| Abdomen 2 views (74019) |
$310.86 |
$471 |
2.9× |
| Ankle 2 views (73600) |
$220.77 |
$334.50 |
2.5× |
| Cervical spine 2 or 3 views (72040) |
$243.21 |
$368.50 |
2.7× |
| Chest 1 view (71045) |
$220.77 |
$334.50 |
2.5× |
| Chest xray 3 views (71047) |
$220.77 |
$334.50 |
2.5× |
| Clavicle complete (73000) |
$220.77 |
$334.50 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$856.68 |
$1,298 |
7.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,705.34 |
$4,099 |
7.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,023.40 |
$3,065.75 |
8.2× |
| CT abdomen w contrast (74160) |
$1,364.22 |
$2,067 |
7.5× |
| CT abdomen w wo contrast (74170) |
$2,696.10 |
$4,085 |
14.9× |
| CT abdomen w/o contrast (74150) |
$1,109.13 |
$1,680.50 |
10.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,532.19 |
$2,321.50 |
8.5× |
| CT angiography upper extremity lt (73206) |
$1,532.19 |
$2,321.50 |
8.5× |
| CT c-spine w/contrast (72126) |
$1,370.82 |
$2,077 |
3.8× |
| CT c-spine w/o contrast (72125) |
$1,335.18 |
$2,023 |
12.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,249.38 |
$1,893 |
6.9× |
| CT chest w contrast (71260) |
$1,427.91 |
$2,163.50 |
7.9× |
| CT chest w/wo contrast (71270) |
$1,516.35 |
$2,297.50 |
8.4× |
| CT head/brain with contrast (70460) |
$1,295.25 |
$1,962.50 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,516.35 |
$2,297.50 |
8.4× |
| CT iac w contrast (70481) |
$1,319.34 |
$1,999 |
7.3× |
| CT lower ext w/o (73700) |
$1,068.21 |
$1,618.50 |
9.9× |
| CT lower extremity w wo contrast (73702) |
$1,319.34 |
$1,999 |
7.3× |
| CT lower extremity w/contrast material (73701) |
$1,319.34 |
$1,999 |
7.3× |
| CT lumbar spine w/contrast (72132) |
$2,794.44 |
$4,234 |
7.8× |
| CT lumbar spine w/o contrast (72131) |
$1,335.18 |
$2,023 |
12.4× |
| CT maxillofacial w contrast (70487) |
$1,319.34 |
$1,999 |
7.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,532.19 |
$2,321.50 |
8.5× |
| CT maxillofacial wo contrast (70486) |
$1,068.21 |
$1,618.50 |
9.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,532.19 |
$2,321.50 |
8.5× |
| CT orbits w/o contrast (70480) |
$1,143.45 |
$1,732.50 |
10.6× |
| CT pelvis w/o contrast (72192) |
$1,122.16 |
$1,700.25 |
10.4× |
| CT pelvis w/wo contrast (72194) |
$1,475.10 |
$2,235 |
8.1× |
| CT scan of arm combo (73202) |
$1,532.19 |
$2,321.50 |
8.5× |
| CT soft tissue neck w contrast (70491) |
$1,364.22 |
$2,067 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,516.35 |
$2,297.50 |
8.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,087.35 |
$1,647.50 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,333.86 |
$2,021 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,335.18 |
$2,023 |
12.4× |
| CT thorax w/o contrast (71250) |
$1,198.89 |
$1,816.50 |
11.1× |
| CT upper ext wo (73200) |
$1,068.21 |
$1,618.50 |
9.9× |
| CT upper extremity with contrast (73201) |
$1,315.38 |
$1,993 |
3.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,802.79 |
$2,731.50 |
10.0× |
| CTA abdomen pelvis (74174) |
$2,561.79 |
$3,881.50 |
7.1× |
| CTA chest (71275) |
$1,758.57 |
$2,664.50 |
9.7× |
| Cta Head (70496) |
$1,742.40 |
$2,640 |
9.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$994.62 |
$1,507 |
2.8× |
| Cta Neck (70498) |
$1,742.40 |
$2,640 |
9.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$560.67 |
$849.50 |
5.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$264.99 |
$401.50 |
3.0× |
| Facial bones min 3 views (70150) |
$308.38 |
$467.25 |
2.9× |
| Fetal biophysical profile non-stress testing (76818) |
$310.86 |
$471 |
2.9× |
| Foot 2 views (73620) |
$220.77 |
$334.50 |
2.5× |
| Forearm 2 views (73090) |
$220.77 |
$334.50 |
2.5× |
| Hand 2 views (73120) |
$310.86 |
$471 |
2.9× |
| Knee 3 views (73562) |
$246.51 |
$373.50 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,046.66 |
$3,101 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,841.40 |
$2,790 |
5.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,367.42 |
$3,587 |
6.6× |
| MRA head w & w/o contrast (70546) |
$2,367.42 |
$3,587 |
6.6× |
| MRA head w/o contrast (70544) |
$2,000.13 |
$3,030.50 |
8.1× |
| MRA head with contrast (70545) |
$1,662.21 |
$2,518.50 |
4.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,618.88 |
$3,968 |
7.3× |
| MRA neck w/o contrast (70547) |
$1,789.26 |
$2,711 |
7.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,493.15 |
$3,777.50 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,848.82 |
$2,801.25 |
7.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,353.40 |
$3,565.75 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,367.42 |
$3,587 |
6.6× |
| MRI c-spine with contrast (72142) |
$1,869.78 |
$2,833 |
5.2× |
| MRI cervical spine w/o contrast (72141) |
$1,908.39 |
$2,891.50 |
7.7× |
| MRI chest w/o & w/contrast material (71552) |
$2,375.34 |
$3,599 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,817.64 |
$2,754 |
7.4× |
| MRI chest with contrast (71551) |
$1,869.78 |
$2,833 |
2.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,855.59 |
$2,811.50 |
5.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,367.42 |
$3,587 |
6.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,789.26 |
$2,711 |
7.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,709.40 |
