| Abdomen 2 views (74019) |
$205.90 |
$382 |
1.8× |
| Ankle 2 views (73600) |
$215.60 |
$400 |
2.3× |
| Arthrogram hip (73525) |
$423.65 |
$786 |
1.1× |
| Arthrogram shoulder (73040) |
$384.85 |
$714 |
1.0× |
| Bone age studies (77072) |
$87.86 |
$163 |
0.8× |
| Bone survey complete (77075) |
$558.40 |
$1,036 |
5.0× |
| Cervical spine 2 or 3 views (72040) |
$256.02 |
$475 |
2.8× |
| Chest 1 view (71045) |
$148.22 |
$275 |
1.6× |
| Chest xray 3 views (71047) |
$150.92 |
$280 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$447.37 |
$830 |
2.4× |
| Clavicle complete (73000) |
$218.29 |
$405 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,521.06 |
$2,822 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,141.60 |
$2,118 |
4.5× |
| CT abdomen w contrast (74160) |
$1,141.60 |
$2,118 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,065.60 |
$1,977 |
5.7× |
| CT abdomen w/o contrast (74150) |
$744.36 |
$1,381 |
6.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,526.99 |
$2,833 |
8.2× |
| CT angiography upper extremity lt (73206) |
$1,790.56 |
$3,322 |
9.6× |
| CT c-spine w/contrast (72126) |
$1,442.36 |
$2,676 |
3.9× |
| CT c-spine w/o contrast (72125) |
$950.26 |
$1,763 |
8.5× |
| CT chest w contrast (71260) |
$1,141.60 |
$2,118 |
6.1× |
| CT chest w/wo contrast (71270) |
$1,141.60 |
$2,118 |
6.1× |
| CT head/brain with contrast (70460) |
$989.60 |
$1,836 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,141.60 |
$2,118 |
6.1× |
| CT iac w contrast (70481) |
$989.60 |
$1,836 |
5.3× |
| CT limited/localized follow up study (76380) |
$542.77 |
$1,007 |
5.8× |
| CT lower ext w/o (73700) |
$907.14 |
$1,683 |
8.1× |
| CT lower extremity w wo contrast (73702) |
$1,442.36 |
$2,676 |
7.7× |
| CT lower extremity w/contrast material (73701) |
$1,360.97 |
$2,525 |
7.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,932.85 |
$3,586 |
10.3× |
| CT lumbar spine w/contrast (72132) |
$1,217.06 |
$2,258 |
3.3× |
| CT lumbar spine w/o contrast (72131) |
$1,141.60 |
$2,118 |
10.2× |
| CT maxillofacial w contrast (70487) |
$1,141.60 |
$2,118 |
6.1× |
| CT maxillofacial wo contrast (70486) |
$1,141.60 |
$2,118 |
10.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,644.33 |
$4,906 |
14.1× |
| CT orbits w/o contrast (70480) |
$912.53 |
$1,693 |
8.2× |
| CT pelvis w/o contrast (72192) |
$936.78 |
$1,738 |
8.4× |
| CT pelvis w/wo contrast (72194) |
$1,297.91 |
$2,408 |
6.9× |
| CT soft tissue neck w contrast (70491) |
$989.60 |
$1,836 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$912.53 |
$1,693 |
8.2× |
| CT thoracic spine w/contrast (72129) |
$1,442.36 |
$2,676 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$950.26 |
$1,763 |
8.5× |
| CT thorax w/o contrast (71250) |
$761.61 |
$1,413 |
6.8× |
| CT upper ext wo (73200) |
$985.29 |
$1,828 |
8.8× |
| CT upper extremity with contrast (73201) |
$897.97 |
$1,666 |
2.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$380.53 |
$706 |
2.0× |
| Cta Abdomen (74175) |
$1,521.06 |
$2,822 |
8.1× |
| CTA abdomen pelvis (74174) |
$2,717.64 |
$5,042 |
7.3× |
| CTA chest (71275) |
$1,521.06 |
$2,822 |
8.1× |
| Cta Head (70496) |
$1,743.66 |
$3,235 |
9.3× |
| Cta Neck (70498) |
$1,814.81 |
$3,367 |
9.7× |
| Cta Pelvis (72191) |
$1,597.06 |
$2,963 |
8.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$362.75 |
$673 |
3.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$229.07 |
$425 |
2.5× |
| Esophagus (74220) |
$372.99 |
$692 |
2.0× |
| Facial bones min 3 views (70150) |
$376.22 |
$698 |
3.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$328.79 |
$610 |
2.9× |
| Foot 2 views (73620) |
$182.72 |
$339 |
2.0× |
| Forearm 2 views (73090) |
$242.55 |
$450 |
2.6× |
| Hand 2 views (73120) |
$184.34 |
$342 |
1.7× |
| Hysterosalpingogram (74740) |
$375.68 |
$697 |
1.5× |
| Knee 3 views (73562) |
$322.86 |
$599 |
3.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,647.72 |
$3,057 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,789.71 |
$7,031 |
10.2× |
| MRA head w & w/o contrast (70546) |
$2,662.12 |
$4,939 |
7.1× |
| MRA head w/o contrast (70544) |
$1,521.06 |
$2,822 |
6.0× |
