| Abdomen 2 views (74019) |
$266.77 |
$381.10 |
2.4× |
| Ankle 2 views (73600) |
$201.88 |
$288.40 |
2.2× |
| Bone age studies (77072) |
$283.35 |
$404.79 |
2.6× |
| Bone survey complete (77075) |
$283.35 |
$404.79 |
2.6× |
| Cervical spine 2 or 3 views (72040) |
$201.88 |
$288.40 |
2.2× |
| Chest 1 view (71045) |
$192.50 |
$275 |
2.1× |
| Chest 3 views (71047) |
$196 |
$280 |
2.1× |
| Clavicle complete (73000) |
$201.88 |
$288.40 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$731.82 |
$1,045.45 |
6.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,018.80 |
$2,884 |
5.5× |
| CT abdomen and pelvis without contrast (74176) |
$845.73 |
$1,208.19 |
3.4× |
| CT abdomen w contrast (74160) |
$1,384.32 |
$1,977.60 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,574.66 |
$2,249.52 |
8.5× |
| CT abdomen w/o contrast (74150) |
$671.25 |
$958.93 |
6.1× |
| CT angio hrt w/3d image (75574) |
$1,855.13 |
$2,650.19 |
5.0× |
| CT angiography upper extremity lt (73206) |
$1,778.71 |
$2,541.01 |
9.6× |
| CT c-spine w/o contrast (72125) |
$795.26 |
$1,136.09 |
7.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,257.42 |
$1,796.32 |
6.8× |
| CT cervical spine with contrast (72126) |
$1,013.01 |
$1,447.15 |
2.8× |
| CT chest w/wo contrast (71270) |
$1,230.75 |
$1,758.21 |
6.7× |
| CT chest with contrast (71260) |
$857.50 |
$1,225 |
4.6× |
| CT head/brain with contrast (70460) |
$803.19 |
$1,147.42 |
4.3× |
| CT head/brain without and with contrast (70470) |
$315 |
$450 |
1.7× |
| CT lower ext w/o (73700) |
$872.41 |
$1,246.30 |
7.9× |
| CT lower extremity w wo contrast (73702) |
$1,300.68 |
$1,858.12 |
7.0× |
| CT lower extremity with contrast (73701) |
$1,023.82 |
$1,462.60 |
5.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,252.38 |
$1,789.11 |
6.8× |
| CT lumbar spine w/o contrast (72131) |
$872.41 |
$1,246.30 |
7.9× |
| CT lumbar spine with contrast (72132) |
$1,015.89 |
$1,451.27 |
2.8× |
| CT maxillofacial w contrast (70487) |
$829.87 |
$1,185.53 |
4.5× |
| CT maxillofacial w/o contrast (70486) |
$725.33 |
$1,036.18 |
6.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,049.06 |
$1,498.65 |
5.7× |
| CT neck soft tissue w contrast (70491) |
$999.31 |
$1,427.58 |
5.4× |
| CT orbits w/o contrast (70480) |
$1,028.87 |
$1,469.81 |
9.3× |
| CT pelvis w & w/o contrast (72194) |
$1,593.41 |
$2,276.30 |
8.6× |
| CT pelvis w/o contrast (72192) |
$682.07 |
$974.38 |
6.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,230.75 |
$1,758.21 |
6.7× |
| CT soft tissue neck w/o contrast (70490) |
$754.89 |
$1,078.41 |
6.8× |
| CT thoracic spine w/contrast (72129) |
$1,023.82 |
$1,462.60 |
5.5× |
| CT thoracic spine w/o contrast (72128) |
$795.26 |
$1,136.09 |
7.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,252.38 |
$1,789.11 |
6.8× |
| CT thorax w/o contrast (71250) |
$630 |
$900 |
5.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,617.20 |
$2,310.29 |
8.7× |
| CT upper extremity w/o contrast rt (73200) |
$969.75 |
$1,385.35 |
8.8× |
| CT upper extremity with contrast (73201) |
$1,241.56 |
$1,773.66 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,455.73 |
$3,508.18 |
13.3× |
| Cta Abdomen (74175) |
$1,754.91 |
$2,507.02 |
9.5× |
| CTA abdomen pelvis (74174) |
$2,229.33 |
$3,184.76 |
6.1× |
| CTA chest (71275) |
$1,717.10 |
$2,453 |
9.3× |
| Cta Head (70496) |
$1,519 |
$2,170 |
8.2× |
| CTA lwr ext w&w/o contrast (73706) |
$1,971.94 |
$2,817.05 |
10.7× |
| Cta Neck (70498) |
$1,519 |
$2,170 |
8.2× |
| Dx ophthalmic us ant segment immersion uni/bi (76513) |
$201.88 |
