| Abdomen 2 views (74019) |
$58 |
$232 |
0.6× |
| Angiography extremity bilateral rs&i (75716) |
$2,973.75 |
$11,895 |
1.0× |
| Angiography extremity unilateral rs&i (75710) |
$1,982.50 |
$7,930 |
0.7× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$3,302.50 |
$13,210 |
0.6× |
| Ankle 2 views (73600) |
$69.38 |
$277.54 |
0.8× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$2,180.75 |
$8,723 |
0.7× |
| Aortography abdominal serialography rs&i (75625) |
$1,982.50 |
$7,930 |
0.7× |
| Arthrogram hip (73525) |
$314.88 |
$1,259.53 |
0.9× |
| Arthrogram shoulder (73040) |
$314.88 |
$1,259.53 |
0.9× |
| Arthrography knee lt (73580) |
$430.70 |
$1,722.81 |
1.3× |
| Bone age studies (77072) |
$75.50 |
$302 |
0.8× |
| Bone survey complete (77075) |
$77.25 |
$309 |
0.8× |
| Cervical spine 2 or 3 views (72040) |
$69.38 |
$277.54 |
0.8× |
| Chest 1 view (71045) |
$69.60 |
$278.40 |
0.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$110.77 |
$443.10 |
0.7× |
| Cisternography Positive Contrast Rs&I (70015) |
$476.75 |
$1,907 |
0.6× |
| Clavicle complete (73000) |
$69.38 |
$277.54 |
0.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$75.50 |
$302 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$899.07 |
$3,596.29 |
2.7× |
| CT abdomen and pelvis without contrast (74176) |
$917.78 |
$3,671.11 |
4.0× |
| CT abdomen w contrast (74160) |
$459.30 |
$1,837.20 |
2.7× |
| CT abdomen w wo contrast (74170) |
$517.40 |
$2,069.60 |
3.1× |
| CT abdomen w/o contrast (74150) |
$297.18 |
$1,188.74 |
3.0× |
| CT c-spine w/o contrast (72125) |
$524.44 |
$2,097.78 |
5.2× |
| CT cervical spine w&w/o contrast (72127) |
$517.40 |
$2,069.60 |
3.1× |
| CT cervical spine with contrast (72126) |
$465.36 |
$1,861.43 |
1.4× |
| CT chest w/wo contrast (71270) |
$517.40 |
$2,069.60 |
3.1× |
| CT chest with contrast (71260) |
$465.36 |
$1,861.43 |
2.8× |
| CT head/brain with contrast (70460) |
$465.36 |
$1,861.43 |
2.8× |
| CT head/brain without and with contrast (70470) |
$699.26 |
$2,797.04 |
4.1× |
| CT iac w contrast (70481) |
$561 |
$2,244 |
3.3× |
| CT lower ext w/o (73700) |
$349.63 |
$1,398.52 |
3.5× |
| CT lower extremity w wo contrast (73702) |
$517.40 |
$2,069.60 |
3.1× |
| CT lower extremity with contrast (73701) |
$320.75 |
$1,283 |
1.9× |
| CT lumbar spine w & w/o contrast (72133) |
$517.40 |
$2,069.60 |
3.1× |
| CT lumbar spine w/o contrast (72131) |
$524.44 |
$2,097.78 |
5.2× |
| CT lumbar spine with contrast (72132) |
$465.36 |
$1,861.43 |
1.4× |
| CT maxillofacial w contrast (70487) |
$465.36 |
$1,861.43 |
2.8× |
| CT maxillofacial w/o contrast (70486) |
$611.85 |
$2,447.41 |
6.1× |
| CT maxillofacial w/wo contrast (70488) |
$517.40 |
$2,069.60 |
3.1× |
| CT neck soft tissue w contrast (70491) |
$465.36 |
$1,861.43 |
2.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$517.40 |
$2,069.60 |
3.1× |
| CT orbits w/o contrast (70480) |
$611.85 |
$2,447.41 |
6.1× |
| CT pelvis w & w/o contrast (72194) |
$517.40 |
$2,069.60 |
3.1× |
| CT pelvis w/o contrast (72192) |
$437.04 |
$1,748.16 |
4.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$517.40 |
$2,069.60 |
3.1× |
| CT soft tissue neck w/o contrast (70490) |
$297.18 |
$1,188.74 |
3.0× |
| CT thoracic spine w/contrast (72129) |
$465.36 |
$1,861.43 |
2.8× |
| CT thoracic spine w/o contrast (72128) |
$437.04 |
$1,748.16 |
4.3× |
| CT thoracic spine w/wo contrast (72130) |
$517.40 |
$2,069.60 |
3.1× |
| CT thorax w/o contrast (71250) |
$297.18 |
$1,188.74 |
3.0× |
| CT upper extremity w/o contrast rt (73200) |
$297.18 |
$1,188.74 |
3.0× |
| CT upper extremity with contrast (73201) |
$465.36 |
$1,861.43 |
1.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$338 |
$1,352 |
2.0× |
| Cta Abdomen (74175) |
$121.75 |
$487 |
0.7× |
| CTA abdomen pelvis (74174) |
$250 |
$1,000 |
0.7× |
