| Abdomen 2 views (74019) |
$171.50 |
$171.50 |
1.6× |
| Ankle 2 views (73600) |
$174 |
$174 |
2.0× |
| Antegrade urography radiological supvj & interpj (74425) |
$55 |
$55 |
0.2× |
| Arthrogram elbow (73085) |
$519 |
$519 |
1.5× |
| Arthrogram hip (73525) |
$515 |
$515 |
1.5× |
| Arthrogram shoulder (73040) |
$337.50 |
$337.50 |
1.0× |
| Arthrogram wrist (73115) |
$238.50 |
$238.50 |
0.7× |
| Arthrography knee lt (73580) |
$240.50 |
$240.50 |
0.7× |
| Bone age studies (77072) |
$201.50 |
$201.50 |
1.9× |
| Bone survey complete (77075) |
$623.50 |
$623.50 |
5.9× |
| Cervical spine 2 or 3 views (72040) |
$242.50 |
$242.50 |
2.8× |
| Chest 1 view (71045) |
$68 |
$68 |
0.8× |
| Chest 3 views (71047) |
$117 |
$117 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$393.50 |
$393.50 |
2.2× |
| Clavicle complete (73000) |
$210 |
$210 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,180.50 |
$1,180.50 |
3.4× |
| CT abdomen and pelvis without contrast (74176) |
$645 |
$645 |
2.7× |
| CT abdomen w contrast (74160) |
$2,100.50 |
$2,100.50 |
11.9× |
| CT abdomen w wo contrast (74170) |
$2,510 |
$2,510 |
14.2× |
| CT abdomen w/o contrast (74150) |
$1,594.50 |
$1,594.50 |
15.2× |
| CT angiography upper extremity lt (73206) |
$2,058.50 |
$2,058.50 |
11.7× |
| CT c-spine w/o contrast (72125) |
$1,837.50 |
$1,837.50 |
17.5× |
| CT cervical spine w&w/o contrast (72127) |
$2,200 |
$2,200 |
12.5× |
| CT cervical spine with contrast (72126) |
$2,068 |
$2,068 |
5.9× |
| CT chest w/wo contrast (71270) |
$2,144.50 |
$2,144.50 |
12.2× |
| CT chest with contrast (71260) |
$1,817.50 |
$1,817.50 |
10.3× |
| CT head/brain with contrast (70460) |
$1,708.50 |
$1,708.50 |
9.7× |
| CT head/brain without and with contrast (70470) |
$2,119 |
$2,119 |
12.0× |
| CT iac w contrast (70481) |
$1,741 |
$1,741 |
9.9× |
| CT limited/localized follow up study (76380) |
$153 |
$153 |
1.8× |
| CT lower ext w/o (73700) |
$1,688.50 |
$1,688.50 |
16.1× |
| CT lower extremity w wo contrast (73702) |
$1,685 |
$1,685 |
9.6× |
| CT lower extremity with contrast (73701) |
$1,506.50 |
$1,506.50 |
8.5× |
| CT lumbar spine w & w/o contrast (72133) |
$2,371 |
$2,371 |
13.5× |
| CT lumbar spine w/o contrast (72131) |
$1,992 |
$1,992 |
19.0× |
| CT lumbar spine with contrast (72132) |
$2,263 |
$2,263 |
6.5× |
| CT maxillofacial w contrast (70487) |
$1,716 |
$1,716 |
9.7× |
| CT maxillofacial w/o contrast (70486) |
$1,344 |
$1,344 |
12.8× |
| CT maxillofacial w/wo contrast (70488) |
$1,838 |
$1,838 |
10.4× |
| CT neck soft tissue w contrast (70491) |
$1,715 |
$1,715 |
9.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,737 |
$1,737 |
9.9× |
| CT orbits w/o contrast (70480) |
$1,491.50 |
$1,491.50 |
14.2× |
| CT pelvis w & w/o contrast (72194) |
$2,254 |
$2,254 |
12.8× |
| CT pelvis w/o contrast (72192) |
$1,474 |
$1,474 |
14.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,941.50 |
$1,941.50 |
11.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,534.50 |
$1,534.50 |
14.6× |
| CT thoracic spine w/contrast (72129) |
$1,829.50 |
$1,829.50 |
10.4× |
| CT thoracic spine w/o contrast (72128) |
$1,735 |
$1,735 |
16.5× |
| CT thoracic spine w/wo contrast (72130) |
$2,163 |
$2,163 |
12.3× |
| CT thorax w/o contrast (71250) |
$1,524 |
$1,524 |
14.5× |
| CT unlisted procedure (76497) |
$981 |
$981 |
11.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,585 |
$1,585 |
9.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,401 |
$1,401 |
13.3× |
| CT upper extremity with contrast (73201) |
$1,497 |
$1,497 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$660 |
$660 |
3.7× |
| Cta Abdomen (74175) |
$2,168.50 |
$2,168.50 |
12.3× |
| CTA abdomen pelvis (74174) |
$2,046 |
$2,046 |
5.8× |
| CTA chest (71275) |
