| Abdomen 2 views (74019) |
$24 |
$30 |
0.3× |
| Ankle 2 views (73600) |
$16.80 |
$21 |
0.2× |
| Bone age studies (77072) |
— |
$73 |
— |
| Bone survey complete (77075) |
— |
$303 |
— |
| Cervical spine 2 or 3 views (72040) |
$24 |
$30 |
0.3× |
| Chest 1 view (71045) |
$18.40 |
$23 |
0.2× |
| Clavicle complete (73000) |
$17.60 |
$22 |
0.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$211.20 |
$264 |
0.7× |
| CT abdomen and pelvis without contrast (74176) |
$183.20 |
$229 |
0.9× |
| CT abdomen w contrast (74160) |
$134.40 |
$168 |
0.9× |
| CT abdomen w wo contrast (74170) |
$147.20 |
$184 |
1.0× |
| CT abdomen w/o contrast (74150) |
$125.60 |
$157 |
1.4× |
| CT angiography upper extremity lt (73206) |
$1,170.79 |
$1,672.56 |
7.7× |
| CT c-spine w/o contrast (72125) |
$104.80 |
$131 |
1.2× |
| CT cervical spine w&w/o contrast (72127) |
— |
$1,025 |
— |
| CT cervical spine with contrast (72126) |
$958.48 |
$1,172.12 |
3.2× |
| CT chest w/wo contrast (71270) |
$132 |
$165 |
0.9× |
| CT chest with contrast (71260) |
$122.40 |
$153 |
0.8× |
| CT head/brain with contrast (70460) |
$119.20 |
$149 |
0.8× |
| CT head/brain without and with contrast (70470) |
$134.40 |
$168 |
0.9× |
| CT iac w contrast (70481) |
$959.79 |
$1,073.06 |
6.3× |
| CT limited/localized follow up study (76380) |
— |
$400 |
— |
| CT lower ext w/o (73700) |
$104.80 |
$131 |
1.2× |
| CT lower extremity w wo contrast (73702) |
$826 |
$825 |
5.5× |
| CT lower extremity with contrast (73701) |
$959.79 |
$1,371.13 |
6.3× |
| CT lumbar spine w & w/o contrast (72133) |
$948.44 |
$1,354.92 |
6.3× |
| CT lumbar spine w/o contrast (72131) |
$104.80 |
$131 |
1.2× |
| CT lumbar spine with contrast (72132) |
$826 |
$1,100 |
2.7× |
| CT maxillofacial w contrast (70487) |
$117.60 |
$147 |
0.8× |
| CT maxillofacial w/o contrast (70486) |
$89.60 |
$112 |
1.0× |
| CT maxillofacial w/wo contrast (70488) |
— |
$900 |
— |
| CT neck soft tissue w contrast (70491) |
$97.60 |
$122 |
0.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$863 |
$1,040 |
5.7× |
| CT orbits w/o contrast (70480) |
$136 |
$170 |
1.5× |
| CT pelvis w & w/o contrast (72194) |
$1,184.32 |
$1,395.94 |
7.8× |
| CT pelvis w/o contrast (72192) |
$114.40 |
$143 |
1.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$169.60 |
$212 |
1.1× |
| CT soft tissue neck w/o contrast (70490) |
$135.20 |
$169 |
1.5× |
| CT thoracic spine w/contrast (72129) |
$958.53 |
$1,122.16 |
6.3× |
| CT thoracic spine w/o contrast (72128) |
$104.80 |
$131 |
1.2× |
| CT thoracic spine w/wo contrast (72130) |
$959.48 |
$1,025 |
6.3× |
| CT thorax w/o contrast (71250) |
$113.60 |
$142 |
1.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$826 |
$1,180 |
5.5× |
| CT upper extremity w/o contrast rt (73200) |
$104.80 |
$131 |
1.2× |
| CT upper extremity with contrast (73201) |
$867.40 |
$1,073.06 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,084.65 |
$1,549.50 |
7.2× |
| Cta Abdomen (74175) |
$1,365 |
$1,755 |
9.0× |
| CTA abdomen pelvis (74174) |
$1,575 |
$2,250 |
5.2× |
| CTA chest (71275) |
$1,084.65 |
$1,549.50 |
7.2× |
| Cta Head (70496) |
$1,465.61 |
$1,720.36 |
9.7× |
| CTA lwr ext w&w/o contrast (73706) |
$1,549.74 |
$2,213.92 |
10.2× |
| Cta Neck (70498) |
$1,084.65 |
$1,549.50 |
7.2× |
| Cta Pelvis (72191) |
$1,365 |
$1,950 |
9.0× |
| Foot 2 views (73620) |
$16.80 |
$21 |
0.2× |
| Forearm 2 views (73090) |
$16.80 |
$21 |
0.2× |
| Hand 2 views (73120) |
$17.60 |
$22 |
0.2× |
| Hand 3 views (73130) |
$19.20 |
$24 |
0.3× |
| Humerus Min 2 Views Left (73060) |
$16.80 |
$21 |
0.2× |
| Knee 3 views (73562) |
$20 |
$25 |
0.3× |
| MRA head w & w/o contrast (70546) |
$2,405 |
$2,405 |
8.0× |
| MRA head w/o contrast (70544) |
$126.40 |
$158 |
0.6× |
| MRA head with contrast (70545) |
$1,527 |
$1,527 |
5.1× |
