| Abdomen 2 views (74019) |
$200.20 |
$308 |
2.0× |
| Ankle 2 views (73600) |
$105.30 |
$162 |
1.3× |
| Bone age studies (77072) |
$117 |
$180 |
1.2× |
| Bone survey complete (77075) |
$460.20 |
$708 |
4.7× |
| Cervical spine 2 or 3 views (72040) |
$171.60 |
$264 |
2.1× |
| Chest 1 view (71045) |
$115.70 |
$178 |
1.4× |
| Chest 3 views (71047) |
$195 |
$300 |
2.4× |
| Clavicle complete (73000) |
$175.50 |
$270 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,445.65 |
$5,301 |
10.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,559.05 |
$3,937 |
11.4× |
| CT abdomen w contrast (74160) |
$1,279.53 |
$1,968.50 |
7.8× |
| CT abdomen w wo contrast (74170) |
$1,657.50 |
$2,550 |
10.1× |
| CT abdomen w/o contrast (74150) |
$1,279.53 |
$1,968.50 |
13.0× |
| CT c-spine w/o contrast (72125) |
$1,069.90 |
$1,646 |
10.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,102.40 |
$1,696 |
6.7× |
| CT cervical spine with contrast (72126) |
$1,086.15 |
$1,671 |
3.3× |
| CT chest w/wo contrast (71270) |
$1,657.50 |
$2,550 |
10.1× |
| CT chest with contrast (71260) |
$1,279.85 |
$1,969 |
7.8× |
| CT head/brain with contrast (70460) |
$1,086.15 |
$1,671 |
6.6× |
| CT head/brain without and with contrast (70470) |
$1,749.15 |
$2,691 |
10.6× |
| CT iac w contrast (70481) |
$1,086.15 |
$1,671 |
6.6× |
| CT lower ext w/o (73700) |
$1,362.08 |
$2,095.50 |
13.9× |
| CT lower extremity w wo contrast (73702) |
$1,259.70 |
$1,938 |
7.7× |
| CT lower extremity with contrast (73701) |
$908.05 |
$1,397 |
5.5× |
| CT lumbar spine w/o contrast (72131) |
$1,077.70 |
$1,658 |
11.0× |
| CT lumbar spine with contrast (72132) |
$1,676.35 |
$2,579 |
5.1× |
| CT maxillofacial w contrast (70487) |
$1,133.60 |
$1,744 |
6.9× |
| CT maxillofacial w/o contrast (70486) |
$1,023.75 |
$1,575 |
10.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,437.15 |
$2,211 |
8.7× |
| CT neck soft tissue w contrast (70491) |
$1,188.20 |
$1,828 |
7.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,549.60 |
$2,384 |
9.4× |
| CT orbits w/o contrast (70480) |
$826.15 |
$1,271 |
8.4× |
| CT pelvis w & w/o contrast (72194) |
$1,825.20 |
$2,808 |
11.1× |
| CT pelvis w/o contrast (72192) |
$993.20 |
$1,528 |
10.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,639.30 |
$2,522 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$868.40 |
$1,336 |
8.9× |
| CT thoracic spine w/contrast (72129) |
$252.20 |
$388 |
1.5× |
| CT thoracic spine w/o contrast (72128) |
$980.85 |
$1,509 |
10.0× |
| CT thoracic spine w/wo contrast (72130) |
$495.30 |
$762 |
3.0× |
| CT thorax w/o contrast (71250) |
$1,073.15 |
$1,651 |
10.9× |
| CT upper extremity w/o contrast rt (73200) |
$819.65 |
$1,261 |
8.4× |
| CT upper extremity with contrast (73201) |
$1,190.48 |
$1,831.50 |
3.6× |
| Cta Abdomen (74175) |
$1,279.85 |
$1,969 |
7.8× |
| CTA abdomen pelvis (74174) |
$2,559.05 |
$3,937 |
7.8× |
| CTA chest (71275) |
$1,279.85 |
$1,969 |
7.8× |
| Cta Head (70496) |
$1,225.90 |
$1,886 |
7.4× |
| Cta Pelvis (72191) |
$1,038.70 |
$1,598 |
6.3× |
| Fetal biophysical profile non-stress testing (76818) |
$129.35 |
$199 |
1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$138.45 |
$213 |
1.4× |
| Foot 2 views (73620) |
$103.02 |
$158.50 |
1.3× |
| Forearm 2 views (73090) |
$228.15 |
$351 |
2.8× |
| Hand 2 views (73120) |
$228.15 |
$351 |
2.3× |
| Hand 3 views (73130) |
$228.15 |
$351 |
2.8× |
| Humerus Min 2 Views Left (73060) |
$152.10 |
$234 |
1.9× |
| Knee 3 views (73562) |
$228.15 |
$351 |
2.8× |
| MRA head w & w/o contrast (70546) |
$2,738.78 |
$4,213.50 |
8.4× |
| MRA head w/o contrast (70544) |
$1,532.70 |
$2,358 |
6.8× |
| MRA neck w/o contrast (70547) |
$1,314.95 |
$2,023 |
5.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,950 |
$3,000 |
6.0× |
| MRI abdomen w/o contrast (74181) |
$1,652.30 |
$2,542 |
7.4× |
| MRI any jnt lwr ext with con lt (73722) |
$2,613 |
$4,020 |
3.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,613 |
$4,020 |
3.6× |
| MRI c-spine with contrast (72142) |
$1,652.30 |
$2,542 |
5.0× |
| MRI cervical spine w/o contrast (72141) |
$1,621.75 |
$2,495 |
7.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$2,613 |
$4,020 |
8.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,613 |
$4,020 |
8.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,125.50 |
$3,270 |
9.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,314.95 |
$2,023 |
5.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,739.10 |
$4,214 |
8.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,952.30 |
$4,542 |
9.0× |
| MRI pelvis w/o contrast (72195) |
$1,621.75 |
$2,495 |
7.2× |
| MRI scan of arm joint before and after contrast (73223) |
$3,100.50 |
$4,770 |
9.5× |
| MRI scan of leg joint before and after contrast (73723) |
$3,100.50 |
$4,770 |
9.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,377.40 |
$5,196 |
10.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,652.30 |
$2,542 |
5.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,377.40 |
$5,196 |
10.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,885 |
$2,900 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,652.30 |
$2,542 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$2,330.25 |
$3,585 |
10.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$3,100.50 |
$4,770 |
9.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,125.50 |
$3,270 |
9.5× |
| Neck soft tissue (70360) |
