| Abdomen 2 views (74019) |
$374.78 |
$374.78 |
4.1× |
| Angiography extremity bilateral rs&i (75716) |
$18,274 |
$18,274 |
6.6× |
| Angiography extremity unilateral rs&i (75710) |
$18,274 |
$18,274 |
6.6× |
| Ankle 2 views (73600) |
$297.88 |
$297.88 |
3.9× |
| Arthrogram elbow (73085) |
$866.88 |
$866.88 |
2.8× |
| Arthrogram hip (73525) |
$598.14 |
$598.14 |
2.0× |
| Arthrogram shoulder (73040) |
$3,519 |
$3,519 |
11.5× |
| Arthrogram wrist (73115) |
$946.71 |
$946.71 |
3.1× |
| Arthrography knee lt (73580) |
$739.38 |
$739.38 |
2.4× |
| Bone age studies (77072) |
$132.42 |
$132.42 |
1.4× |
| Bone survey complete (77075) |
$533.94 |
$533.94 |
5.8× |
| Cervical spine 2 or 3 views (72040) |
$341.90 |
$341.90 |
4.5× |
| Chest 1 view (71045) |
$520.17 |
$520.17 |
6.8× |
| Chest 3 views (71047) |
$212.88 |
$212.88 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$513.54 |
$513.54 |
3.3× |
| Clavicle complete (73000) |
$429.88 |
$429.88 |
5.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,474.10 |
$1,474.10 |
16.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,624.72 |
$2,624.72 |
8.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,503.81 |
$1,503.81 |
7.2× |
| CT abdomen w contrast (74160) |
$1,808.66 |
$1,808.66 |
11.8× |
| CT abdomen w wo contrast (74170) |
$2,081.38 |
$2,081.38 |
13.5× |
| CT abdomen w/o contrast (74150) |
$1,160.81 |
$1,160.81 |
12.7× |
| CT angiography upper extremity lt (73206) |
$2,380.07 |
$2,380.07 |
15.5× |
| CT c-spine w/o contrast (72125) |
$1,395.17 |
$1,395.17 |
15.2× |
| CT cervical spine w&w/o contrast (72127) |
$2,033.22 |
$2,033.22 |
13.2× |
| CT cervical spine with contrast (72126) |
$1,702.68 |
$1,702.68 |
5.6× |
| CT chest w/wo contrast (71270) |
$2,063.74 |
$2,063.74 |
13.4× |
| CT chest with contrast (71260) |
$1,705.27 |
$1,705.27 |
11.1× |
| CT head/brain with contrast (70460) |
$1,407.35 |
$1,407.35 |
9.2× |
| CT head/brain without and with contrast (70470) |
$1,425.83 |
$1,425.83 |
9.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$497.56 |
$497.56 |
6.5× |
| CT iac w contrast (70481) |
$2,083.06 |
$2,083.06 |
13.6× |
| CT lower ext w/o (73700) |
$2,042.36 |
$2,042.36 |
22.3× |
| CT lower extremity w wo contrast (73702) |
$2,109.03 |
$2,109.03 |
13.7× |
| CT lower extremity with contrast (73701) |
$1,688.40 |
$1,688.40 |
11.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,033.22 |
$2,033.22 |
13.2× |
| CT lumbar spine w/o contrast (72131) |
$1,361.43 |
$1,361.43 |
14.9× |
| CT lumbar spine with contrast (72132) |
$1,704.78 |
$1,704.78 |
5.6× |
| CT maxillofacial w contrast (70487) |
$1,783.74 |
$1,783.74 |
11.6× |
| CT maxillofacial w/o contrast (70486) |
$1,482.46 |
$1,482.46 |
16.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,143.89 |
$2,143.89 |
13.9× |
| CT neck soft tissue w contrast (70491) |
$1,742.93 |
$1,742.93 |
11.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,305.03 |
$2,305.03 |
15.0× |
| CT orbits w/o contrast (70480) |
$1,800.33 |
$1,800.33 |
19.6× |
| CT pelvis w & w/o contrast (72194) |
$1,989.26 |
$1,989.26 |
12.9× |
| CT pelvis w/o contrast (72192) |
$1,134.77 |
$1,134.77 |
12.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,076.20 |
$2,076.20 |
13.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,449.63 |
$1,449.63 |
15.8× |
| CT thoracic spine w/contrast (72129) |
$1,709.05 |
$1,709.05 |
11.1× |
| CT thoracic spine w/o contrast (72128) |
$1,365.70 |
$1,365.70 |
14.9× |
| CT thoracic spine w/wo contrast (72130) |
$2,043.93 |
$2,043.93 |
13.3× |
| CT thorax w/o contrast (71250) |
$1,364.02 |
$1,364.02 |
14.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$3,169.95 |
