| Abdomen 2 views (74019) |
$214.60 |
$536.50 |
2.2× |
| Ankle 2 views (73600) |
$180.40 |
$451 |
2.2× |
| Bone age studies (77072) |
$419.20 |
$1,048 |
4.3× |
| Bone survey complete (77075) |
$226 |
$565 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$250 |
$444.50 |
3.1× |
| Chest 1 view (71045) |
$346.40 |
$866 |
4.3× |
| Chest 3 views (71047) |
$346.40 |
$866 |
4.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$700.40 |
$1,751 |
4.3× |
| Clavicle complete (73000) |
$176.80 |
$442 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$239.60 |
$599 |
2.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$750 |
$1,909 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$750 |
$1,234 |
3.4× |
| CT abdomen w contrast (74160) |
$750 |
$938.50 |
4.6× |
| CT abdomen w wo contrast (74170) |
$750 |
$944.50 |
4.6× |
| CT abdomen w/o contrast (74150) |
$750 |
$583 |
7.7× |
| CT angio hrt w/3d image (75574) |
$604.40 |
$1,511 |
1.9× |
| CT angiography upper extremity lt (73206) |
$418.60 |
$1,046.50 |
2.6× |
| CT c-spine w/o contrast (72125) |
$750 |
$581.50 |
7.7× |
| CT cervical spine w&w/o contrast (72127) |
$750 |
$996 |
4.6× |
| CT cervical spine with contrast (72126) |
$750 |
$1,948.50 |
2.3× |
| CT chest w/wo contrast (71270) |
$750 |
$1,751 |
4.6× |
| CT chest with contrast (71260) |
$750 |
$936.50 |
4.6× |
| CT head/brain with contrast (70460) |
$750 |
$931.50 |
4.6× |
| CT head/brain without and with contrast (70470) |
$750 |
$938.50 |
4.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$50 |
$477 |
0.6× |
| CT iac w contrast (70481) |
$750 |
$1,751 |
4.6× |
| CT lower ext w/o (73700) |
$750 |
$578.50 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$750 |
$991.50 |
4.6× |
| CT lower extremity with contrast (73701) |
$750 |
$1,751 |
4.6× |
| CT lumbar spine w & w/o contrast (72133) |
$750 |
$996 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$750 |
$581.50 |
7.7× |
| CT lumbar spine with contrast (72132) |
$750 |
$1,948.50 |
2.3× |
| CT maxillofacial w contrast (70487) |
$750 |
$1,751 |
4.6× |
| CT maxillofacial w/o contrast (70486) |
$750 |
$580.50 |
7.7× |
| CT maxillofacial w/wo contrast (70488) |
$750 |
$1,004 |
4.6× |
| CT neck soft tissue w contrast (70491) |
$750 |
$944 |
4.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$750 |
$1,012 |
4.6× |
| CT orbits w/o contrast (70480) |
$750 |
$1,048 |
7.7× |
| CT pelvis w & w/o contrast (72194) |
$750 |
$1,283.50 |
4.6× |
| CT pelvis w/o contrast (72192) |
$750 |
$578.50 |
7.7× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$250 |
$443.50 |
3.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$750 |
$947 |
4.6× |
| CT soft tissue neck w/o contrast (70490) |
$750 |
$587.50 |
7.7× |
| CT thoracic spine w/contrast (72129) |
$750 |
$991.50 |
4.6× |
| CT thoracic spine w/o contrast (72128) |
$750 |
$581.50 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$750 |
$996 |
4.6× |
| CT thorax w/o contrast (71250) |
$750 |
$581.50 |
7.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$750 |
$991.50 |
4.6× |
| CT upper extremity w/o contrast rt (73200) |
$750 |
$578.50 |
7.7× |
| CT upper extremity with contrast (73201) |
$750 |
$1,890 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$397.60 |
$994 |
2.4× |
| Cta Abdomen (74175) |
$422.20 |
$1,055.50 |
2.6× |
| CTA abdomen pelvis (74174) |
$767 |
$1,917.50 |
2.4× |
| CTA chest (71275) |
$388.20 |
$970.50 |
2.4× |
| Cta Head (70496) |
$416.60 |
$1,041.50 |
2.5× |
| Cta Neck (70498) |
$416.60 |
$1,041.50 |
2.5× |
| Cta Pelvis (72191) |
$418.60 |
$1,046.50 |
2.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$221.20 |
$553 |
2.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$182 |
$455 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$250.60 |
$626.50 |
2.6× |
| Fluoroscopy up to 1 hr (76000) |
$934 |
$2,335 |
4.2× |
| Foot 2 views (73620) |
$176.60 |
$441.50 |
2.2× |
| Forearm 2 views (73090) |
$179.60 |
$449 |
2.2× |
| Hand 2 views (73120) |
$14.40 |
$36 |
0.1× |
| Hand 3 views (73130) |
$250 |
$866 |
3.1× |
