| Abdomen 2 views (74019) |
$95.80 |
$122.50 |
1.1× |
| Bone survey complete (77075) |
$179.08 |
$229 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$93.06 |
$119 |
1.2× |
| Chest 1 view (71045) |
$78.98 |
$101 |
1.1× |
| Chest 3 views (71047) |
$103.62 |
$132.50 |
1.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$207.23 |
$265 |
1.4× |
| Clavicle complete (73000) |
$85.63 |
$109.50 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$241.64 |
$309 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,079.16 |
$1,380 |
3.6× |
| CT abdomen and pelvis without contrast (74176) |
$676.82 |
$865.50 |
3.3× |
| CT abdomen w contrast (74160) |
$613.87 |
$785 |
4.1× |
| CT abdomen w wo contrast (74170) |
$784.34 |
$1,003 |
5.2× |
| CT abdomen w/o contrast (74150) |
$503.61 |
$644 |
5.6× |
| CT angiography upper extremity lt (73206) |
$599.01 |
$766 |
4.0× |
| CT c-spine w/o contrast (72125) |
$548.96 |
$702 |
6.1× |
| CT cervical spine w&w/o contrast (72127) |
$743.68 |
$951 |
4.9× |
| CT chest w/wo contrast (71270) |
$742.12 |
$949 |
4.9× |
| CT chest with contrast (71260) |
$547.79 |
$700.50 |
3.6× |
| CT head/brain with contrast (70460) |
$529.02 |
$676.50 |
3.5× |
| CT head/brain without and with contrast (70470) |
$719.44 |
$920 |
4.8× |
| CT iac w contrast (70481) |
$504.78 |
$645.50 |
3.3× |
| CT lower ext w/o (73700) |
$477.80 |
$611 |
5.3× |
| CT lower extremity w wo contrast (73702) |
$609.96 |
$780 |
4.0× |
| CT lower extremity with contrast (73701) |
$547.79 |
$700.50 |
3.6× |
| CT lumbar spine w & w/o contrast (72133) |
$655.70 |
$838.50 |
4.3× |
| CT lumbar spine w/o contrast (72131) |
$584.94 |
$748 |
6.5× |
| CT maxillofacial w contrast (70487) |
$335.08 |
$428.50 |
2.2× |
| CT maxillofacial w/o contrast (70486) |
$485.62 |
$621 |
5.4× |
| CT maxillofacial w/wo contrast (70488) |
$407.42 |
$521 |
2.7× |
| CT neck soft tissue w contrast (70491) |
$566.56 |
$724.50 |
3.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$567.34 |
$725.50 |
3.8× |
| CT orbits w/o contrast (70480) |
$518.86 |
$663.50 |
5.8× |
| CT pelvis w & w/o contrast (72194) |
$774.96 |
$991 |
5.1× |
| CT pelvis w/o contrast (72192) |
$499.70 |
$639 |
5.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$638.11 |
$816 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$517.68 |
$662 |
5.7× |
| CT thoracic spine w/o contrast (72128) |
$573.99 |
$734 |
6.4× |
| CT thoracic spine w/wo contrast (72130) |
$656.88 |
$840 |
4.3× |
| CT thorax w/o contrast (71250) |
$499.30 |
$638.50 |
5.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$643.98 |
$823.50 |
4.3× |
| CT upper extremity w/o contrast rt (73200) |
$498.14 |
$637 |
5.5× |
| CT upper extremity with contrast (73201) |
$615.04 |
$786.50 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$808.98 |
$1,034.50 |
5.3× |
| Cta Abdomen (74175) |
$625.60 |
$800 |
4.1× |
| CTA abdomen pelvis (74174) |
$1,120.60 |
$1,433 |
3.7× |
| CTA chest (71275) |
$591.97 |
$757 |
3.9× |
| Cta Head (70496) |
$604.88 |
$773.50 |
4.0× |
| Cta Neck (70498) |
$483.66 |
$618.50 |
3.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$78.98 |
$101 |
0.9× |
| Esophagus (74220) |
$200.58 |
$256.50 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$113.78 |
$145.50 |
0.6× |
| Forearm 2 views (73090) |
$82.50 |
$105.50 |
1.1× |
| Hand 2 views (73120) |
$129.81 |
$166 |
1.4× |
| Hand 3 views (73130) |
$90.32 |
$115.50 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$85.24 |
$109 |
1.1× |
| Hysterosalpingogram (74740) |
$197.46 |
$252.50 |
1.0× |
| Knee 3 views (73562) |
$93.84 |
$120 |
1.3× |
| MRA head w & w/o contrast (70546) |
$894.61 |
$1,144 |
3.0× |
| MRA head w/o contrast (70544) |
$599.40 |
$766.50 |
2.9× |
| MRA head with contrast (70545) |
$607.22 |
$776.50 |
2.0× |
| MRA neck w contrast (70548) |
$669 |
$855.50 |
2.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$935.27 |
$1,196 |
3.1× |
| MRA neck w/o contrast (70547) |
$601.75 |
$769.50 |
2.9× |
| MRI abdomen w contrast (74182) |
$754.63 |
$965 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$844.17 |
$1,079.50 |
2.8× |
| MRI abdomen w/o contrast (74181) |
$530.20 |
$678 |
2.6× |
| MRI any jnt lwr ext with con lt (73722) |
$763.62 |
$976.50 |
1.1× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$761.28 |
$973.50 |
1.1× |
| MRI c-spine with contrast (72142) |
$663.14 |
$848 |
2.2× |
| MRI cervical spine w/o contrast (72141) |
$460.60 |
$589 |
2.2× |
| MRI chest w/o & w/contrast material (71552) |
$1,146.80 |
$1,466.50 |
3.8× |
| MRI chest w/o contrast (71550) |
$783.56 |
$1,002 |
3.8× |
| MRI chest with contrast (71551) |
$824.62 |
$1,054.50 |
1.2× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$807.02 |
$1,032 |
2.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$685.03 |
$876 |
2.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$584.94 |
$748 |
2.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$546.62 |
$699 |
2.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$819.14 |
$1,047.50 |
2.7× |
| MRI orbit/face/neck w/contrast (70542) |
$738.99 |
$945 |
2.5× |
| MRI pelvis w contrast (72196) |
$679.16 |
$868.50 |
2.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$840.65 |
$1,075 |
2.8× |
| MRI pelvis w/o contrast (72195) |
$602.92 |
$771 |
2.9× |
| MRI scan of arm joint before and after contrast (73223) |
$891.48 |
$1,140 |
3.0× |
| MRI scan of leg joint before and after contrast (73723) |
$839.08 |
$1,073 |
2.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$773.40 |
$989 |
2.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$654.54 |
$837 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$772.62 |
$988 |
2.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$658.84 |
$842.50 |
2.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$742.90 |