$3,169.95 |
20.6× |
| CT upper extremity w/o contrast rt (73200) |
$2,035.95 |
$2,035.95 |
22.2× |
| CT upper extremity with contrast (73201) |
$2,497.32 |
$2,497.32 |
8.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,923.06 |
$2,923.06 |
19.0× |
| Cta Abdomen (74175) |
$2,637.04 |
$2,637.04 |
17.2× |
| CTA abdomen pelvis (74174) |
$3,241.14 |
$3,241.14 |
10.6× |
| CTA chest (71275) |
$2,622.48 |
$2,622.48 |
17.1× |
| Cta Head (70496) |
$3,238.48 |
$3,238.48 |
21.1× |
| CTA lwr ext w&w/o contrast (73706) |
$2,632.70 |
$2,632.70 |
17.1× |
| Cta Neck (70498) |
$3,347.54 |
$3,347.54 |
21.8× |
| Cta Pelvis (72191) |
$2,602.74 |
$2,602.74 |
16.9× |
| Diskography lumbar (72295) |
$12,134.40 |
$12,134.40 |
7.1× |
| Esophagus (74220) |
$515.76 |
$515.76 |
3.4× |
| Fluoroscopy up to 1 hr (76000) |
$503.45 |
$503.45 |
2.4× |
| Foot 2 views (73620) |
$621.93 |
$621.93 |
8.2× |
| Forearm 2 views (73090) |
$357.48 |
$357.48 |
4.7× |
| Hand 2 views (73120) |
$629 |
$629 |
6.9× |
| Hand 3 views (73130) |
$520.17 |
$520.17 |
6.8× |
| Humerus Min 2 Views Left (73060) |
$520.17 |
$520.17 |
6.8× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$230.40 |
$230.40 |
2.5× |
| Knee 3 views (73562) |
$780.26 |
$780.26 |
10.2× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$291.30 |
$291.30 |
3.8× |
| MRA head w & w/o contrast (70546) |
$3,883.95 |
$3,883.95 |
12.7× |
| MRA head w/o contrast (70544) |
$2,568.65 |
$2,568.65 |
12.3× |
| MRA head with contrast (70545) |
$2,521.61 |
$2,521.61 |
8.2× |
| MRA neck w contrast (70548) |
$2,739.73 |
$2,739.73 |
9.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,892.49 |
$3,892.49 |
12.7× |
| MRA neck w/o contrast (70547) |
$2,575.23 |
$2,575.23 |
12.3× |
| MRI abdomen w contrast (74182) |
$2,795.31 |
$2,795.31 |
9.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,013.50 |
$3,013.50 |
9.9× |
| MRI abdomen w/o contrast (74181) |
$1,963.36 |
$1,963.36 |
9.4× |
| MRI any jnt lwr ext with con lt (73722) |
$2,324.84 |
$2,324.84 |
3.4× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,432.66 |
$3,432.66 |
5.0× |
| MRI c-spine with contrast (72142) |
$2,545.13 |
$2,545.13 |
8.3× |
| MRI cervical spine w/o contrast (72141) |
$1,946.28 |
$1,946.28 |
9.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,560.97 |
$3,560.97 |
11.6× |
| MRI chest w/o contrast (71550) |
$2,562.21 |
$2,562.21 |
12.3× |
| MRI chest with contrast (71551) |
$2,813.46 |
$2,813.46 |
4.1× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,705.34 |
$3,705.34 |
12.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,519.44 |
$2,519.44 |
8.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,243.57 |
$2,243.57 |
10.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,438.17 |
$2,438.17 |
11.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,949.31 |
$2,949.31 |
9.6× |
| MRI orbit/face/neck w/contrast (70542) |
$2,194.36 |
$2,194.36 |
7.2× |
| MRI pelvis w contrast (72196) |
$2,491.65 |
$2,491.65 |
8.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,000.62 |
$3,000.62 |
9.8× |
| MRI pelvis w/o contrast (72195) |
$2,752.40 |
$2,752.40 |
13.2× |
| MRI scan of arm joint before and after contrast (73223) |
$2,793.21 |
$2,793.21 |
9.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,791.04 |
$2,791.04 |
9.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,814.56 |
$2,814.56 |
9.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,483.11 |
$2,483.11 |
8.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,797.48 |
$2,797.48 |
9.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,181.55 |
$2,181.55 |
