| Abdomen 2 views (74019) |
$465.50 |
$465.50 |
4.4× |
| Angiography extremity unilateral rs&i (75710) |
$7,573 |
$7,573 |
2.4× |
| Ankle 2 views (73600) |
$550 |
$550 |
6.3× |
| Antegrade urography radiological supvj & interpj (74425) |
$1,307 |
$1,307 |
3.7× |
| Arthrogram elbow (73085) |
$1,442 |
$1,442 |
4.1× |
| Arthrogram hip (73525) |
$1,386 |
$1,386 |
4.0× |
| Arthrogram shoulder (73040) |
$1,378 |
$1,378 |
3.9× |
| Arthrogram wrist (73115) |
$1,474 |
$1,474 |
4.2× |
| Arthrography knee lt (73580) |
$2,003 |
$2,003 |
5.7× |
| Bone age studies (77072) |
$473 |
$473 |
4.5× |
| Bone survey complete (77075) |
$586 |
$586 |
5.6× |
| Cervical spine 2 or 3 views (72040) |
$529 |
$529 |
6.1× |
| Chest 1 view (71045) |
$387.50 |
$387.50 |
4.4× |
| Chest 3 views (71047) |
$361 |
$361 |
4.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$721 |
$721 |
4.1× |
| Clavicle complete (73000) |
$401 |
$401 |
4.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$485 |
$485 |
4.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,470.50 |
$6,470.50 |
18.5× |
| CT abdomen and pelvis without contrast (74176) |
$4,729 |
$4,729 |
19.7× |
| CT abdomen w contrast (74160) |
$3,384 |
$3,384 |
19.2× |
| CT abdomen w wo contrast (74170) |
$3,173 |
$3,173 |
18.0× |
| CT abdomen w/o contrast (74150) |
$2,498 |
$2,498 |
23.8× |
| CT angiography upper extremity lt (73206) |
$1,492 |
$1,492 |
8.5× |
| CT c-spine w/o contrast (72125) |
$2,272 |
$2,272 |
21.6× |
| CT cervical spine w&w/o contrast (72127) |
$2,772 |
$2,772 |
15.7× |
| CT cervical spine with contrast (72126) |
$2,889 |
$2,889 |
8.2× |
| CT chest w/wo contrast (71270) |
$3,391 |
$3,391 |
19.2× |
| CT chest with contrast (71260) |
$2,874.50 |
$2,874.50 |
16.3× |
| CT head/brain with contrast (70460) |
$2,329 |
$2,329 |
13.2× |
| CT head/brain without and with contrast (70470) |
$2,847 |
$2,847 |
16.2× |
| CT iac w contrast (70481) |
$2,065.50 |
$2,065.50 |
11.7× |
| CT limited/localized follow up study (76380) |
$2,102 |
$2,102 |
24.0× |
| CT lower ext w/o (73700) |
$2,216 |
$2,216 |
21.1× |
| CT lower extremity w wo contrast (73702) |
$4,426 |
$4,426 |
25.1× |
| CT lower extremity with contrast (73701) |
$3,484.50 |
$3,484.50 |
19.8× |
| CT lumbar spine w & w/o contrast (72133) |
$3,762.50 |
$3,762.50 |
21.4× |
| CT lumbar spine w/o contrast (72131) |
$2,805 |
$2,805 |
26.7× |
| CT lumbar spine with contrast (72132) |
$2,306 |
$2,306 |
6.6× |
| CT maxillofacial w contrast (70487) |
$2,367 |
$2,367 |
13.4× |
| CT maxillofacial w/o contrast (70486) |
$2,345 |
$2,345 |
22.3× |
| CT maxillofacial w/wo contrast (70488) |
$3,219 |
$3,219 |
18.3× |
| CT neck soft tissue w contrast (70491) |
$2,874.50 |
$2,874.50 |
16.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,590.50 |
$2,590.50 |
14.7× |
| CT orbits w/o contrast (70480) |
$2,383 |
$2,383 |
22.7× |
| CT pelvis w & w/o contrast (72194) |
$3,349 |
$3,349 |
19.0× |
| CT pelvis w/o contrast (72192) |
$2,306 |
$2,306 |
22.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,687.50 |
$3,687.50 |
20.9× |
| CT soft tissue neck w/o contrast (70490) |
$2,505 |
$2,505 |
23.9× |
| CT thoracic spine w/contrast (72129) |
$2,889 |
$2,889 |
16.4× |
| CT thoracic spine w/o contrast (72128) |
$2,272 |
$2,272 |
21.6× |
| CT thoracic spine w/wo contrast (72130) |
$2,787 |
$2,787 |
15.8× |
| CT thorax w/o contrast (71250) |
$3,173 |
$3,173 |
30.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$4,426 |
$4,426 |
25.1× |
| CT upper extremity w/o contrast rt (73200) |
$2,216 |
$2,216 |
21.1× |
| CT upper extremity with contrast (73201) |
$2,535 |
$2,535 |
7.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,492 |
$1,492 |
8.5× |
| Cta Abdomen (74175) |
$970 |
$970 |
5.5× |
| CTA abdomen pelvis (74174) |
$1,190.50 |
$1,190.50 |
3.4× |
| CTA chest (71275) |