$950 |
2.5× |
| MRI thoracic spine w/o contrast (72146) |
$460.20 |
$588.50 |
2.2× |
| MRI tmj (70336) |
$644.37 |
$824 |
3.1× |
| MRI upper ext joint w/o contrast (73221) |
$486.02 |
$621.50 |
2.4× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,000.57 |
$1,279.50 |
3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$723.35 |
$925 |
3.5× |
| Neck soft tissue (70360) |
$84.46 |
$108 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$227.96 |
$291.50 |
2.5× |
| Osseous survey limited (77074) |
$117.30 |
$150 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$81.33 |
$104 |
0.9× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$841.04 |
$1,075.50 |
2.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$123.56 |
$158 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$123.94 |
$158.50 |
1.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$144.67 |
$185 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$96.97 |
$124 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$83.68 |
$107 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$116.52 |
$149 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$265.88 |
$340 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$258.06 |
$330 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$226.39 |
$289.50 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$88.76 |
$113.50 |
1.2× |
| Radiological examination surgical specimen (76098) |
$324.92 |
$415.50 |
0.7× |
| Ribs bilateral 3 views (71110) |
$97.75 |
$125 |
1.1× |
| Scapula complete (73010) |
$77.42 |
$99 |
0.9× |
| Sella turcica (70240) |
$78.20 |
$100 |
1.0× |
| Small bowel series (74250) |
$241.24 |
$308.50 |
1.6× |
| Speech evaluation complex (70371) |
$209.58 |
$268 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$200.19 |
$256 |
2.2× |
| Urethrocystography voiding (74455) |
$254.54 |
$325.50 |
1.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$269.40 |
$344.50 |
1.8× |
| Us abdl aorta screen aaa (76706) |
$207.23 |
$265 |
2.3× |
| Us breast unilateral complete (76641) |
$175.17 |
$224 |
1.9× |
| Us breast unilateral limited (76642) |
$154.06 |
$197 |
2.1× |
| Us chest (76604) |
$176.34 |
$225.50 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$139.58 |
$178.50 |
1.5× |
| Us ob transvaginal (76817) |
$192.76 |
$246.50 |
2.1× |
| Us pelvic non ob complete (76856) |
$230.30 |
$294.50 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$162.66 |
$208 |
1.8× |
| Us pregnancy ltd (76815) |
$127.86 |
$163.50 |
1.4× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$230.30 |
$294.50 |
2.6× |
| Us retroperitoneal complete (76770) |
$251.02 |
$321 |
2.8× |
| Us retroperitoneal limited (76775) |
$125.12 |
$160 |
1.4× |
| Us scrotum and contents (76870) |
$207.23 |
$265 |
2.3× |
| Us soft tissue head/neck (76536) |
$226.78 |
$290 |
2.5× |
| Us xtr non-vasc lmtd (76882) |
$148.19 |
$189.50 |
1.6× |
| Venogram extremity bilateral (75822) |
$703.80 |
$900 |
0.5× |
| Venography extremity unilateral rs&i (75820) |
$674.48 |
$862.50 |
0.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$140.76 |
$180 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$74.29 |
$95 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$89.54 |
$114.50 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$410.16 |
$524.50 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$82.50 |
$105.50 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$86.02 |
$110 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$86.02 |
$110 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$100.88 |
$129 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$100.48 |
$128.50 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$87.58 |
$112 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$81.72 |
$104.50 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$93.06 |
$119 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$141.94 |
$181.50 |
1.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$90.71 |
$116 |
1.2× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$76.64 |
$98 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$101.27 |
$129.50 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$89.93 |
$115 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$125.12 |
$160 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$143.50 |
$183.50 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$92.66 |
$118.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$85.63 |
$109.50 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$87.98 |
$112.50 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$91.10 |
$116.50 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$135.28 |
$173 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$59.82 |
$76.50 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$94.62 |
$121 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$86.80 |
$111 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$86.41 |
$110.50 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$82.11 |
$105 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$94.23 |
$120.50 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$143.10 |
$183 |
1.6× |
| Xr chest 4+ views (71048) |
$111.04 |
$142 |
1.2× |
| Xr Cholecystography Oral Contrast (74290) |
$165.40 |
$211.50 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$91.10 |
$116.50 |
1.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$93.45 |
$119.50 |
1.0× |
| Xr optic foramina (70190) |
$82.89 |
$106 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$144.28 |
$184.50 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$84.84 |
$108.50 |
1.1× |
| Xr tmj bilateral (70330) |
$105.96 |
$135.50 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$96.97 |
$124 |
1.3× |