| Abdomen 2 views (74019) |
$141.90 |
$189.19 |
1.3× |
| Ankle 2 views (73600) |
$117.20 |
$156.26 |
1.3× |
| Arthrogram elbow (73085) |
$307.13 |
$409.50 |
0.9× |
| Arthrogram hip (73525) |
$678.34 |
$904.45 |
1.9× |
| Arthrogram shoulder (73040) |
$454.96 |
$606.61 |
1.3× |
| Arthrogram wrist (73115) |
$410.94 |
$547.92 |
1.2× |
| Arthrography knee lt (73580) |
$307.13 |
$409.50 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$150.24 |
$200.32 |
1.7× |
| Chest 1 view (71045) |
$111.60 |
$148.79 |
1.3× |
| Clavicle complete (73000) |
$144.56 |
$192.76 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$926.92 |
$1,235.90 |
8.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,499.78 |
$3,333.04 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,612.58 |
$2,150.11 |
6.6× |
| CT abdomen w contrast (74160) |
$1,670.17 |
$2,226.90 |
9.3× |
| CT abdomen w wo contrast (74170) |
$1,995.23 |
$2,660.30 |
11.1× |
| CT abdomen w/o contrast (74150) |
$865.56 |
$1,154.08 |
8.1× |
| CT c-spine w/o contrast (72125) |
$1,188.82 |
$1,585.10 |
11.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,831.16 |
$2,441.55 |
10.2× |
| CT cervical spine with contrast (72126) |
$1,607.78 |
$2,143.72 |
4.5× |
| CT chest w/wo contrast (71270) |
$1,505.33 |
$2,007.10 |
8.4× |
| CT chest with contrast (71260) |
$1,339.58 |
$1,786.11 |
7.5× |
| CT head/brain with contrast (70460) |
$1,087.50 |
$1,450 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,306.14 |
$1,741.52 |
7.3× |
| CT iac w contrast (70481) |
$3,385.20 |
$4,513.60 |
18.9× |
| CT limited/localized follow up study (76380) |
$1,361.88 |
$1,815.84 |
15.3× |
| CT lower ext w/o (73700) |
$1,139.68 |
$1,519.58 |
10.7× |
| CT lower extremity w wo contrast (73702) |
$1,826.66 |
$2,435.54 |
10.2× |
| CT lower extremity with contrast (73701) |
$1,448.36 |
$1,931.15 |
8.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,822.98 |
$2,430.63 |
10.2× |
| CT lumbar spine w/o contrast (72131) |
$1,277.45 |
$1,703.26 |
12.0× |
| CT lumbar spine with contrast (72132) |
$1,610.90 |
$2,147.88 |
4.5× |
| CT maxillofacial w contrast (70487) |
$1,055.58 |
$1,407.43 |
5.9× |
| CT maxillofacial w/o contrast (70486) |
$916.26 |
$1,221.68 |
8.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,384.24 |
$1,845.64 |
7.7× |
| CT neck soft tissue w contrast (70491) |
$1,333.74 |
$1,778.31 |
7.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$3,395.57 |
$4,527.43 |
18.9× |
| CT orbits w/o contrast (70480) |
$1,446.07 |
$1,928.10 |
13.5× |
| CT pelvis w & w/o contrast (72194) |
$1,776.13 |
$2,368.17 |
9.9× |
| CT pelvis w/o contrast (72192) |
$858.80 |
$1,145.07 |
8.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,637.44 |
$2,183.25 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,035.84 |
$1,381.12 |
9.7× |
| CT thoracic spine w/contrast (72129) |
$1,494.47 |
$1,992.63 |
8.3× |
| CT thoracic spine w/o contrast (72128) |
$1,283.30 |
$1,711.06 |
12.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,834.03 |
$2,445.37 |
10.2× |
| CT thorax w/o contrast (71250) |
$1,026.83 |
$1,369.10 |
9.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,853.40 |
$2,471.20 |
10.3× |
| CT upper extremity w/o contrast rt (73200) |
$344.72 |
$459.63 |
3.2× |
| CT upper extremity with contrast (73201) |
$2,700.36 |
$3,600.48 |
7.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$3,003 |
$4,004 |
16.8× |
| Cta Abdomen (74175) |
$2,132.72 |
$2,843.62 |
11.9× |
| CTA abdomen pelvis (74174) |
$2,647.12 |
$3,529.50 |
7.4× |
| Cta Head (70496) |
$2,003.68 |
$2,671.58 |
11.2× |
| CTA lwr ext w&w/o contrast (73706) |
$512.78 |
$683.71 |
2.9× |
| Cta Neck (70498) |
$1,997.83 |
$2,663.78 |
11.1× |
| Cta Pelvis (72191) |
$1,973.67 |
$2,631.56 |
11.0× |
| Fetal biophysical profile non-stress testing (76818) |
$546 |
$728 |
5.1× |
| Fluoroscopy up to 1 hr (76000) |
$262.90 |
$350.53 |
1.1× |
| Foot 2 views (73620) |
$118.82 |
$158.44 |
1.3× |
| Forearm 2 views (73090) |
$120 |
$160 |
1.3× |
| Hand 2 views (73120) |
$123.90 |
$165.20 |
1.2× |
