| Abdomen 2 views (74019) |
$292.20 |
$487 |
2.8× |
| Ankle 2 views (73600) |
$292.20 |
$487 |
3.3× |
| Arthrogram elbow (73085) |
$948.60 |
$1,581 |
2.7× |
| Arthrogram hip (73525) |
$1,116.60 |
$1,861 |
3.2× |
| Arthrogram shoulder (73040) |
$946.20 |
$1,577 |
2.7× |
| Arthrogram wrist (73115) |
$597 |
$995 |
1.7× |
| Arthrography knee lt (73580) |
$1,182.60 |
$1,971 |
3.4× |
| Bone age studies (77072) |
$148.80 |
$248 |
1.4× |
| Bone survey complete (77075) |
$199.20 |
$332 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$451.20 |
$752 |
5.2× |
| Chest 1 view (71045) |
$315 |
$525 |
3.6× |
| Chest 3 views (71047) |
$393.30 |
$655.50 |
4.5× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$597 |
$995 |
3.4× |
| Clavicle complete (73000) |
$349.20 |
$582 |
4.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$397.20 |
$662 |
3.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,199.20 |
$5,332 |
9.1× |
| CT abdomen and pelvis without contrast (74176) |
$3,199.20 |
$5,332 |
13.3× |
| CT abdomen w contrast (74160) |
$3,199.20 |
$5,332 |
18.2× |
| CT abdomen w wo contrast (74170) |
$3,199.20 |
$5,332 |
18.2× |
| CT abdomen w/o contrast (74150) |
$415.20 |
$692 |
4.0× |
| CT c-spine w/o contrast (72125) |
$415.20 |
$692 |
4.0× |
| CT cervical spine w&w/o contrast (72127) |
$415.80 |
$693 |
2.4× |
| CT cervical spine with contrast (72126) |
$415.20 |
$692 |
1.2× |
| CT chest w/wo contrast (71270) |
$767.40 |
$1,279 |
4.4× |
| CT chest with contrast (71260) |
$642.60 |
$1,071 |
3.6× |
| CT head/brain with contrast (70460) |
$1,022.40 |
$1,704 |
5.8× |
| CT head/brain without and with contrast (70470) |
$1,459.80 |
$2,433 |
8.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$397.20 |
$662 |
4.5× |
| CT iac w contrast (70481) |
$1,063.20 |
$1,772 |
6.0× |
| CT lower ext w/o (73700) |
$397.20 |
$662 |
3.8× |
| CT lower extremity w wo contrast (73702) |
$3,198.60 |
$5,331 |
18.2× |
| CT lower extremity with contrast (73701) |
$1,332.60 |
$2,221 |
7.6× |
| CT lumbar spine w & w/o contrast (72133) |
$415.80 |
$693 |
2.4× |
| CT lumbar spine w/o contrast (72131) |
$415.20 |
$692 |
4.0× |
| CT lumbar spine with contrast (72132) |
$415.20 |
$692 |
1.2× |
| CT maxillofacial w contrast (70487) |
$842.40 |
$1,404 |
4.8× |
| CT maxillofacial w/o contrast (70486) |
$1,533 |
$2,555 |
14.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,533 |
$2,555 |
8.7× |
| CT neck soft tissue w contrast (70491) |
$1,533 |
$2,555 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,022.40 |
$1,704 |
5.8× |
| CT orbits w/o contrast (70480) |
$1,022.40 |
$1,704 |
9.7× |
| CT pelvis w & w/o contrast (72194) |
$3,199.20 |
$5,332 |
18.2× |
| CT pelvis w/o contrast (72192) |
$3,199.20 |
$5,332 |
30.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,022.40 |
$1,704 |
5.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,533 |
$2,555 |
14.6× |
| CT thoracic spine w/contrast (72129) |
$3,199.20 |
$5,332 |
18.2× |
| CT thoracic spine w/o contrast (72128) |
$972.60 |
$1,621 |
9.3× |
| CT thoracic spine w/wo contrast (72130) |
$432.60 |
$721 |
2.5× |
| CT thorax w/o contrast (71250) |
$412.80 |
$688 |
3.9× |
| CT unlisted procedure (76497) |
$257.40 |
$429 |
2.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,800.60 |
$3,001 |
17.1× |
| CT upper extremity with contrast (73201) |
$397.20 |
$662 |
1.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,413.20 |
$4,022 |
13.7× |
| Cta Abdomen (74175) |
$3,327 |
$5,545 |
18.9× |
| CTA abdomen pelvis (74174) |
$3,198.60 |
$5,331 |
9.1× |
| CTA chest (71275) |
$1,459.80 |
$2,433 |
8.3× |
| Cta Head (70496) |
$1,022.40 |
$1,704 |
5.8× |
| CTA lwr ext w&w/o contrast (73706) |
$3,198.60 |
$5,331 |
18.2× |
| Cta Neck (70498) |
$1,022.40 |
$1,704 |
5.8× |
| Cystography minimum 3 views rs&i (74430) |