| MRA neck w contrast (70548) |
$2,815.20 |
$5,223 |
7.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,815.20 |
$5,223 |
7.6× |
| MRA neck w/o contrast (70547) |
$1,736.66 |
$3,222 |
6.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,119.19 |
$5,787 |
8.4× |
| MRI abdomen w/o contrast (74181) |
$1,716.18 |
$3,184 |
6.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,802.95 |
$3,345 |
2.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,335.33 |
$6,188 |
9.0× |
| MRI c-spine with contrast (72142) |
$1,959.80 |
$3,636 |
5.3× |
| MRI cervical spine w/o contrast (72141) |
$1,521.06 |
$2,822 |
6.0× |
| MRI chest w/o & w/contrast material (71552) |
$3,119.19 |
$5,787 |
8.4× |
| MRI chest w/o contrast (71550) |
$59.29 |
$110 |
0.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,048.74 |
$3,801 |
5.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,789.71 |
$7,031 |
10.2× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,562.02 |
$2,898 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,043.19 |
$5,646 |
11.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,043.19 |
$5,646 |
8.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,166.09 |
$5,874 |
8.5× |
| MRI pelvis w/o contrast (72195) |
$1,554.48 |
$2,884 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,233.46 |
$5,999 |
8.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,018.55 |
$3,745 |
5.4× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,233.46 |
$5,999 |
8.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,233.46 |
$5,999 |
8.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,635.33 |
$3,034 |
6.4× |
| MRI up ext w/o contrast (73218) |
$1,550.16 |
$2,876 |
6.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,550.16 |
$2,876 |
6.1× |
| MRI, joint upper extrem combo (73223) |
$3,121.89 |
$5,792 |
8.4× |
| Myelogram Lumbar (72265) |
$557.33 |
$1,034 |
0.7× |
| Neck soft tissue (70360) |
$152 |
$282 |
1.6× |
| Ob us nuchal meas 1 gest (76813) |
$62.52 |
$116 |
0.6× |
| Pelvis 1 or 2 views (72170) |
$131.52 |
$244 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$242.55 |
$450 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$218.29 |
$405 |
2.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$218.29 |
$405 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$298.07 |
$553 |
3.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$372.45 |
$691 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$161.70 |
$300 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$218.29 |
$405 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$269.50 |
$500 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$164.93 |
$306 |
1.8× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$356.28 |
$661 |
3.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$288.36 |
$535 |
2.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$437.13 |
$811 |
3.9× |
| Radex Humerus Minimum 2 Views (73060) |
$178.41 |
$331 |
1.9× |
| Radex Kne 1/2 Views (73560) |
$295.37 |
$548 |
3.2× |
| Radex Kne Compl 4/More Views (73564) |
$349.81 |
$649 |
3.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$178.41 |
$331 |
1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$269.50 |
$500 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$218.29 |
$405 |
2.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$269.50 |
$500 |
2.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$341.19 |
$633 |
3.7× |
| Radex Toe Minimum 2 Views (73660) |
$173.56 |
$322 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$242.55 |
$450 |
2.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$272.73 |
$506 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$152 |
$282 |
1.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$88.93 |
$165 |
0.8× |
| Radiologic exam chest 2 views (71046) |
$152 |
$282 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$485.10 |
$900 |
2.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$420.96 |
$781 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$524.45 |
$973 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$342.80 |
$636 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$178.41 |