| CTA chest (71275) |
$524.18 |
$2,096.74 |
3.1× |
| Cta Head (70496) |
$524.18 |
$2,096.74 |
3.1× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$524.18 |
$2,096.74 |
1.6× |
| Cta Neck (70498) |
$524.18 |
$2,096.74 |
3.1× |
| Cta Pelvis (72191) |
$524.18 |
$2,096.74 |
3.1× |
| Diskogram cervical (72285) |
$1,377.89 |
$5,511.56 |
0.7× |
| Diskography lumbar (72295) |
$1,377.89 |
$5,511.56 |
0.7× |
| Esophagus (74220) |
$170.50 |
$682 |
1.0× |
| Fluoroscopy up to 1 hr (76000) |
$158.75 |
$635 |
0.7× |
| Foot 2 views (73620) |
$69.38 |
$277.54 |
0.8× |
| Forearm 2 views (73090) |
$273.60 |
$1,094.40 |
3.3× |
| Functional MRI brain by tech (70554) |
$84.75 |
$339 |
0.4× |
| Hand 2 views (73120) |
$69.38 |
$277.54 |
0.7× |
| Hand 3 views (73130) |
$76.50 |
$306 |
0.9× |
| Humerus Min 2 Views Left (73060) |
$69.38 |
$277.54 |
0.8× |
| Hysterosalpingogram (74740) |
$305.11 |
$1,220.44 |
1.3× |
| Knee 3 views (73562) |
$69.38 |
$277.54 |
0.8× |
| Mr safety determination physician/other qhp (76016) |
$66.25 |
$265 |
0.8× |
| Mr safety implant pos&/immoblj supvj phys/qhp (76019) |
$44.75 |
$179 |
0.8× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$18.75 |
$75 |
0.7× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$69 |
$276 |
0.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$181.50 |
$726 |
0.8× |
| MRA head w & w/o contrast (70546) |
$548.50 |
$2,194 |
1.6× |
| MRA head w/o contrast (70544) |
$498.70 |
$1,994.81 |
2.2× |
| MRA head with contrast (70545) |
$642.29 |
$2,569.17 |
1.9× |
| MRA neck w contrast (70548) |
$548.50 |
$2,194 |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$603.25 |
$2,413 |
1.8× |
| MRA neck w/o contrast (70547) |
$498.70 |
$1,994.81 |
2.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$764.81 |
$3,059.24 |
2.3× |
| MRI abdomen w/o contrast (74181) |
$158.75 |
$635 |
0.7× |
| MRI any jnt lwr ext with con lt (73722) |
$624.18 |
$2,496.73 |
0.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$624.18 |
$2,496.73 |
0.8× |
| MRI c-spine with contrast (72142) |
$642.27 |
$2,569.09 |
1.9× |
| MRI cervical spine w/o contrast (72141) |
$582.20 |
$2,328.82 |
2.5× |
| MRI chest w/o & w/contrast material (71552) |
$754.87 |
$3,019.47 |
2.2× |
| MRI chest w/o contrast (71550) |
$416.69 |
$1,666.76 |
1.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$484.65 |
$1,938.62 |
2.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$498.70 |
$1,994.81 |
2.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$786.98 |
$3,147.91 |
2.3× |
| MRI orbit/face/neck w/contrast (70542) |
$642.27 |
$2,569.09 |
1.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$764.81 |
$3,059.24 |
2.3× |
| MRI pelvis w/o contrast (72195) |
$484.65 |
$1,938.62 |
2.1× |
| MRI scan of arm joint before and after contrast (73223) |
$618.75 |
$2,475 |
1.8× |
| MRI scan of leg joint before and after contrast (73723) |
$588.50 |
$2,354 |
1.8× |
| MRI spectroscopy (76390) |
$2,520.26 |
$10,081.05 |
30.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$786.98 |
$3,147.91 |
2.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$624.18 |
$2,496.73 |
1.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$764.81 |
$3,059.24 |
2.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$480.50 |
$1,922 |
1.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$764.81 |
$3,059.24 |
2.3× |
| MRI thoracic spine w/o contrast (72146) |
$484.65 |
$1,938.62 |
2.1× |
| MRI tmj (70336) |
$159 |
$636 |
0.7× |
| MRI upper ext joint w/o contrast (73221) |
$484.65 |
$1,938.62 |
2.1× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$131.25 |
$525 |
0.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$159 |
$636 |
0.7× |
| Neck soft tissue (70360) |
$58 |
$232 |
0.7× |
| Pelvis 1 or 2 views (72170) |
$69.38 |
$277.54 |
0.7× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$764.81 |