| MRA neck w contrast (70548) |
$904 |
$1,610 |
3.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,406 |
$2,406 |
8.0× |
| MRA neck w/o contrast (70547) |
$846 |
$846 |
4.1× |
| MRI abdomen w contrast (74182) |
$181.60 |
$227 |
0.6× |
| MRI abdomen w/o & w/contrast material (74183) |
— |
$1,191 |
— |
| MRI abdomen w/o contrast (74181) |
$153.60 |
$192 |
0.7× |
| MRI c-spine with contrast (72142) |
— |
$1,646 |
— |
| MRI cervical spine w/o contrast (72141) |
$156 |
$195 |
0.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,361 |
$2,361 |
7.8× |
| MRI chest w/o contrast (71550) |
$153.60 |
$192 |
0.7× |
| MRI chest with contrast (71551) |
$1,792 |
$1,792 |
2.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
— |
$219.50 |
— |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$141.60 |
$177 |
0.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$177 |
$792 |
0.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$225.60 |
$282 |
0.8× |
| MRI orbit/face/neck w/contrast (70542) |
— |
$1,407 |
— |
| MRI pelvis w contrast (72196) |
$1,605 |
$1,605 |
5.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$230.40 |
$288 |
0.8× |
| MRI pelvis w/o contrast (72195) |
$154.40 |
$193 |
0.8× |
| MRI scan of arm joint before and after contrast (73223) |
$972 |
$972 |
3.2× |
| MRI scan of leg joint before and after contrast (73723) |
$226.40 |
$283 |
0.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$241.60 |
$302 |
0.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
— |
$1,584 |
— |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$241.60 |
$302 |
0.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
— |
$1,486 |
— |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
— |
$1,925 |
— |
| MRI thoracic spine w/o contrast (72146) |
$156 |
$195 |
0.8× |
| MRI tmj (70336) |
$194 |
$194 |
0.9× |
| MRI upper ext joint w/o contrast (73221) |
$144 |
$180 |
0.7× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,183.50 |
$2,084 |
3.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$143.20 |
$179 |
0.7× |
| Neck soft tissue (70360) |
$19.20 |
$24 |
0.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$226.95 |
$324.21 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$18.40 |
$23 |
0.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$225.60 |
$282 |
0.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$89.44 |
$103.38 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$33.60 |
$42 |
0.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$24 |
$71.50 |
0.3× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$26.40 |
$33 |
0.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$19.20 |
$24 |
0.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$18.40 |
$23 |
0.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$100.42 |
$143.45 |
1.3× |
| Ribs bilateral 3 views (71110) |
— |
$139.20 |
— |
| Scanogram (77073) |
— |
$100 |
— |
| Scapula complete (73010) |
$19.20 |
$24 |
0.2× |
| Small bowel series (74250) |
$118 |
$118 |
0.8× |
| Spine thoracic 3 views (72072) |
$123.18 |
$120.98 |
1.4× |
| Thoracolumbar 2 views (72080) |
$24 |
$30 |
0.3× |
| Tmj unilateral (70328) |
— |
$90 |
— |
| Ultrasound, abdomen limited (76705) |
$61.60 |
$77 |
0.7× |
| Upper Extremity Infant (73092) |
$16.80 |
$21 |
0.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$283 |
— |
| Us abdl aorta screen aaa (76706) |
$57.60 |
$72 |
0.6× |
| Us breast unilateral complete (76641) |
$76.80 |
$96 |
0.9× |
| Us chest (76604) |
$60 |
$75 |
0.7× |
| Us compl joint r-t w/image documentation (76881) |
$96 |
$120 |
1.1× |
| Us pelvic non ob complete (76856) |
$72 |
$90 |
0.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$168.70 |
$241 |
1.9× |
| Us pregnancy ltd (76815) |
$68 |
$85 |
0.8× |
| Us retroperitoneal complete (76770) |
