| Abdomen 2 views (74019) |
$648.90 |
$721 |
5.6× |
| Ankle 2 views (73600) |
$422.10 |
$469 |
4.4× |
| Bone age studies (77072) |
$102.60 |
$114 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$721.80 |
$802 |
7.4× |
| Chest 1 view (71045) |
$370.80 |
$412 |
3.8× |
| Chest xray 3 views (71047) |
$547.20 |
$608 |
5.6× |
| Clavicle complete (73000) |
$423.90 |
$471 |
4.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$546.30 |
$607 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$6,512.40 |
$7,236 |
16.8× |
| CT abdomen and pelvis without contrast (74176) |
$5,710.50 |
$6,345 |
21.5× |
| CT abdomen w contrast (74160) |
$3,260.70 |
$3,623 |
16.7× |
| CT abdomen w wo contrast (74170) |
$4,509 |
$5,010 |
23.1× |
| CT abdomen w/o contrast (74150) |
$2,326.50 |
$2,585 |
20.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$4,541.40 |
$5,046 |
23.2× |
| CT c-spine w/contrast (72126) |
$3,020.40 |
$3,356 |
7.8× |
| CT c-spine w/o contrast (72125) |
$2,813.40 |
$3,126 |
24.1× |
| CT cervical spine w&w/o contrast (72127) |
$3,745.80 |
$4,162 |
19.2× |
| CT chest w contrast (71260) |
$3,288.60 |
$3,654 |
16.8× |
| CT chest w/wo contrast (71270) |
$4,508.10 |
$5,009 |
23.1× |
| CT head/brain with contrast (70460) |
$2,424.60 |
$2,694 |
12.4× |
| CT head/brain without and with contrast (70470) |
$3,528.90 |
$3,921 |
18.1× |
| CT iac w contrast (70481) |
$3,528.90 |
$3,921 |
18.1× |
| CT lower ext w/o (73700) |
$2,002.95 |
$2,225.50 |
17.2× |
| CT lower extremity w wo contrast (73702) |
$2,827.80 |
$3,142 |
14.5× |
| CT lower extremity w/contrast material (73701) |
$2,435.40 |
$2,706 |
12.5× |
| CT lumbar spine w & w/o contrast (72133) |
$4,438.80 |
$4,932 |
22.7× |
| CT lumbar spine w/contrast (72132) |
$3,859.20 |
$4,288 |
9.9× |
| CT lumbar spine w/o contrast (72131) |
$3,139.20 |
$3,488 |
26.9× |
| CT maxillofacial w contrast (70487) |
$2,417.40 |
$2,686 |
12.4× |
| CT maxillofacial w/wo contrast (70488) |
$2,888.10 |
$3,209 |
14.8× |
| CT maxillofacial wo contrast (70486) |
$3,166.20 |
$3,518 |
27.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,939.40 |
$3,266 |
15.0× |
| CT orbits w/o contrast (70480) |
$2,512.80 |
$2,792 |
21.6× |
| CT pelvis w/o contrast (72192) |
$2,730.60 |
$3,034 |
23.4× |
| CT pelvis w/wo contrast (72194) |
$4,189.50 |
$4,655 |
21.4× |
| CT scan of arm combo (73202) |
$2,866.50 |
$3,185 |
14.7× |
| CT soft tissue neck w contrast (70491) |
$2,908.80 |
$3,232 |
14.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,257.10 |
$3,619 |
16.7× |
| CT soft tissue neck w/o contrast (70490) |
$2,616.30 |
$2,907 |
22.5× |
| CT thoracic spine w/contrast (72129) |
$3,009.60 |
$3,344 |
15.4× |
| CT thoracic spine w/o contrast (72128) |
$2,721.60 |
$3,024 |
23.4× |
| CT thoracic spine w/wo contrast (72130) |
$3,204 |
$3,560 |
16.4× |
| CT thorax w/o contrast (71250) |
$2,565.90 |
$2,851 |
22.0× |
| CT upper ext wo (73200) |
$2,308.50 |
$2,565 |
19.8× |
| CT upper extremity with contrast (73201) |
$2,425.50 |
$2,695 |
6.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,674.80 |
$2,972 |
13.7× |
| Cta Abdomen (74175) |
$3,663.90 |
$4,071 |
18.7× |
| CTA abdomen pelvis (74174) |
$5,007.60 |
$5,564 |
12.9× |
| CTA chest (71275) |
$4,319.10 |
$4,799 |
22.1× |
| Cta Head (70496) |
$3,620.70 |
$4,023 |
18.5× |
| Cta Neck (70498) |
$3,888 |
$4,320 |
19.9× |
| Cta Pelvis (72191) |
$2,736 |
$3,040 |
14.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$665.10 |
$739 |
5.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$270 |
$300 |
2.8× |
| Facial bones min 3 views (70150) |
$469.80 |
$522 |
4.0× |
| Fetal biophysical profile non-stress testing (76818) |
$956.70 |
$1,063 |
8.2× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$706.50 |
$785 |
6.1× |
| Foot 2 views (73620) |
$429.30 |
$477 |
4.4× |
| Forearm 2 views (73090) |
$480.60 |
$534 |
5.0× |
| Hand 2 views (73120) |
$496.80 |
$552 |
4.3× |
| Knee 3 views (73562) |
$580.50 |
$645 |
6.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$3,822.30 |
$4,247 |
4.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,822.30 |
$4,247 |
9.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$4,247.10 |
