| Abdomen 2 views (74019) |
$179.20 |
$224 |
1.7× |
| Ankle 2 views (73600) |
$136.40 |
$170.50 |
1.6× |
| Bone age studies (77072) |
$130.80 |
$163.50 |
1.3× |
| Bone survey complete (77075) |
$246.40 |
$308 |
2.4× |
| Bone survey infant (77076) |
$172.40 |
$215.50 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$132.80 |
$166 |
1.5× |
| Chest 1 view (71045) |
$121.20 |
$151.50 |
1.4× |
| Chest xray 3 views (71047) |
$197.20 |
$246.50 |
2.3× |
| Clavicle complete (73000) |
$103.20 |
$129 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$463.20 |
$579 |
4.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$910.40 |
$1,138 |
2.6× |
| CT abdomen and pelvis without contrast (74176) |
$693.60 |
$867 |
2.9× |
| CT abdomen w contrast (74160) |
$516 |
$645 |
3.0× |
| CT abdomen w wo contrast (74170) |
$580 |
$725 |
3.3× |
| CT abdomen w/o contrast (74150) |
$393.60 |
$492 |
3.8× |
| CT angiography upper extremity lt (73206) |
$605.20 |
$756.50 |
3.5× |
| CT c-spine w/contrast (72126) |
$560 |
$700 |
1.6× |
| CT c-spine w/o contrast (72125) |
$388.40 |
$485.50 |
3.8× |
| CT cervical spine w&w/o contrast (72127) |
$573.20 |
$716.50 |
3.3× |
| CT chest w contrast (71260) |
$510.80 |
$638.50 |
2.9× |
| CT chest w/wo contrast (71270) |
$572.40 |
$715.50 |
3.3× |
| CT head/brain with contrast (70460) |
$508.80 |
$636 |
2.9× |
| CT head/brain without and with contrast (70470) |
$573.20 |
$716.50 |
3.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$172.40 |
$215.50 |
2.0× |
| CT iac w contrast (70481) |
$552 |
$690 |
3.2× |
| CT limited/localized follow up study (76380) |
$252 |
$315 |
2.9× |
| CT lower ext w/o (73700) |
$385.60 |
$482 |
3.7× |
| CT lower extremity w/contrast material (73701) |
$547.60 |
$684.50 |
3.2× |
| CT lumbar spine w & w/o contrast (72133) |
$619.60 |
$774.50 |
3.6× |
| CT lumbar spine w/contrast (72132) |
$552.80 |
$691 |
1.6× |
| CT lumbar spine w/o contrast (72131) |
$388.40 |
$485.50 |
3.8× |
| CT maxillofacial w contrast (70487) |
$550.80 |
$688.50 |
3.2× |
| CT maxillofacial w/wo contrast (70488) |
$619.60 |
$774.50 |
3.6× |
| CT maxillofacial wo contrast (70486) |
$392 |
$490 |
3.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$622.40 |
$778 |
3.6× |
| CT orbits w/o contrast (70480) |
$398.40 |
$498 |
3.9× |
| CT pelvis w/o contrast (72192) |
$388 |
$485 |
3.8× |
| CT pelvis w/wo contrast (72194) |
$570.40 |
$713 |
3.3× |
| CT scan of arm combo (73202) |
$611.20 |
$764 |
3.5× |
| CT soft tissue neck w contrast (70491) |
$522 |
$652.50 |
3.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$591.20 |
$739 |
3.4× |
| CT soft tissue neck w/o contrast (70490) |
$398.40 |
$498 |
3.9× |
| CT thoracic spine w/contrast (72129) |
$542 |
$677.50 |
3.1× |
| CT thoracic spine w/o contrast (72128) |
$388.40 |
$485.50 |
3.8× |
| CT thoracic spine w/wo contrast (72130) |
$608.40 |
$760.50 |
3.5× |
| CT thorax w/o contrast (71250) |
$388.40 |
$485.50 |
3.8× |
| CT upper ext wo (73200) |
$385.60 |
$482 |
3.7× |
| CT upper extremity with contrast (73201) |
$548.80 |
$686 |
1.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$635.20 |
$794 |
3.7× |
| Cta Abdomen (74175) |
$722 |
$902.50 |
4.2× |
| CTA abdomen pelvis (74174) |
$895.60 |
$1,119.50 |
2.6× |
| CTA chest (71275) |
$607.20 |
$759 |
3.5× |
| Cta Head (70496) |
$603.20 |
$754 |
3.5× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$661.60 |
$827 |
1.9× |
| Cta Neck (70498) |
$602.80 |
$753.50 |
3.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$182.40 |
$228 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$151.20 |
$189 |
1.5× |
| Facial bones min 3 views (70150) |
$149.20 |
$186.50 |
1.4× |
| Fetal biophysical profile non-stress testing (76818) |
$134.96 |
$168.70 |
1.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$134.56 |
$168.20 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$438 |
$547.50 |
1.9× |
| Foot 2 views (73620) |
$102.40 |
$128 |
1.2× |
| Forearm 2 views (73090) |
$103.20 |
$129 |
1.2× |
| Hand 2 views (73120) |
$96.40 |
$120.50 |
0.9× |
| Knee 3 views (73562) |
$140 |
$175 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$858 |
$1,072.50 |
