| Abdomen 2 views (74019) |
$155.40 |
$222 |
1.6× |
| Ankle 2 views (73600) |
$86.10 |
$123 |
1.1× |
| Bone age studies (77072) |
$57.40 |
$82 |
0.6× |
| Bone survey complete (77075) |
$166.60 |
$238 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$74.20 |
$106 |
0.9× |
| Chest 1 view (71045) |
$115.65 |
$165.22 |
1.5× |
| Clavicle complete (73000) |
$173.48 |
$247.83 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$390.91 |
$558.44 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,277.50 |
$1,825 |
4.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,015 |
$1,450 |
4.7× |
| CT abdomen w contrast (74160) |
$593.60 |
$848 |
3.7× |
| CT abdomen w wo contrast (74170) |
$667.80 |
$954 |
4.2× |
| CT abdomen w/o contrast (74150) |
$501.20 |
$716 |
5.3× |
| CT angiography upper extremity lt (73206) |
$787.50 |
$1,125 |
4.9× |
| CT c-spine w/o contrast (72125) |
$504.70 |
$721 |
5.3× |
| CT cervical spine w&w/o contrast (72127) |
$742 |
$1,060 |
4.6× |
| CT cervical spine with contrast (72126) |
$593.60 |
$848 |
1.9× |
| CT chest w/wo contrast (71270) |
$980 |
$1,400 |
6.1× |
| CT chest with contrast (71260) |
$890.40 |
$1,272 |
5.6× |
| CT head/brain with contrast (70460) |
$593.60 |
$848 |
3.7× |
| CT head/brain without and with contrast (70470) |
$641.90 |
$917 |
4.0× |
| CT iac w contrast (70481) |
$593.60 |
$848 |
3.7× |
| CT lower ext w/o (73700) |
$519.40 |
$742 |
5.5× |
| CT lower extremity w wo contrast (73702) |
$925.05 |
$1,321.50 |
5.8× |
| CT lower extremity with contrast (73701) |
$696.50 |
$995 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$742 |
$1,060 |
4.6× |
| CT lumbar spine w/o contrast (72131) |
$464.10 |
$663 |
4.9× |
| CT lumbar spine with contrast (72132) |
$593.60 |
$848 |
1.9× |
| CT maxillofacial w contrast (70487) |
$593.60 |
$848 |
3.7× |
| CT maxillofacial w/o contrast (70486) |
$464.10 |
$663 |
4.9× |
| CT maxillofacial w/wo contrast (70488) |
$816.20 |
$1,166 |
5.1× |
| CT neck soft tissue w contrast (70491) |
$667.80 |
$954 |
4.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$667.80 |
$954 |
4.2× |
| CT orbits w/o contrast (70480) |
$464.10 |
$663 |
4.9× |
| CT pelvis w & w/o contrast (72194) |
$1,002.40 |
$1,432 |
6.3× |
| CT pelvis w/o contrast (72192) |
$511.70 |
$731 |
5.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$890.40 |
$1,272 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$464.10 |
$663 |
4.9× |
| CT thoracic spine w/contrast (72129) |
$593.60 |
$848 |
3.7× |
| CT thoracic spine w/o contrast (72128) |
$490 |
$700 |
5.1× |
| CT thoracic spine w/wo contrast (72130) |
$742 |
$1,060 |
4.6× |
| CT thorax w/o contrast (71250) |
$719.60 |
$1,028 |
7.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$779.10 |
$1,113 |
4.9× |
| CT upper extremity w/o contrast rt (73200) |
$482.30 |
$689 |
5.1× |
| CT upper extremity with contrast (73201) |
$519.40 |
$742 |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,575 |
$2,250 |
9.9× |
| Cta Abdomen (74175) |
$1,024.10 |
$1,463 |
6.4× |
| CTA abdomen pelvis (74174) |
$1,140.30 |
$1,629 |
3.6× |
| CTA chest (71275) |
$1,024.10 |
$1,463 |
6.4× |
| Cta Head (70496) |
$651 |
$930 |
4.1× |
| CTA lwr ext w&w/o contrast (73706) |
$962.50 |
$1,375 |
6.0× |
| Cta Neck (70498) |
$651 |
$930 |
4.1× |
| Cta Pelvis (72191) |
$682.50 |
$975 |
4.3× |
| Diskogram cervical (72285) |
$1,281 |
$1,830 |
0.7× |
| Diskography lumbar (72295) |
$1,270.85 |
$1,815.50 |
0.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$157.50 |
$225 |
1.7× |
| Foot 2 views (73620) |
$53.90 |
$77 |
0.7× |
| Forearm 2 views (73090) |
$173.48 |
$247.83 |
2.2× |
| Hand 2 views (73120) |
$155.40 |
$222 |
1.6× |
| Hand 3 views (73130) |
$173.48 |
$247.83 |
2.2× |
| Humerus Min 2 Views Left (73060) |
$173.48 |
$247.83 |
2.2× |
| Knee 3 views (73562) |
$134.40 |
$192 |
1.7× |
| MRA head w/o contrast (70544) |
$593.60 |
$848 |
2.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$752.50 |
$1,075 |
2.4× |
| MRA neck w/o contrast (70547) |
$593.60 |
$848 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,614.20 |
$2,306 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$614.60 |
$878 |
2.8× |
| MRI c-spine with contrast (72142) |
$1,614.20 |
$2,306 |
5.1× |
| MRI cervical spine w/o contrast (72141) |
$779.10 |
$1,113 |
3.6× |
| MRI chest w/o & w/contrast material (71552) |
$1,614.20 |
$2,306 |
5.1× |
| MRI chest w/o contrast (71550) |
$667.80 |
$954 |
3.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$602 |
$860 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$593.60 |
$848 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,444.10 |
$2,063 |
4.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,291.50 |
$1,845 |
4.1× |
| MRI pelvis w/o contrast (72195) |
$742 |
$1,060 |
3.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,614.20 |
$2,306 |
5.1× |
| MRI scan of leg joint before and after contrast (73723) |
$857.50 |
$1,225 |
2.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,630.30 |
$2,329 |
5.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$779.10 |
$1,113 |
2.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,614.20 |
$2,306 |
5.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,614.20 |
$2,306 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,956.50 |
$2,795 |
6.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,280.30 |
$1,829 |
5.9× |
| MRI tmj (70336) |