$3,059.24 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$106.63 |
$426.54 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$176.56 |
$706.26 |
1.8× |
| Radex hips bilateral with pelvis 2 views (73521) |
$176.56 |
$706.26 |
1.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$58 |
$232 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$77.75 |
$311 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$69.60 |
$278.40 |
0.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$54.50 |
$218 |
0.7× |
| Radiological examination surgical specimen (76098) |
$339.25 |
$1,357 |
0.6× |
| Ribs bilateral 3 views (71110) |
$74 |
$296 |
0.7× |
| Sacroiliac Joints < 3 Views (72200) |
$69.38 |
$277.54 |
0.7× |
| Scapula complete (73010) |
$77.75 |
$311 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$97.42 |
$389.67 |
1.0× |
| Small bowel series (74250) |
$121.25 |
$485 |
0.7× |
| Spine thoracic 3 views (72072) |
$69.38 |
$277.54 |
0.7× |
| Thoracolumbar 2 views (72080) |
$69.38 |
$277.54 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$243 |
$972 |
2.4× |
| Us elastography parenchyma (76981) |
$77.75 |
$311 |
0.8× |
| Us pelvic non ob complete (76856) |
$77.75 |
$311 |
0.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$77.75 |
$311 |
0.8× |
| Us retroperitoneal complete (76770) |
$77.75 |
$311 |
0.8× |
| Us retroperitoneal limited (76775) |
$77.75 |
$311 |
0.8× |
| Us soft tissue head/neck (76536) |
$98.70 |
$394.80 |
1.0× |
| Us xtr non-vasc lmtd (76882) |
$74 |
$296 |
0.7× |
| Wrist 2 views (73100) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$96.25 |
$385 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$43 |
$172 |
0.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$42 |
$168 |
0.5× |
| X-ray exam hip uni 1 view (73501) |
$106.63 |
$426.54 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$106.63 |
$426.54 |
1.3× |
| X-ray exam hip uni 4/> views (73503) |
$117.50 |
$470 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$77.25 |
$309 |
0.8× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$92.70 |
$370.80 |
0.9× |
| X-ray eye for foreign body (70030) |
$43 |
$172 |
0.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$56.25 |
$225 |
0.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$97.18 |
$388.75 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$69.38 |
$277.54 |
0.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$116.90 |
$467.60 |
1.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$69.38 |
$277.54 |
0.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$43 |
$172 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$74 |
$296 |
0.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$69.38 |
$277.54 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$86.73 |
$346.92 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$65 |
$260 |
0.8× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$74 |
$296 |
0.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$69.38 |
$277.54 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$69.38 |
$277.54 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$69.38 |
$277.54 |
0.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$92.70 |
$370.80 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$43 |
$172 |
0.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$63.75 |
$255 |
0.8× |
| Xr c-spine 6 or more views (72052) |
$116.90 |
$467.60 |
1.2× |
| Xr finger(s) 2+ views (73140) |
$69.38 |
$277.54 |
0.8× |
| Xr shoulder 1 view (73020) |
$55 |
$220 |
0.7× |
| Xr spine cervical 4 or 5 views (72050) |
$116.90 |
$467.60 |
1.2× |
| Xr tibia/fibula 2 views (73590) |
$69.38 |
$277.54 |
0.8× |
| Xr tmj bilateral (70330) |
$55 |
$220 |
0.7× |
| Xray knee 1 or 2 views rt (73560) |
$69.38 |
$277.54 |
0.8× |