| Abdomen 2 views (74019) |
$150.75 |
$201 |
1.5× |
| Ankle 2 views (73600) |
$111.38 |
$148.50 |
1.3× |
| Bone age studies (77072) |
$180.38 |
$240.50 |
1.7× |
| Bone survey complete (77075) |
$271.88 |
$362.50 |
2.6× |
| Bone survey infant (77076) |
$178.12 |
$237.50 |
1.7× |
| Cervical spine 2 or 3 views (72040) |
$130.50 |
$174 |
1.5× |
| Chest 1 view (71045) |
$104.25 |
$139 |
1.2× |
| Chest xray 3 views (71047) |
$276.75 |
$369 |
3.2× |
| Clavicle complete (73000) |
$111.38 |
$148.50 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$718.88 |
$958.50 |
7.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,257.75 |
$1,677 |
3.6× |
| CT abdomen and pelvis without contrast (74176) |
$858.38 |
$1,144.50 |
3.6× |
| CT abdomen w contrast (74160) |
$564.38 |
$752.50 |
3.3× |
| CT abdomen w wo contrast (74170) |
$698.25 |
$931 |
4.0× |
| CT abdomen w/o contrast (74150) |
$507.75 |
$677 |
4.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$991.88 |
$1,322.50 |
5.7× |
| CT angiography upper extremity lt (73206) |
$906 |
$1,208 |
5.2× |
| CT c-spine w/contrast (72126) |
$517.50 |
$690 |
1.5× |
| CT c-spine w/o contrast (72125) |
$480 |
$640 |
4.6× |
| CT cervical spine w&w/o contrast (72127) |
$578.25 |
$771 |
3.3× |
| CT chest w contrast (71260) |
$563.25 |
$751 |
3.3× |
| CT chest w/wo contrast (71270) |
$994.12 |
$1,325.50 |
5.7× |
| CT head/brain with contrast (70460) |
$582.38 |
$776.50 |
3.4× |
| CT head/brain without and with contrast (70470) |
$813.75 |
$1,085 |
4.7× |
| CT iac w contrast (70481) |
$595.12 |
$793.50 |
3.4× |
| CT limited/localized follow up study (76380) |
$232.50 |
$310 |
2.7× |
| CT lower ext w/o (73700) |
$526.12 |
$701.50 |
5.1× |
| CT lower extremity w wo contrast (73702) |
$829.50 |
$1,106 |
4.8× |
| CT lower extremity w/contrast material (73701) |
$526.12 |
$701.50 |
3.0× |
| CT lumbar spine w & w/o contrast (72133) |
$578.25 |
$771 |
3.3× |
| CT lumbar spine w/contrast (72132) |
$562.12 |
$749.50 |
1.6× |
| CT lumbar spine w/o contrast (72131) |
$476.62 |
$635.50 |
4.6× |
| CT maxillofacial w contrast (70487) |
$566.25 |
$755 |
3.3× |
| CT maxillofacial w/wo contrast (70488) |
$858.75 |
$1,145 |
5.0× |
| CT maxillofacial wo contrast (70486) |
$483.75 |
$645 |
4.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$783.38 |
$1,044.50 |
4.5× |
| CT orbits w/o contrast (70480) |
$491.25 |
$655 |
4.8× |
| CT pelvis w/o contrast (72192) |
$480.38 |
$640.50 |
4.7× |
| CT pelvis w/wo contrast (72194) |
$849.38 |
$1,132.50 |
4.9× |
| CT scan of arm combo (73202) |
$632.62 |
$843.50 |
3.7× |
| CT soft tissue neck w contrast (70491) |
$570 |
$760 |
3.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$822.38 |
$1,096.50 |
4.7× |
| CT soft tissue neck w/o contrast (70490) |
$511.88 |
$682.50 |
5.0× |
| CT thoracic spine w/contrast (72129) |
$111.75 |
$149 |
0.6× |
| CT thoracic spine w/o contrast (72128) |
$476.62 |
$635.50 |
4.6× |
| CT thoracic spine w/wo contrast (72130) |
$578.25 |
$771 |
3.3× |
| CT thorax w/o contrast (71250) |
$477.38 |
$636.50 |
4.6× |
| CT upper ext wo (73200) |
$526.12 |
$701.50 |
5.1× |
| CT upper extremity with contrast (73201) |
$586.12 |
$781.50 |
1.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,275.75 |
$1,701 |
7.4× |
| Cta Abdomen (74175) |
$868.88 |
$1,158.50 |
5.0× |
| CTA abdomen pelvis (74174) |
$952.12 |
$1,269.50 |
2.8× |
| CTA chest (71275) |
$869.62 |
$1,159.50 |
5.0× |
| Cta Head (70496) |
$861.38 |
$1,148.50 |
5.0× |
| Cta Neck (70498) |
$861.38 |
$1,148.50 |
5.0× |
| Cta Pelvis (72191) |
$608.25 |
$811 |
3.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$193.50 |
$258 |
1.9× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$102.75 |
$137 |
1.2× |
| Facial bones min 3 views (70150) |
$163.12 |
$217.50 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$252.75 |
$337 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$413.25 |
$551 |
1.8× |
| Foot 2 views (73620) |
$106.88 |
$142.50 |
1.2× |
| Forearm 2 views (73090) |
$111.38 |
$148.50 |
1.3× |
| Hand 2 views (73120) |
$134.25 |
$179 |
1.3× |
| Knee 3 views (73562) |
$136.88 |
$182.50 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$930 |
$1,240 |
