| Abdomen 2 views (74019) |
$245 |
$327 |
2.3× |
| Ankle 2 views (73600) |
$265 |
$353 |
3.0× |
| Bone age studies (77072) |
$234 |
$312 |
2.2× |
| Cervical spine 2 or 3 views (72040) |
$197 |
$262 |
2.3× |
| Chest 1 view (71045) |
$180 |
$240 |
2.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$353 |
$470 |
2.0× |
| Clavicle complete (73000) |
$332.50 |
$443.50 |
3.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$326 |
$434 |
3.1× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$439 |
$585 |
2.5× |
| Corpora cavernosography (74445) |
$508 |
$677 |
4.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,875 |
$2,500 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,907 |
$2,542 |
8.0× |
| CT abdomen w contrast (74160) |
$1,637.50 |
$2,183 |
9.3× |
| CT abdomen w wo contrast (74170) |
$1,418 |
$1,890 |
8.0× |
| CT abdomen w/o contrast (74150) |
$1,658 |
$2,211 |
15.8× |
| CT angiography upper extremity lt (73206) |
$1,574 |
$2,098 |
8.9× |
| CT c-spine w/o contrast (72125) |
$900 |
$1,200 |
8.6× |
| CT cervical spine w&w/o contrast (72127) |
$1,575 |
$2,100 |
8.9× |
| CT cervical spine with contrast (72126) |
$1,246 |
$1,661 |
3.6× |
| CT chest w/wo contrast (71270) |
$1,717 |
$2,289 |
9.7× |
| CT chest with contrast (71260) |
$1,357 |
$1,809 |
7.7× |
| CT head/brain with contrast (70460) |
$1,396 |
$1,861 |
7.9× |
| CT head/brain without and with contrast (70470) |
$2,036 |
$2,714 |
11.6× |
| CT iac w contrast (70481) |
$1,293 |
$1,724 |
7.3× |
| CT lower ext w/o (73700) |
$1,521 |
$2,028 |
14.5× |
| CT lower extremity w wo contrast (73702) |
$1,873.50 |
$2,497.50 |
10.6× |
| CT lower extremity with contrast (73701) |
$1,772 |
$2,362.50 |
10.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,575 |
$2,100 |
8.9× |
| CT lumbar spine w/o contrast (72131) |
$900 |
$1,200 |
8.6× |
| CT lumbar spine with contrast (72132) |
$1,246 |
$1,661 |
3.6× |
| CT maxillofacial w contrast (70487) |
$1,521 |
$2,028 |
8.6× |
| CT maxillofacial w/o contrast (70486) |
$1,088 |
$1,450 |
10.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,752.50 |
$2,336 |
9.9× |
| CT neck soft tissue w contrast (70491) |
$1,396 |
$1,861 |
7.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,793 |
$2,391 |
10.2× |
| CT orbits w/o contrast (70480) |
$1,111 |
$1,481 |
10.6× |
| CT pelvis w & w/o contrast (72194) |
$1,517 |
$2,022 |
8.6× |
| CT pelvis w/o contrast (72192) |
$1,071 |
$1,428 |
10.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,838 |
$2,450 |
10.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,164 |
$1,552 |
11.1× |
| CT thoracic spine w/contrast (72129) |
$1,246 |
$1,661 |
7.1× |
| CT thoracic spine w/o contrast (72128) |
$900 |
$1,200 |
8.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,575 |
$2,100 |
8.9× |
| CT thorax w/o contrast (71250) |
$900 |
$1,200 |
8.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,829 |
$2,438 |
10.4× |
| CT upper extremity w/o contrast rt (73200) |
$1,521 |
$2,028 |
14.5× |
| CT upper extremity with contrast (73201) |
$1,696 |
$2,261 |
4.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,649 |
$2,199 |
9.4× |
| Cta Abdomen (74175) |
$1,514 |
$2,018 |
8.6× |
| CTA abdomen pelvis (74174) |
$2,243 |
$2,990 |
6.4× |
| CTA chest (71275) |
$1,649 |
$2,199 |
9.4× |
| Cta Head (70496) |
$1,129 |
$1,505 |
6.4× |
| CTA lwr ext w&w/o contrast (73706) |
$1,514 |
$2,018 |
8.6× |
| Cta Neck (70498) |
$1,129 |
$1,505 |
6.4× |
| Cta Pelvis (72191) |
$1,513 |
$2,017 |
8.6× |
| Cystography minimum 3 views rs&i (74430) |
$770 |
$1,026 |
2.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$281 |
$375 |
2.7× |
| Esophagus (74220) |
$420 |
$560 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$345 |
$460 |
3.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$345 |
$460 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$501 |
$668 |
2.1× |
| Foot 2 views (73620) |
$165 |
$220 |
1.9× |
| Forearm 2 views (73090) |
$165 |
$220 |
1.9× |
| Hand 3 views (73130) |
$219.50 |
$292.50 |
2.5× |
| Humerus Min 2 Views Left (73060) |
$200.50 |
$267.50 |
2.3× |
| Knee 3 views (73562) |
$219.50 |
$292.50 |
2.5× |
| MRA head w & w/o contrast (70546) |
$1,986 |
$2,648 |
5.7× |
| MRA head w/o contrast (70544) |
$1,535 |
$2,046 |
6.4× |
| MRA head with contrast (70545) |
$1,773 |
$2,364 |
5.1× |
| MRA neck w contrast (70548) |
$1,773 |
$2,364 |
5.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,986 |
$2,648 |
5.7× |
| MRA neck w/o contrast (70547) |
$1,535 |
$2,046 |
6.4× |
| MRI abdomen w contrast (74182) |
$1,773 |
$2,364 |
5.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,165 |
$2,887 |
6.2× |
| MRI abdomen w/o contrast (74181) |
$1,512 |
$2,016 |
6.3× |
| MRI any jnt lwr ext with con lt (73722) |
$1,773 |
$2,364 |
2.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,773 |
$2,364 |
2.3× |
| MRI c-spine with contrast (72142) |
$1,773 |
$2,364 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$1,673 |
$2,231 |
7.0× |
| MRI chest w/o & w/contrast material (71552) |
$1,986 |
$2,648 |
5.7× |
| MRI chest w/o contrast (71550) |
$1,596 |
$2,128 |
6.7× |
| MRI chest with contrast (71551) |
$1,773 |
$2,364 |
2.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,773 |
$2,364 |
5.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,773 |
$2,364 |
5.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,660 |
$2,213 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,523 |
$2,030.50 |
6.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,986 |
$2,648 |
5.7× |
| MRI orbit/face/neck w/contrast (70542) |
$1,773 |
$2,364 |
5.1× |
| MRI pelvis w contrast (72196) |
$1,844 |
$2,458 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,126 |
$2,834 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,643 |
$2,190 |
6.9× |
| MRI scan of arm joint before and after contrast (73223) |
$1,986 |
$2,648 |
5.7× |
| MRI scan of leg joint before and after contrast (73723) |
$1,986 |
$2,648 |
