| Abdomen 2 views (74019) |
$109.58 |
$136.97 |
1.2× |
| Cervical spine 2 or 3 views (72040) |
$64 |
$80 |
0.9× |
| Chest 1 view (71045) |
$129.44 |
$161.80 |
1.7× |
| Chest 3 views (71047) |
$129.44 |
$161.80 |
1.7× |
| Clavicle complete (73000) |
$129.44 |
$161.80 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$372 |
$465 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,394.20 |
$1,742.75 |
4.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,212.80 |
$1,516 |
5.9× |
| CT abdomen w contrast (74160) |
$579.40 |
$724.25 |
3.8× |
| CT abdomen w wo contrast (74170) |
$683.20 |
$854 |
4.5× |
| CT abdomen w/o contrast (74150) |
$521.80 |
$652.25 |
5.8× |
| CT c-spine w/o contrast (72125) |
$507.80 |
$634.75 |
5.6× |
| CT cervical spine with contrast (72126) |
$396 |
$495 |
1.3× |
| CT chest w/wo contrast (71270) |
$686.80 |
$858.50 |
4.5× |
| CT chest with contrast (71260) |
$610.60 |
$763.25 |
4.0× |
| CT head/brain with contrast (70460) |
$489.40 |
$611.75 |
3.2× |
| CT head/brain without and with contrast (70470) |
$585.40 |
$731.75 |
3.9× |
| CT lower ext w/o (73700) |
$445.60 |
$557 |
4.9× |
| CT lower extremity with contrast (73701) |
$460.80 |
$576 |
3.0× |
| CT lumbar spine w & w/o contrast (72133) |
$533.60 |
$667 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$526.80 |
$658.50 |
5.8× |
| CT lumbar spine with contrast (72132) |
$476 |
$595 |
1.6× |
| CT maxillofacial w contrast (70487) |
$475.20 |
$594 |
3.1× |
| CT maxillofacial w/o contrast (70486) |
$419.20 |
$524 |
4.7× |
| CT maxillofacial w/wo contrast (70488) |
$410 |
$512.50 |
2.7× |
| CT neck soft tissue w contrast (70491) |
$765.60 |
$957 |
5.1× |
| CT pelvis w & w/o contrast (72194) |
$711 |
$888.75 |
4.7× |
| CT pelvis w/o contrast (72192) |
$527 |
$658.75 |
5.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$276 |
$345 |
1.8× |
| CT soft tissue neck w/o contrast (70490) |
$454.40 |
$568 |
5.0× |
| CT thoracic spine w/contrast (72129) |
$640 |
$800 |
4.2× |
| CT thoracic spine w/o contrast (72128) |
$526.80 |
$658.50 |
5.8× |
| CT thoracic spine w/wo contrast (72130) |
$640 |
$800 |
4.2× |
| CT thorax w/o contrast (71250) |
$841.20 |
$1,051.50 |
9.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$584.80 |
$731 |
3.9× |
| CT upper extremity w/o contrast rt (73200) |
$446 |
$557.50 |
4.9× |
| CT upper extremity with contrast (73201) |
$356 |
$445 |
1.2× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$740 |
$925 |
4.9× |
| Cta Abdomen (74175) |
$640 |
$800 |
4.2× |
| CTA chest (71275) |
$630 |
$787.50 |
4.2× |
| Cta Head (70496) |
$700 |
$875 |
4.6× |
| CTA lwr ext w&w/o contrast (73706) |
$276 |
$345 |
1.8× |
| Cta Neck (70498) |
$700 |
$875 |
4.6× |
| Echo exam of fetal heart (76825) |
$953.60 |
$1,192 |
2.0× |
| Forearm 2 views (73090) |
$129.44 |
$161.80 |
1.7× |
| Hand 3 views (73130) |
$129.44 |
$161.80 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$440 |
$550 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$129.44 |
$161.80 |
1.7× |
| MRA head w & w/o contrast (70546) |
$930 |
$1,162.50 |
3.1× |
| MRA head w/o contrast (70544) |
$580 |
$725 |
2.8× |
| MRA head with contrast (70545) |
$770 |
$962.50 |
2.6× |
| MRA neck w contrast (70548) |
$770 |
$962.50 |
2.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$930 |
$1,162.50 |
3.1× |
| MRA neck w/o contrast (70547) |
$580 |
$725 |
2.8× |
| MRI abdomen w contrast (74182) |
$770 |
$962.50 |
2.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$930 |
$1,162.50 |
3.1× |
| MRI abdomen w/o contrast (74181) |
$800 |
$1,000 |
3.9× |
| MRI c-spine with contrast (72142) |
$770 |
$962.50 |
2.6× |
| MRI cervical spine w/o contrast (72141) |
$580 |
$725 |
2.8× |
| MRI chest w/o & w/contrast material (71552) |
$930 |
$1,162.50 |
3.1× |
| MRI chest w/o contrast (71550) |
$960 |
$1,200 |
4.7× |
| MRI chest with contrast (71551) |
$740 |
$925 |
1.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$580 |
$725 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$610 |
$762.50 |
3.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,080 |
$1,350 |
3.6× |
| MRI pelvis w contrast (72196) |
$770 |
$962.50 |
2.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$930 |
$1,162.50 |
