| Abdomen 2 views (74019) |
$126 |
$180 |
1.3× |
| Ankle 2 views (73600) |
$84 |
$120 |
1.1× |
| Bone age studies (77072) |
$112 |
$160 |
1.2× |
| Bone survey complete (77075) |
$357 |
$510 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$129.50 |
$185 |
1.6× |
| Chest 1 view (71045) |
$91 |
$130 |
1.2× |
| Chest 3 views (71047) |
$150.50 |
$215 |
1.9× |
| Clavicle complete (73000) |
$105 |
$150 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$689.50 |
$985 |
7.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,872.50 |
$2,675 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,246 |
$1,780 |
5.8× |
| CT abdomen w contrast (74160) |
$1,081.50 |
$1,545 |
6.8× |
| CT abdomen w/o contrast (74150) |
$896 |
$1,280 |
9.5× |
| CT c-spine w/o contrast (72125) |
$973 |
$1,390 |
10.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,386 |
$1,980 |
8.8× |
| CT cervical spine with contrast (72126) |
$1,158.50 |
$1,655 |
3.7× |
| CT chest w/wo contrast (71270) |
$1,263.50 |
$1,805 |
8.0× |
| CT chest with contrast (71260) |
$1,085 |
$1,550 |
6.9× |
| CT head/brain with contrast (70460) |
$1,004.50 |
$1,435 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,046.50 |
$1,495 |
6.6× |
| CT iac w contrast (70481) |
$1,186.50 |
$1,695 |
7.5× |
| CT lower ext w/o (73700) |
$906.50 |
$1,295 |
9.6× |
| CT lower extremity w wo contrast (73702) |
$1,421 |
$2,030 |
9.0× |
| CT lower extremity with contrast (73701) |
$1,071 |
$1,530 |
6.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,431.50 |
$2,045 |
9.0× |
| CT lumbar spine w/o contrast (72131) |
$952 |
$1,360 |
10.1× |
| CT lumbar spine with contrast (72132) |
$1,176 |
$1,680 |
3.7× |
| CT maxillofacial w contrast (70487) |
$1,053.50 |
$1,505 |
6.7× |
| CT maxillofacial w/o contrast (70486) |
$805 |
$1,150 |
8.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,200.50 |
$1,715 |
7.6× |
| CT neck soft tissue w contrast (70491) |
$1,116.50 |
$1,595 |
7.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,330 |
$1,900 |
8.4× |
| CT orbits w/o contrast (70480) |
$959 |
$1,370 |
10.2× |
| CT pelvis w & w/o contrast (72194) |
$1,333.50 |
$1,905 |
8.4× |
| CT pelvis w/o contrast (72192) |
$997.50 |
$1,425 |
10.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,330 |
$1,900 |
8.4× |
| CT soft tissue neck w/o contrast (70490) |
$868 |
$1,240 |
9.2× |
| CT thoracic spine w/contrast (72129) |
$1,144.50 |
$1,635 |
7.2× |
| CT thoracic spine w/o contrast (72128) |
$998.20 |
$1,426 |
10.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,270.50 |
$1,815 |
8.0× |
| CT thorax w/o contrast (71250) |
$938 |
$1,340 |
9.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,309 |
$1,870 |
8.3× |
| CT upper extremity w/o contrast rt (73200) |
$931 |
$1,330 |
9.9× |
| CT upper extremity with contrast (73201) |
$1,060.50 |
$1,515 |
3.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,054.50 |
$2,935 |
13.0× |
| Cta Abdomen (74175) |
$1,564.50 |
$2,235 |
9.9× |
| CTA abdomen pelvis (74174) |
$2,149.70 |
$3,071 |
6.8× |
| CTA chest (71275) |
$1,550.50 |
$2,215 |
9.8× |
| Cta Head (70496) |
$1,753.50 |
$2,505 |
11.1× |
| Cta Neck (70498) |
$1,680 |
$2,400 |
10.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$294 |
$420 |
3.1× |
| Esophagus (74220) |
$213.55 |
$305.07 |
1.3× |
| Foot 2 views (73620) |
$84 |
$120 |
1.1× |
| Forearm 2 views (73090) |
$116.59 |
$166.56 |
1.5× |
| Hand 2 views (73120) |
$105 |
$150 |
1.1× |
| Hand 3 views (73130) |
$126 |
$180 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$42 |
$60 |
0.5× |
| Knee 3 views (73562) |
$133 |
$190 |
1.7× |
| MRA head w & w/o contrast (70546) |
$2,898 |
$4,140 |
9.2× |
| MRA head w/o contrast (70544) |
$1,750 |
$2,500 |
8.1× |
| MRA head with contrast (70545) |
$2,023 |
$2,890 |
6.4× |
| MRA neck w contrast (70548) |
$2,072 |
$2,960 |
6.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,674 |
$3,820 |
8.5× |
| MRA neck w/o contrast (70547) |
$1,736 |
$2,480 |
8.1× |
| MRI abdomen w contrast (74182) |
$1,897 |
$2,710 |
6.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,898 |
$4,140 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$1,638 |
$2,340 |
7.6× |
| MRI any jnt lwr ext with con lt (73722) |
$2,079 |
$2,970 |
2.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,984.50 |
$2,835 |
2.8× |
| MRI c-spine with contrast (72142) |
$1,981 |
$2,830 |
6.3× |
| MRI cervical spine w/o contrast (72141) |
$1,690.50 |
$2,415 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,982 |
$4,260 |
9.5× |
| MRI chest w/o contrast (71550) |
$1,792 |
$2,560 |
8.3× |
| MRI chest with contrast (71551) |
$2,005.50 |
$2,865 |
2.8× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,837.50 |
$2,625 |
5.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,995 |
$2,850 |
6.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,683.50 |
$2,405 |
7.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,641.50 |
$2,345 |
7.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,224.25 |
$3,177.50 |
7.1× |
| MRI orbit/face/neck w/contrast (70542) |
$1,907.50 |
$2,725 |
6.1× |
| MRI pelvis w contrast (72196) |
$2,012.50 |
$2,875 |
6.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,754.50 |
$3,935 |
8.8× |
| MRI pelvis w/o contrast (72195) |
$1,788.50 |
$2,555 |
8.3× |
| MRI scan of arm joint before and after contrast (73223) |
$2,562 |
$3,660 |
8.1× |
| MRI scan of leg joint before and after contrast (73723) |