$1,128 |
$1,880 |
3.2× |
| Diskogram cervical (72285) |
$1,915.20 |
$3,192 |
1.0× |
| Diskography lumbar (72295) |
$1,915.20 |
$3,192 |
1.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$199.20 |
$332 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$205.20 |
$342 |
2.3× |
| Esophageal motility (78258) |
$901.20 |
$1,502 |
2.2× |
| Esophagus (74220) |
$472.80 |
$788 |
2.7× |
| Fetal biophysical profile non-stress testing (76818) |
$744 |
$1,240 |
7.1× |
| Fluoroscopy up to 1 hr (76000) |
$282.60 |
$471 |
1.2× |
| Foot 2 views (73620) |
$304.20 |
$507 |
3.5× |
| Forearm 2 views (73090) |
$282.60 |
$471 |
3.2× |
| Functional MRI brain by tech (70554) |
$4,122 |
$6,870 |
17.2× |
| Hand 2 views (73120) |
$261 |
$435 |
2.5× |
| Hand 3 views (73130) |
$292.20 |
$487 |
3.3× |
| Humerus Min 2 Views Left (73060) |
$326.40 |
$544 |
3.7× |
| Hysterosalpingogram (74740) |
$415.20 |
$692 |
1.7× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$192.60 |
$321 |
1.8× |
| Knee 3 views (73562) |
$361.20 |
$602 |
4.1× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$169.20 |
$282 |
1.9× |
| MRA head w & w/o contrast (70546) |
$2,928.60 |
$4,881 |
8.4× |
| MRA head w/o contrast (70544) |
$3,075.60 |
$5,126 |
12.8× |
| MRA head with contrast (70545) |
$2,679.60 |
$4,466 |
7.6× |
| MRA neck w contrast (70548) |
$2,816.40 |
$4,694 |
8.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,928.60 |
$4,881 |
8.4× |
| MRA neck w/o contrast (70547) |
$2,928.60 |
$4,881 |
12.2× |
| MRI abdomen w contrast (74182) |
$3,649.80 |
$6,083 |
10.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,121.40 |
$6,869 |
11.8× |
| MRI abdomen w/o contrast (74181) |
$3,199.20 |
$5,332 |
13.3× |
| MRI any jnt lwr ext with con lt (73722) |
$3,683.40 |
$6,139 |
4.7× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,830.40 |
$6,384 |
4.9× |
| MRI c-spine with contrast (72142) |
$3,649.80 |
$6,083 |
10.4× |
| MRI cervical spine w/o contrast (72141) |
$3,199.20 |
$5,332 |
13.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,931.20 |
$6,552 |
11.2× |
| MRI chest w/o contrast (71550) |
$3,042 |
$5,070 |
12.7× |
| MRI chest with contrast (71551) |
$3,042 |
$5,070 |
3.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$3,931.20 |
$6,552 |
11.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,598.80 |
$5,998 |
10.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$3,042 |
$5,070 |
12.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,042 |
$5,070 |
12.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,931.20 |
$6,552 |
11.2× |
| MRI orbit/face/neck w/contrast (70542) |
$3,830.40 |
$6,384 |
10.9× |
| MRI pelvis w contrast (72196) |
$3,830.40 |
$6,384 |
10.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,121.40 |
$6,869 |
11.8× |
| MRI pelvis w/o contrast (72195) |
$3,199.20 |
$5,332 |
13.3× |
| MRI scan of arm joint before and after contrast (73223) |
$4,121.40 |
$6,869 |
11.8× |
| MRI scan of leg joint before and after contrast (73723) |
$4,121.40 |
$6,869 |
11.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,121.40 |
$6,869 |
11.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,830.40 |
$6,384 |
10.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,121.40 |
$6,869 |
11.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,649.80 |
$6,083 |
10.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,121.40 |
$6,869 |
11.8× |
| MRI thoracic spine w/o contrast (72146) |
$3,277.80 |
$5,463 |
13.7× |
| MRI tmj (70336) |
$3,042 |
$5,070 |
12.7× |
| MRI upper ext joint w/o contrast (73221) |
$3,199.20 |
$5,332 |
13.3× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,931.20 |
$6,552 |
11.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$3,042 |
$5,070 |
12.7× |
| Myelogram Cervical (72240) |
