× |
| Bone survey complete (77075) |
$562.50 |
$750 |
5.9× |
| Cervical spine 2 or 3 views (72040) |
$228.75 |
$305 |
2.9× |
| Chest 1 view (71045) |
$156 |
$208 |
1.9× |
| Chest 3 views (71047) |
$274.50 |
$366 |
3.4× |
| Clavicle complete (73000) |
$144 |
$192 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$855.75 |
$1,141 |
8.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,661 |
$3,548 |
8.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,647 |
$2,196 |
7.5× |
| CT abdomen w contrast (74160) |
$1,407.75 |
$1,877 |
8.7× |
| CT abdomen w wo contrast (74170) |
$1,701 |
$2,268 |
10.5× |
| CT abdomen w/o contrast (74150) |
$1,191.75 |
$1,589 |
12.4× |
| CT c-spine w/o contrast (72125) |
$1,315.50 |
$1,754 |
13.7× |
| CT chest w/wo contrast (71270) |
$1,562.25 |
$2,083 |
9.7× |
| CT chest with contrast (71260) |
$1,477.50 |
$1,970 |
9.2× |
| CT head/brain with contrast (70460) |
$1,191.75 |
$1,589 |
7.4× |
| CT head/brain without and with contrast (70470) |
$1,506.75 |
$2,009 |
9.3× |
| CT iac w contrast (70481) |
$861.75 |
$1,149 |
5.3× |
| CT limited/localized follow up study (76380) |
$390 |
$520 |
4.9× |
| CT lower ext w/o (73700) |
$1,284.75 |
$1,713 |
13.4× |
| CT lower extremity w wo contrast (73702) |
$1,425 |
$1,900 |
8.8× |
| CT lower extremity with contrast (73701) |
$1,395 |
$1,860 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$1,302.75 |
$1,737 |
13.5× |
| CT maxillofacial w contrast (70487) |
$862.50 |
$1,150 |
5.3× |
| CT maxillofacial w/o contrast (70486) |
$1,083 |
$1,444 |
11.3× |
| CT maxillofacial w/wo contrast (70488) |
$870 |
$1,160 |
5.4× |
| CT neck soft tissue w contrast (70491) |
$1,377.75 |
$1,837 |
8.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$876.75 |
$1,169 |
5.4× |
| CT orbits w/o contrast (70480) |
$1,184.25 |
$1,579 |
12.3× |
| CT pelvis w & w/o contrast (72194) |
$1,612.50 |
$2,150 |
10.0× |
| CT pelvis w/o contrast (72192) |
$1,251 |
$1,668 |
13.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,455.75 |
$1,941 |
9.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,140 |
$1,520 |
11.9× |
| CT thoracic spine w/o contrast (72128) |
$1,299.75 |
$1,733 |
13.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,500 |
$2,000 |
9.3× |
| CT thorax w/o contrast (71250) |
$1,280.25 |
$1,707 |
13.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$879 |
$1,172 |
5.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,138.50 |
$1,518 |
11.8× |
| CT upper extremity with contrast (73201) |
$1,388.25 |
$1,851 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,141.75 |
$4,189 |
19.5× |
| Cta Abdomen (74175) |
$1,092 |
$1,456 |
6.8× |
| CTA abdomen pelvis (74174) |
$2,105.25 |
$2,807 |
6.6× |
| CTA chest (71275) |
$2,042.25 |
$2,723 |
12.7× |
| Cta Head (70496) |
$1,980.75 |
$2,641 |
12.3× |
| CTA lwr ext w&w/o contrast (73706) |
$1,248 |
$1,664 |
7.7× |
| Cta Neck (70498) |
$1,958.25 |
$2,611 |
12.1× |
| Cta Pelvis (72191) |
$1,092 |
$1,456 |
6.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$354.75 |
$473 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$336 |
$448 |
3.5× |
| Foot 2 views (73620) |
$138.60 |
$184.50 |
1.7× |
| Forearm 2 views (73090) |
$173.25 |
$231 |
2.2× |
| Hand 2 views (73120) |
$198 |
$264 |
2.1× |
| Hand 3 views (73130) |
$205.50 |
$274 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$189.75 |
$253 |
2.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$135 |
$180 |
1.4× |
| Knee 3 views (73562) |
$235.50 |
$314 |
2.9× |
| MRA head w & w/o contrast (70546) |
$1,650 |
$2,200 |
5.1× |
| MRA head w/o contrast (70544) |
$1,569 |
$2,092 |
7.2× |
| MRA head with contrast (70545) |
$1,552.50 |
$2,070 |
4.8× |
| MRA neck w contrast (70548) |
$1,552.50 |
$2,070 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,183.25 |
$2,911 |
6.8× |
| MRA neck w/o contrast (70547) |
$1,832.25 |
$2,443 |
8.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,233.50 |
$2,978 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$1,521.75 |
$2,029 |
6.9× |
| MRI c-spine with contrast (72142) |
$1,631.25 |
$2,175 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,612.50 |
$2,150 |
7.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,457.25 |
$1,943 |
4.5× |
| MRI chest w/o contrast (71550) |
$1,290.75 |
$1,721 |
5.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,355.25 |
$1,807 |
6.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,290.75 |
$1,721 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,457.25 |
$1,943 |
4.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,170.50 |
$2,894 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$1,497 |
$1,996 |
6.8× |
| MRI scan of arm joint before and after contrast (73223) |
$1,467 |
$1,956 |
4.6× |
| MRI scan of leg joint before and after contrast (73723) |
$1,934.25 |
$2,579 |
6.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,046.75 |
$2,729 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,622.25 |
$2,163 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,028.75 |
$2,705 |
6.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,754.25 |
$2,339 |
5.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,027.25 |
$2,703 |
6.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,509.75 |
$2,013 |
6.9× |
| MRI tmj (70336) |
$1,290.75 |
$1,721 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,345.50 |
$1,794 |
6.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,691.25 |
$2,255 |
5.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,356 |
$1,808 |
6.2× |
| Neck soft tissue (70360) |
$191.25 |
$255 |
2.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$352.50 |
$470 |
3.7× |
| Osseous survey limited (77074) |