$4,719 |
10.9× |
| MRA head w & w/o contrast (70546) |
$5,967.90 |
$6,631 |
15.4× |
| MRA head w/o contrast (70544) |
$3,978.90 |
$4,421 |
15.0× |
| MRA neck w contrast (70548) |
$3,329.10 |
$3,699 |
8.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$7,134.30 |
$7,927 |
18.4× |
| MRA neck w/o contrast (70547) |
$3,258.90 |
$3,621 |
12.3× |
| MRI abdomen w contrast (74182) |
$6,985.80 |
$7,762 |
18.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$7,866 |
$8,740 |
20.2× |
| MRI abdomen w/o contrast (74181) |
$3,313.80 |
$3,682 |
12.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,864.60 |
$4,294 |
4.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,359.70 |
$3,733 |
8.6× |
| MRI c-spine with contrast (72142) |
$4,073.40 |
$4,526 |
10.5× |
| MRI cervical spine w/o contrast (72141) |
$4,033.80 |
$4,482 |
15.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$4,767.30 |
$5,297 |
12.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$5,661.90 |
$6,291 |
14.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$4,075.20 |
$4,528 |
15.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$3,588.30 |
$3,987 |
13.5× |
| MRI orbit face neck w contrast (70542) |
$4,401.90 |
$4,891 |
11.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$5,869.80 |
$6,522 |
15.1× |
| MRI pelvis w/contrast (72196) |
$3,925.80 |
$4,362 |
10.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$6,317.10 |
$7,019 |
16.2× |
| MRI pelvis w/o contrast (72195) |
$4,401.90 |
$4,891 |
16.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,490 |
$6,100 |
14.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,925.80 |
$4,362 |
10.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$6,073.20 |
$6,748 |
15.6× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$4,737.60 |
$5,264 |
12.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$5,571.90 |
$6,191 |
14.3× |
| MRI thoracic spine w/o contrast (72146) |
$4,049.10 |
$4,499 |
15.2× |
| MRI up ext w/o contrast (73218) |
$4,170.60 |
$4,634 |
15.7× |
| MRI upper ext joint w/o contrast (73221) |
$3,933.90 |
$4,371 |
14.8× |
| MRI, joint upper extrem combo (73223) |
$4,521.60 |
$5,024 |
11.6× |
| Neck soft tissue (70360) |
$403.20 |
$448 |
4.2× |
| Nonvascular shunt X-ray (75809) |
$747 |
$830 |
6.4× |
| Ob us nuchal meas 1 gest (76813) |
$297.90 |
$331 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$449.10 |
$499 |
3.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$569.70 |
$633 |
5.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$400.50 |
$445 |
4.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$528.30 |
$587 |
5.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$649.80 |
$722 |
6.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$1,298.70 |
$1,443 |
11.1× |
| Radex fingr minimum 2 views (73140) |
$383.40 |
$426 |
4.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$559.80 |
$622 |
5.8× |
| Radex Hand Minimum 3 Views (73130) |
$569.70 |
$633 |
5.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$336.60 |
$374 |
3.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$625.50 |
$695 |
5.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$432 |
$480 |
3.7× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$783 |
$870 |
6.7× |
| Radex Humerus Minimum 2 Views (73060) |
$540 |
$600 |
5.6× |
| Radex Kne 1/2 Views (73560) |
$625.50 |
$695 |
6.4× |
| Radex Kne Compl 4/More Views (73564) |
$594 |
$660 |
5.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$379.80 |
$422 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$513.90 |
$571 |
5.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$569.70 |
$633 |
4.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$558 |
$620 |
5.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$304.20 |
$338 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$602.10 |
$669 |
5.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$403.20 |
$448 |
4.2× |
| Radex Toe Minimum 2 Views (73660) |
$400.50 |
$445 |
4.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$238.50 |
$265 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$569.70 |
$633 |
