| Abdomen 2 views (74019) |
$199.38 |
$486.30 |
1.9× |
| Ankle 2 views (73600) |
$105.86 |
$258.20 |
1.2× |
| Arthrogram elbow (73085) |
$593.12 |
$1,446.65 |
1.7× |
| Arthrogram hip (73525) |
$593.12 |
$1,446.65 |
1.7× |
| Arthrogram shoulder (73040) |
$593.12 |
$1,446.65 |
1.7× |
| Arthrogram wrist (73115) |
$593.12 |
$1,446.65 |
1.7× |
| Arthrography knee lt (73580) |
$593.12 |
$1,446.65 |
1.7× |
| Bone age studies (77072) |
$151.92 |
$370.55 |
1.4× |
| Bone survey complete (77075) |
$417.93 |
$1,019.35 |
3.9× |
| Cervical spine 2 or 3 views (72040) |
$219.92 |
$536.40 |
2.5× |
| Chest 1 view (71045) |
$143.25 |
$349.40 |
1.6× |
| Chest 3 views (71047) |
$249.11 |
$607.60 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$217.27 |
$529.95 |
1.2× |
| Clavicle complete (73000) |
$180.66 |
$440.65 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$124.10 |
$302.70 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,256.59 |
$5,503.90 |
6.3× |
| CT abdomen and pelvis without contrast (74176) |
$2,179.49 |
$5,315.85 |
8.9× |
| CT abdomen w contrast (74160) |
$1,283.42 |
$3,130.30 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,592.76 |
$3,884.80 |
8.9× |
| CT abdomen w/o contrast (74150) |
$1,177.11 |
$2,871 |
11.0× |
| CT angiography upper extremity lt (73206) |
$1,411.15 |
$3,441.85 |
7.9× |
| CT c-spine w/o contrast (72125) |
$1,281.59 |
$3,125.85 |
12.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,102.32 |
$2,688.60 |
6.2× |
| CT cervical spine with contrast (72126) |
$1,517.02 |
$3,700.05 |
4.3× |
| CT chest w/wo contrast (71270) |
$1,568.57 |
$3,825.80 |
8.8× |
| CT chest with contrast (71260) |
$1,270.18 |
$3,098 |
7.1× |
| CT head/brain with contrast (70460) |
$1,174.83 |
$2,865.45 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,457.24 |
$3,554.25 |
8.1× |
| CT heart no contrast quant eval coronry calcium (75571) |
$77.10 |
$188.05 |
0.9× |
| CT iac w contrast (70481) |
$673.65 |
$1,643.05 |
3.8× |
| CT limited/localized follow up study (76380) |
$469.51 |
$1,145.15 |
5.3× |
| CT lower ext w/o (73700) |
$1,073.99 |
$2,619.50 |
10.1× |
| CT lower extremity w wo contrast (73702) |
$886.38 |
$2,161.92 |
4.9× |
| CT lower extremity with contrast (73701) |
$919.79 |
$2,243.40 |
5.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,051.42 |
$2,564.45 |
5.9× |
| CT lumbar spine w/o contrast (72131) |
$1,243.28 |
$3,032.40 |
11.6× |
| CT lumbar spine with contrast (72132) |
$1,444.49 |
$3,523.15 |
4.1× |
| CT maxillofacial w contrast (70487) |
$1,050.75 |
$2,562.82 |
5.9× |
| CT maxillofacial w/o contrast (70486) |
$760.66 |
$1,855.28 |
7.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,290.85 |
$3,148.42 |
7.2× |
| CT neck soft tissue w contrast (70491) |
$1,254.68 |
$3,060.20 |
7.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$838.63 |
$2,045.45 |
4.7× |
| CT orbits w/o contrast (70480) |
$594.88 |
$1,450.95 |
5.6× |
| CT pelvis w & w/o contrast (72194) |
$932.70 |
$2,274.90 |
5.2× |
| CT pelvis w/o contrast (72192) |
$1,107.75 |
$2,701.85 |
10.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,489.65 |
$3,633.30 |
8.3× |
| CT soft tissue neck w/o contrast (70490) |
$587.26 |
$1,432.35 |
5.5× |
| CT thoracic spine w/contrast (72129) |
$1,603.24 |
$3,910.35 |
8.9× |
| CT thoracic spine w/o contrast (72128) |
$1,566.28 |
$3,820.20 |
14.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,085.37 |
$2,647.25 |
6.1× |
| CT thorax w/o contrast (71250) |
$1,014.23 |
$2,473.75 |
9.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$557.43 |
$1,359.60 |
3.1× |
| CT upper extremity w/o contrast rt (73200) |
$1,029.75 |
$2,511.60 |
9.6× |
| CT upper extremity with contrast (73201) |
$466.12 |
$1,136.90 |
1.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,115.05 |