$734.30 |
$1,049 |
3.4× |
| MRI upper ext joint w/o contrast (73221) |
$890.40 |
$1,272 |
4.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$779.10 |
$1,113 |
2.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$602 |
$860 |
2.8× |
| Neck soft tissue (70360) |
$60.20 |
$86 |
0.8× |
| Osseous survey infant (77076) |
$168 |
$240 |
1.8× |
| Osseous survey limited (77074) |
$228.90 |
$327 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$155.67 |
$222.38 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$857.50 |
$1,225 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$88.90 |
$127 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$155.67 |
$222.38 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$157.50 |
$225 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$91 |
$130 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$115.65 |
$165.22 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$173.48 |
$247.83 |
2.2× |
| Ribs bilateral 3 views (71110) |
$112 |
$160 |
1.2× |
| Sacroiliac Joints < 3 Views (72200) |
$85.40 |
$122 |
0.9× |
| Scapula complete (73010) |
$71.40 |
$102 |
0.8× |
| Spine thoracic 3 views (72072) |
$96.60 |
$138 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$154 |
$220 |
1.6× |
| Upper Extremity Infant (73092) |
$95.55 |
$136.50 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$267.40 |
$382 |
1.7× |
| Us abdl aorta screen aaa (76706) |
$122.50 |
$175 |
1.3× |
| Us breast unilateral limited (76642) |
$70 |
$100 |
0.9× |
| Us chest (76604) |
$131.60 |
$188 |
1.4× |
| Us ob transvaginal (76817) |
$134.40 |
$192 |
1.4× |
| Us pelvic non ob complete (76856) |
$145.60 |
$208 |
1.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$117.60 |
$168 |
1.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$168 |
$240 |
1.8× |
| Us retroperitoneal complete (76770) |
$230.30 |
$329 |
2.4× |
| Us retroperitoneal limited (76775) |
$192.15 |
$274.50 |
2.0× |
| Us scrotum and contents (76870) |
$218.40 |
$312 |
2.3× |
| Us soft tissue head/neck (76536) |
$131.60 |
$188 |
1.4× |
| Us xtr non-vasc lmtd (76882) |
$131.60 |
$188 |
1.4× |
| Wrist 2 views (73100) |
$115.65 |
$165.22 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$124.60 |
$178 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$57.40 |
$82 |
0.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$173.48 |
$247.83 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$173.48 |
$247.83 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$101.50 |
$145 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$85.40 |
$122 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$115.65 |
$165.22 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$164.50 |
$235 |
1.7× |
| X-ray exam of femur 1 (73551) |
$63 |
$90 |
0.8× |
| X-ray eye for foreign body (70030) |
$112 |
$160 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$85.40 |
$122 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$67.90 |
$97 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$101.85 |
$145.50 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$173.48 |
$247.83 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$63.70 |
$91 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$93.10 |
$133 |
1.0× |
| 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) |
$95.55 |
$136.50 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$81.90 |
$117 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$155.67 |
$222.38 |
1.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$128.10 |
$183 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$85.40 |
$122 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$60.20 |
$86 |
0.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$79.80 |
$114 |
0.8× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$127.40 |
$182 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$115.65 |
$165.22 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$177.80 |
$254 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$213.50 |
$305 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$99.40 |
$142 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$67.90 |
$97 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$127.05 |
$181.50 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$85.40 |
$122 |
1.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$71.40 |
$102 |
0.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$99.40 |
$142 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$74.20 |
$106 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$60.20 |
$86 |
0.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$63.70 |
$91 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$81.90 |
$117 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$57.40 |
$82 |
0.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$173.48 |
$247.83 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$160.30 |
$229 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$173.48 |
$247.83 |
2.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$67.90 |
$97 |
0.7× |
| Xr shoulder 1 view (73020) |
$63.70 |
$91 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$155.67 |
$222.38 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$95.55 |
$136.50 |
1.2× |
| Xr tmj bilateral (70330) |
$160.30 |
$229 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$95.55 |
$136.50 |
1.2× |