| Abdomen 2 views (74019) |
$480 |
$480 |
4.4× |
| Ankle 2 views (73600) |
$345 |
$345 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$451.50 |
$451.50 |
5.0× |
| Chest 1 view (71045) |
$341.50 |
$341.50 |
3.8× |
| Chest 3 views (71047) |
$457 |
$457 |
5.1× |
| Clavicle complete (73000) |
$336 |
$336 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$2,389 |
$2,389 |
22.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,825 |
$6,825 |
18.8× |
| CT abdomen and pelvis without contrast (74176) |
$5,276.50 |
$5,276.50 |
21.3× |
| CT abdomen w contrast (74160) |
$3,176.50 |
$3,176.50 |
17.4× |
| CT abdomen w wo contrast (74170) |
$4,384 |
$4,384 |
24.1× |
| CT abdomen w/o contrast (74150) |
$2,966.50 |
$2,966.50 |
27.3× |
| CT c-spine w/o contrast (72125) |
$3,622.50 |
$3,622.50 |
33.4× |
| CT cervical spine w&w/o contrast (72127) |
$3,386.50 |
$3,386.50 |
18.6× |
| CT cervical spine with contrast (72126) |
$2,494 |
$2,494 |
6.9× |
| CT chest w/wo contrast (71270) |
$3,478.25 |
$3,478.25 |
19.1× |
| CT chest with contrast (71260) |
$3,491.50 |
$3,491.50 |
19.2× |
| CT head/brain with contrast (70460) |
$2,231.50 |
$2,231.50 |
12.3× |
| CT head/brain without and with contrast (70470) |
$2,903.50 |
$2,903.50 |
15.9× |
| CT iac w contrast (70481) |
$2,513.25 |
$2,513.25 |
13.8× |
| CT limited/localized follow up study (76380) |
$1,969 |
$1,969 |
21.8× |
| CT lower ext w/o (73700) |
$2,257.50 |
$2,257.50 |
20.8× |
| CT lower extremity w wo contrast (73702) |
$3,281.50 |
$3,281.50 |
18.0× |
| CT lower extremity with contrast (73701) |
$3,146 |
$3,146 |
17.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,645 |
$2,645 |
14.5× |
| CT lumbar spine w/o contrast (72131) |
$2,562 |
$2,562 |
23.6× |
| CT lumbar spine with contrast (72132) |
$2,494 |
$2,494 |
6.9× |
| CT maxillofacial w contrast (70487) |
$2,225 |
$2,225 |
12.2× |
| CT maxillofacial w/o contrast (70486) |
$2,192.50 |
$2,192.50 |
20.2× |
| CT maxillofacial w/wo contrast (70488) |
$3,071.50 |
$3,071.50 |
16.9× |
| CT neck soft tissue w contrast (70491) |
$3,071.50 |
$3,071.50 |
16.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,684.50 |
$2,684.50 |
14.7× |
| CT orbits w/o contrast (70480) |
$2,883.50 |
$2,883.50 |
26.6× |
| CT pelvis w & w/o contrast (72194) |
$2,645 |
$2,645 |
14.5× |
| CT pelvis w/o contrast (72192) |
$3,517.50 |
$3,517.50 |
32.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,439 |
$3,439 |
18.9× |
| CT soft tissue neck w/o contrast (70490) |
$3,281.50 |
$3,281.50 |
30.2× |
| CT thoracic spine w/contrast (72129) |
$2,494 |
$2,494 |
13.7× |
| CT thoracic spine w/o contrast (72128) |
$3,071.50 |
$3,071.50 |
28.3× |
| CT thoracic spine w/wo contrast (72130) |
$2,645 |
$2,645 |
14.5× |
| CT thorax w/o contrast (71250) |
$2,598.75 |
$2,598.75 |
23.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,342.50 |
$2,342.50 |
12.9× |
| CT upper extremity w/o contrast rt (73200) |
$2,161 |
$2,161 |
19.9× |
| CT upper extremity with contrast (73201) |
$2,189.50 |
$2,189.50 |
6.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,727.50 |
$3,727.50 |
20.5× |
| Cta Abdomen (74175) |
$3,911.50 |
$3,911.50 |
21.5× |
| CTA abdomen pelvis (74174) |
$6,388 |
$6,388 |
17.6× |
| CTA chest (71275) |
$3,983.25 |
$3,983.25 |
21.9× |
| Cta Head (70496) |
$3,176.50 |
$3,176.50 |
17.4× |
| Cta Neck (70498) |
$3,727.50 |
$3,727.50 |
20.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$619.50 |
$619.50 |
5.7× |
| Foot 2 views (73620) |
$299.50 |
$299.50 |
3.3× |
| Forearm 2 views (73090) |
$388.50 |
$388.50 |
4.3× |
| Hand 2 views (73120) |
$388.50 |
$388.50 |
3.6× |
| Hand 3 views (73130) |
$420 |
$420 |
4.6× |
| Humerus Min 2 Views Left (73060) |
$425.50 |
$425.50 |
4.7× |