$2,719.65 |
6.2× |
| Cta Abdomen (74175) |
$1,621.96 |
$3,956 |
9.1× |
| CTA abdomen pelvis (74174) |
$2,980.22 |
$7,268.85 |
8.4× |
| CTA chest (71275) |
$1,403.43 |
$3,423 |
7.8× |
| Cta Head (70496) |
$1,313.53 |
$3,203.75 |
7.3× |
| CTA lwr ext w&w/o contrast (73706) |
$739.23 |
$1,803 |
4.1× |
| Cta Neck (70498) |
$1,410.72 |
$3,440.80 |
7.9× |
| Cta Pelvis (72191) |
$374.12 |
$912.50 |
2.1× |
| Cystography minimum 3 views rs&i (74430) |
$475.84 |
$1,160.60 |
1.3× |
| Diskogram cervical (72285) |
$3,284.54 |
$8,011.08 |
1.6× |
| Diskography lumbar (72295) |
$258.68 |
$630.95 |
0.1× |
| Esophagus (74220) |
$194.38 |
$474.10 |
1.1× |
| Fetal biophysical profile non-stress testing (76818) |
$248.52 |
$606.15 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$248.52 |
$606.15 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$289.25 |
$705.50 |
1.2× |
| Foot 2 views (73620) |
$152.37 |
$371.65 |
1.7× |
| Forearm 2 views (73090) |
$105.86 |
$258.20 |
1.2× |
| Hand 2 views (73120) |
$105.86 |
$258.20 |
1.0× |
| Hand 3 views (73130) |
$195.73 |
$477.40 |
2.2× |
| Humerus Min 2 Views Left (73060) |
$170.17 |
$415.05 |
1.9× |
| Hysterosalpingogram (74740) |
$587.20 |
$1,432.20 |
2.4× |
| Knee 3 views (73562) |
$241.81 |
$589.80 |
2.7× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$105.86 |
$258.20 |
1.2× |
| MRA head w & w/o contrast (70546) |
$1,860.76 |
$4,538.45 |
5.2× |
| MRA head w/o contrast (70544) |
$1,196.29 |
$2,917.80 |
4.9× |
| MRA head with contrast (70545) |
$1,433.03 |
$3,495.20 |
4.0× |
| MRA neck w contrast (70548) |
$1,451.17 |
$3,539.45 |
4.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,982.86 |
$4,836.25 |
5.6× |
| MRA neck w/o contrast (70547) |
$1,269.77 |
$3,097 |
5.2× |
| MRI abdomen w contrast (74182) |
$2,027.10 |
$4,944.15 |
5.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,469.20 |
$6,022.45 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,660.27 |
$4,049.45 |
6.8× |
| MRI any jnt lwr ext with con lt (73722) |
$1,693.60 |
$4,130.75 |
2.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,220.91 |
$2,977.85 |
1.5× |
| MRI breast w/o contrast bilateral (77047) |
$820.77 |
$2,001.90 |
3.4× |
| MRI c-spine with contrast (72142) |
$1,560.19 |
$3,805.35 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,385.16 |
$3,378.45 |
5.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,633.82 |
$3,984.95 |
4.6× |
| MRI chest w/o contrast (71550) |
$1,089.96 |
$2,658.45 |
4.5× |
| MRI chest with contrast (71551) |
$1,607.63 |
$3,921.05 |
2.0× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$935.37 |
$2,281.40 |
2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,080.59 |
$2,635.60 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,186.25 |
$2,893.30 |
4.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,108.23 |
$2,703 |
4.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,710.45 |
$4,171.85 |
4.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,666.38 |
$4,064.35 |
4.7× |
| MRI pelvis w contrast (72196) |
$1,621.67 |
$3,955.30 |
4.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,856.93 |
$4,529.10 |
5.2× |
| MRI pelvis w/o contrast (72195) |
$1,384.24 |
$3,376.20 |
5.7× |
| MRI scan of arm joint before and after contrast (73223) |
$1,522.94 |
$3,714.50 |
4.3× |
| MRI scan of leg joint before and after contrast (73723) |
$1,687.66 |
$4,116.25 |
4.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,835.03 |
$4,475.70 |
5.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,721.40 |
$4,198.55 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,941.32 |
$4,734.95 |
5.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,653.48 |
$4,032.90 |
4.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,198.19 |
$5,361.45 |