5.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,165 |
$2,887 |
6.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,773 |
$2,364 |
5.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,165 |
$2,887 |
6.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,773 |
$2,364 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,126 |
$2,834 |
6.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,673 |
$2,231 |
7.0× |
| MRI tmj (70336) |
$762 |
$1,016 |
3.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,643 |
$2,190 |
6.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,165 |
$2,887 |
6.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,673 |
$2,231 |
7.0× |
| Neck soft tissue (70360) |
$196 |
$261 |
2.2× |
| Osseous survey infant (77076) |
$338 |
$450 |
3.2× |
| Osseous survey limited (77074) |
$638 |
$850 |
6.1× |
| Pelvis 1 or 2 views (72170) |
$241 |
$321 |
2.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,126 |
$2,834 |
6.1× |
| Pr red cell survival study (78130) |
$17 |
$22 |
0.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$308 |
$410 |
2.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$305 |
$406 |
2.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$224 |
$299 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$146 |
$194 |
1.7× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$220 |
$293 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$402 |
$536 |
2.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$437 |
$582 |
2.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$212 |
$283 |
2.4× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$2.50 |
$3.50 |
0.0× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$2 |
$3 |
0.0× |
| Ribs bilateral 3 views (71110) |
$278 |
$371 |
2.6× |
| Scapula complete (73010) |
$315.50 |
$421 |
3.0× |
| Sella turcica (70240) |
$196 |
$261 |
2.2× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$355 |
$473 |
3.4× |
| Small bowel series (74250) |
$402 |
$536 |
2.3× |
| Spine thoracic 3 views (72072) |
$262 |
$349 |
2.5× |
| Tmj unilateral (70328) |
$103.50 |
$138 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$329 |
$438.50 |
3.1× |
| Urethrocystography voiding (74455) |
$770 |
$1,026 |
3.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$680.50 |
$907 |
3.9× |
| Us abdl aorta screen aaa (76706) |
$323 |
$430 |
3.1× |
| Us breast unilateral complete (76641) |
$280 |
$373 |
2.7× |
| Us chest (76604) |
$299 |
$399 |
2.8× |
| Us compl joint r-t w/image documentation (76881) |
$390 |
$520 |
3.7× |
| Us ob transvaginal (76817) |
$345 |
$460 |
3.3× |
| Us pelvic non ob complete (76856) |
$369 |
$492 |
3.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$376 |
$501 |
3.6× |
| Us retroperitoneal complete (76770) |
$352 |
$469 |
3.4× |
| Us retroperitoneal limited (76775) |
$303 |
$404 |
2.9× |
| Us scrotum and contents (76870) |
$369 |
$492 |
3.5× |
| Us soft tissue head/neck (76536) |
$323 |
$431 |
3.1× |
| Venogram extremity bilateral (75822) |
$2,181 |
$2,908 |
1.4× |
| Venography extremity unilateral rs&i (75820) |
$1,861 |
$2,481 |
1.2× |
| Wrist 2 views (73100) |
$165 |
$220 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$255 |
$340 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$277 |
$369 |
3.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$302.50 |
$403 |
3.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$419 |
$558 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$180 |
$240 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$229 |
$305 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$143 |
$190 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$180 |
$240 |
2.1× |
| X-ray exam of femur 1 (73551) |
$165 |
$220 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$313.50 |
$418 |
3.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$229 |
$305 |
2.6× |
| X-ray head for orthodontia (70350) |
$161 |
$214 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$170.50 |
$227.50 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$135 |
$180 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$257 |
$342 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$253.50 |
$338 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$285 |
$380 |
2.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$141 |
$188 |
1.6× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$204 |
$272 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$240 |
$320 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$188 |
$250.50 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$257 |
$342 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$223 |
$297 |
2.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$240 |
$320 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$213.50 |
$284.50 |
2.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$270.50 |
$360.50 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$431 |
$575 |
4.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$129 |
$172 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$434 |
$578 |
4.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$241 |
$321 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$196 |
$261 |
2.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$196 |
$261 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$209 |
$279 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$233 |
$311 |
2.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$285 |
$380 |
2.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$180 |
$240 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$229 |
$305 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$450 |
$600 |
4.3× |
| Xr finger(s) 2+ views (73140) |
$176 |
$235 |
2.0× |
| Xr shoulder 1 view (73020) |
$158 |
$210 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$263 |
$351 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$180 |
$240 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$157 |
$209 |
1.8× |