| Abdomen 2 views (74019) |
$196.50 |
$262 |
2.1× |
| Ankle 2 views (73600) |
$196.50 |
$262 |
2.5× |
| Arthrogram elbow (73085) |
$1,157.25 |
$1,543 |
3.7× |
| Arthrogram hip (73525) |
$1,157.25 |
$1,543 |
3.7× |
| Arthrogram shoulder (73040) |
$703.50 |
$938 |
2.2× |
| Arthrogram wrist (73115) |
$1,157.25 |
$1,543 |
3.7× |
| Arthrography knee lt (73580) |
$1,157.25 |
$1,543 |
3.7× |
| Bone age studies (77072) |
$196.50 |
$262 |
2.1× |
| Bone survey complete (77075) |
$328.50 |
$438 |
3.5× |
| Cervical spine 2 or 3 views (72040) |
$196.50 |
$262 |
2.5× |
| Chest 1 view (71045) |
$196.50 |
$262 |
2.5× |
| Clavicle complete (73000) |
$167.25 |
$223 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,959.75 |
$2,613 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,283.25 |
$1,711 |
5.9× |
| CT abdomen w contrast (74160) |
$1,399.50 |
$1,866 |
8.8× |
| CT abdomen w wo contrast (74170) |
$1,654.50 |
$2,206 |
10.4× |
| CT abdomen w/o contrast (74150) |
$987 |
$1,316 |
10.4× |
| CT c-spine w/o contrast (72125) |
$865.50 |
$1,154 |
9.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,357.50 |
$1,810 |
8.5× |
| CT cervical spine with contrast (72126) |
$1,227 |
$1,636 |
3.9× |
| CT chest w/wo contrast (71270) |
$1,655.25 |
$2,207 |
10.4× |
| CT chest with contrast (71260) |
$1,399.50 |
$1,866 |
8.8× |
| CT head/brain with contrast (70460) |
$1,133.25 |
$1,511 |
7.1× |
| CT head/brain without and with contrast (70470) |
$1,451.25 |
$1,935 |
9.1× |
| CT iac w contrast (70481) |
$1,272 |
$1,696 |
8.0× |
| CT limited/localized follow up study (76380) |
$480 |
$640 |
6.1× |
| CT lower ext w/o (73700) |
$869.25 |
$1,159 |
9.2× |
| CT lower extremity w wo contrast (73702) |
$1,505.25 |
$2,007 |
9.5× |
| CT lower extremity with contrast (73701) |
$1,309.50 |
$1,746 |
8.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,548 |
$2,064 |
9.7× |
| CT lumbar spine w/o contrast (72131) |
$987 |
$1,316 |
10.4× |
| CT lumbar spine with contrast (72132) |
$1,399.50 |
$1,866 |
4.4× |
| CT maxillofacial w contrast (70487) |
$1,227 |
$1,636 |
7.7× |
| CT maxillofacial w/o contrast (70486) |
$959.25 |
$1,279 |
10.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,451.25 |
$1,935 |
9.1× |
| CT neck soft tissue w contrast (70491) |
$1,320.75 |
$1,761 |
8.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,357.50 |
$1,810 |
8.5× |
| CT orbits w/o contrast (70480) |
$865.50 |
$1,154 |
9.1× |
| CT pelvis w & w/o contrast (72194) |
$1,655.25 |
$2,207 |
10.4× |
| CT pelvis w/o contrast (72192) |
$987 |
$1,316 |
10.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,451.25 |
$1,935 |
9.1× |
| CT soft tissue neck w/o contrast (70490) |
$865.50 |
$1,154 |
9.1× |
| CT thoracic spine w/contrast (72129) |
$1,399.50 |
$1,866 |
8.8× |
| CT thoracic spine w/o contrast (72128) |
$987 |
$1,316 |
10.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,548 |
$2,064 |
9.7× |
| CT thorax w/o contrast (71250) |
$987 |
$1,316 |
10.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,505.25 |
$2,007 |
9.5× |
| CT upper extremity w/o contrast rt (73200) |
$869.25 |
$1,159 |
9.2× |
| CT upper extremity with contrast (73201) |
$1,309.50 |
$1,746 |
4.1× |
| Cta Abdomen (74175) |
$1,551 |
$2,068 |
9.8× |
| CTA abdomen pelvis (74174) |
$1,551 |
$2,068 |
4.9× |
| CTA chest (71275) |
$1,551 |
$2,068 |
9.8× |
| Cta Head (70496) |
$1,359.75 |
$1,813 |
8.6× |
| Cta Neck (70498) |
$1,359.75 |
$1,813 |
8.6× |
| Cta Pelvis (72191) |
$1,551 |
$2,068 |
9.8× |
| Cystography minimum 3 views rs&i (74430) |
$894 |
$1,192 |
2.8× |
| Diskogram cervical (72285) |
$6,531.75 |
$8,709 |
3.7× |
| Esophagus (74220) |
$489 |
$652 |
3.1× |
| Fluoroscopy up to 1 hr (76000) |
$444 |
$592 |
2.1× |
| Forearm 2 views (73090) |
$167.25 |
$223 |
2.1× |
| Hand 2 views (73120) |
$167.25 |
$223 |
1.8× |
| Hand 3 views (73130) |
$167.25 |
$223 |
2.1× |
| Humerus Min 2 Views Left (73060) |
$167.25 |
$223 |
2.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$196.50 |
$262 |
2.1× |
| Knee 3 views (73562) |
$167.25 |
$223 |
2.1× |
| MRA head w & w/o contrast (70546) |
