| Abdomen 2 views (74019) |
$147.96 |
$197.28 |
1.4× |
| Antegrade urography radiological supvj & interpj (74425) |
$307.04 |
$409.38 |
0.9× |
| Arthrogram hip (73525) |
$614.07 |
$818.76 |
1.8× |
| Arthrogram shoulder (73040) |
$614.07 |
$818.76 |
1.8× |
| Arthrogram wrist (73115) |
$409.92 |
$546.56 |
1.2× |
| Arthrography knee lt (73580) |
$614.07 |
$818.76 |
1.8× |
| Bone age studies (77072) |
$94.20 |
$125.59 |
0.9× |
| Bone survey complete (77075) |
$176.65 |
$235.53 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$127.47 |
$169.96 |
1.5× |
| Chest 1 view (71045) |
$110.55 |
$147.40 |
1.3× |
| Chest 3 views (71047) |
$143.29 |
$191.05 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$143.49 |
$191.32 |
0.8× |
| Clavicle complete (73000) |
$104.70 |
$139.60 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$849.77 |
$1,133.03 |
8.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,583.36 |
$2,111.15 |
4.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,490.84 |
$1,987.78 |
6.2× |
| CT abdomen w contrast (74160) |
$894.50 |
$1,192.67 |
5.1× |
| CT abdomen w wo contrast (74170) |
$1,058.41 |
$1,411.21 |
6.0× |
| CT abdomen w/o contrast (74150) |
$894.50 |
$1,192.67 |
8.5× |
| CT angiography upper extremity lt (73206) |
$1,290.79 |
$1,721.05 |
7.3× |
| CT c-spine w/o contrast (72125) |
$826.10 |
$1,101.47 |
7.9× |
| CT cervical spine w&w/o contrast (72127) |
$745.69 |
$994.25 |
4.2× |
| CT cervical spine with contrast (72126) |
$745.69 |
$994.25 |
2.1× |
| CT chest w/wo contrast (71270) |
$1,013.73 |
$1,351.64 |
5.8× |
| CT chest with contrast (71260) |
$894.50 |
$1,192.67 |
5.1× |
| CT head/brain with contrast (70460) |
$745.69 |
$994.25 |
4.2× |
| CT head/brain without and with contrast (70470) |
$1,061.66 |
$1,415.54 |
6.0× |
| CT iac w contrast (70481) |
$745.43 |
$993.90 |
4.2× |
| CT limited/localized follow up study (76380) |
$274.29 |
$365.72 |
3.1× |
| CT lower ext w/o (73700) |
$931.78 |
$1,242.37 |
8.9× |
| CT lower extremity w wo contrast (73702) |
$931.78 |
$1,242.37 |
5.3× |
| CT lower extremity with contrast (73701) |
$931.78 |
$1,242.37 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,341.76 |
$1,789.01 |
7.6× |
| CT lumbar spine w/o contrast (72131) |
$894.50 |
$1,192.67 |
8.5× |
| CT lumbar spine with contrast (72132) |
$894.50 |
$1,192.67 |
2.6× |
| CT maxillofacial w contrast (70487) |
$563.64 |
$751.52 |
3.2× |
| CT maxillofacial w/o contrast (70486) |
$894.50 |
$1,192.67 |
8.5× |
| CT maxillofacial w/wo contrast (70488) |
$648.90 |
$865.20 |
3.7× |
| CT neck soft tissue w contrast (70491) |
$407.23 |
$542.97 |
2.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$745.43 |
$993.90 |
4.2× |
| CT orbits w/o contrast (70480) |
$745.43 |
$993.90 |
7.1× |
| CT pelvis w & w/o contrast (72194) |
$1,061.66 |
$1,415.54 |
6.0× |
| CT pelvis w/o contrast (72192) |
$894.50 |
$1,192.67 |
8.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$688.42 |
$917.89 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$479.10 |
$638.80 |
4.6× |
| CT thoracic spine w/contrast (72129) |
$563.64 |
$751.52 |
3.2× |
| CT thoracic spine w/o contrast (72128) |
$550.96 |
$734.61 |
5.3× |
| CT thoracic spine w/wo contrast (72130) |
$688.42 |
$917.89 |
3.9× |
| CT thorax w/o contrast (71250) |
$894.50 |
$1,192.67 |
8.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$563.64 |
$751.52 |
3.2× |
| CT upper extremity w/o contrast rt (73200) |
$563.64 |
$751.52 |
5.4× |
| CT upper extremity with contrast (73201) |
$563.64 |
$751.52 |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,290.79 |
$1,721.05 |
7.3× |
| Cta Abdomen (74175) |
$479.10 |
$638.80 |
2.7× |
| CTA abdomen pelvis (74174) |
$790.99 |
$1,054.65 |
2.3× |
| CTA chest (71275) |
$1,204.73 |
$1,606.31 |
6.9× |
| Cta Head (70496) |
$1,135.04 |
$1,513.38 |
6.5× |
| CTA lwr ext w&w/o contrast (73706) |
$1,204.73 |
$1,606.31 |
6.9× |
| Cta Neck (70498) |
$1,204.73 |
$1,606.31 |
6.9× |
| Cta Pelvis (72191) |
$1,204.73 |
$1,606.31 |
6.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$307.28 |
$409.70 |
2.9× |
| Echoencephalography real time imaging (76506) |
$150.59 |
$200.79 |
1.4× |
| Esophagus (74220) |
$165.02 |
$220.02 |
0.9× |
| Fetal biophysical profile non-stress testing (76818) |
$223.74 |
$298.32 |
2.1× |
| Fluoroscopy up to 1 hr (76000) |
$183.45 |
$244.60 |
0.8× |
| Forearm 2 views (73090) |
$102.43 |
$136.57 |
1.2× |
| Hand 3 views (73130) |
$102.40 |
$136.54 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$108.12 |
$144.16 |
1.2× |
| Knee 3 views (73562) |
$162.11 |
$216.14 |
1.9× |