7.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,560.11 |
$2,560.11 |
8.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,950.55 |
$1,950.55 |
9.3× |
| MRI tmj (70336) |
$1,858.57 |
$1,858.57 |
8.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,806.56 |
$1,806.56 |
8.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,002.79 |
$3,002.79 |
9.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,260.65 |
$2,260.65 |
10.8× |
| Myelogram Cervical (72240) |
$726.90 |
$726.90 |
1.1× |
| Myelogram Lumbar (72265) |
$712.38 |
$712.38 |
1.0× |
| Myelogram thoracic (72255) |
$693.84 |
$693.84 |
1.0× |
| Myelography 2 or more regions (72270) |
$1,109.76 |
$1,109.76 |
1.6× |
| Neck soft tissue (70360) |
$157.62 |
$157.62 |
2.1× |
| Nm peritoneal-venous shunt patency (78291) |
$394.40 |
$394.40 |
1.1× |
| Osseous survey infant (77076) |
$577.68 |
$577.68 |
6.3× |
| Osseous survey limited (77074) |
$433.38 |
$433.38 |
4.7× |
| Pelvis 1 or 2 views (72170) |
$452.28 |
$452.28 |
4.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,028.48 |
$3,028.48 |
9.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$216.18 |
$216.18 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$432.46 |
$432.46 |
4.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$328.77 |
$328.77 |
3.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$500.22 |
$500.22 |
5.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$225.30 |
$225.30 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$520.17 |
$520.17 |
6.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$427.38 |
$427.38 |
5.6× |
| Radiologic exam colon single contrast study (74270) |
$887.28 |
$887.28 |
5.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$725.94 |
$725.94 |
4.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$326.52 |
$326.52 |
4.3× |
| Ribs bilateral 3 views (71110) |
$231.24 |
$231.24 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$168.66 |
$168.66 |
1.8× |
| Scanogram (77073) |
$520 |
$520 |
5.7× |
| Scapula complete (73010) |
$183.42 |
$183.42 |
2.0× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$460 |
$460 |
5.0× |
| Small bowel series (74250) |
$574.20 |
$574.20 |
3.7× |
| Spine thoracic 3 views (72072) |
$317.50 |
$317.50 |
3.5× |
| Thoracolumbar 2 views (72080) |
$170.88 |
$170.88 |
2.2× |
| Tmj unilateral (70328) |
$181.68 |
$181.68 |
2.4× |
| Ultrasound scan of cornea to determine thickness (76514) |
$198 |
$198 |
7.8× |
| Ultrasound, abdomen limited (76705) |
$606.48 |
$606.48 |
6.6× |
| Upper Extremity Infant (73092) |
$184.92 |
$184.92 |
2.0× |
| Us abdl aorta screen aaa (76706) |
$606.48 |
$606.48 |
6.6× |
| Us breast unilateral complete (76641) |
$828.54 |
$828.54 |
9.0× |
| Us breast unilateral limited (76642) |
$780 |
$780 |
10.2× |
| Us chest (76604) |
$495.66 |
$495.66 |
5.4× |
| Us compl joint r-t w/image documentation (76881) |
$684.36 |
$684.36 |
7.5× |
| Us infant hips dynamic (76885) |
$835.14 |
$835.14 |
11.0× |
| Us ob transvaginal (76817) |
$576.78 |
$576.78 |
6.3× |
| Us pelvic non ob complete (76856) |
$698.40 |
$698.40 |
7.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$532.44 |
$532.44 |
5.8× |
| Us pregnancy ltd (76815) |
$922 |
$922 |
10.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$715.62 |
$715.62 |
7.8× |
| Us retroperitoneal complete (76770) |
$743.46 |
$743.46 |
8.1× |
| Us retroperitoneal limited (76775) |
$743.46 |
$743.46 |
8.1× |
| Us scrotum and contents (76870) |
$697.38 |
$697.38 |
7.6× |
| Us soft tissue head/neck (76536) |
$684.66 |
$684.66 |
7.5× |
| Us xtr non-vasc lmtd (76882) |
$201.18 |
$201.18 |
2.2× |
| Venogram extremity bilateral (75822) |