$288.40 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$262.50 |
$375 |
2.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$201.88 |
$288.40 |
2.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$201.88 |
$288.40 |
1.8× |
| Fluoroscopy up to 1 hr (76000) |
$115.36 |
$164.80 |
0.5× |
| Foot 2 views (73620) |
$157.50 |
$225 |
1.7× |
| Forearm 2 views (73090) |
$201.88 |
$288.40 |
2.2× |
| Hand 2 views (73120) |
$283.35 |
$404.79 |
2.6× |
| Hand 3 views (73130) |
$213.50 |
$305 |
2.3× |
| Humerus Min 2 Views Left (73060) |
$201.88 |
$288.40 |
2.2× |
| Knee 3 views (73562) |
$213.50 |
$305 |
2.3× |
| MRA head w/o contrast (70544) |
$1,799.62 |
$2,570.88 |
7.1× |
| MRA neck w contrast (70548) |
$1,855.13 |
$2,650.19 |
5.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,086.60 |
$4,409.43 |
8.4× |
| MRA neck w/o contrast (70547) |
$1,799.62 |
$2,570.88 |
7.1× |
| MRI abdomen w contrast (74182) |
$2,214.91 |
$3,164.16 |
6.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,370.65 |
$3,386.64 |
6.4× |
| MRI abdomen w/o contrast (74181) |
$1,564.57 |
$2,235.10 |
6.2× |
| MRI any jnt lwr ext with con lt (73722) |
$2,246.64 |
$3,209.48 |
2.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,227.89 |
$3,182.70 |
2.7× |
| MRI c-spine with contrast (72142) |
$1,770.78 |
$2,529.68 |
4.8× |
| MRI cervical spine w/o contrast (72141) |
$1,123.32 |
$1,604.74 |
4.5× |
| MRI chest w/o contrast (71550) |
$1,799.62 |
$2,570.88 |
7.1× |
| MRI chest with contrast (71551) |
$2,772.25 |
$3,960.35 |
3.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,407.42 |
$3,439.17 |
6.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,855.13 |
$2,650.19 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,789.52 |
$2,556.46 |
7.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,522.03 |
$2,174.33 |
6.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,219.96 |
$3,171.37 |
6.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,362.72 |
$3,375.31 |
6.4× |
| MRI pelvis w/o contrast (72195) |
$1,799.62 |
$2,570.88 |
7.1× |
| MRI scan of arm joint before and after contrast (73223) |
$2,713.84 |
$3,876.92 |
7.4× |
| MRI scan of leg joint before and after contrast (73723) |
$2,711.68 |
$3,873.83 |
7.4× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,987.80 |
$2,839.71 |
5.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,739.05 |
$2,484.36 |
4.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,979.87 |
$2,828.38 |
5.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,754.91 |
$2,507.02 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,992.84 |
$2,846.92 |
5.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,126.20 |
$1,608.86 |
4.5× |
| MRI tmj (70336) |
$1,799.62 |
$2,570.88 |
7.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,266.08 |
$1,808.68 |
5.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,933.75 |
$4,191.07 |
8.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,802.50 |
$2,575 |
7.2× |
| Neck soft tissue (70360) |
$201.88 |
$288.40 |
2.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$201.88 |
$288.40 |
1.8× |
| Oph US Dx B-Scan&Quan a-Scan Sm Pt Enctr (76510) |
$209.09 |
$298.70 |
1.5× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$121.85 |
$174.07 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$283.35 |
$404.79 |
2.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,378.58 |
$3,397.97 |
6.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$283.35 |
$404.79 |
2.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$283.35 |
$404.79 |
