| Abdomen 2 views (74019) |
$180.60 |
$258 |
1.9× |
| Ankle 2 views (73600) |
$108.50 |
$155 |
1.4× |
| Bone age studies (77072) |
$133.70 |
$191 |
1.4× |
| Bone survey complete (77075) |
$216.30 |
$309 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$162.40 |
$232 |
2.1× |
| Chest 1 view (71045) |
$126 |
$180 |
1.6× |
| Chest 3 views (71047) |
$155.40 |
$222 |
2.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$739.20 |
$1,056 |
4.7× |
| Clavicle complete (73000) |
$115.50 |
$165 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$147 |
$210 |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,523.50 |
$3,605 |
8.0× |
| CT abdomen and pelvis without contrast (74176) |
$2,279.90 |
$3,257 |
10.6× |
| CT abdomen w contrast (74160) |
$1,226.75 |
$1,752.50 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,442 |
$2,060 |
9.1× |
| CT abdomen w/o contrast (74150) |
$1,081.50 |
$1,545 |
11.4× |
| CT c-spine w/o contrast (72125) |
$1,117.90 |
$1,597 |
11.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,085 |
$1,550 |
6.8× |
| CT cervical spine with contrast (72126) |
$1,262.10 |
$1,803 |
4.0× |
| CT chest w/wo contrast (71270) |
$1,297.80 |
$1,854 |
8.2× |
| CT chest with contrast (71260) |
$1,227.80 |
$1,754 |
7.7× |
| CT head/brain with contrast (70460) |
$1,225.70 |
$1,751 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,402.80 |
$2,004 |
8.8× |
| CT iac w contrast (70481) |
$1,225.70 |
$1,751 |
7.7× |
| CT lower ext w/o (73700) |
$1,052.10 |
$1,503 |
11.1× |
| CT lower extremity w wo contrast (73702) |
$1,586.20 |
$2,266 |
10.0× |
| CT lower extremity with contrast (73701) |
$1,117.90 |
$1,597 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$1,117.90 |
$1,597 |
11.8× |
| CT lumbar spine with contrast (72132) |
$1,262.10 |
$1,803 |
4.0× |
| CT maxillofacial w contrast (70487) |
$122.50 |
$175 |
0.8× |
| CT maxillofacial w/o contrast (70486) |
$1,052.10 |
$1,503 |
11.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,297.80 |
$1,854 |
8.2× |
| CT neck soft tissue w contrast (70491) |
$1,225.70 |
$1,751 |
7.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,402.80 |
$2,004 |
8.8× |
| CT orbits w/o contrast (70480) |
$1,052.10 |
$1,503 |
11.1× |
| CT pelvis w & w/o contrast (72194) |
$1,406.30 |
$2,009 |
8.9× |
| CT pelvis w/o contrast (72192) |
$1,030.75 |
$1,472.50 |
10.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,586.20 |
$2,266 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,052.10 |
$1,503 |
11.1× |
| CT thoracic spine w/contrast (72129) |
$1,262.10 |
$1,803 |
7.9× |
| CT thoracic spine w/o contrast (72128) |
$1,052.10 |
$1,503 |
11.1× |
| CT thorax w/o contrast (71250) |
$1,052.80 |
$1,504 |
11.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,658.30 |
$2,369 |
10.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,009.40 |
$1,442 |
10.7× |
| CT upper extremity with contrast (73201) |
$1,081.50 |
$1,545 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,802.50 |
$2,575 |
11.3× |
| CTA chest (71275) |
$1,550.50 |
$2,215 |
9.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$252.70 |
$361 |
2.7× |
| Echoencephalography real time imaging (76506) |
$308 |
$440 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$209.30 |
$299 |
2.2× |
| Foot 2 views (73620) |
$133.70 |
$191 |
1.7× |
| Forearm 2 views (73090) |
$126 |
$180 |
1.6× |
| Hand 2 views (73120) |
$133.70 |
$191 |
1.4× |
| Hand 3 views (73130) |
$162.40 |
$232 |
2.1× |
| Humerus Min 2 Views Left (73060) |
$133.70 |
$191 |
1.7× |
| Knee 3 views (73562) |
$144.20 |
$206 |
1.8× |
| MRA head w/o contrast (70544) |
$1,369.90 |
$1,957 |
6.3× |
| MRA neck w contrast (70548) |
$1,442 |
$2,060 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,514.10 |
$2,163 |
4.8× |
| MRA neck w/o contrast (70547) |
$1,369.90 |
$1,957 |
6.3× |
| MRI abdomen w contrast (74182) |
$865.20 |
$1,236 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,514.10 |
$2,163 |
4.8× |
| MRI abdomen w/o contrast (74181) |
$1,225.70 |
$1,751 |
5.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,802.50 |
$2,575 |
2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,369.90 |
$1,957 |
1.9× |
| MRI c-spine with contrast (72142) |
$1,514.10 |
$2,163 |
4.8× |
| MRI cervical spine w/o contrast (72141) |
$1,369.90 |
$1,957 |
6.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,514.10 |
$2,163 |
4.8× |
| MRI chest w/o contrast (71550) |
$1,369.90 |
$1,957 |
6.3× |
| MRI chest with contrast (71551) |
$1,442 |
$2,060 |
2.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,225.70 |
$1,751 |
3.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,802.50 |
$2,575 |
5.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,442 |
$2,060 |
6.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,369.90 |
$1,957 |
6.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,379.30 |
$3,399 |
7.5× |
| MRI orbit/face/neck w/contrast (70542) |
$1,442 |
$2,060 |
4.6× |
| MRI pelvis w contrast (72196) |
$1,514.10 |
$2,163 |
4.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,586.20 |
$2,266 |
5.0× |
| MRI pelvis w/o contrast (72195) |
$1,442 |
$2,060 |
6.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,586.20 |
$2,266 |
5.0× |
| MRI scan of leg joint before and after contrast (73723) |
$2,379.30 |
$3,399 |
7.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,379.30 |
$3,399 |
7.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,442 |
$2,060 |
4.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,802.50 |
$2,575 |
5.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,442 |
$2,060 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,658.30 |
$2,369 |