$2,264 |
$2,264 |
12.8× |
| Cta Head (70496) |
$2,273 |
$2,273 |
12.9× |
| CTA lwr ext w&w/o contrast (73706) |
$2,128.50 |
$2,128.50 |
12.1× |
| Cta Neck (70498) |
$2,214.50 |
$2,214.50 |
12.6× |
| Cta Pelvis (72191) |
$2,017 |
$2,017 |
11.4× |
| Esophagus (74220) |
$425 |
$425 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$406 |
$406 |
1.7× |
| Foot 2 views (73620) |
$185 |
$185 |
2.1× |
| Forearm 2 views (73090) |
$242 |
$242 |
2.8× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$168 |
$168 |
0.7× |
| Hand 2 views (73120) |
$210 |
$210 |
2.0× |
| Hand 3 views (73130) |
$225.50 |
$225.50 |
2.6× |
| Humerus Min 2 Views Left (73060) |
$199 |
$199 |
2.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$199.50 |
$199.50 |
1.9× |
| Knee 3 views (73562) |
$222 |
$222 |
2.5× |
| Manual appl stress pfrmd phys/qhp joint films (77071) |
$162 |
$162 |
1.9× |
| MRA head w & w/o contrast (70546) |
$2,692.50 |
$2,692.50 |
7.7× |
| MRA head w/o contrast (70544) |
$1,848 |
$1,848 |
7.7× |
| MRA head with contrast (70545) |
$2,093 |
$2,093 |
6.0× |
| MRA neck w contrast (70548) |
$2,252.50 |
$2,252.50 |
6.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,485 |
$2,485 |
7.1× |
| MRA neck w/o contrast (70547) |
$1,815 |
$1,815 |
7.6× |
| MRI abdomen w contrast (74182) |
$2,048.50 |
$2,048.50 |
5.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,003.50 |
$3,003.50 |
8.6× |
| MRI abdomen w/o contrast (74181) |
$1,850 |
$1,850 |
7.7× |
| MRI any jnt lwr ext with con lt (73722) |
$1,961.50 |
$1,961.50 |
2.5× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,085.50 |
$2,085.50 |
2.6× |
| MRI c-spine with contrast (72142) |
$2,286.50 |
$2,286.50 |
6.5× |
| MRI cervical spine w/o contrast (72141) |
$2,120.50 |
$2,120.50 |
8.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,175 |
$2,175 |
6.2× |
| MRI chest w/o contrast (71550) |
$1,776.50 |
$1,776.50 |
7.4× |
| MRI chest with contrast (71551) |
$1,909.50 |
$1,909.50 |
2.4× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,885.50 |
$1,885.50 |
5.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,950.50 |
$1,950.50 |
5.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,894 |
$1,894 |
7.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,000 |
$2,000 |
8.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,596.50 |
$2,596.50 |
7.4× |
| MRI orbit/face/neck w/contrast (70542) |
$2,118.50 |
$2,118.50 |
6.0× |
| MRI pelvis w contrast (72196) |
$2,157 |
$2,157 |
6.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,610.50 |
$2,610.50 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$1,882.50 |
$1,882.50 |
7.9× |
| MRI scan of arm joint before and after contrast (73223) |
$2,660 |
$2,660 |
7.6× |
| MRI scan of leg joint before and after contrast (73723) |
$2,587 |
$2,587 |
7.4× |
| MRI spectroscopy (76390) |
$1,470 |
$1,470 |
16.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,939.50 |
$2,939.50 |
8.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,284 |
$2,284 |
6.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,915.50 |
$2,915.50 |
8.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,234.50 |
$2,234.50 |
6.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,927.50 |
$2,927.50 |
8.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,120.50 |
$2,120.50 |
8.8× |
| MRI tmj (70336) |
$654.50 |
$654.50 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,886.50 |
$1,886.50 |
7.9× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,741.50 |
$2,741.50 |
7.8× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$935 |
$935 |
3.9× |
| Myelogram Cervical (72240) |
$845 |
$845 |
1.1× |
| Myelogram Lumbar (72265) |
$1,097.50 |
$1,097.50 |
1.4× |
| Myelogram thoracic (72255) |