| Hand 3 views (73130) |
$147.61 |
$196.82 |
1.7× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,458.32 |
$1,944.42 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$146.44 |
$195.26 |
1.6× |
| Knee 3 views (73562) |
$166.70 |
$222.26 |
1.9× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$67.41 |
$89.88 |
0.8× |
| MRA head w/o contrast (70544) |
$1,509.54 |
$2,012.72 |
6.2× |
| MRA neck w contrast (70548) |
$1,584.48 |
$2,112.64 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,148.78 |
$2,865.03 |
6.0× |
| MRA neck w/o contrast (70547) |
$1,515.28 |
$2,020.36 |
6.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,786.61 |
$2,382.14 |
5.0× |
| MRI abdomen w/o contrast (74181) |
$2,045.04 |
$2,726.72 |
8.4× |
| MRI any jnt lwr ext with con lt (73722) |
$1,800.78 |
$2,401.04 |
2.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,504.71 |
$2,006.28 |
1.9× |
| MRI c-spine with contrast (72142) |
$1,470.72 |
$1,960.96 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,408.40 |
$1,877.86 |
5.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,671.78 |
$3,562.38 |
7.5× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,915.85 |
$2,554.46 |
5.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,461.30 |
$1,948.40 |
4.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$577.57 |
$770.09 |
2.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,787.26 |
$2,383.02 |
5.0× |
| MRI orbit/face/neck w/contrast (70542) |
$1,489.97 |
$1,986.62 |
4.2× |
| MRI pelvis w contrast (72196) |
$1,461.30 |
$1,948.40 |
4.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,988.04 |
$2,650.72 |
5.6× |
| MRI pelvis w/o contrast (72195) |
$1,339.39 |
$1,785.86 |
5.5× |
| MRI scan of arm joint before and after contrast (73223) |
$1,873.28 |
$2,497.70 |
5.3× |
| MRI scan of leg joint before and after contrast (73723) |
$837.94 |
$1,117.25 |
2.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,622.24 |
$2,162.98 |
4.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,449.84 |
$1,933.12 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,757.84 |
$2,343.78 |
4.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,463.36 |
$1,951.14 |
4.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,628.38 |
$2,171.17 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$1,410.74 |
$1,880.98 |
5.8× |
| MRI tmj (70336) |
$1,179.90 |
$1,573.19 |
4.8× |
| MRI upper ext joint w/o contrast (73221) |
$1,423.61 |
$1,898.14 |
5.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,280.72 |
$3,040.95 |
6.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,799.14 |
$2,398.86 |
7.4× |
| Neck soft tissue (70360) |
$115.51 |
$154.01 |
1.3× |
| Osseous survey infant (77076) |
$343.45 |
$457.93 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$150.64 |
$200.84 |
1.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,028.50 |
$2,704.66 |
5.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$105.82 |
$141.09 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$341.64 |
$455.52 |
3.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$153.78 |
$205.03 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$125.26 |
$167 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$155.63 |
$207.50 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$161.65 |
$215.54 |
1.8× |
| Ribs bilateral 3 views (71110) |
$185.70 |
$247.60 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$56.35 |
$75.13 |
0.5× |
| Scapula complete (73010) |
$165.84 |
$221.12 |
1.6× |
| Screening digital breast tomosynthesis (77063) |
$88.14 |
$117.52 |
3.8× |
| Small bowel series (74250) |
$230.72 |
$307.62 |
1.3× |
| Spine thoracic 3 views (72072) |
$185.59 |
$247.45 |
1.7× |
| Thoracolumbar 2 views (72080) |
$130.94 |
$174.60 |
1.5× |
| Tmj unilateral (70328) |
$125.39 |
$167.18 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$408.68 |
$544.91 |
3.8× |
| Upper Extremity Infant (73092) |
$50.45 |
$67.27 |
0.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$459.10 |
$612.12 |
2.6× |