| Knee 3 views (73562) |
$499 |
$499 |
5.5× |
| MRA head w & w/o contrast (70546) |
$3,768.50 |
$3,768.50 |
10.4× |
| MRA head w/o contrast (70544) |
$3,790.50 |
$3,790.50 |
15.3× |
| MRA head with contrast (70545) |
$3,766.50 |
$3,766.50 |
10.4× |
| MRA neck w contrast (70548) |
$3,222.50 |
$3,222.50 |
8.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,404 |
$3,404 |
9.4× |
| MRA neck w/o contrast (70547) |
$4,243 |
$4,243 |
17.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,825 |
$4,825 |
13.3× |
| MRI abdomen w/o contrast (74181) |
$4,195 |
$4,195 |
16.9× |
| MRI any jnt lwr ext with con lt (73722) |
$2,674.50 |
$2,674.50 |
3.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,563.50 |
$3,563.50 |
4.4× |
| MRI bone marrow blood supply (77084) |
$2,310 |
$2,310 |
9.3× |
| MRI c-spine with contrast (72142) |
$4,195 |
$4,195 |
11.6× |
| MRI cervical spine w/o contrast (72141) |
$3,820 |
$3,820 |
15.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,404 |
$3,404 |
9.4× |
| MRI chest w/o contrast (71550) |
$3,038.50 |
$3,038.50 |
12.3× |
| MRI chest with contrast (71551) |
$3,222.50 |
$3,222.50 |
4.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,674.50 |
$2,674.50 |
7.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,596.50 |
$3,596.50 |
9.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,596.50 |
$3,596.50 |
14.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,384 |
$3,384 |
13.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,587 |
$3,587 |
9.9× |
| MRI orbit/face/neck w/contrast (70542) |
$3,404 |
$3,404 |
9.4× |
| MRI pelvis w contrast (72196) |
$3,222.50 |
$3,222.50 |
8.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,357.50 |
$4,357.50 |
12.0× |
| MRI pelvis w/o contrast (72195) |
$3,344.50 |
$3,344.50 |
13.5× |
| MRI scan of arm joint before and after contrast (73223) |
$4,230.50 |
$4,230.50 |
11.7× |
| MRI scan of leg joint before and after contrast (73723) |
$2,857 |
$2,857 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,455 |
$5,455 |
15.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,404 |
$3,404 |
9.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,329 |
$5,329 |
14.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,404 |
$3,404 |
9.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,587 |
$3,587 |
9.9× |
| MRI thoracic spine w/o contrast (72146) |
$4,283 |
$4,283 |
17.3× |
| MRI tmj (70336) |
$2,857 |
$2,857 |
11.5× |
| MRI upper ext joint w/o contrast (73221) |
$3,481 |
$3,481 |
14.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,857 |
$2,857 |
7.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,344.50 |
$3,344.50 |
13.5× |
| Neck soft tissue (70360) |
$451.50 |
$451.50 |
5.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$892.50 |
$892.50 |
8.2× |
| Pelvis 1 or 2 views (72170) |
$394 |
$394 |
3.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$4,777.50 |
$4,777.50 |
13.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$856 |
$856 |
7.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$569 |
$569 |
5.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$679.50 |
$679.50 |
6.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$367.50 |
$367.50 |
4.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$524 |
$524 |
4.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$420 |
$420 |
4.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$435.75 |
$435.75 |
4.8× |
| Ribs bilateral 3 views (71110) |
$672 |
$672 |
6.2× |
| Scapula complete (73010) |
$369 |
$369 |
3.4× |
| Screening digital breast tomosynthesis (77063) |
$160.50 |
$160.50 |
6.9× |
| Thoracolumbar 2 views (72080) |
$504 |
$504 |
5.6× |
| Ultrasound, abdomen limited (76705) |
$892.50 |