2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$283.35 |
$404.79 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$208.37 |
$297.67 |
2.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$175 |
$250 |
1.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$201.88 |
$288.40 |
2.2× |
| Radiological examination surgical specimen (76098) |
$204.04 |
$291.49 |
0.4× |
| Radiopharmaceutical therapy, unlisted procedure UNSCHEDULED (79999) |
$576.80 |
$824 |
2.3× |
| Ribs bilateral 3 views (71110) |
$283.35 |
$404.79 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$283.35 |
$404.79 |
2.6× |
| Scanogram (77073) |
$283.35 |
$404.79 |
2.6× |
| Scapula complete (73010) |
$283.35 |
$404.79 |
2.6× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$560.22 |
$800.31 |
5.1× |
| Small bowel series (74250) |
$460 |
$657.14 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$262.50 |
$375 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$284.07 |
$405.82 |
2.6× |
| Upper Extremity Infant (73092) |
$283.35 |
$404.79 |
2.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$460 |
$657.14 |
2.5× |
| Us abdl aorta screen aaa (76706) |
$201.88 |
$288.40 |
1.8× |
| Us breast unilateral complete (76641) |
$201.88 |
$288.40 |
1.8× |
| Us breast unilateral limited (76642) |
$151.41 |
$216.30 |
1.6× |
| Us chest (76604) |
$201.88 |
$288.40 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$201.88 |
$288.40 |
1.8× |
| Us fetal nuchal translucency 1st gestation (76813) |
$201.88 |
$288.40 |
1.8× |
| Us kidney transplant (76776) |
$201.88 |
$288.40 |
1.8× |
| Us ob transvaginal (76817) |
$201.88 |
$288.40 |
1.8× |
| Us pelvic non ob complete (76856) |
$201.88 |
$288.40 |
1.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$201.88 |
$288.40 |
1.8× |
| Us pregnancy ltd (76815) |
$378 |
$540 |
3.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$201.88 |
$288.40 |
1.8× |
| Us retroperitoneal complete (76770) |
$201.88 |
$288.40 |
1.8× |
| Us retroperitoneal limited (76775) |
$232.19 |
$331.70 |
2.1× |
| Us scrotum and contents (76870) |
$233.94 |
$334.20 |
2.1× |
| Us soft tissue head/neck (76536) |
$630 |
$900 |
5.7× |
| Us transrectal (76872) |
$352.45 |
$503.50 |
3.2× |
| Us xtr non-vasc lmtd (76882) |
$232.19 |
$331.70 |
2.1× |
| Us, eye b-scan (76512) |
$201.88 |
$288.40 |
1.8× |
| Vertebral fracture assessment via dxa (77086) |
$206.21 |
$294.58 |
2.2× |
| Wrist 2 views (73100) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$201.88 |
$288.40 |
2.2× |
| X-ray exam hip uni 1 view (73501) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$290.50 |
$415 |
2.6× |
| X-ray eye for foreign body (70030) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$196 |
$280 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$201.16 |
$287.37 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$288.40 |
$412 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$283.35 |
$404.79 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$201.88 |
$288.40 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$245 |
$350 |
2.7× |
| Xr c-spine 6 or more views (72052) |
$283.35 |
$404.79 |
2.6× |
| Xr chest 4+ views (71048) |
$283.35 |
$404.79 |
2.6× |
| Xr finger(s) 2+ views (73140) |
$201.88 |
$288.40 |
2.2× |
| Xr shoulder 1 view (73020) |
$201.88 |
$288.40 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$283.35 |
$404.79 |
2.6× |
| Xr tibia/fibula 2 views (73590) |
$201.88 |
$288.40 |
2.2× |
| Xr tmj bilateral (70330) |
$201.88 |
$288.40 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$201.88 |
$288.40 |
2.2× |