$2,008.50 |
$2,678 |
6.4× |
| MRA head w/o contrast (70544) |
$1,672.50 |
$2,230 |
7.7× |
| MRA head with contrast (70545) |
$1,677 |
$2,236 |
5.3× |
| MRA neck w contrast (70548) |
$1,677 |
$2,236 |
5.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,008.50 |
$2,678 |
6.4× |
| MRA neck w/o contrast (70547) |
$1,672.50 |
$2,230 |
7.7× |
| MRI abdomen w contrast (74182) |
$1,848 |
$2,464 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,352 |
$3,136 |
7.4× |
| MRI abdomen w/o contrast (74181) |
$1,672.50 |
$2,230 |
7.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,774.50 |
$2,366 |
2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,677 |
$2,236 |
2.4× |
| MRI bone marrow blood supply (77084) |
$1,545 |
$2,060 |
7.2× |
| MRI c-spine with contrast (72142) |
$1,848 |
$2,464 |
5.8× |
| MRI cervical spine w/o contrast (72141) |
$1,672.50 |
$2,230 |
7.7× |
| MRI chest w/o & w/contrast material (71552) |
$2,352 |
$3,136 |
7.4× |
| MRI chest w/o contrast (71550) |
$1,672.50 |
$2,230 |
7.7× |
| MRI chest with contrast (71551) |
$1,848 |
$2,464 |
2.6× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,677 |
$2,236 |
5.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,677 |
$2,236 |
5.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,479 |
$1,972 |
6.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,672.50 |
$2,230 |
7.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,352 |
$3,136 |
7.4× |
| MRI orbit/face/neck w/contrast (70542) |
$1,848 |
$2,464 |
5.8× |
| MRI pelvis w contrast (72196) |
$1,848 |
$2,464 |
5.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,352 |
$3,136 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$1,672.50 |
$2,230 |
7.7× |
| MRI scan of arm joint before and after contrast (73223) |
$2,008.50 |
$2,678 |
6.4× |
| MRI scan of leg joint before and after contrast (73723) |
$2,355.75 |
$3,141 |
7.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,352 |
$3,136 |
7.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,848 |
$2,464 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,352 |
$3,136 |
7.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,848 |
$2,464 |
5.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,352 |
$3,136 |
7.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,672.50 |
$2,230 |
7.7× |
| MRI tmj (70336) |
$2,318.25 |
$3,091 |
10.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,479 |
$1,972 |
6.8× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,008.50 |
$2,678 |
6.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,479 |
$1,972 |
6.8× |
| Myelogram Lumbar (72265) |
$2,074.50 |
$2,766 |
2.9× |
| Myelogram thoracic (72255) |
$1,966.50 |
$2,622 |
2.8× |
| Neck soft tissue (70360) |
$196.50 |
$262 |
2.5× |
| Osseous survey infant (77076) |
$328.50 |
$438 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$196.50 |
$262 |
2.1× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,008.50 |
$2,678 |
6.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$860.25 |
$1,147 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$328.50 |
$438 |
4.2× |
| Radex hips bilateral with pelvis 2 views (73521) |
$293.25 |
$391 |
3.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$196.50 |
$262 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$239.25 |
$319 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$196.50 |
$262 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$196.50 |
$262 |
2.5× |
| Radiologic exam colon single contrast study (74270) |
$414 |
$552 |
2.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$477.75 |
$637 |
3.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$477.75 |
$637 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$270 |
$360 |
3.4× |
| Scanogram (77073) |
$239.25 |
$319 |
2.5× |
| Scapula complete (73010) |
$167.25 |
$223 |
1.8× |
| Sella turcica (70240) |
$196.50 |
$262 |
2.5× |
| Small bowel series (74250) |
$330 |
$440 |
2.1× |
| Spine thoracic 3 views (72072) |
$239.25 |
$319 |
2.5× |
| Thoracolumbar 2 views (72080) |
$196.50 |
$262 |
2.5× |