$450 |
$600 |
4.7× |
| Pelvis 1 or 2 views (72170) |
$184.50 |
$246 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,935.75 |
$2,581 |
6.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$392.70 |
$523 |
4.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$254.92 |
$339 |
2.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$487.50 |
$650 |
5.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$284.25 |
$379 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$197.25 |
$263 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$207 |
$276 |
2.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$192.75 |
$257 |
2.4× |
| Ribs bilateral 3 views (71110) |
$198 |
$264 |
2.1× |
| Scapula complete (73010) |
$153.78 |
$205 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$95.25 |
$127 |
4.1× |
| Sella turcica (70240) |
$120.45 |
$160 |
1.5× |
| Spine thoracic 3 views (72072) |
$295.50 |
$394 |
3.1× |
| Therapeutic Enema (74283) |
$370.50 |
$494 |
2.3× |
| Thoracolumbar 2 views (72080) |
$187.50 |
$250 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$463.50 |
$618 |
4.8× |
| Unlisted Ultrasound Procedure (76999) |
$336 |
$448 |
4.2× |
| Upper Extremity Infant (73092) |
$120.45 |
$160 |
1.3× |
| Us abdl aorta screen aaa (76706) |
$336 |
$448 |
3.5× |
| Us breast unilateral complete (76641) |
$327 |
$436 |
3.4× |
| Us breast unilateral limited (76642) |
$306.75 |
$409 |
3.8× |
| Us chest (76604) |
$336 |
$448 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$336 |
$448 |
3.5× |
| Us ob detailed single fetus (76811) |
$415.50 |
$554 |
1.9× |
| Us ob transvaginal (76817) |
$357.75 |
$477 |
3.7× |
| Us pelvic non ob complete (76856) |
$495.75 |
$661 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$336 |
$448 |
3.5× |
| Us pregnancy ltd (76815) |
$336 |
$448 |
3.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$355.50 |
$474 |
3.7× |
| Us retroperitoneal complete (76770) |
$439.50 |
$586 |
4.6× |
| Us retroperitoneal limited (76775) |
$352.12 |
$469.50 |
3.7× |
| Us scrotum and contents (76870) |
$352.50 |
$470 |
3.7× |
| Us soft tissue head/neck (76536) |
$564.75 |
$753 |
5.9× |
| Us transrectal (76872) |
$336 |
$448 |
3.5× |
| Us xtr non-vasc lmtd (76882) |
$350.25 |
$467 |
3.6× |
| Wrist 2 views (73100) |
$139.50 |
$186 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$260.70 |
$347 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$142.50 |
$190 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$196.50 |
$262 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$159.75 |
$213 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$203.25 |
$271 |
2.5× |
| X-ray exam hip uni 1 view (73501) |
$151.35 |
$201.50 |
1.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$258.38 |
$344.50 |
3.2× |
| X-ray exam hip uni 4/> views (73503) |
$198 |
$264 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$348.75 |
$465 |
3.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$375 |
$500 |
3.9× |
| X-ray exam of femur 1 (73551) |
$132 |
$176 |
1.6× |
| X-ray eye for foreign body (70030) |
$141.75 |
$189 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$267.75 |
$357 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$173.25 |
$231 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$213 |
$284 |
2.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$138.22 |
$184 |
1.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$258 |
$344 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$143.25 |
$191 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$222.75 |
$297 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$263.25 |
$351 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$361.50 |
$482 |
3.8× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$225.75 |
$301 |
2.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$220.50 |
$294 |
2.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$120.45 |
$160 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$183.75 |
$245 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$231.82 |
$309 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$147.68 |
$196 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$261.75 |
$349 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$335.25 |
$447 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$291.75 |
$389 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$192.75 |
$257 |
2.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$189 |
$252 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$187.50 |
$250 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$120.45 |
$160 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$307.50 |
$410 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$198.75 |
$265 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$168.75 |
$225 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$124.57 |
$166 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$142.50 |
$190 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$216 |
$288 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$178.20 |
$237 |
1.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$153.75 |
$205 |
1.9× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$205.50 |
$274 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$262.50 |
$350 |
2.7× |
| Xr finger(s) 2+ views (73140) |
$152.25 |
$203 |
1.9× |
| Xr shoulder 1 view (73020) |
$135.22 |
$180 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$226.88 |
$302 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$204 |
$272 |
2.5× |
| Xr tmj bilateral (70330) |
$120.45 |
$160 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$152.25 |
$203 |
1.9× |