$2,597 |
$3,710 |
8.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,894.50 |
$4,135 |
9.2× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,257.50 |
$3,225 |
7.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,698.50 |
$3,855 |
8.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,953 |
$2,790 |
6.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,824.50 |
$4,035 |
9.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,750 |
$2,500 |
8.1× |
| MRI tmj (70336) |
$1,743 |
$2,490 |
8.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,610 |
$2,300 |
7.5× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$2,562 |
$3,660 |
8.1× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,624 |
$2,320 |
7.5× |
| Neck soft tissue (70360) |
$105 |
$150 |
1.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$399 |
$570 |
4.2× |
| Pelvis 1 or 2 views (72170) |
$126 |
$180 |
1.3× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$2,632 |
$3,760 |
8.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$157.50 |
$225 |
1.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$325.50 |
$465 |
3.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$140 |
$200 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$108.50 |
$155 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$119 |
$170 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$126 |
$180 |
1.6× |
| Ribs bilateral 3 views (71110) |
$150.50 |
$215 |
1.6× |
| Scanogram (77073) |
$105 |
$150 |
1.1× |
| Scapula complete (73010) |
$120.09 |
$171.56 |
1.3× |
| Sella turcica (70240) |
$112 |
$160 |
1.4× |
| Tmj unilateral (70328) |
$112 |
$160 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$367.50 |
$525 |
3.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$557.03 |
$795.75 |
3.5× |
| Us abdl aorta screen aaa (76706) |
$367.50 |
$525 |
3.9× |
| Us breast unilateral limited (76642) |
$232.40 |
$332 |
3.0× |
| Us chest (76604) |
$322 |
$460 |
3.4× |
| Us compl joint r-t w/image documentation (76881) |
$192.55 |
$275.07 |
2.0× |
| Us kidney transplant (76776) |
$581 |
$830 |
6.2× |
| Us ob detailed single fetus (76811) |
$822.50 |
$1,175 |
3.8× |
| Us ob transvaginal (76817) |
$378 |
$540 |
4.0× |
| Us pelvic non ob complete (76856) |
$378 |
$540 |
4.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$259 |
$370 |
2.7× |
| Us pregnancy ltd (76815) |
$311.50 |
$445 |
3.3× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$434 |
$620 |
4.6× |
| Us retroperitoneal complete (76770) |
$430.50 |
$615 |
4.6× |
| Us retroperitoneal limited (76775) |
$304.50 |
$435 |
3.2× |
| Us scrotum and contents (76870) |
$423.50 |
$605 |
4.5× |
| Us soft tissue head/neck (76536) |
$371 |
$530 |
3.9× |
| Us xtr non-vasc lmtd (76882) |
$286.65 |
$409.50 |
3.0× |
| Wrist 2 views (73100) |
$126 |
$180 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$112 |
$160 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$150.50 |
$215 |
1.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$98 |
$140 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$129.50 |
$185 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$112 |
$160 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$154 |
$220 |
2.0× |
| X-ray exam of femur 1 (73551) |
$113.09 |
$161.56 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$154 |
$220 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$124.68 |
$178.11 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$114.84 |
$164.06 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$98 |
$140 |
1.2× |
| X-ray IV pyelogram+drip infusn (74410) |
$557.03 |
$795.75 |
3.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$98 |
$140 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$199.52 |
$285.03 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$140 |
$200 |
1.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$189 |
$270 |
2.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$119 |
$170 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$147 |
$210 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$122.50 |
$175 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$150.50 |
$215 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$185.50 |
$265 |
2.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$150.50 |
$215 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$122.50 |
$175 |
1.6× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$157.50 |
$225 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$140 |
$200 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$175 |
$250 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$140 |
$200 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$143.50 |
$205 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$119 |
$170 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$133 |
$190 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$105 |
$150 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$136.50 |
$195 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$378 |
$540 |
4.0× |
| Xr finger(s) 2+ views (73140) |
$115.50 |
$165 |
1.5× |
| Xr shoulder 1 view (73020) |
$107.84 |
$154.06 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$196 |
$280 |
2.1× |
| Xr tibia/fibula 2 views (73590) |
$118.34 |
$169.06 |
1.5× |
| Xr tmj bilateral (70330) |
$161.88 |
$231.25 |
2.1× |
| Xray knee 1 or 2 views rt (73560) |
$120.09 |
$171.56 |
1.5× |