$1,294.80 |
$2,158 |
1.6× |
| Myelogram Lumbar (72265) |
$1,261.80 |
$2,103 |
1.6× |
| Myelogram thoracic (72255) |
$1,206 |
$2,010 |
1.5× |
| Myelography 2 or more regions (72270) |
$1,294.80 |
$2,158 |
1.6× |
| Neck soft tissue (70360) |
$292.20 |
$487 |
3.3× |
| Nm cisternogram (78630) |
$1,206 |
$2,010 |
2.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$597 |
$995 |
5.7× |
| Osseous survey infant (77076) |
$199.20 |
$332 |
1.9× |
| Osseous survey limited (77074) |
$205.20 |
$342 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$215.40 |
$359 |
2.1× |
| Pr MRI brain w/o dye (70557) |
$3,649.20 |
$6,082 |
6.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,931.20 |
$6,552 |
11.2× |
| Pr sono bone density measure,peripheral (76977) |
$472.80 |
$788 |
4.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$520.20 |
$867 |
6.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$412.20 |
$687 |
3.9× |
| Radex hips bilateral with pelvis 2 views (73521) |
$302.40 |
$504 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$501 |
$835 |
4.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$292.20 |
$487 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$225.60 |
$376 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$315 |
$525 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$315 |
$525 |
3.6× |
| Radiologic exam colon single contrast study (74270) |
$767.40 |
$1,279 |
4.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$744 |
$1,240 |
4.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$415.50 |
$692.50 |
2.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$327 |
$545 |
3.7× |
| Ribs bilateral 3 views (71110) |
$393 |
$655 |
3.7× |
| Sacroiliac Joints < 3 Views (72200) |
$225.60 |
$376 |
2.1× |
| Scanogram (77073) |
$177 |
$295 |
1.7× |
| Scapula complete (73010) |
$361.20 |
$602 |
3.4× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$1,287.60 |
$2,146 |
12.3× |
| Small bowel series (74250) |
$597 |
$995 |
3.4× |
| Spine thoracic 3 views (72072) |
$463.80 |
$773 |
4.4× |
| Superior sagittal sinus venogram (75870) |
$3,479.40 |
$5,799 |
1.1× |
| Thoracolumbar 2 views (72080) |
$441 |
$735 |
5.0× |
| Tmj unilateral (70328) |
$51 |
$85 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$631.20 |
$1,052 |
6.0× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$248.40 |
$414 |
2.8× |
| Unlisted fluoroscopic procedure (76496) |
$834 |
$1,390 |
9.5× |
| Unlisted Ultrasound Procedure (76999) |
$225.60 |
$376 |
2.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$891.60 |
$1,486 |
5.1× |
| Us abdl aorta screen aaa (76706) |
$738 |
$1,230 |
7.0× |
| Us breast unilateral complete (76641) |
$326.40 |
$544 |
3.1× |
| Us breast unilateral limited (76642) |
$327 |
$545 |
3.7× |
| Us chest (76604) |
$677.40 |
$1,129 |
6.5× |
| Us compl joint r-t w/image documentation (76881) |
$326.40 |
$544 |
3.1× |
| Us fetal nuchal translucency 1st gestation (76813) |
$620.40 |
$1,034 |
5.9× |
| Us ob detailed single fetus (76811) |
$597 |
$995 |
2.5× |
| Us ob transvaginal (76817) |
$744 |
$1,240 |
7.1× |
| Us pelvic non ob complete (76856) |
$708.30 |
$1,180.50 |
6.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$451.20 |
$752 |
4.3× |
| Us pregnancy ltd (76815) |
$597 |
$995 |
5.7× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$744 |
$1,240 |
7.1× |
| Us retroperitoneal complete (76770) |
$709.20 |
$1,182 |
6.8× |
| Us retroperitoneal limited (76775) |
$517.20 |
$862 |
4.9× |
| Us scrotum and contents (76870) |
$493.80 |
$823 |
4.7× |
| Us soft tissue head/neck (76536) |
$665.40 |
$1,109 |
6.3× |
| Us xtr non-vasc lmtd (76882) |
$472.80 |
$788 |
4.5× |
| Venography caval inferior serialography rs&i (75825) |
$1,287.60 |
$2,146 |
0.4× |
| Venography caval superior serialography rs&i (75827) |