$892.50 |
8.2× |
| Unlisted Ultrasound Procedure (76999) |
$365.50 |
$365.50 |
4.0× |
| Upper Extremity Infant (73092) |
$219.50 |
$219.50 |
2.0× |
| Us abdl aorta screen aaa (76706) |
$441 |
$441 |
4.1× |
| Us breast unilateral complete (76641) |
$532.50 |
$532.50 |
4.9× |
| Us breast unilateral limited (76642) |
$425.50 |
$425.50 |
4.7× |
| Us chest (76604) |
$580.50 |
$580.50 |
5.3× |
| Us compl joint r-t w/image documentation (76881) |
$684.50 |
$684.50 |
6.3× |
| Us ob transvaginal (76817) |
$766.50 |
$766.50 |
7.1× |
| Us pelvic non ob complete (76856) |
$1,139.50 |
$1,139.50 |
10.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$532.50 |
$532.50 |
4.9× |
| Us pregnancy ltd (76815) |
$601 |
$601 |
5.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$924 |
$924 |
8.5× |
| Us retroperitoneal complete (76770) |
$953 |
$953 |
8.8× |
| Us retroperitoneal limited (76775) |
$796.50 |
$796.50 |
7.3× |
| Us scrotum and contents (76870) |
$892.50 |
$892.50 |
8.2× |
| Us soft tissue head/neck (76536) |
$787.50 |
$787.50 |
7.3× |
| Us xtr non-vasc lmtd (76882) |
$599.50 |
$599.50 |
5.5× |
| Wrist 2 views (73100) |
$320.50 |
$320.50 |
3.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$630 |
$630 |
5.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$299.50 |
$299.50 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$399 |
$399 |
4.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$420 |
$420 |
4.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$451.50 |
$451.50 |
5.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$457 |
$457 |
5.1× |
| X-ray eye for foreign body (70030) |
$263.50 |
$263.50 |
2.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$560 |
$560 |
5.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$350.50 |
$350.50 |
3.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$420 |
$420 |
4.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$320.50 |
$320.50 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$329.50 |
$329.50 |
3.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$214 |
$214 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$609 |
$609 |
5.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$609 |
$609 |
5.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$441 |
$441 |
4.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$391.50 |
$391.50 |
4.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$531.50 |
$531.50 |
4.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$467.50 |
$467.50 |
5.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$435.75 |
$435.75 |
4.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$418 |
$418 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$535.50 |
$535.50 |
4.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$504 |
$504 |
4.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$430.50 |
$430.50 |
4.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$373 |
$373 |
4.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$439 |
$439 |
4.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$493.50 |
$493.50 |
4.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$344.50 |
$344.50 |
3.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$377 |
$377 |
4.2× |
| Xr c-spine 6 or more views (72052) |
$1,024 |
$1,024 |
9.4× |
| Xr finger(s) 2+ views (73140) |
$273 |
$273 |
3.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$287.50 |
$287.50 |
2.6× |
| Xr shoulder 1 view (73020) |
$299.50 |
$299.50 |
3.3× |
| Xr spine cervical 4 or 5 views (72050) |
$681.75 |
$681.75 |
6.3× |
| Xr tibia/fibula 2 views (73590) |
$420 |
$420 |
4.6× |
| Xr tmj bilateral (70330) |
$530.50 |
$530.50 |
5.9× |
| Xray knee 1 or 2 views rt (73560) |
$373 |
$373 |
4.1× |