$331 |
1.9× |
| Ribs bilateral 3 views (71110) |
$299.68 |
$556 |
2.7× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$259.52 |
$481.50 |
1.0× |
| Scapula (73010) |
$218.29 |
$405 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$122.35 |
$227 |
5.2× |
| Shoulder 1 view (73020) |
$215.60 |
$400 |
2.3× |
| Small bowel series (74250) |
$480.79 |
$892 |
2.6× |
| Spine thoracic 3 views (72072) |
$344.96 |
$640 |
3.1× |
| Tbs technical calculation only (77091) |
$19.40 |
$36 |
0.2× |
| Thoracolumbar 2 views (72080) |
$239.32 |
$444 |
2.6× |
| Ultrasound breast complete (76641) |
$409.64 |
$760 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$303.46 |
$563 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$195.66 |
$363 |
1.8× |
| Umbilical-artery Doppler (OB) (76820) |
$246.86 |
$458 |
2.2× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$258.18 |
$479 |
2.8× |
| Us breast unilateral limited (76642) |
$312.62 |
$580 |
3.4× |
| Us chest (76604) |
$195.38 |
$362.50 |
1.8× |
| Us compl joint r-t w/image documentation (76881) |
$242.55 |
$450 |
2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$171.13 |
$317.50 |
1.5× |
| Us ob limited (76815) |
$168.44 |
$312.50 |
1.5× |
| Us ob transvaginal (76817) |
$187.84 |
$348.50 |
1.7× |
| Us pelvic non ob complete (76856) |
$501.81 |
$931 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$166.82 |
$309.50 |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$426.35 |
$791 |
3.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$416.65 |
$773 |
3.7× |
| Us retroperitoneal complete (76770) |
$430.12 |
$798 |
3.9× |
| Us retroperitoneal limited (76775) |
$150.92 |
$280 |
1.4× |
| Us scrotum and contents (76870) |
$291.60 |
$541 |
2.6× |
| Us soft tissue head/neck (76536) |
$271.12 |
$503 |
2.4× |
| Us spinal canal and contents (76800) |
$472.70 |
$877 |
4.2× |
| Us, eye b-scan (76512) |
$29.38 |
$54.50 |
0.3× |
| Wrist 2 views (73100) |
$230.69 |
$428 |
2.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$228.54 |
$424 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$269.50 |
$500 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$191.34 |
$355 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$178.41 |
$331 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$356.28 |
$661 |
3.2× |
| X-ray exam of femur 2/> (73552) |
$218.29 |
$405 |
2.3× |
| X-ray eye for foreign body (70030) |
$111.57 |
$207 |
1.2× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$269.50 |
$500 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$230.69 |
$428 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$318.55 |
$591 |
3.4× |
| X-ray leg, infant (73592) |
$274.35 |
$509 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$298.07 |
$553 |
2.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$384.31 |
$713 |
3.4× |
| X-ray nose-rectum child f.b. (76010) |
$6.47 |
$12 |
0.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$292.14 |
$542 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$242.55 |
$450 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$299.68 |
$556 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$384.85 |
$714 |
3.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$170.32 |
$316 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$239.32 |
$444 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$292.14 |
$542 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$323.40 |
$600 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$222.07 |
$412 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$137.98 |
$256 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$218.29 |
$405 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$178.41 |
$331 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$239.32 |
$444 |
2.1× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$449.53 |
$834 |
4.0× |
| Xr bone length studies (77073) |
$256.02 |
$475 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$384.31 |
$713 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$384.31 |
$713 |
3.4× |
| Xr chest 4+ views (71048) |
$205.90 |
$382 |
1.8× |