$77.60 |
$97 |
0.9× |
| Us retroperitoneal limited (76775) |
$208.39 |
$297.70 |
2.3× |
| Us scrotum and contents (76870) |
$67.20 |
$84 |
0.7× |
| Us soft tissue head/neck (76536) |
$59.20 |
$74 |
0.7× |
| Us xtr non-vasc lmtd (76882) |
$21.92 |
$31.31 |
0.2× |
| Venography extremity unilateral rs&i (75820) |
— |
$1,025 |
— |
| Wrist 2 views (73100) |
$17.60 |
$22 |
0.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$33.60 |
$42 |
0.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
— |
$109 |
— |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$18.40 |
$23 |
0.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
— |
$200 |
— |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$17.60 |
$22 |
0.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$100.42 |
$143.45 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$20 |
$25 |
0.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$24 |
$30 |
0.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$86.18 |
$123.12 |
1.0× |
| X-ray exam of femur 1 (73551) |
$16.80 |
$21 |
0.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$28 |
$35 |
0.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$93.91 |
$108.58 |
1.3× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$17.60 |
$22 |
0.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$87.81 |
$125.44 |
1.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$19.20 |
$24 |
0.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$24.80 |
$31 |
0.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$165.05 |
$235.79 |
2.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
— |
$88 |
— |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$24 |
$30 |
0.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$131.22 |
$187.45 |
1.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$17.60 |
$22 |
0.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
— |
$50 |
— |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$29.60 |
$37 |
0.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$124.40 |
$133.86 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$23.20 |
$29 |
0.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$106.96 |
$120 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$137.40 |
$160.64 |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$24 |
$30 |
0.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$100.42 |
$72 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$16.80 |
$21 |
0.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$24 |
$30 |
0.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$93.91 |
$109.58 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$137.40 |
$147.14 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$19.20 |
$24 |
0.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$76.40 |
$95.22 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$47 |
$47 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$20.80 |
$26 |
0.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$21.60 |
$27 |
0.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$93.91 |
$134.16 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$14.40 |
$18 |
0.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$19.20 |
$24 |
0.3× |
| Xr c-spine 6 or more views (72052) |
$107.87 |
$137 |
1.2× |
| Xr chest 4+ views (71048) |
$137.40 |
$196.29 |
1.5× |
| Xr Cholecystography Oral Contrast (74290) |
$110 |
$110 |
0.7× |
| Xr finger(s) 2+ views (73140) |
$15.20 |
$19 |
0.2× |
| Xr shoulder 1 view (73020) |
$16.80 |
$21 |
0.2× |
| Xr spine cervical 4 or 5 views (72050) |
$82.92 |
$118.45 |
0.9× |
| Xr tibia/fibula 2 views (73590) |
$16.80 |
$21 |
0.2× |
| Xr tmj bilateral (70330) |
$90 |
$90 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$17.60 |
$22 |
0.2× |