$9,127 |
$9,127 |
6.6× |
| Venography extremity unilateral rs&i (75820) |
$9,127 |
$9,127 |
6.6× |
| Wrist 2 views (73100) |
$351.70 |
$351.70 |
4.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$398.20 |
$398.20 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$229.86 |
$229.86 |
3.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$385.24 |
$385.24 |
5.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$520.17 |
$520.17 |
6.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$190.62 |
$190.62 |
2.5× |
| X-ray exam hip uni 1 view (73501) |
$164.22 |
$164.22 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$520.17 |
$520.17 |
6.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$270.90 |
$270.90 |
3.0× |
| X-ray exam of femur 1 (73551) |
$154.14 |
$154.14 |
2.0× |
| X-ray eye for foreign body (70030) |
$247.50 |
$247.50 |
3.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$242.04 |
$242.04 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$170.88 |
$170.88 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$481 |
$481 |
6.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$162.96 |
$162.96 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$196.38 |
$196.38 |
2.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$250.44 |
$250.44 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$385.30 |
$385.30 |
5.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$362.42 |
$362.42 |
4.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$362.58 |
$362.58 |
4.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$266.16 |
$266.16 |
2.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$190.62 |
$190.62 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$253.90 |
$253.90 |
3.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$247.92 |
$247.92 |
2.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$246.60 |
$246.60 |
2.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$184.38 |
$184.38 |
2.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$223.92 |
$223.92 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$426.23 |
$426.23 |
4.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$393.12 |
$393.12 |
4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$165 |
$165 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$520.17 |
$520.17 |
6.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$221.64 |
$221.64 |
2.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$126.54 |
$126.54 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$267.54 |
$267.54 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$212.28 |
$212.28 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$133.38 |
$133.38 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$211.86 |
$211.86 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$178.44 |
$178.44 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$355.94 |
$355.94 |
3.9× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$250.32 |
$250.32 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$173.34 |
$173.34 |
2.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$520.17 |
$520.17 |
6.8× |
| Xr c-spine 6 or more views (72052) |
$436.28 |
$436.28 |
4.8× |
| Xr finger(s) 2+ views (73140) |
$447.17 |
$447.17 |
5.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$305.55 |
$305.55 |
3.3× |
| Xr shoulder 1 view (73020) |
$135.24 |
$135.24 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$629.37 |
$629.37 |
6.9× |
| Xr tibia/fibula 2 views (73590) |
$315.24 |
$315.24 |
4.1× |
| Xr tmj bilateral (70330) |
$274.62 |
$274.62 |
3.6× |
| Xray knee 1 or 2 views rt (73560) |
$780 |
$780 |
10.2× |