5.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$1,600.20 |
$1,778 |
13.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$565.20 |
$628 |
5.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$729.90 |
$811 |
6.3× |
| Radiologic exam chest 2 views (71046) |
$444.60 |
$494 |
4.6× |
| Radiologic exam colon single contrast study (74270) |
$2,326.50 |
$2,585 |
11.9× |
| Radiologic examination femur 1 view (73551) |
$598.50 |
$665 |
6.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$494.10 |
$549 |
5.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$421.20 |
$468 |
3.6× |
| Ribs bilateral 3 views (71110) |
$297 |
$330 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$313.20 |
$348 |
2.7× |
| Scapula (73010) |
$423.90 |
$471 |
3.6× |
| Shoulder 1 view (73020) |
$540 |
$600 |
5.6× |
| Spine thoracic 3 views (72072) |
$849.60 |
$944 |
7.3× |
| Thoracolumbar 2 views (72080) |
$865.80 |
$962 |
8.9× |
| Tmj unilateral (70328) |
$258.30 |
$287 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$809.10 |
$899 |
6.9× |
| Ultrasound, abdomen limited (76705) |
$782.10 |
$869 |
6.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$362.70 |
$403 |
3.7× |
| Unlisted ultrasound procedure (76999) |
$855.90 |
$951 |
8.8× |
| Us chest (76604) |
$779.40 |
$866 |
6.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$626.40 |
$696 |
5.4× |
| Us ob detailed single fetus (76811) |
$1,055.25 |
$1,172.50 |
4.0× |
| Us ob limited (76815) |
$516.60 |
$574 |
4.4× |
| Us ob transvaginal (76817) |
$747.90 |
$831 |
6.4× |
| Us pelvic non ob complete (76856) |
$880.20 |
$978 |
7.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$447.30 |
$497 |
3.8× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$635.40 |
$706 |
5.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$897.30 |
$997 |
7.7× |
| Us retroperitoneal complete (76770) |
$883.80 |
$982 |
7.6× |
| Us retroperitoneal limited (76775) |
$442.80 |
$492 |
3.8× |
| Us scrotum and contents (76870) |
$599.40 |
$666 |
5.1× |
| Us soft tissue head/neck (76536) |
$919.80 |
$1,022 |
7.9× |
| Vertebral fracture assessment via dxa (77086) |
$234 |
$260 |
2.4× |
| Wrist 2 views (73100) |
$459.90 |
$511 |
4.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$603.45 |
$670.50 |
5.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$270 |
$300 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$483.30 |
$537 |
5.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$579.60 |
$644 |
6.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$620.10 |
$689 |
5.3× |
| X-ray exam of femur 2/> (73552) |
$598.50 |
$665 |
6.2× |
| X-ray eye for foreign body (70030) |
$653.40 |
$726 |
6.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$356.40 |
$396 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$300.60 |
$334 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$444.60 |
$494 |
4.6× |
| X-ray leg, infant (73592) |
$238.50 |
$265 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$465.30 |
$517 |
4.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$566.10 |
$629 |
4.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$468.90 |
$521 |
4.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$396.90 |
$441 |
4.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$595.80 |
$662 |
5.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$769.50 |
$855 |
6.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$980.10 |
$1,089 |
8.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$569.70 |
$633 |
5.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$453.60 |
$504 |
4.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$493.20 |
$548 |
4.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$353.70 |
$393 |
3.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$691.20 |
$768 |
7.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$797.40 |
$886 |
8.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$609.30 |
$677 |
5.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$900 |
$1,000 |
7.7× |
| Xr c-spine 4 or 5 views (72050) |
$626.40 |
$696 |
5.4× |
| Xr c-spine 6 or more views (72052) |
$1,202.40 |
$1,336 |
10.3× |