6.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,347.75 |
$3,287.20 |
5.5× |
| MRI upper ext joint w/o contrast (73221) |
$1,276.12 |
$3,112.50 |
5.2× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,740.12 |
$4,244.20 |
4.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,145.17 |
$2,793.10 |
4.7× |
| Myelogram Cervical (72240) |
$1,103.18 |
$2,690.70 |
1.4× |
| Myelogram Lumbar (72265) |
$1,103.18 |
$2,690.70 |
1.4× |
| Myelogram thoracic (72255) |
$1,103.18 |
$2,690.70 |
1.4× |
| Myelography 2 or more regions (72270) |
$1,103.18 |
$2,690.70 |
1.4× |
| Neck soft tissue (70360) |
$105.92 |
$258.35 |
1.2× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$318.91 |
$777.85 |
3.0× |
| Osseous survey infant (77076) |
$207.58 |
$506.30 |
1.9× |
| Osseous survey limited (77074) |
$167.87 |
$409.45 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$178.86 |
$436.25 |
1.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,779.83 |
$4,341.05 |
5.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$587.14 |
$1,432.05 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$249.78 |
$609.23 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$143.25 |
$349.40 |
1.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$151.92 |
$370.55 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$175.64 |
$428.40 |
2.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$175.64 |
$428.40 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$308.97 |
$753.60 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$279.23 |
$681.05 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$279.23 |
$681.05 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$219 |
$534.15 |
2.5× |
| Ribs bilateral 3 views (71110) |
$258.68 |
$630.95 |
2.4× |
| Sacroiliac Joints < 3 Views (72200) |
$27.83 |
$67.90 |
0.3× |
| Scapula complete (73010) |
$109.96 |
$268.20 |
1.0× |
| Sella turcica (70240) |
$105.92 |
$258.35 |
1.2× |
| Small bowel series (74250) |
$226.73 |
$553 |
1.3× |
| Spine thoracic 3 views (72072) |
$273.75 |
$667.70 |
2.6× |
| Tmj unilateral (70328) |
$113.13 |
$275.95 |
1.3× |
| Ultrasound, abdomen limited (76705) |
$248.52 |
$606.15 |
2.3× |
| Umbilical-artery Doppler (OB) (76820) |
$202.10 |
$492.95 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$475.84 |
$1,160.60 |
2.0× |
| Urethrocystography voiding (74455) |
$475.84 |
$1,160.60 |
2.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$475.84 |
$1,160.60 |
2.7× |
| Us abdl aorta screen aaa (76706) |
$205.71 |
$501.75 |
1.9× |
| Us breast unilateral complete (76641) |
$266.43 |
$649.85 |
2.5× |
| Us breast unilateral limited (76642) |
$88.49 |
$215.85 |
1.0× |
| Us chest (76604) |
$327.56 |
$798.95 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$334.41 |
$815.65 |
3.1× |
| Us ob detailed single fetus (76811) |
$570.76 |
$1,392.10 |
2.3× |
| Us ob transvaginal (76817) |
$375.94 |
$916.95 |
3.5× |
| Us pelvic non ob complete (76856) |
$427.05 |
$1,041.60 |
4.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$245.91 |
$599.80 |
2.3× |
| Us pregnancy ltd (76815) |
$337.61 |
$823.45 |
3.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$182.49 |
$445.10 |
1.7× |
| Us retroperitoneal complete (76770) |
$358.60 |
$874.65 |
3.4× |
| Us retroperitoneal limited (76775) |
$301.57 |
$735.55 |
2.8× |
| Us scrotum and contents (76870) |
$369.55 |
$901.35 |
3.5× |
| Us soft tissue head/neck (76536) |
$396.94 |
$968.15 |
3.7× |
| Us transrectal (76872) |
$248.52 |
$606.15 |
2.3× |
| Us xtr non-vasc lmtd (76882) |
$204.38 |
$498.50 |
1.9× |
| Venogram extremity bilateral (75822) |
$1,364.27 |
$3,327.50 |
0.8× |
| Venography extremity unilateral rs&i (75820) |
$1,527.29 |
$3,725.10 |
0.9× |
| Wrist 2 views (73100) |
$151.02 |