1.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$858 |
$1,072.50 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,046.80 |
$1,308.50 |
3.0× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$62.40 |
$78 |
0.7× |
| MRA head w & w/o contrast (70546) |
$1,031.60 |
$1,289.50 |
3.0× |
| MRA head w/o contrast (70544) |
$708 |
$885 |
3.0× |
| MRA head with contrast (70545) |
$858 |
$1,072.50 |
2.5× |
| MRA neck w contrast (70548) |
$858 |
$1,072.50 |
2.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,028 |
$1,285 |
3.0× |
| MRA neck w/o contrast (70547) |
$748 |
$935 |
3.2× |
| MRI abdomen w contrast (74182) |
$858 |
$1,072.50 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,048.80 |
$1,311 |
3.0× |
| MRI abdomen w/o contrast (74181) |
$743.20 |
$929 |
3.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$858 |
$1,072.50 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,046.80 |
$1,308.50 |
3.0× |
| MRI c-spine with contrast (72142) |
$858 |
$1,072.50 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$724.80 |
$906 |
3.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,052 |
$1,315 |
3.1× |
| MRI chest w/o contrast (71550) |
$743.20 |
$929 |
3.2× |
| MRI chest with contrast (71551) |
$858 |
$1,072.50 |
1.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$858 |
$1,072.50 |
2.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,046.80 |
$1,308.50 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$748 |
$935 |
3.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$743.20 |
$929 |
3.2× |
| MRI orbit face neck w contrast (70542) |
$858 |
$1,072.50 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,046.40 |
$1,308 |
3.0× |
| MRI pelvis w/contrast (72196) |
$858 |
$1,072.50 |
2.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,867.20 |
$2,334 |
5.4× |
| MRI pelvis w/o contrast (72195) |
$722 |
$902.50 |
3.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,061.20 |
$1,326.50 |
3.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$862.80 |
$1,078.50 |
2.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,054 |
$1,317.50 |
3.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$858 |
$1,072.50 |
2.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,054.40 |
$1,318 |
3.1× |
| MRI temporomandibular joint (70336) |
$722.40 |
$903 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$724.80 |
$906 |
3.1× |
| MRI up ext w/o contrast (73218) |
$716.40 |
$895.50 |
3.0× |
| MRI upper ext joint w/o contrast (73221) |
$716.40 |
$895.50 |
3.0× |
| MRI, joint upper extrem combo (73223) |
$1,046.80 |
$1,308.50 |
3.0× |
| Neck soft tissue (70360) |
$97.20 |
$121.50 |
1.1× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$243.60 |
$304.50 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$130 |
$162.50 |
1.3× |
| PET image w/CT, skull-thigh (78815) |
$1,775.60 |
$2,219.50 |
1.3× |
| PET imaging CT for attenuation limited area (78814) |
$1,730.40 |
$2,163 |
1.2× |
| PET imaging for CT attenuation whole body (78816) |
$1,776.80 |
$2,221 |
1.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$138 |
$172.50 |
1.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$103.20 |
$129 |
1.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$104.80 |
$131 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$94.80 |
$118.50 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$104.80 |
$131 |
1.2× |
| Radex Hand Minimum 3 Views (73130) |
$138 |
$172.50 |
1.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$97.60 |
$122 |
1.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$183.20 |
$229 |
1.8× |
| Radex Humerus Minimum 2 Views (73060) |
$104.80 |
$131 |
1.2× |
| Radex Kne 1/2 Views (73560) |
$96.40 |
$120.50 |
1.1× |
| Radex Kne Compl 4/More Views (73564) |
$156.40 |
$195.50 |
1.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$148.80 |
$186 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$96.80 |
$121 |
1.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$134.40 |
$168 |
1.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$139.60 |
$174.50 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$105.20 |
$131.50 |
1.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$151.20 |