$152.10 |
$234 |
1.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$188.50 |
$290 |
1.9× |
| Osseous survey infant (77076) |
$460.20 |
$708 |
4.7× |
| Osseous survey limited (77074) |
$494 |
$760 |
5.0× |
| Pelvis 1 or 2 views (72170) |
$152.10 |
$234 |
1.6× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$3,100.50 |
$4,770 |
9.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$332.80 |
$512 |
3.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$420.55 |
$647 |
4.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$256.10 |
$394 |
2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$135.85 |
$209 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$146.25 |
$225 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$254.15 |
$391 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$167.70 |
$258 |
2.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$228.15 |
$351 |
2.8× |
| Ribs bilateral 3 views (71110) |
$191.75 |
$295 |
2.0× |
| Sacroiliac Joints < 3 Views (72200) |
$187.20 |
$288 |
1.9× |
| Scapula complete (73010) |
$175.50 |
$270 |
1.8× |
| Spine thoracic 3 views (72072) |
$234.65 |
$361 |
2.4× |
| Therapeutic Enema (74283) |
$770.25 |
$1,185 |
4.7× |
| Thoracolumbar 2 views (72080) |
$91.65 |
$141 |
1.1× |
| Ultrasound, abdomen limited (76705) |
$542.42 |
$834.50 |
5.5× |
| Umbilical-artery Doppler (OB) (76820) |
$144.95 |
$223 |
1.5× |
| Upper Extremity Infant (73092) |
$279.82 |
$430.50 |
2.9× |
| Us abdl aorta screen aaa (76706) |
$117 |
$180 |
1.2× |
| Us breast unilateral complete (76641) |
$394.22 |
$606.50 |
4.0× |
| Us breast unilateral limited (76642) |
$281.78 |
$433.50 |
3.5× |
| Us chest (76604) |
$144.95 |
$223 |
1.5× |
| Us compl joint r-t w/image documentation (76881) |
$190.45 |
$293 |
1.9× |
| Us infant hips limited static (76886) |
$91.65 |
$141 |
1.1× |
| Us ob detailed single fetus (76811) |
$361.40 |
$556 |
1.6× |
| Us ob transvaginal (76817) |
$182.65 |
$281 |
1.9× |
| Us pelvic non ob complete (76856) |
$510.25 |
$785 |
5.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$386.75 |
$595 |
3.9× |
| Us pregnancy ltd (76815) |
$315.90 |
$486 |
3.2× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$159.25 |
$245 |
1.6× |
| Us retroperitoneal complete (76770) |
$612.95 |
$943 |
6.2× |
| Us retroperitoneal limited (76775) |
$610.35 |
$939 |
6.2× |
| Us scrotum and contents (76870) |
$363.35 |
$559 |
3.7× |
| Us soft tissue head/neck (76536) |
$409.50 |
$630 |
4.2× |
| Us xtr non-vasc lmtd (76882) |
$105.30 |
$162 |
1.1× |
| Wrist 2 views (73100) |
$168.68 |
$259.50 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$358.80 |
$552 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$131.30 |
$202 |
1.6× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$128.05 |
$197 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$208.65 |
$321 |
2.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$228.15 |
$351 |
2.8× |
| X-ray exam hip uni 1 view (73501) |
$108.55 |
$167 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$209.95 |
$323 |
2.6× |
| X-ray exam of small bowel - fl small bowel series enteroclysis tube (74251) |
$317.20 |
$488 |
1.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$188.50 |
$290 |
1.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$124.80 |
$192 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$175.50 |
$270 |
2.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$265.20 |
$408 |
2.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$279.82 |
$430.50 |
3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$194.35 |
$299 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$345.15 |
$531 |
3.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$243.75 |
$375 |
2.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$92.95 |
$143 |
1.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$123.50 |
$190 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$123.50 |
$190 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$228.15 |
$351 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$169 |
$260 |
2.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$202.15 |
$311 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$299.65 |
$461 |
3.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$152.10 |
$234 |
1.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$228.15 |
$351 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$187.20 |
$288 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$135.85 |
$209 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$241.80 |
$372 |
2.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$135.85 |
$209 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$123.50 |
$190 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$117 |
$180 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$103.35 |
$159 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$228.15 |
$351 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$458.25 |
$705 |
4.7× |
| Xr chest 4+ views (71048) |
$247 |
$380 |
2.5× |
| Xr finger(s) 2+ views (73140) |
$228.15 |
$351 |
2.8× |
| XR Mastoids < 3 Views Bilateral (70120) |
$210.60 |
$324 |
2.1× |
| Xr spine cervical 4 or 5 views (72050) |
$378.95 |
$583 |
3.9× |
| Xr tibia/fibula 2 views (73590) |
$228.15 |
$351 |
2.8× |
| Xr tmj bilateral (70330) |
$179.40 |
$276 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$183.30 |
$282 |
2.2× |