| MRA head w & w/o contrast (70546) |
$1,093.52 |
$1,458.02 |
3.1× |
| MRA head w/o contrast (70544) |
$1,024.24 |
$1,365.65 |
4.3× |
| MRA head with contrast (70545) |
$1,024.24 |
$1,365.65 |
2.9× |
| MRA neck w contrast (70548) |
$890.64 |
$1,187.52 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,093.52 |
$1,458.02 |
3.1× |
| MRA neck w/o contrast (70547) |
$890.64 |
$1,187.52 |
3.7× |
| MRI abdomen w contrast (74182) |
$950.88 |
$1,267.84 |
2.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,118.68 |
$1,491.57 |
3.2× |
| MRI abdomen w/o contrast (74181) |
$950.88 |
$1,267.84 |
4.0× |
| MRI any jnt lwr ext with con lt (73722) |
$1,382.74 |
$1,843.65 |
1.8× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,024.24 |
$1,365.65 |
1.3× |
| MRI bone marrow blood supply (77084) |
$774.47 |
$1,032.62 |
3.2× |
| MRI c-spine with contrast (72142) |
$1,024.24 |
$1,365.65 |
2.9× |
| MRI cervical spine w/o contrast (72141) |
$1,118.68 |
$1,491.57 |
4.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,118.68 |
$1,491.57 |
3.2× |
| MRI chest w/o contrast (71550) |
$950.88 |
$1,267.84 |
4.0× |
| MRI chest with contrast (71551) |
$950.88 |
$1,267.84 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,280.30 |
$1,707.06 |
3.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,280.73 |
$1,707.64 |
5.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$890.64 |
$1,187.52 |
3.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,286.48 |
$1,715.31 |
3.7× |
| MRI orbit/face/neck w/contrast (70542) |
$890.64 |
$1,187.52 |
2.5× |
| MRI pelvis w contrast (72196) |
$1,280.30 |
$1,707.06 |
3.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,450.40 |
$1,933.86 |
4.2× |
| MRI pelvis w/o contrast (72195) |
$1,280.30 |
$1,707.06 |
5.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,024.24 |
$1,365.65 |
2.9× |
| MRI scan of leg joint before and after contrast (73723) |
$1,485.19 |
$1,980.25 |
4.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,024.24 |
$1,365.65 |
2.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,365.66 |
$1,820.88 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,529.57 |
$2,039.42 |
4.4× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$925.06 |
$1,233.41 |
2.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,118.68 |
$1,491.57 |
3.2× |
| MRI thoracic spine w/o contrast (72146) |
$890.64 |
$1,187.52 |
3.7× |
| MRI tmj (70336) |
$559.55 |
$746.07 |
2.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,280.30 |
$1,707.06 |
5.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,280.30 |
$1,707.06 |
3.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,024.24 |
$1,365.65 |
4.3× |
| Myelogram Cervical (72240) |
$550.41 |
$733.88 |
0.7× |
| Myelogram Lumbar (72265) |
$550.41 |
$733.88 |
0.7× |
| Myelography 2 or more regions (72270) |
$1,085.11 |
$1,446.81 |
1.4× |
| Neck soft tissue (70360) |
$79.67 |
$106.22 |
0.9× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$138.98 |
$185.31 |
1.3× |
| Osseous survey infant (77076) |
$111.87 |
$149.16 |
1.1× |
| Osseous survey limited (77074) |
$129.08 |
$172.11 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$120.65 |
$160.86 |
1.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,280.30 |
$1,707.06 |
3.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$97.88 |
$130.50 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$161.25 |
$215 |
1.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$155.75 |
$207.66 |
1.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$161.25 |
$215 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$119.49 |
$159.32 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$113.81 |
$151.74 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$149.58 |
$199.44 |
1.7× |
| Radiologic exam colon single contrast study (74270) |
$202.13 |
$269.50 |
1.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$173.28 |
$231.04 |
1.0× |
| Radiologic exam upr gi trc single contrast study (74240) |
$160.52 |
$214.02 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$108.12 |
$144.16 |
1.2× |
| Ribs bilateral 3 views (71110) |
$216.23 |
$288.31 |
2.1× |
| Scanogram (77073) |
$171.79 |
$229.05 |
1.6× |
| Scapula complete (73010) |
$98.96 |
$131.94 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$39.71 |
$52.94 |
1.7× |
| Small bowel series (74250) |
$216.23 |
$288.31 |
1.2× |
| Spine thoracic 3 views (72072) |
$165.02 |
$220.02 |
1.6× |
| Thoracolumbar 2 views (72080) |
$121.14 |
$161.52 |
1.4× |
| Tmj unilateral (70328) |
$94.67 |
$126.22 |
1.1× |
| Tomogram (76100) |
$172.10 |
$229.47 |
1.6× |