$189 |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$116 |
$145 |
1.3× |
| Radex Toe Minimum 2 Views (73660) |
$99.60 |
$124.50 |
1.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$153.20 |
$191.50 |
1.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$104.80 |
$131 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$127.60 |
$159.50 |
1.5× |
| Radiologic exam chest 2 views (71046) |
$148 |
$185 |
1.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$96 |
$120 |
1.1× |
| Scapula (73010) |
$104.80 |
$131 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$89.20 |
$111.50 |
3.8× |
| Shoulder 1 view (73020) |
$115.20 |
$144 |
1.3× |
| Spine thoracic 3 views (72072) |
$147.20 |
$184 |
1.4× |
| Thoracolumbar 2 views (72080) |
$98.80 |
$123.50 |
1.1× |
| Tmj unilateral (70328) |
$108.40 |
$135.50 |
1.3× |
| Ultrasound breast complete (76641) |
$161.60 |
$202 |
1.6× |
| Ultrasound Exam Aaa Screen (76706) |
$56.80 |
$71 |
0.5× |
| Ultrasound, abdomen limited (76705) |
$61.60 |
$77 |
0.6× |
| Umbilical-artery Doppler (OB) (76820) |
$171.60 |
$214.50 |
1.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$100 |
$125 |
1.2× |
| Urethrocystogram voiding (74455) |
$440.80 |
$551 |
1.9× |
| Us breast unilateral limited (76642) |
$159.20 |
$199 |
1.9× |
| Us chest (76604) |
$104.80 |
$131 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$95.20 |
$119 |
0.9× |
| Us elastography parenchyma (76981) |
$151.60 |
$189.50 |
1.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$72 |
$90 |
0.7× |
| Us ob detailed single fetus (76811) |
$395.60 |
$494.50 |
1.7× |
| Us ob limited (76815) |
$68.80 |
$86 |
0.7× |
| Us ob transvaginal (76817) |
$224 |
$280 |
2.2× |
| Us pelvic non ob complete (76856) |
$225.60 |
$282 |
2.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$90.40 |
$113 |
0.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$241.60 |
$302 |
2.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$168 |
$210 |
1.6× |
| Us retroperitoneal complete (76770) |
$228.40 |
$285.50 |
2.2× |
| Us retroperitoneal limited (76775) |
$77.20 |
$96.50 |
0.7× |
| Us scrotum and contents (76870) |
$223.20 |
$279 |
2.2× |
| Us soft tissue head/neck (76536) |
$59.20 |
$74 |
0.6× |
| Us, eye b-scan (76512) |
$48 |
$60 |
0.5× |
| Wrist 2 views (73100) |
$96.40 |
$120.50 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$152.40 |
$190.50 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.80 |
$163.50 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$102.40 |
$128 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$108 |
$135 |
1.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$142.80 |
$178.50 |
1.4× |
| X-ray exam of femur 2/> (73552) |
$104.80 |
$131 |
1.2× |
| X-ray eye for foreign body (70030) |
$97.20 |
$121.50 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$106.80 |
$133.50 |
1.2× |
| X-ray IV pyelogram (ivp) (74400) |
$344.40 |
$430.50 |
2.0× |
| X-ray leg, infant (73592) |
$150.80 |
$188.50 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$132.80 |
$166 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$181.60 |
$227 |
1.8× |
| X-ray nose-rectum child f.b. (76010) |
$103.60 |
$129.50 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$157.60 |
$197 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$99.60 |
$124.50 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$162 |
$202.50 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$170.40 |
$213 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$99.60 |
$124.50 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$96.80 |
$121 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$159.20 |
$199 |
1.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$164.40 |
$205.50 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$141.60 |
$177 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$101.20 |
$126.50 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$98 |
$122.50 |
1.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$131.60 |
$164.50 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$136 |
$170 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$152 |
$190 |
1.5× |