$2,590 |
6.9× |
| MRI orbit face neck w contrast (70542) |
$1,841.40 |
$2,790 |
5.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,588.85 |
$3,922.50 |
7.2× |
| MRI pelvis w/contrast (72196) |
$1,963.17 |
$2,974.50 |
5.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,430.62 |
$3,682.75 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$1,848.82 |
$2,801.25 |
7.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,493.81 |
$3,778.50 |
6.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,079 |
$3,150 |
5.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,618.88 |
$3,968 |
7.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,963.17 |
$2,974.50 |
5.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,493.81 |
$3,778.50 |
6.9× |
| MRI temporomandibular joint (70336) |
$1,731.18 |
$2,623 |
7.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,908.39 |
$2,891.50 |
7.7× |
| MRI up ext w/o contrast (73218) |
$1,803.45 |
$2,732.50 |
7.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,789.26 |
$2,711 |
7.3× |
| MRI, joint upper extrem combo (73223) |
$2,367.42 |
$3,587 |
6.6× |
| Neck soft tissue (70360) |
$220.77 |
$334.50 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$310.86 |
$471 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$228.69 |
$346.50 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$220.77 |
$334.50 |
2.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$228.69 |
$346.50 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$305.91 |
$463.50 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$220.77 |
$334.50 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$220.77 |
$334.50 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$220.77 |
$334.50 |
2.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$228.69 |
$346.50 |
2.5× |
| Radex Humerus Minimum 2 Views (73060) |
$228.69 |
$346.50 |
2.5× |
| Radex Kne 1/2 Views (73560) |
$228.69 |
$346.50 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$310.86 |
$471 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$311.52 |
$472 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$220.77 |
$334.50 |
2.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$310.86 |
$471 |
2.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$228.69 |
$346.50 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$248.49 |
$376.50 |
2.8× |
| Radex Toe Minimum 2 Views (73660) |
$220.77 |
$334.50 |
2.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$305.91 |
$463.50 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$228.69 |
$346.50 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$220.77 |
$334.50 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$220.77 |
$334.50 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$228.69 |
$346.50 |
2.5× |
| Ribs bilateral 3 views (71110) |
$275.55 |
$417.50 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$310.86 |
$471 |
2.9× |
| Scapula (73010) |
$310.86 |
$471 |
2.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$114.51 |
$173.50 |
4.9× |
| Shoulder 1 view (73020) |
$220.77 |
$334.50 |
2.5× |
| Spine thoracic 3 views (72072) |
$310.86 |
$471 |
2.9× |
| Thoracolumbar 2 views (72080) |
$235.95 |
$357.50 |
2.6× |
| Ultrasound breast complete (76641) |
$496.32 |
$752 |
4.6× |
| Ultrasound Exam Aaa Screen (76706) |
$350.13 |
$530.50 |
3.2× |
| Ultrasound, abdomen limited (76705) |
$467.94 |
$709 |
4.3× |
| Us breast unilateral limited (76642) |
$321.42 |
$487 |
3.6× |
| Us chest (76604) |
$496.32 |
$752 |
4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$323.07 |
$489.50 |
3.0× |
| Us ob limited (76815) |
$414.48 |
$628 |
3.8× |
| Us ob transvaginal (76817) |
$414.48 |
$628 |
3.8× |
| Us pelvic non ob complete (76856) |
$396.66 |
$601 |
3.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$305.91 |
$463.50 |
2.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$430.98 |
$653 |
4.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$496.32 |
$752 |
4.6× |
| Us retroperitoneal limited (76775) |
$458.70 |
$695 |
4.3× |
| Us soft tissue head/neck (76536) |
$496.32 |
$752 |
4.6× |
| Us transrectal (76872) |
$343.86 |
$521 |
3.2× |
| Wrist 2 views (73100) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$267.96 |
$406 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$191.24 |
$289.75 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$228.69 |
$346.50 |
2.5× |
| X-ray eye for foreign body (70030) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$220.77 |
$334.50 |
2.5× |
| X-ray leg, infant (73592) |
$248.49 |
$376.50 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$310.86 |
$471 |
2.9× |
| X-ray nose-rectum child f.b. (76010) |
$235.95 |
$357.50 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$216.81 |
$328.50 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$310.86 |
$471 |
3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$310.86 |
$471 |
2.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$310.86 |
$471 |
2.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$220.77 |
$334.50 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$310.86 |
$471 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$308.38 |
$467.25 |
2.9× |