$1,470.50 |
$1,470.50 |
8.3× |
| Cta Head (70496) |
$1,470.50 |
$1,470.50 |
8.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$734 |
$734 |
2.1× |
| CTA lwr ext w&w/o contrast (73706) |
$723 |
$723 |
4.1× |
| Cta Neck (70498) |
$1,470.50 |
$1,470.50 |
8.3× |
| Cystography minimum 3 views rs&i (74430) |
$1,153 |
$1,153 |
3.3× |
| Dacryocystography (70170) |
$915 |
$915 |
3.8× |
| Diskogram cervical (72285) |
$3,028 |
$3,028 |
1.5× |
| Diskography lumbar (72295) |
$1,958.88 |
$1,958.88 |
1.0× |
| Esophagus (74220) |
$703 |
$703 |
4.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$795 |
$795 |
7.6× |
| Fluoroscopy up to 1 hr (76000) |
$852 |
$852 |
3.6× |
| Foot 2 views (73620) |
$527 |
$527 |
6.0× |
| Forearm 2 views (73090) |
$346 |
$346 |
4.0× |
| Hand 2 views (73120) |
$365 |
$365 |
3.5× |
| Hand 3 views (73130) |
$348 |
$348 |
4.0× |
| Humerus Min 2 Views Left (73060) |
$456 |
$456 |
5.2× |
| Hysterosalpingogram (74740) |
$1,448 |
$1,448 |
6.0× |
| Knee 3 views (73562) |
$881 |
$881 |
10.1× |
| Mammary ductogram or galactogram single (77053) |
$1,435 |
$1,435 |
6.0× |
| MRA head w & w/o contrast (70546) |
$4,890 |
$4,890 |
14.0× |
| MRA head w/o contrast (70544) |
$3,258 |
$3,258 |
13.6× |
| MRA head with contrast (70545) |
$1,654 |
$1,654 |
4.7× |
| MRA neck w contrast (70548) |
$4,296 |
$4,296 |
12.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,774 |
$4,774 |
13.6× |
| MRA neck w/o contrast (70547) |
$3,081 |
$3,081 |
12.9× |
| MRI abdomen w contrast (74182) |
$3,775 |
$3,775 |
10.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$7,501 |
$7,501 |
21.4× |
| MRI abdomen w/o contrast (74181) |
$5,045.50 |
$5,045.50 |
21.1× |
| MRI any jnt lwr ext with con lt (73722) |
$3,758.50 |
$3,758.50 |
4.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$4,344 |
$4,344 |
5.5× |
| MRI c-spine with contrast (72142) |
$4,135 |
$4,135 |
11.8× |
| MRI cervical spine w/o contrast (72141) |
$3,429.50 |
$3,429.50 |
14.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,797.50 |
$3,797.50 |
10.8× |
| MRI chest w/o contrast (71550) |
$3,217.50 |
$3,217.50 |
13.4× |
| MRI chest with contrast (71551) |
$3,844 |
$3,844 |
4.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$5,201 |
$5,201 |
14.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$5,369.50 |
$5,369.50 |
15.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,701 |
$3,701 |
15.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,085 |
$3,085 |
12.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,377.50 |
$5,377.50 |
15.3× |
| MRI orbit/face/neck w/contrast (70542) |
$3,383 |
$3,383 |
9.7× |
| MRI pelvis w contrast (72196) |
$3,801 |
$3,801 |
10.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$6,209 |
$6,209 |
17.7× |
| MRI pelvis w/o contrast (72195) |
$3,533 |
$3,533 |
14.7× |
| MRI scan of arm joint before and after contrast (73223) |
$4,742 |
$4,742 |
13.5× |
| MRI scan of leg joint before and after contrast (73723) |
$5,523 |
$5,523 |
15.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,559 |
$5,559 |
15.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,802 |
$3,802 |
10.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,377.50 |
$5,377.50 |
15.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,520 |
$3,520 |
10.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,877 |
$4,877 |
13.9× |
| MRI thoracic spine w/o contrast (72146) |
$3,054 |
$3,054 |
12.7× |
| MRI tmj (70336) |
$2,946 |
$2,946 |
12.3× |
| MRI upper ext joint w/o contrast (73221) |
$4,402 |
$4,402 |
18.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$4,534 |
$4,534 |
12.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,585 |
$3,585 |
15.0× |
| Myelogram Cervical (72240) |
$2,514 |
$2,514 |
3.2× |
| Myelogram Lumbar (72265) |
$2,277 |
$2,277 |
2.9× |