$3,479.40 |
$5,799 |
2.2× |
| Venography renal unilateral selective rs&i (75831) |
$3,534.60 |
$5,891 |
1.1× |
| Wrist 2 views (73100) |
$261 |
$435 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$415.20 |
$692 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$307.20 |
$512 |
3.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$315 |
$525 |
3.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$641.40 |
$1,069 |
3.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$292.20 |
$487 |
3.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$326.40 |
$544 |
3.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$165 |
$275 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$271.20 |
$452 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$338.40 |
$564 |
3.9× |
| X-ray exam hip uni 4/> views (73503) |
$338.40 |
$564 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$439.80 |
$733 |
4.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$439.80 |
$733 |
4.2× |
| X-ray exam of femur 1 (73551) |
$340.20 |
$567 |
3.9× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$958.20 |
$1,597 |
5.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$304.20 |
$507 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$384.60 |
$641 |
4.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$315 |
$525 |
3.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$270 |
$450 |
3.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$201.60 |
$336 |
2.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$292.20 |
$487 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$304.20 |
$507 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$406.20 |
$677 |
3.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$744 |
$1,240 |
7.1× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$415.20 |
$692 |
4.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$201.60 |
$336 |
2.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$391.80 |
$653 |
3.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$270.60 |
$451 |
2.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$402.60 |
$671 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$361.20 |
$602 |
4.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$361.20 |
$602 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$508.20 |
$847 |
4.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$261 |
$435 |
2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$225.60 |
$376 |
2.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$393 |
$655 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$428.40 |
$714 |
4.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$261 |
$435 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$428.40 |
$714 |
4.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$304.20 |
$507 |
2.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$304.20 |
$507 |
3.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$338.40 |
$564 |
3.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$428.40 |
$714 |
4.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$530.40 |
$884 |
5.1× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$248.40 |
$414 |
2.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$292.20 |
$487 |
3.3× |
| Xr arthrogram ankle (73615) |
$1,254 |
$2,090 |
3.6× |
| Xr c-spine 6 or more views (72052) |
$665.40 |
$1,109 |
6.3× |
| Xr chest 4+ views (71048) |
$393 |
$655 |
3.7× |
| Xr finger(s) 2+ views (73140) |
$225.60 |
$376 |
2.6× |
| Xr optic foramina (70190) |
$259.20 |
$432 |
3.0× |
| Xr shoulder 1 view (73020) |
$304.20 |
$507 |
3.5× |
| Xr spine cervical 4 or 5 views (72050) |
$563.40 |
$939 |
5.4× |
| Xr tibia/fibula 2 views (73590) |
$326.40 |
$544 |
3.7× |
| Xray knee 1 or 2 views rt (73560) |
$304.20 |
$507 |
3.5× |