$368.35 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$257.07 |
$627 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$126.83 |
$309.35 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$223.55 |
$545.25 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$427.95 |
$1,043.80 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$176.11 |
$429.55 |
2.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$208.50 |
$508.55 |
2.3× |
| X-ray exam hip uni 1 view (73501) |
$211.68 |
$516.30 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$184.78 |
$450.70 |
2.1× |
| X-ray exam hip uni 4/> views (73503) |
$294.72 |
$718.85 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$182.49 |
$445.10 |
1.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$461.72 |
$1,126.15 |
4.3× |
| X-ray eye for foreign body (70030) |
$187.51 |
$457.35 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$167.87 |
$409.45 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$117.71 |
$287.10 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$193.90 |
$472.95 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$105.86 |
$258.20 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$105.92 |
$258.35 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$251.86 |
$614.30 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$247.72 |
$604.20 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$251.39 |
$613.15 |
2.4× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$236.32 |
$576.40 |
2.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$105.92 |
$258.35 |
1.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$105.92 |
$258.35 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$141.42 |
$344.95 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$229.94 |
$560.85 |
2.2× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$475.84 |
$1,160.60 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$154.46 |
$376.72 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$207.59 |
$506.32 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$327.13 |
$797.90 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$105.86 |
$258.20 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$199.38 |
$486.30 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$204.85 |
$499.65 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$267.83 |
$653.25 |
3.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$105.92 |
$258.35 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$372.30 |
$908.05 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$109.49 |
$267.05 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$105.86 |
$258.20 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$132.36 |
$322.85 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$263.26 |
$642.10 |
3.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$211.68 |
$516.30 |
2.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$185.64 |
$452.80 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$105.86 |
$258.20 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$201.20 |
$490.75 |
2.3× |
| Xr arthrogram ankle (73615) |
$593.12 |
$1,446.65 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$331.69 |
$809 |
3.1× |
| Xr chest 4+ views (71048) |
$140.30 |
$342.20 |
1.3× |
| Xr Cholecystography Oral Contrast (74290) |
$187.98 |
$458.50 |
1.0× |
| Xr finger(s) 2+ views (73140) |
$134.13 |
$327.15 |
1.5× |
| Xr optic foramina (70190) |
$110.86 |
$270.40 |
1.2× |
| Xr shoulder 1 view (73020) |
$140.97 |
$343.85 |
1.6× |
| Xr spine cervical 4 or 5 views (72050) |
$283.33 |
$691.05 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$198.46 |
$484.05 |
2.2× |
| Xr tmj bilateral (70330) |
$226.29 |
$551.95 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$179.76 |
$438.45 |
2.0× |