| Abdomen 2 views (74019) |
$111.15 |
$123.50 |
1.1× |
| Ankle 2 views (73600) |
$80.10 |
$89 |
0.9× |
| Bone age studies (77072) |
$85.05 |
$94.50 |
0.8× |
| Bone survey complete (77075) |
$292.05 |
$324.50 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$97.20 |
$108 |
1.1× |
| Chest 1 view (71045) |
$63 |
$70 |
0.7× |
| Chest xray 3 views (71047) |
$99.45 |
$110.50 |
1.2× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$250.65 |
$278.50 |
1.4× |
| Clavicle complete (73000) |
$80.10 |
$89 |
0.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$600.75 |
$667.50 |
5.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,186.20 |
$1,318 |
3.4× |
| CT abdomen and pelvis without contrast (74176) |
$766.80 |
$852 |
3.3× |
| CT abdomen w contrast (74160) |
$311.40 |
$346 |
1.8× |
| CT abdomen w wo contrast (74170) |
$949.05 |
$1,054.50 |
5.5× |
| CT abdomen w/o contrast (74150) |
$652.50 |
$725 |
6.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,003.50 |
$1,115 |
5.8× |
| CT angiography upper extremity lt (73206) |
$857.25 |
$952.50 |
4.9× |
| CT c-spine w/contrast (72126) |
$820.35 |
$911.50 |
2.4× |
| CT c-spine w/o contrast (72125) |
$631.80 |
$702 |
6.1× |
| CT cervical spine w&w/o contrast (72127) |
$915.30 |
$1,017 |
5.3× |
| CT chest w contrast (71260) |
$765.45 |
$850.50 |
4.4× |
| CT chest w/wo contrast (71270) |
$927.45 |
$1,030.50 |
5.4× |
| CT head/brain with contrast (70460) |
$473.85 |
$526.50 |
2.7× |
| CT head/brain without and with contrast (70470) |
$518.85 |
$576.50 |
3.0× |
| CT iac w contrast (70481) |
$557.10 |
$619 |
3.2× |
| CT limited/localized follow up study (76380) |
$474.30 |
$527 |
5.5× |
| CT lower ext w/o (73700) |
$616.50 |
$685 |
6.0× |
| CT lower extremity w wo contrast (73702) |
$825.30 |
$917 |
4.8× |
| CT lower extremity w/contrast material (73701) |
$727.65 |
$808.50 |
4.2× |
| CT lumbar spine w/contrast (72132) |
$967.50 |
$1,075 |
2.8× |
| CT lumbar spine w/o contrast (72131) |
$845.10 |
$939 |
8.2× |
| CT maxillofacial w contrast (70487) |
$495 |
$550 |
2.9× |
| CT maxillofacial w/wo contrast (70488) |
$622.35 |
$691.50 |
3.6× |
| CT maxillofacial wo contrast (70486) |
$427.50 |
$475 |
4.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$634.95 |
$705.50 |
3.7× |
| CT orbits w/o contrast (70480) |
$477 |
$530 |
4.6× |
| CT pelvis w/o contrast (72192) |
$604.35 |
$671.50 |
5.9× |
| CT pelvis w/wo contrast (72194) |
$912.15 |
$1,013.50 |
5.3× |
| CT soft tissue neck w contrast (70491) |
$512.10 |
$569 |
3.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$679.95 |
$755.50 |
3.9× |
| CT soft tissue neck w/o contrast (70490) |
$443.25 |
$492.50 |
4.3× |
| CT thoracic spine w/contrast (72129) |
$968.40 |
$1,076 |
5.6× |
| CT thoracic spine w/o contrast (72128) |
$639.45 |
$710.50 |
6.2× |
| CT thorax w/o contrast (71250) |
$600.75 |
$667.50 |
5.8× |
| CT upper ext wo (73200) |
$614.70 |
$683 |
6.0× |
| CT upper extremity with contrast (73201) |
$711.90 |
$791 |
2.1× |
| Cta Abdomen (74175) |
$982.80 |
$1,092 |
5.7× |
| CTA abdomen pelvis (74174) |
$1,211.85 |
$1,346.50 |
3.5× |
| CTA chest (71275) |
$945.90 |
$1,051 |
5.5× |
| Cta Head (70496) |
$791.55 |
$879.50 |
4.6× |
| Cta Neck (70498) |
$785.25 |
$872.50 |
4.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$199.35 |
$221.50 |
1.9× |
| Esophagus (74220) |
$253.35 |
$281.50 |
1.5× |
| Facial bones min 3 views (70150) |
$81 |
$90 |
0.8× |
| Fetal biophysical profile non-stress testing (76818) |
$332.10 |
$369 |
3.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$308.25 |
$342.50 |
3.0× |
| Fluoroscopy up to 1 hr (76000) |
$178.65 |
$198.50 |
0.8× |
| Foot 2 views (73620) |
$76.95 |
$85.50 |
0.9× |
| Forearm 2 views (73090) |
$77.40 |
$86 |
0.9× |
| Hand 2 views (73120) |
$73.80 |
$82 |
0.7× |
| Knee 3 views (73562) |
$99.90 |
$111 |
1.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,232.10 |
$1,369 |
3.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,780.20 |
$1,978 |
5.2× |
| MRA head w/o contrast (70544) |
$884.70 |
$983 |
3.8× |
| MRA neck w contrast (70548) |
$974.25 |
$1,082.50 |
2.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,364.85 |
$1,516.50 |
4.0× |
| MRA neck w/o contrast (70547) |
$918 |
$1,020 |
3.9× |
| MRI abdomen w contrast (74182) |
$1,555.20 |
$1,728 |
4.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,748.25 |
$1,942.50 |
5.1× |
| MRI abdomen w/o contrast (74181) |
$1,120.50 |
$1,245 |
4.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,332.90 |
$1,481 |
1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,628.55 |
$1,809.50 |
4.7× |
| MRI c-spine with contrast (72142) |
$1,457.55 |
$1,619.50 |
4.2× |
| MRI cervical spine w/o contrast (72141) |
$916.65 |
$1,018.50 |
3.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,409.85 |
$1,566.50 |
4.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,717.20 |
$1,908 |
5.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,244.25 |
$1,382.50 |
5.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$908.55 |
$1,009.50 |
3.9× |
| MRI orbit face neck w contrast (70542) |
$967.05 |
$1,074.50 |
2.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,426.50 |
$1,585 |
4.1× |
| MRI pelvis w/contrast (72196) |
$1,128.60 |
$1,254 |
3.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,674.45 |