$911 |
$911 |
1.2× |
| Myelography 2 or more regions (72270) |
$1,351.50 |
$1,351.50 |
1.7× |
| Neck soft tissue (70360) |
$132 |
$132 |
1.5× |
| Nm csf leak detection (78650) |
$797 |
$797 |
0.6× |
| Orthopantogram (70355) |
$34 |
$34 |
0.4× |
| Osseous survey infant (77076) |
$186 |
$186 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$204.50 |
$204.50 |
1.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,600 |
$2,600 |
7.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$318 |
$318 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$203.50 |
$203.50 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$236.50 |
$236.50 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$170 |
$170 |
1.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$105 |
$105 |
1.0× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$376.50 |
$376.50 |
3.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$262.50 |
$262.50 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$82 |
$82 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$165.50 |
$165.50 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$84 |
$84 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$520.50 |
$520.50 |
3.0× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$239.50 |
$239.50 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$452 |
$452 |
2.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$109 |
$109 |
0.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$120 |
$120 |
1.4× |
| Ribs bilateral 3 views (71110) |
$285.50 |
$285.50 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$128 |
$128 |
1.2× |
| Scanogram (77073) |
$330 |
$330 |
3.1× |
| Scapula complete (73010) |
$171.50 |
$171.50 |
1.6× |
| Sella turcica (70240) |
$93.50 |
$93.50 |
1.1× |
| Small bowel series (74250) |
$388.50 |
$388.50 |
2.2× |
| Spine thoracic 3 views (72072) |
$34 |
$34 |
0.3× |
| Temporomandble Jt Arthrography Rs&I (70332) |
$517 |
$517 |
2.2× |
| Thoracolumbar 2 views (72080) |
$229.50 |
$229.50 |
2.6× |
| Tmj unilateral (70328) |
$28 |
$28 |
0.3× |
| Tomogram (76100) |
$99 |
$99 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$519.50 |
$519.50 |
4.9× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$253 |
$253 |
2.9× |
| Unlisted fluoroscopic procedure (76496) |
$385.50 |
$385.50 |
4.4× |
| Unlisted magnetic resonance procedure (76498) |
$1,297.50 |
$1,297.50 |
14.8× |
| Unlisted Ultrasound Procedure (76999) |
$211 |
$211 |
2.4× |
| Upper Extremity Infant (73092) |
$94.50 |
$94.50 |
0.9× |
| Urethrocystography retrograde rs&i (74450) |
$278 |
$278 |
1.2× |
| Urethrocystography voiding (74455) |
$571.50 |
$571.50 |
2.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,226 |
$1,226 |
7.0× |
| Us breast unilateral complete (76641) |
$217 |
$217 |
2.1× |
| Us breast unilateral limited (76642) |
$190 |
$190 |
2.2× |
| Us chest (76604) |
$351 |
$351 |
3.3× |
| Us compl joint r-t w/image documentation (76881) |
$716 |
$716 |
6.8× |
| Us infant hips dynamic (76885) |
$253 |
$253 |
2.9× |
| Us infant hips limited static (76886) |
$242.50 |
$242.50 |
2.8× |
| Us kidney transplant (76776) |
$493 |
$493 |
4.7× |
| Us pelvic non ob complete (76856) |
$599.50 |
$599.50 |
5.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$540 |
$540 |
5.1× |
| Us retroperitoneal complete (76770) |
$501 |
$501 |
4.8× |
| Us retroperitoneal limited (76775) |
$368 |
$368 |
3.5× |
| Us scrotum and contents (76870) |
$525 |
$525 |
5.0× |
| Us soft tissue head/neck (76536) |
$477.50 |
$477.50 |
4.5× |
| Us spinal canal and contents (76800) |
$282.50 |
$282.50 |
2.7× |
| Us xtr non-vasc lmtd (76882) |
$472 |
$472 |
4.5× |
| Wrist 2 views (73100) |
$214.50 |
$214.50 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$174 |
