| Abdomen 2 views (74019) |
$334 |
$417 |
3.0× |
| Ankle 2 views (73600) |
$190 |
$237 |
2.1× |
| Bone age studies (77072) |
$41 |
$51 |
0.4× |
| Cervical spine 2 or 3 views (72040) |
$262 |
$327 |
2.9× |
| Chest 1 view (71045) |
$287 |
$359 |
3.1× |
| Clavicle complete (73000) |
$238 |
$297 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,069 |
$1,336 |
9.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,988 |
$2,485 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,503 |
$1,879 |
6.0× |
| CT abdomen w contrast (74160) |
$1,538 |
$1,922 |
8.3× |
| CT abdomen w wo contrast (74170) |
$1,922 |
$2,402 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,230 |
$1,537 |
11.2× |
| CT angiography upper extremity lt (73206) |
$691 |
$864 |
3.7× |
| CT c-spine w/o contrast (72125) |
$1,122 |
$1,403 |
10.2× |
| CT cervical spine with contrast (72126) |
$1,251 |
$1,564 |
3.4× |
| CT chest w/wo contrast (71270) |
$2,082 |
$2,603 |
11.3× |
| CT chest with contrast (71260) |
$1,602 |
$2,002 |
8.7× |
| CT head/brain with contrast (70460) |
$1,002 |
$1,252 |
5.4× |
| CT head/brain without and with contrast (70470) |
$1,662 |
$2,078 |
9.0× |
| CT iac w contrast (70481) |
$1,039.50 |
$1,299.50 |
5.6× |
| CT lower ext w/o (73700) |
$851 |
$1,064 |
7.7× |
| CT lower extremity w wo contrast (73702) |
$1,510 |
$1,888 |
8.2× |
| CT lower extremity with contrast (73701) |
$1,078 |
$1,348 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$1,001 |
$1,251 |
9.1× |
| CT lumbar spine with contrast (72132) |
$1,126 |
$1,407 |
3.1× |
| CT maxillofacial w contrast (70487) |
$1,564 |
$1,955 |
8.5× |
| CT maxillofacial w/o contrast (70486) |
$1,002 |
$1,252 |
9.1× |
| CT maxillofacial w/wo contrast (70488) |
$441 |
$551 |
2.4× |
| CT neck soft tissue w contrast (70491) |
$1,002 |
$1,252 |
5.4× |
| CT orbits w/o contrast (70480) |
$751 |
$939 |
6.8× |
| CT pelvis w & w/o contrast (72194) |
$1,715 |
$2,144 |
9.3× |
| CT pelvis w/o contrast (72192) |
$930 |
$1,163 |
8.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,574 |
$1,967 |
8.5× |
| CT soft tissue neck w/o contrast (70490) |
$834 |
$1,042 |
7.6× |
| CT thoracic spine w/contrast (72129) |
$1,405 |
$1,756 |
7.6× |
| CT thoracic spine w/o contrast (72128) |
$1,201 |
$1,501 |
10.9× |
| CT thorax w/o contrast (71250) |
$1,068 |
$1,335 |
9.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$447.50 |
$559.50 |
2.4× |
| CT upper extremity w/o contrast rt (73200) |
$794 |
$993 |
7.2× |
| CT upper extremity with contrast (73201) |
$929 |
$1,161 |
2.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,290 |
$1,613 |
7.0× |
| Cta Abdomen (74175) |
$2,289 |
$2,861 |
12.4× |
| CTA abdomen pelvis (74174) |
$2,106 |
$2,633 |
5.7× |
| CTA chest (71275) |
$1,699 |
$2,124 |
9.2× |
| Cta Head (70496) |
$1,165 |
$1,456 |
6.3× |
| Cta Neck (70498) |
$1,002 |
$1,252 |
5.4× |
| Cta Pelvis (72191) |
$1,732 |
$2,165 |
9.4× |
| Dxa bone density study 1/> sites axial skel (77080) |
$714 |
$893 |
6.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$218 |
$273 |
2.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$334 |
$417 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$588 |
$735 |
2.3× |
| Foot 2 views (73620) |
$190 |
$237 |
2.1× |
| Forearm 2 views (73090) |
$238 |
$297 |
2.6× |
| Hand 2 views (73120) |
$190 |
$237 |
1.7× |
| Hand 3 views (73130) |
$238 |
$297 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$238 |
$297 |
2.6× |
| Knee 3 views (73562) |
$285 |
$356 |
3.1× |
| MRA head w/o contrast (70544) |
$1,589 |
$1,986 |
6.3× |
| MRA neck w contrast (70548) |
$3,173 |
$3,966 |
8.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,806 |
$4,758 |
10.3× |
| MRA neck w/o contrast (70547) |
$2,434 |
$3,043 |
9.7× |
| MRI abdomen w contrast (74182) |
$2,715 |
$3,394 |
7.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,561 |
$4,451 |
9.7× |
| MRI abdomen w/o contrast (74181) |
$1,769 |
$2,211 |
7.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,602 |
$2,003 |
1.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,602 |
$2,003 |
1.9× |
| MRI cervical spine w/o contrast (72141) |
$1,979 |
$2,474 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$4,426 |
$5,533 |
12.0× |
| MRI chest w/o contrast (71550) |
$835 |
$1,044 |
3.3× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$923 |
$1,154 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$923 |
$1,154 |
2.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,052 |
$2,565 |
8.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,015 |
$3,769 |
12.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,410 |
$5,513 |
12.0× |
| MRI orbit/face/neck w/contrast (70542) |
$3,833 |
$4,791 |
10.4× |
| MRI pelvis w contrast (72196) |
$1,557 |
$1,946 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,946 |
$2,432 |
5.3× |
| MRI pelvis w/o contrast (72195) |
$1,246 |
$1,557 |
5.0× |
| MRI scan of arm joint before and after contrast (73223) |
$1,520.50 |
$1,900.50 |
4.1× |
| MRI scan of leg joint before and after contrast (73723) |
$923 |
$1,154 |