3.1× |
| MRI pelvis w/o contrast (72195) |
$200 |
$250 |
1.0× |
| MRI scan of arm joint before and after contrast (73223) |
$960 |
$1,200 |
3.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$930 |
$1,162.50 |
3.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$770 |
$962.50 |
2.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$960 |
$1,200 |
3.2× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$740 |
$925 |
2.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$930 |
$1,162.50 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$580 |
$725 |
2.8× |
| MRI upper ext joint w/o contrast (73221) |
$840 |
$1,050 |
4.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$260 |
$325 |
0.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$580 |
$725 |
2.8× |
| Myocardial Spect Multiple Studies (78452) |
$1,280 |
$1,600 |
1.1× |
| Neck soft tissue (70360) |
$97.92 |
$122.40 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$348.70 |
$435.88 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$107.58 |
$134.47 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$930 |
$1,162.50 |
3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$114.38 |
$142.97 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$60.80 |
$76 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$44.80 |
$56 |
0.6× |
| Sacroiliac Joints < 3 Views (72200) |
$174.35 |
$217.94 |
1.9× |
| Scapula complete (73010) |
$174.35 |
$217.94 |
1.9× |
| Spine thoracic 3 views (72072) |
$115.98 |
$144.97 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$274.35 |
$342.94 |
3.0× |
| Us breast unilateral complete (76641) |
$145.73 |
$182.16 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$348.70 |
$435.88 |
3.9× |
| Us pelvic non ob complete (76856) |
$243.59 |
$304.49 |
2.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$274.28 |
$342.86 |
3.0× |
| Us retroperitoneal complete (76770) |
$348.70 |
$435.88 |
3.9× |
| Us scrotum and contents (76870) |
$348.70 |
$435.88 |
3.9× |
| Us soft tissue head/neck (76536) |
$230.66 |
$288.32 |
2.6× |
| Us xtr non-vasc lmtd (76882) |
$348.70 |
$435.88 |
3.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$129.44 |
$161.80 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$129.44 |
$161.80 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$129.44 |
$161.80 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$129.44 |
$161.80 |
1.7× |
| X-ray exam of femur 1 (73551) |
$83.92 |
$104.90 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$117.18 |
$146.47 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$41.60 |
$52 |
0.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$129.44 |
$161.80 |
1.7× |
| X-ray IV pyelogram+drip infusn (74410) |
$210.84 |
$263.55 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$107.18 |
$133.97 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$113.18 |
$141.47 |
1.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$86.32 |
$107.90 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$43.20 |
$54 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$129.44 |
$161.80 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$174.35 |
$217.94 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$41.60 |
$52 |
0.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$129.44 |
$161.80 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$53.60 |
$67 |
0.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$129.44 |
$161.80 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$174.35 |
$217.94 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$55.20 |
$69 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$87.12 |
$108.90 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$113.18 |
$141.47 |
1.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$129.44 |
$161.80 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$129.44 |
$161.80 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$129.44 |
$161.80 |
1.7× |
| Xr shoulder 1 view (73020) |
$129.44 |
$161.80 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$66.40 |
$83 |
0.7× |
| Xr tibia/fibula 2 views (73590) |
$129.44 |
$161.80 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$129.44 |
$161.80 |
1.7× |