| Tmj unilateral (70328) |
$167.25 |
$223 |
2.1× |
| Tomogram (76100) |
$328.50 |
$438 |
3.5× |
| Upper Extremity Infant (73092) |
$167.25 |
$223 |
1.8× |
| Urethrocystography retrograde rs&i (74450) |
$648 |
$864 |
3.0× |
| Urethrocystography voiding (74455) |
$705.75 |
$941 |
3.3× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$705.75 |
$941 |
4.4× |
| Us pelvic non ob complete (76856) |
$428.25 |
$571 |
4.5× |
| Us transrectal (76872) |
$387.75 |
$517 |
4.1× |
| Wrist 2 views (73100) |
$196.50 |
$262 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$328.50 |
$438 |
3.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$196.50 |
$262 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$208.79 |
$278.38 |
2.6× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$507.75 |
$677 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$261 |
$348 |
3.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$177.71 |
$236.94 |
2.3× |
| X-ray exam hip uni 1 view (73501) |
$167.25 |
$223 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$204.42 |
$272.56 |
2.6× |
| X-ray exam of femur 1 (73551) |
$162 |
$216 |
2.1× |
| X-ray eye for foreign body (70030) |
$271.50 |
$362 |
3.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$239.25 |
$319 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196.50 |
$262 |
2.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$167.25 |
$223 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$167.25 |
$223 |
2.1× |
| X-ray IV pyelogram+drip infusn (74410) |
$705.75 |
$941 |
4.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$239.25 |
$319 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$196.50 |
$262 |
2.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$285.75 |
$381 |
3.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$196.50 |
$262 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$328.50 |
$438 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$196.50 |
$262 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$196.50 |
$262 |
2.5× |
| X-ray of voice box or throat (70370) |
$386.25 |
$515 |
4.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$239.25 |
$319 |
2.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$196.50 |
$262 |
2.1× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$878.25 |
$1,171 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$239.25 |
$319 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$328.50 |
$438 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$196.50 |
$262 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$196.50 |
$262 |
2.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$1,006.50 |
$1,342 |
12.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$239.25 |
$319 |
3.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$196.50 |
$262 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$328.50 |
$438 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$196.50 |
$262 |
2.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$196.50 |
$262 |
2.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$196.50 |
$262 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$196.50 |
$262 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$239.25 |
$319 |
2.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$239.25 |
$319 |
2.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$167.25 |
$223 |
2.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$177.71 |
$236.94 |
2.3× |
| Xr arthrogram ankle (73615) |
$1,157.25 |
$1,543 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$328.50 |
$438 |
3.5× |
| Xr Cholecystography Oral Contrast (74290) |
$330 |
$440 |
2.1× |
| Xr finger(s) 2+ views (73140) |
$167.25 |
$223 |
2.1× |
| Xr internal auditory meati complete (70134) |
$328.50 |
$438 |
0.7× |
| Xr shoulder 1 view (73020) |
$167.25 |
$223 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$328.50 |
$438 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$167.25 |
$223 |
2.1× |
| Xr tmj bilateral (70330) |
$196.50 |
$262 |
2.5× |
| Xray knee 1 or 2 views rt (73560) |
$167.25 |
$223 |
2.1× |