5.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,369.90 |
$1,957 |
6.3× |
| MRI tmj (70336) |
$1,081.50 |
$1,545 |
5.0× |
| MRI upper ext joint w/o contrast (73221) |
$1,297.80 |
$1,854 |
6.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,369.90 |
$1,957 |
4.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,153.60 |
$1,648 |
5.3× |
| Myelogram Lumbar (72265) |
$53.20 |
$76 |
0.1× |
| Neck soft tissue (70360) |
$133.70 |
$191 |
1.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$108.50 |
$155 |
1.1× |
| Osseous survey infant (77076) |
$180.60 |
$258 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$126 |
$180 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,874.60 |
$2,678 |
5.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$164.50 |
$235 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$171.50 |
$245 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$126 |
$180 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$210 |
$300 |
2.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$162.40 |
$232 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$133.70 |
$191 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$144.20 |
$206 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$133.70 |
$191 |
1.7× |
| Ribs bilateral 3 views (71110) |
$234.50 |
$335 |
2.5× |
| Scapula complete (73010) |
$126 |
$180 |
1.3× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$216.30 |
$309 |
2.3× |
| Small bowel series (74250) |
$270.20 |
$386 |
1.7× |
| Spine thoracic 3 views (72072) |
$223.30 |
$319 |
2.4× |
| Thoracolumbar 2 views (72080) |
$162.40 |
$232 |
2.1× |
| Ultrasound, abdomen limited (76705) |
$342.30 |
$489 |
3.6× |
| Upper Extremity Infant (73092) |
$133.70 |
$191 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$429.10 |
$613 |
2.7× |
| Us abdl aorta screen aaa (76706) |
$320.60 |
$458 |
3.4× |
| Us breast unilateral complete (76641) |
$216.30 |
$309 |
2.3× |
| Us breast unilateral limited (76642) |
$180.60 |
$258 |
2.3× |
| Us ob detailed single fetus (76811) |
$335.30 |
$479 |
1.6× |
| Us ob transvaginal (76817) |
$144.20 |
$206 |
1.5× |
| Us pelvic non ob complete (76856) |
$306.60 |
$438 |
3.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$306.60 |
$438 |
3.2× |
| Us pregnancy ltd (76815) |
$108.50 |
$155 |
1.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$231 |
$330 |
2.4× |
| Us retroperitoneal complete (76770) |
$306.60 |
$438 |
3.2× |
| Us retroperitoneal limited (76775) |
$320.60 |
$458 |
3.4× |
| Us scrotum and contents (76870) |
$180.60 |
$258 |
1.9× |
| Us soft tissue head/neck (76536) |
$307.30 |
$439 |
3.2× |
| Us xtr non-vasc lmtd (76882) |
$97.30 |
$139 |
1.0× |
| Wrist 2 views (73100) |
$144.20 |
$206 |
1.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$198.10 |
$283 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$144.20 |
$206 |
1.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$126 |
$180 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$115.50 |
$165 |
1.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$158.90 |
$227 |
2.0× |
| X-ray exam entire spi 4/5 vw (72083) |
$182 |
$260 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$115.50 |
$165 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$115.50 |
$165 |
1.5× |
| X-ray exam hip uni 4/> views (73503) |
$126 |
$180 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133.70 |
$191 |
1.4× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$140 |
$200 |
1.5× |
| X-ray exam of femur 1 (73551) |
$133.70 |
$191 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$143.15 |
$204.50 |
1.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$100.80 |
$144 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$133.70 |
$191 |
1.7× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$108.50 |
$155 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$180.60 |
$258 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$144.20 |
$206 |
1.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$133.70 |
$191 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$162.40 |
$232 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$149.80 |
$214 |
1.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$144.20 |
$206 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$116.20 |
$166 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$162.40 |
$232 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$234.50 |
$335 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$284.90 |
$407 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$162.40 |
$232 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$144.20 |
$206 |
1.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$144.20 |
$206 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$198.10 |
$283 |
2.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$144.20 |
$206 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$216.30 |
$309 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$180.60 |
$258 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$149.10 |
$213 |
1.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$144.20 |
$206 |
1.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$162.40 |
$232 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$162.40 |
$232 |
2.1× |
| Xr c-spine 6 or more views (72052) |
$342.30 |
$489 |
3.6× |
| Xr chest 4+ views (71048) |
$162.40 |
$232 |
1.7× |
| Xr shoulder 1 view (73020) |
$115.50 |
$165 |
1.5× |
| Xr spine cervical 4 or 5 views (72050) |
$324.80 |
$464 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$133.70 |
$191 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$126 |
$180 |
1.6× |