1.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$930 |
$1,240 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,156.50 |
$1,542 |
3.4× |
| MRA head w & w/o contrast (70546) |
$1,092.38 |
$1,456.50 |
3.2× |
| MRA head w/o contrast (70544) |
$876.38 |
$1,168.50 |
3.7× |
| MRA head with contrast (70545) |
$834.38 |
$1,112.50 |
2.4× |
| MRA neck w contrast (70548) |
$1,245.38 |
$1,660.50 |
3.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,205.25 |
$1,607 |
3.5× |
| MRA neck w/o contrast (70547) |
$716.62 |
$955.50 |
3.0× |
| MRI abdomen w contrast (74182) |
$858.75 |
$1,145 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,369.12 |
$1,825.50 |
4.0× |
| MRI abdomen w/o contrast (74181) |
$798 |
$1,064 |
3.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$931.50 |
$1,242 |
1.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,149.38 |
$1,532.50 |
3.3× |
| MRI c-spine with contrast (72142) |
$1,054.88 |
$1,406.50 |
3.1× |
| MRI cervical spine w/o contrast (72141) |
$772.12 |
$1,029.50 |
3.3× |
| MRI chest w/o & w/contrast material (71552) |
$1,117.50 |
$1,490 |
3.2× |
| MRI chest w/o contrast (71550) |
$885 |
$1,180 |
3.8× |
| MRI chest with contrast (71551) |
$901.88 |
$1,202.50 |
1.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$976.88 |
$1,302.50 |
2.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,137 |
$1,516 |
3.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$999.38 |
$1,332.50 |
4.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$723 |
$964 |
3.1× |
| MRI orbit face neck w contrast (70542) |
$854.25 |
$1,139 |
2.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,314.75 |
$1,753 |
3.8× |
| MRI pelvis w/contrast (72196) |
$679.12 |
$905.50 |
2.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$891.38 |
$1,188.50 |
2.6× |
| MRI pelvis w/o contrast (72195) |
$814.12 |
$1,085.50 |
3.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,398.38 |
$1,864.50 |
4.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$778.88 |
$1,038.50 |
2.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,253.62 |
$1,671.50 |
3.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$867.75 |
$1,157 |
2.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,418.62 |
$1,891.50 |
4.1× |
| MRI temporomandibular joint (70336) |
$729 |
$972 |
3.1× |
| MRI thoracic spine w/o contrast (72146) |
$857.25 |
$1,143 |
3.6× |
| MRI up ext w/o contrast (73218) |
$666 |
$888 |
2.8× |
| MRI upper ext joint w/o contrast (73221) |
$843.75 |
$1,125 |
3.6× |
| MRI, joint upper extrem combo (73223) |
$1,156.50 |
$1,542 |
3.4× |
| Neck soft tissue (70360) |
$117.38 |
$156.50 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$110.62 |
$147.50 |
1.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$127.50 |
$170 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$122.62 |
$163.50 |
1.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$127.88 |
$170.50 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$122.25 |
$163 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$126 |
$168 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$111.38 |
$148.50 |
1.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$126 |
$168 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$144.38 |
$192.50 |
1.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$114.75 |
$153 |
1.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$160.12 |
$213.50 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$114.38 |
$152.50 |
1.3× |
| Radex Kne 1/2 Views (73560) |
$122.25 |
$163 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$153 |
$204 |
1.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$147 |
$196 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$130.12 |
$173.50 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$139.50 |
$186 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$105 |
$140 |
1.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$165.38 |
$220.50 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$112.88 |
$150.50 |
1.3× |
| Radex Toe Minimum 2 Views (73660) |
$121.12 |
$161.50 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$125.62 |
$167.50 |
1.2× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$129.75 |