| Myelogram thoracic (72255) |
$2,277 |
$2,277 |
2.9× |
| Myelography 2 or more regions (72270) |
$2,889 |
$2,889 |
3.7× |
| Neck soft tissue (70360) |
$388 |
$388 |
4.4× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$849 |
$849 |
8.1× |
| Osseous survey limited (77074) |
$572 |
$572 |
5.4× |
| Pelvis 1 or 2 views (72170) |
$374.50 |
$374.50 |
3.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$5,575 |
$5,575 |
15.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$213 |
$213 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$351 |
$351 |
3.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$351 |
$351 |
3.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$403 |
$403 |
3.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$377 |
$377 |
3.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$459 |
$459 |
5.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$359 |
$359 |
4.1× |
| Radiologic exam colon single contrast study (74270) |
$763 |
$763 |
4.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$789 |
$789 |
4.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$755 |
$755 |
4.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$345 |
$345 |
3.9× |
| Radiological examination surgical specimen (76098) |
$1,411 |
$1,411 |
2.6× |
| Ribs bilateral 3 views (71110) |
$351 |
$351 |
3.3× |
| Sacroiliac Joints < 3 Views (72200) |
$411 |
$411 |
3.9× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$805 |
$805 |
3.4× |
| Scanogram (77073) |
$427 |
$427 |
4.1× |
| Scapula complete (73010) |
$575 |
$575 |
5.5× |
| Sella turcica (70240) |
$401 |
$401 |
4.6× |
| Sialogram (70390) |
$1,077 |
$1,077 |
4.5× |
| Small bowel series (74250) |
$724 |
$724 |
4.1× |
| Spine thoracic 3 views (72072) |
$857.50 |
$857.50 |
8.2× |
| Therapeutic Enema (74283) |
$758 |
$758 |
4.3× |
| Thoracolumbar 2 views (72080) |
$407 |
$407 |
4.7× |
| Tmj unilateral (70328) |
$370 |
$370 |
4.2× |
| Tomogram (76100) |
$761 |
$761 |
7.2× |
| Ultrasound, abdomen limited (76705) |
$1,047.50 |
$1,047.50 |
10.0× |
| Unlisted fluoroscopic procedure (76496) |
$385 |
$385 |
4.4× |
| Upper Extremity Infant (73092) |
$196 |
$196 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$1,214 |
$1,214 |
5.1× |
| Urethrocystography voiding (74455) |
$1,194 |
$1,194 |
5.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,186 |
$1,186 |
6.7× |
| Us abdl aorta screen aaa (76706) |
$1,122.50 |
$1,122.50 |
10.7× |
| Us breast unilateral complete (76641) |
$801 |
$801 |
7.6× |
| Us breast unilateral limited (76642) |
$801 |
$801 |
9.2× |
| Us chest (76604) |
$421 |
$421 |
4.0× |
| Us compl joint r-t w/image documentation (76881) |
$801 |
$801 |
7.6× |
| Us fetal nuchal translucency 1st gestation (76813) |
$405 |
$405 |
3.9× |
| Us guided compression repair (76936) |
$689 |
$689 |
3.2× |
| Us ob detailed single fetus (76811) |
$849 |
$849 |
3.5× |
| Us ob transvaginal (76817) |
$535 |
$535 |
5.1× |
| Us pelvic non ob complete (76856) |
$1,079 |
$1,079 |
10.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$519 |
$519 |
4.9× |
| Us pregnancy ltd (76815) |
$543 |
$543 |
5.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$443 |
$443 |
4.2× |
| Us retroperitoneal complete (76770) |
$1,047.50 |
$1,047.50 |
10.0× |
| Us retroperitoneal limited (76775) |
$1,139 |
$1,139 |
10.8× |
| Us scrotum and contents (76870) |
$819 |
$819 |
7.8× |
| Us soft tissue head/neck (76536) |
$820 |
$820 |
7.8× |
| Us spinal canal and contents (76800) |
$303 |
$303 |
2.9× |
| Us transrectal (76872) |
$778 |
$778 |
7.4× |
| Us xtr non-vasc lmtd (76882) |
$867.66 |
$867.66 |
8.3× |
| Venogram extremity bilateral (75822) |
$2,753 |
$2,753 |
1.7× |
| Venography extremity unilateral rs&i (75820) |
$2,642 |
$2,642 |
1.7× |
| Wrist 2 views (73100) |
$438 |
$438 |
5.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$648 |