$1,860.50 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,076.85 |
$1,196.50 |
4.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,664.55 |
$1,849.50 |
4.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,762.20 |
$1,958 |
5.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,714.95 |
$1,905.50 |
5.0× |
| MRI temporomandibular joint (70336) |
$916.65 |
$1,018.50 |
3.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,147.50 |
$1,275 |
4.9× |
| MRI up ext w/o contrast (73218) |
$1,252.80 |
$1,392 |
5.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,060.65 |
$1,178.50 |
4.5× |
| Neck soft tissue (70360) |
$58.95 |
$65.50 |
0.7× |
| Pelvis 1 or 2 views (72170) |
$79.20 |
$88 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$93.60 |
$104 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$79.65 |
$88.50 |
0.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$93.60 |
$104 |
1.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$106.20 |
$118 |
1.2× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$129.60 |
$144 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$95.40 |
$106 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$85.05 |
$94.50 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$88.20 |
$98 |
1.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$104.40 |
$116 |
1.2× |
| Radex Humerus Minimum 2 Views (73060) |
$80.10 |
$89 |
0.9× |
| Radex Kne 1/2 Views (73560) |
$81.90 |
$91 |
1.0× |
| Radex Kne Compl 4/More Views (73564) |
$104.85 |
$116.50 |
1.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$109.35 |
$121.50 |
1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$60.30 |
$67 |
0.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$84.60 |
$94 |
1.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$43.65 |
$48.50 |
0.5× |
| Radex Toe Minimum 2 Views (73660) |
$85.50 |
$95 |
1.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$105.75 |
$117.50 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$65.70 |
$73 |
0.8× |
| Radiologic exam chest 2 views (71046) |
$82.80 |
$92 |
1.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$356.40 |
$396 |
2.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$251.55 |
$279.50 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$76.05 |
$84.50 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$81.90 |
$91 |
0.8× |
| Scapula (73010) |
$88.65 |
$98.50 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$106.65 |
$118.50 |
4.6× |
| Shoulder 1 view (73020) |
$65.70 |
$73 |
0.8× |
| Small bowel series (74250) |
$302.40 |
$336 |
1.7× |
| Spine thoracic 3 views (72072) |
$102.60 |
$114 |
1.0× |
| Thoracolumbar 2 views (72080) |
$100.35 |
$111.50 |
1.2× |
| Ultrasound Exam Aaa Screen (76706) |
$332.55 |
$369.50 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$169.65 |
$188.50 |
1.6× |
| Umbilical-artery Doppler (OB) (76820) |
$109.80 |
$122 |
1.1× |
| Us breast unilateral limited (76642) |
$261.90 |
$291 |
3.0× |
| Us chest (76604) |
$243 |
$270 |
2.4× |
| Us compl joint r-t w/image documentation (76881) |
$231.75 |
$257.50 |
2.2× |
| Us ob detailed single fetus (76811) |
$525.15 |
$583.50 |
2.2× |
| Us ob limited (76815) |
$248.40 |
$276 |
2.4× |
| Us ob transvaginal (76817) |
$293.85 |
$326.50 |
2.8× |
| Us pelvic non ob complete (76856) |
$229.95 |
$255.50 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$139.95 |
$155.50 |
1.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$327.60 |
$364 |
3.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$205.65 |
$228.50 |
2.0× |
| Us retroperitoneal complete (76770) |
$321.30 |
$357 |
3.1× |
| Us retroperitoneal limited (76775) |
$257.85 |
$286.50 |
2.5× |
| Us scrotum and contents (76870) |
$292.50 |
$325 |
2.8× |
| Us soft tissue head/neck (76536) |
$194.85 |
$216.50 |
1.9× |
| Wrist 2 views (73100) |
$88.65 |
$98.50 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$128.70 |
$143 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$112.05 |
$124.50 |
1.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$614.25 |
$682.50 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$79.65 |
$88.50 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$108.90 |
$121 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$152.10 |
$169 |
1.5× |
| X-ray exam of femur 2/> (73552) |
$78.30 |
$87 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$68.85 |
$76.50 |
0.8× |
| X-ray leg, infant (73592) |
$110.70 |
$123 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$98.10 |
$109 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$175.05 |
$194.50 |
1.7× |
| X-ray nose-rectum child f.b. (76010) |
$73.80 |
$82 |
0.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$83.25 |
$92.50 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$108.45 |
$120.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$80.10 |
$89 |
0.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$64.80 |
$72 |
0.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$104.85 |
$116.50 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$86.40 |
$96 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$132.30 |
$147 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$171.45 |
$190.50 |
1.7× |
| Xr chest 4+ views (71048) |
$126 |
$140 |
1.2× |