$173 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$108.38 |
$144.50 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$113.25 |
$151 |
1.1× |
| Radiologic exam chest 2 views (71046) |
$106.12 |
$141.50 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$116.62 |
$155.50 |
1.4× |
| Ribs bilateral 3 views (71110) |
$159.75 |
$213 |
1.5× |
| Scapula (73010) |
$120 |
$160 |
1.2× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$267 |
$356 |
11.4× |
| Shoulder 1 view (73020) |
$123.38 |
$164.50 |
1.4× |
| Small bowel series (74250) |
$182.62 |
$243.50 |
1.1× |
| Spine thoracic 3 views (72072) |
$157.12 |
$209.50 |
1.5× |
| Thoracolumbar 2 views (72080) |
$103.12 |
$137.50 |
1.2× |
| Tmj unilateral (70328) |
$117 |
$156 |
1.4× |
| Ultrasound breast complete (76641) |
$282 |
$376 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$207 |
$276 |
2.0× |
| Ultrasound, abdomen limited (76705) |
$243.75 |
$325 |
2.4× |
| Umbilical-artery Doppler (OB) (76820) |
$134.62 |
$179.50 |
1.3× |
| Us breast unilateral limited (76642) |
$216.75 |
$289 |
2.5× |
| Us chest (76604) |
$280.50 |
$374 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$303.38 |
$404.50 |
2.9× |
| Us encephalogram (76506) |
$60 |
$80 |
0.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$181.12 |
$241.50 |
1.8× |
| Us ob detailed single fetus (76811) |
$420.38 |
$560.50 |
1.8× |
| Us ob limited (76815) |
$171.38 |
$228.50 |
1.7× |
| Us ob transvaginal (76817) |
$268.50 |
$358 |
2.6× |
| Us pelvic non ob complete (76856) |
$289.50 |
$386 |
2.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$234.38 |
$312.50 |
2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$263.25 |
$351 |
2.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$271.12 |
$361.50 |
2.6× |
| Us retroperitoneal complete (76770) |
$306.38 |
$408.50 |
3.0× |
| Us retroperitoneal limited (76775) |
$232.88 |
$310.50 |
2.3× |
| Us scrotum and contents (76870) |
$252.75 |
$337 |
2.4× |
| Us soft tissue head/neck (76536) |
$265.12 |
$353.50 |
2.6× |
| Wrist 2 views (73100) |
$122.25 |
$163 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$193.12 |
$257.50 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$116.62 |
$155.50 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$110.25 |
$147 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$128.25 |
$171 |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$172.50 |
$230 |
1.7× |
| X-ray exam of femur 2/> (73552) |
$132.38 |
$176.50 |
1.5× |
| X-ray eye for foreign body (70030) |
$118.88 |
$158.50 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$108.75 |
$145 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$164.25 |
$219 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$138.75 |
$185 |
1.6× |
| X-ray leg, infant (73592) |
$187.50 |
$250 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$147 |
$196 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$162.75 |
$217 |
1.6× |
| X-ray nose-rectum child f.b. (76010) |
$106.50 |
$142 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$171.75 |
$229 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$131.25 |
$175 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$145.50 |
$194 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$165.75 |
$221 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$131.25 |
$175 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$108.38 |
$144.50 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$201 |
$268 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$171.38 |
$228.50 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$107.62 |
$143.50 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$141.38 |
$188.50 |
1.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$87.38 |
$116.50 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$129 |
$172 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$127.12 |
$169.50 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$170.62 |
$227.50 |
1.7× |
| Xr bone length studies (77073) |
$166.88 |
$222.50 |
1.6× |
| Xr c-spine 4 or 5 views (72050) |
$199.88 |
$266.50 |
1.9× |
| Xr c-spine 6 or more views (72052) |
$204.75 |
$273 |
2.0× |