| Us breast unilateral complete (76641) |
$339.71 |
$452.94 |
3.2× |
| Us breast unilateral limited (76642) |
$233.17 |
$310.89 |
2.6× |
| Us chest (76604) |
$66.50 |
$88.66 |
0.6× |
| Us compl joint r-t w/image documentation (76881) |
$361.92 |
$482.56 |
3.4× |
| Us ob transvaginal (76817) |
$321.98 |
$429.30 |
3.0× |
| Us pelvic non ob complete (76856) |
$390.03 |
$520.04 |
3.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$362.70 |
$483.60 |
3.4× |
| Us pregnancy ltd (76815) |
$257.82 |
$343.76 |
2.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$291.80 |
$389.06 |
2.7× |
| Us retroperitoneal complete (76770) |
$555.22 |
$740.29 |
5.2× |
| Us retroperitoneal limited (76775) |
$324.39 |
$432.52 |
3.0× |
| Us scrotum and contents (76870) |
$314.09 |
$418.78 |
2.9× |
| Us soft tissue head/neck (76536) |
$341.65 |
$455.53 |
3.2× |
| Us xtr non-vasc lmtd (76882) |
$237.12 |
$316.16 |
2.2× |
| Wrist 2 views (73100) |
$137.54 |
$183.40 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$166.38 |
$221.84 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$294.06 |
$392.08 |
3.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$146.34 |
$195.12 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$139.88 |
$186.52 |
1.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$146.83 |
$195.78 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$132.79 |
$177.06 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$184.38 |
$245.83 |
2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$249.53 |
$332.70 |
2.3× |
| X-ray exam of femur 1 (73551) |
$150.45 |
$200.60 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$174.90 |
$233.20 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$115.24 |
$153.64 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$141.24 |
$188.32 |
1.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$124.22 |
$165.64 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$133 |
$177.34 |
1.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$175.63 |
$234.18 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$63.86 |
$85.16 |
0.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$48.02 |
$64.02 |
0.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$155.08 |
$206.78 |
1.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$243.12 |
$324.16 |
2.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$182.60 |
$243.46 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$159.58 |
$212.77 |
1.8× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$154.50 |
$206 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$179.53 |
$239.38 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$156.68 |
$208.92 |
1.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$202.42 |
$269.89 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$81.33 |
$108.44 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$118.26 |
$157.68 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$131.50 |
$175.32 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$142.42 |
$189.88 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$169.74 |
$226.32 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$128.30 |
$171.06 |
1.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$86.94 |
$115.92 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$124.04 |
$165.38 |
1.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$120.64 |
$160.86 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$124.48 |
$165.97 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$157.36 |
$209.82 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$281.32 |
$375.08 |
2.6× |
| Xr chest 4+ views (71048) |
$155.36 |
$207.15 |
1.5× |
| Xr finger(s) 2+ views (73140) |
$153.14 |
$204.20 |
1.7× |
| Xr shoulder 1 view (73020) |
$118.44 |
$157.92 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$252.39 |
$336.52 |
2.4× |
| Xr tibia/fibula 2 views (73590) |
$138.25 |
$184.34 |
1.6× |
| Xr tmj bilateral (70330) |
$381.04 |
$508.06 |
4.3× |
| Xray knee 1 or 2 views rt (73560) |
$130.52 |
$174.04 |
1.5× |