| Ultrasound scan to determine eye length and lens power (76519) |
$96.08 |
$128.10 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$126.32 |
$168.43 |
1.2× |
| Unlisted Ultrasound Procedure (76999) |
$145.91 |
$194.55 |
1.7× |
| Upper Extremity Infant (73092) |
$89.53 |
$119.37 |
0.9× |
| Urethrocystography voiding (74455) |
$183.45 |
$244.60 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$256.05 |
$341.40 |
1.5× |
| Urograpy infusion drip &/bolus techq w/wo tomo (74415) |
$284.51 |
$379.35 |
1.6× |
| Us abdl aorta screen aaa (76706) |
$273.14 |
$364.18 |
2.6× |
| Us breast unilateral complete (76641) |
$394.46 |
$525.95 |
3.8× |
| Us breast unilateral limited (76642) |
$121.27 |
$161.69 |
1.4× |
| Us chest (76604) |
$256.01 |
$341.34 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$261.76 |
$349.01 |
2.5× |
| Us ob transvaginal (76817) |
$214.59 |
$286.12 |
2.0× |
| Us pelvic non ob complete (76856) |
$341.42 |
$455.22 |
3.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$170.90 |
$227.86 |
1.6× |
| Us pregnancy ltd (76815) |
$216.23 |
$288.31 |
2.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$220.58 |
$294.10 |
2.1× |
| Us retroperitoneal complete (76770) |
$327.76 |
$437.01 |
3.1× |
| Us retroperitoneal limited (76775) |
$124.35 |
$165.80 |
1.2× |
| Us scrotum and contents (76870) |
$307.28 |
$409.70 |
2.9× |
| Us soft tissue head/neck (76536) |
$210.30 |
$280.40 |
2.0× |
| Us transrectal (76872) |
$257.30 |
$343.06 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$130.88 |
$174.50 |
1.2× |
| Venography extremity unilateral rs&i (75820) |
$662.76 |
$883.68 |
0.4× |
| Wrist 2 views (73100) |
$102.43 |
$136.57 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$261.26 |
$348.34 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$75.71 |
$100.94 |
0.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$102.43 |
$136.57 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$173.28 |
$231.04 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$116.09 |
$154.79 |
1.3× |
| X-ray exam entire spi 4/5 vw (72083) |
$161.25 |
$215 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$108.12 |
$144.16 |
1.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$154.78 |
$206.37 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$102.43 |
$136.57 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$102.43 |
$136.57 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$169 |
$225.34 |
1.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$65.84 |
$87.78 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$127.47 |
$169.96 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$178.13 |
$237.51 |
1.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$121.97 |
$162.63 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$102.43 |
$136.57 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$119.49 |
$159.32 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$91.43 |
$121.91 |
0.9× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$307.04 |
$409.38 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$113.81 |
$151.74 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$170.72 |
$227.62 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$284.51 |
$379.35 |
2.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$119.49 |
$159.32 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$127.47 |
$169.96 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$113.81 |
$151.74 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$100.95 |
$134.60 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$154.78 |
$206.37 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$100.95 |
$134.60 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$79.67 |
$106.22 |
0.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$84.12 |
$112.16 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$127.47 |
$169.96 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$102.43 |
$136.57 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$108.78 |
$145.04 |
1.2× |
| Xr c-spine 6 or more views (72052) |
$198.02 |
$264.03 |
1.9× |
| Xr chest 4+ views (71048) |
$149.73 |
$199.64 |
1.4× |
| Xr Cholecystography Oral Contrast (74290) |
$160.52 |
$214.02 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$102.43 |
$136.57 |
1.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$159.92 |
$213.23 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$102.43 |
$136.57 |
1.2× |
| Xr tmj bilateral (70330) |
$90.15 |
$120.20 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$102.43 |
$136.57 |
1.2× |