| Humerus Min 2 Views Left (73060) |
$180.20 |
$450.50 |
2.2× |
| Knee 3 views (73562) |
$346.40 |
$866 |
4.3× |
| MRA head w & w/o contrast (70546) |
$1,624 |
$4,060 |
5.0× |
| MRA head w/o contrast (70544) |
$934 |
$2,335 |
4.2× |
| MRA head with contrast (70545) |
$447.60 |
$1,119 |
1.4× |
| MRA neck w contrast (70548) |
$1,676 |
$4,190 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,703.20 |
$4,258 |
5.2× |
| MRA neck w/o contrast (70547) |
$1,694 |
$4,235 |
7.6× |
| MRI abdomen w contrast (74182) |
$900 |
$2,154.50 |
2.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$900 |
$1,535.50 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$900 |
$1,489.50 |
4.0× |
| MRI any jnt lwr ext with con lt (73722) |
$900 |
$7,629 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$900 |
$7,629 |
1.2× |
| MRI c-spine with contrast (72142) |
$900 |
$2,108.50 |
2.8× |
| MRI cervical spine w/o contrast (72141) |
$900 |
$1,324 |
4.0× |
| MRI chest w/o & w/contrast material (71552) |
$900 |
$2,132.50 |
2.8× |
| MRI chest w/o contrast (71550) |
$900 |
$1,443.50 |
4.0× |
| MRI chest with contrast (71551) |
$900 |
$4,182.50 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$900 |
$2,154.50 |
2.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$900 |
$3,665 |
2.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$900 |
$2,335 |
4.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$900 |
$2,335 |
4.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$900 |
$3,665 |
2.8× |
| MRI orbit/face/neck w/contrast (70542) |
$900 |
$2,154.50 |
2.8× |
| MRI pelvis w contrast (72196) |
$900 |
$2,154.50 |
2.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$900 |
$2,154.50 |
2.8× |
| MRI pelvis w/o contrast (72195) |
$900 |
$2,132.50 |
4.0× |
| MRI scan of arm joint before and after contrast (73223) |
$900 |
$3,665 |
2.8× |
| MRI scan of leg joint before and after contrast (73723) |
$900 |
$3,665 |
2.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$900 |
$2,025 |
2.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$900 |
$2,177.50 |
2.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$900 |
$336 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$900 |
$1,969 |
2.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$900 |
$2,000.50 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$900 |
$1,324 |
4.0× |
| MRI tmj (70336) |
$900 |
$2,335 |
4.0× |
| MRI upper ext joint w/o contrast (73221) |
$900 |
$2,335 |
4.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$900 |
$3,665 |
2.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$900 |
$2,335 |
4.0× |
| Neck soft tissue (70360) |
$177 |
$442.50 |
2.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$227.20 |
$568 |
2.3× |
| Osseous survey infant (77076) |
$230.80 |
$577 |
2.4× |
| Osseous survey limited (77074) |
$223.20 |
$558 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$213.40 |
$533.50 |
2.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$900 |
$3,665 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$181.80 |
$454.50 |
2.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$215.40 |
$538.50 |
2.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$419.20 |
$1,048 |
4.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$223 |
$557.50 |
2.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$213.80 |
$534.50 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$177.60 |
$444 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$419.20 |
$1,048 |
4.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$265 |
$442.50 |
3.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$346.40 |
$866 |
4.3× |
| Scapula complete (73010) |
$216.60 |
$541.50 |
2.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$81.40 |
$203.50 |
0.8× |
| Spine thoracic 3 views (72072) |
$214.20 |
$535.50 |
2.2× |
| Ultrasound scan of cornea to determine thickness (76514) |
$63.20 |
$158 |
2.3× |
| Ultrasound scan to determine eye length and lens power (76519) |
$211.60 |
$529 |
2.2× |
| Ultrasound, abdomen limited (76705) |