$648 |
6.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$710 |
$710 |
8.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$388.50 |
$388.50 |
4.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,001 |
$1,001 |
5.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$440 |
$440 |
5.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$487 |
$487 |
5.6× |
| X-ray exam hip uni 1 view (73501) |
$216 |
$216 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$284 |
$284 |
3.2× |
| X-ray exam hip uni 4/> views (73503) |
$356 |
$356 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$587.50 |
$587.50 |
5.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$678 |
$678 |
6.5× |
| X-ray exam of femur 1 (73551) |
$216 |
$216 |
2.5× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$1,212 |
$1,212 |
6.9× |
| X-ray eye for foreign body (70030) |
$621 |
$621 |
7.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$565.50 |
$565.50 |
5.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$371.50 |
$371.50 |
4.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$372 |
$372 |
4.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$343 |
$343 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$369 |
$369 |
4.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$819 |
$819 |
7.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$397 |
$397 |
4.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$544.50 |
$544.50 |
6.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$546 |
$546 |
5.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$994.50 |
$994.50 |
9.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$781.50 |
$781.50 |
7.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$347 |
$347 |
4.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$415 |
$415 |
4.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$405 |
$405 |
3.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$347 |
$347 |
3.3× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$1,280 |
$1,280 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$384.50 |
$384.50 |
4.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$393 |
$393 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$621 |
$621 |
5.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$665 |
$665 |
6.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$411 |
$411 |
4.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$465 |
$465 |
5.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$457.50 |
$457.50 |
5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$764.50 |
$764.50 |
7.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$409 |
$409 |
3.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$393 |
$393 |
4.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$493 |
$493 |
5.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$364.50 |
$364.50 |
4.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$391 |
$391 |
3.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$338 |
$338 |
3.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$361 |
$361 |
4.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$520.34 |
$520.34 |
6.0× |
| Xr arthrogram ankle (73615) |
$2,054.50 |
$2,054.50 |
5.9× |
| Xr c-spine 6 or more views (72052) |
$656.50 |
$656.50 |
6.3× |
| Xr chest 4+ views (71048) |
$574 |
$574 |
5.5× |
| Xr finger(s) 2+ views (73140) |
$354 |
$354 |
4.0× |
| XR Mastoids < 3 Views Bilateral (70120) |
$365 |
$365 |
3.5× |
| Xr optic foramina (70190) |
$351 |
$351 |
4.0× |
| Xr shoulder 1 view (73020) |
$500 |
$500 |
5.7× |
| Xr spine cervical 4 or 5 views (72050) |
$649.50 |
$649.50 |
6.2× |
| Xr tibia/fibula 2 views (73590) |
$512 |
$512 |
5.9× |
| Xr tmj bilateral (70330) |
$497 |
$497 |
5.7× |
| Xray knee 1 or 2 views rt (73560) |
$533 |
$533 |
6.1× |