2.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,107 |
$5,134 |
11.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,107 |
$5,134 |
11.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,107 |
$5,134 |
11.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,345 |
$2,931 |
9.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,954 |
$2,442 |
7.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,186 |
$3,982 |
8.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,804.50 |
$2,255.50 |
7.2× |
| Neck soft tissue (70360) |
$238 |
$297 |
2.6× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$334 |
$417 |
3.0× |
| Orthopantogram (70355) |
$240 |
$300 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$270 |
$337 |
2.4× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,186 |
$3,982 |
8.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$389 |
$486 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$238 |
$297 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$400 |
$500 |
3.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$316 |
$395 |
3.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$238 |
$297 |
2.6× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$693 |
$866 |
2.8× |
| Scapula complete (73010) |
$299 |
$373.50 |
2.7× |
| Spine thoracic 3 views (72072) |
$399 |
$499 |
3.6× |
| Ultrasound, abdomen limited (76705) |
$1,020 |
$1,275 |
9.2× |
| Umbilical-artery Doppler (OB) (76820) |
$334 |
$417 |
3.0× |
| Us abdl aorta screen aaa (76706) |
$334 |
$417 |
3.0× |
| Us breast unilateral complete (76641) |
$522 |
$652 |
4.7× |
| Us breast unilateral limited (76642) |
$271 |
$339 |
3.0× |
| Us chest (76604) |
$500 |
$625 |
4.5× |
| Us compl joint r-t w/image documentation (76881) |
$499 |
$624 |
4.5× |
| Us fetal nuchal translucency 1st gestation (76813) |
$334 |
$417 |
3.0× |
| Us kidney transplant (76776) |
$334 |
$417 |
3.0× |
| Us ob transvaginal (76817) |
$334 |
$417 |
3.0× |
| Us pelvic non ob complete (76856) |
$647 |
$809 |
5.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$334 |
$417 |
3.0× |
| Us pregnancy ltd (76815) |
$334 |
$417 |
3.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$334 |
$417 |
3.0× |
| Us retroperitoneal complete (76770) |
$947 |
$1,184 |
8.6× |
| Us retroperitoneal limited (76775) |
$790 |
$987 |
7.2× |
| Us scrotum and contents (76870) |
$569 |
$711 |
5.2× |
| Us soft tissue head/neck (76536) |
$609 |
$761 |
5.5× |
| Us spinal canal and contents (76800) |
$334 |
$417 |
3.0× |
| Us xtr non-vasc lmtd (76882) |
$222 |
$278 |
2.0× |
| Wrist 2 views (73100) |
$190 |
$237 |
2.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$238 |
$297 |
2.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$238 |
$297 |
2.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$190 |
$237 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$238 |
$297 |
2.6× |
| X-ray exam hip uni 1 view (73501) |
$238 |
$297 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$285 |
$356 |
3.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$400 |
$500 |
3.6× |
| X-ray eye for foreign body (70030) |
$158 |
$198 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$334 |
$417 |
3.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$238 |
$297 |
2.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$238 |
$297 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$238 |
$297 |
2.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$334 |
$417 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$238 |
$297 |
2.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$334 |
$417 |
3.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$480 |
$600 |
4.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$238 |
$297 |
2.6× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$324 |
$405 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$334 |
$417 |
3.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$400 |
$500 |
3.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$334 |
$417 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$238 |
$297 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$238 |
$297 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$285 |
$356 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$238 |
$297 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$264 |
$330 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$334 |
$417 |
3.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$238 |
$297 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$238 |
$297 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$333 |
$416 |
3.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$238 |
$297 |
2.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$238 |
$297 |
2.6× |
| Xr c-spine 6 or more views (72052) |
$334 |
$417 |
3.0× |
| Xr finger(s) 2+ views (73140) |
$238 |
$297 |
2.6× |
| Xr shoulder 1 view (73020) |
$190 |
$237 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$298 |
$372 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$238 |
$297 |
2.6× |
| Xray knee 1 or 2 views rt (73560) |
$238 |
$297 |
2.6× |