$450 |
$580 |
4.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$346.40 |
$866 |
4.3× |
| Upper Extremity Infant (73092) |
$214.20 |
$535.50 |
2.2× |
| Us abdl aorta screen aaa (76706) |
$419.20 |
$1,048 |
4.3× |
| Us chest (76604) |
$226 |
$565 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$228.60 |
$571.50 |
2.3× |
| Us ob transvaginal (76817) |
$235.60 |
$589 |
2.4× |
| Us pelvic non ob complete (76856) |
$450 |
$558.50 |
4.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$221.60 |
$554 |
2.3× |
| Us pregnancy ltd (76815) |
$234.80 |
$587 |
2.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$224.80 |
$562 |
2.3× |
| Us retroperitoneal complete (76770) |
$450 |
$140 |
4.6× |
| Us retroperitoneal limited (76775) |
$419.20 |
$1,048 |
4.3× |
| Us scrotum and contents (76870) |
$222.60 |
$556.50 |
2.3× |
| Us soft tissue head/neck (76536) |
$450 |
$1,048 |
4.6× |
| Us xtr non-vasc lmtd (76882) |
$419.20 |
$1,048 |
4.3× |
| Wrist 2 views (73100) |
$179.60 |
$449 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$216.20 |
$540.50 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$181.60 |
$454 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$250 |
$442.50 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$179.20 |
$448 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$177 |
$442.50 |
2.2× |
| X-ray exam hip uni 1 view (73501) |
$140 |
$866 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$140 |
$450.50 |
1.7× |
| X-ray exam of femur 1 (73551) |
$346.40 |
$866 |
4.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$215 |
$537.50 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$250 |
$442.50 |
3.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$179.60 |
$449 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$180.40 |
$451 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$214 |
$535 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$177 |
$442.50 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$177.80 |
$444.50 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$250 |
$535.50 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$217 |
$542.50 |
2.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$177 |
$442.50 |
2.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$178.80 |
$447 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$220.60 |
$551.50 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$177.80 |
$444.50 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$215.20 |
$538 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$216.20 |
$540.50 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$213.60 |
$534 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$177 |
$442.50 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$346.40 |
$866 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$183 |
$457.50 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$177 |
$442.50 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$216.80 |
$542 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$218.80 |
$547 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$179.20 |
$448 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$180 |
$450 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$177.60 |
$444 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$215.40 |
$538.50 |
2.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$176.20 |
$440.50 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$250 |
$442.50 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$223.40 |
$558.50 |
2.3× |
| Xr chest 4+ views (71048) |
$218 |
$545 |
2.2× |
| Xr finger(s) 2+ views (73140) |
$176.20 |
$440.50 |
2.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$215.20 |
$538 |
2.2× |
| Xr shoulder 1 view (73020) |
$179.20 |
$448 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$419.20 |
$1,048 |
4.3× |
| Xr tibia/fibula 2 views (73590) |
$180.20 |
$450.50 |
2.2× |
| Xr tmj bilateral (70330) |
$178.20 |
$445.50 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$255 |
$36 |
3.1× |