$174 |
2.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$213 |
$213 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$221.50 |
$221.50 |
2.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$233.50 |
$233.50 |
2.7× |
| X-ray exam entire spi 4/5 vw (72083) |
$333.50 |
$333.50 |
3.2× |
| X-ray exam hip uni 1 view (73501) |
$97 |
$97 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$209.50 |
$209.50 |
2.4× |
| X-ray exam hip uni 4/> views (73503) |
$269.50 |
$269.50 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$297 |
$297 |
2.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$331 |
$331 |
3.2× |
| X-ray exam of femur 1 (73551) |
$110.50 |
$110.50 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$265.50 |
$265.50 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$178.50 |
$178.50 |
2.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$210.50 |
$210.50 |
2.4× |
| X-ray head for orthodontia (70350) |
$30 |
$30 |
0.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$199.50 |
$199.50 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$145 |
$145 |
1.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$258.50 |
$258.50 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$245.50 |
$245.50 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$91.50 |
$91.50 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$287.50 |
$287.50 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$54 |
$54 |
0.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$180 |
$180 |
2.1× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$28 |
$28 |
0.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$137.50 |
$137.50 |
1.3× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$255.50 |
$255.50 |
2.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$230.50 |
$230.50 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$225 |
$225 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$50 |
$50 |
0.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$215.50 |
$215.50 |
2.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$219 |
$219 |
2.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$226 |
$226 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$306 |
$306 |
3.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$140.50 |
$140.50 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$298.50 |
$298.50 |
2.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$188.50 |
$188.50 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$187.50 |
$187.50 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$220 |
$220 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$202 |
$202 |
2.3× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$56 |
$56 |
0.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$314 |
$314 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$34 |
$34 |
0.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$174 |
$174 |
2.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$249.50 |
$249.50 |
2.9× |
| Xr arthrogram ankle (73615) |
$239 |
$239 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$59 |
$59 |
0.6× |
| Xr chest 4+ views (71048) |
$146 |
$146 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$159 |
$159 |
1.8× |
| Xr internal auditory meati complete (70134) |
$307.50 |
$307.50 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$93 |
$93 |
0.9× |
| Xr optic foramina (70190) |
$95.50 |
$95.50 |
1.1× |
| Xr shoulder 1 view (73020) |
$154 |
$154 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$356 |
$356 |
3.4× |
| Xr tibia/fibula 2 views (73590) |
$205 |
$205 |
2.3× |
| Xr tmj bilateral (70330) |
$110.50 |
$110.50 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$201 |
$201 |
2.3× |