| Abdomen 2 views (74019) |
$109.14 |
$170 |
1.0× |
| Ankle 2 views (73600) |
$91.16 |
$142 |
1.0× |
| Arthrogram hip (73525) |
$332.56 |
$518 |
0.9× |
| Arthrogram shoulder (73040) |
$527.08 |
$821 |
1.5× |
| Bone &/Joint Imaging Limited Area (78300) |
$633.01 |
$986 |
1.5× |
| Bone &/joint imaging whole body (78306) |
$1,079.84 |
$1,682 |
2.6× |
| Bone Imaging 3 Phase (78315) |
$1,259.60 |
$1,962 |
3.1× |
| Bone survey complete (77075) |
$213.79 |
$333 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$154.72 |
$241 |
1.7× |
| Chest 1 view (71045) |
$237.54 |
$370 |
2.6× |
| Chest xray 3 views (71047) |
$150.87 |
$235 |
1.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$330.63 |
$515 |
1.8× |
| Clavicle complete (73000) |
$199.66 |
$311 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,024.63 |
$1,596 |
9.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,591.75 |
$4,037 |
7.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,960.03 |
$3,053 |
8.0× |
| CT abdomen w contrast (74160) |
$1,313.53 |
$2,046 |
7.3× |
| CT abdomen w wo contrast (74170) |
$1,598.58 |
$2,490 |
8.8× |
| CT abdomen w/o contrast (74150) |
$1,063.79 |
$1,657 |
9.9× |
| CT c-spine w/o contrast (72125) |
$1,407.91 |
$2,193 |
13.0× |
| CT chest w contrast (71260) |
$1,371.95 |
$2,137 |
7.6× |
| CT chest w/wo contrast (71270) |
$1,453.49 |
$2,264 |
8.0× |
| CT head/brain with contrast (70460) |
$1,180 |
$1,838 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,420.10 |
$2,212 |
7.8× |
| CT iac w contrast (70481) |
$1,294.27 |
$2,016 |
7.1× |
| CT limited/localized follow up study (76380) |
$503.97 |
$785 |
5.6× |
| CT lower ext w/o (73700) |
$1,286.57 |
$2,004 |
11.9× |
| CT lower extremity w wo contrast (73702) |
$1,850.24 |
$2,882 |
10.2× |
| CT lower extremity w/contrast material (73701) |
$1,338.57 |
$2,085 |
7.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,669.84 |
$2,601 |
9.2× |
| CT lumbar spine w/o contrast (72131) |
$1,296.84 |
$2,020 |
12.0× |
| CT maxillofacial w contrast (70487) |
$1,256.39 |
$1,957 |
6.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,483.02 |
$2,310 |
8.2× |
| CT maxillofacial wo contrast (70486) |
$1,223.65 |
$1,906 |
11.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,381.58 |
$2,152 |
7.6× |
| CT orbits w/o contrast (70480) |
$1,126.71 |
$1,755 |
10.4× |
| CT pelvis w/o contrast (72192) |
$1,211.45 |
$1,887 |
11.2× |
| CT pelvis w/wo contrast (72194) |
$1,472.11 |
$2,293 |
8.1× |
| CT scan of arm combo (73202) |
$1,169.72 |
$1,822 |
6.5× |
| CT soft tissue neck w contrast (70491) |
$1,278.86 |
$1,992 |
7.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,361.04 |
$2,120 |
7.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,050.31 |
$1,636 |
9.7× |
| CT thoracic spine w/o contrast (72128) |
$1,221.73 |
$1,903 |
11.3× |
| CT thorax w/o contrast (71250) |
$1,210.81 |
$1,886 |
11.2× |
| CT unlisted procedure (76497) |
$5,939.78 |
$9,252 |
66.1× |
| CT upper ext wo (73200) |
$1,121.57 |
$1,747 |
10.4× |
| CT upper extremity with contrast (73201) |
$1,320.59 |
$2,057 |
3.7× |
| Cta Abdomen (74175) |
$1,764.86 |
$2,749 |
9.7× |
| CTA abdomen pelvis (74174) |
$2,831.22 |
$4,410 |
7.9× |
| CTA chest (71275) |
$1,756.51 |
$2,736 |
9.7× |
| Cta Head (70496) |
$1,678.19 |
$2,614 |
9.3× |
| Cta Neck (70498) |
$1,709.65 |
$2,663 |
9.4× |
| Cystography minimum 3 views rs&i (74430) |
$390.98 |
$609 |
1.1× |
| Esophagus (74220) |
$399.97 |
$623 |
2.2× |
| Facial bones min 3 views (70150) |
$95.66 |
$149 |
0.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$430.78 |
$671 |
4.0× |
| Fluoroscopy up to 1 hr (76000) |
$308.80 |
$481 |
1.3× |
| Foot 2 views (73620) |
$120.05 |
$187 |
1.3× |
| Forearm 2 views (73090) |
$205.44 |
$320 |
2.3× |
| Hand 2 views (73120) |
$189.39 |
$295 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,342.42 |
$2,091 |
2.4× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,187.70 |
$1,850 |
2.9× |
| Hysterosalpingogram (74740) |
$514.88 |
$802 |
2.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$166.92 |
$260 |
1.5× |
| Knee 3 views (73562) |
$139.96 |
$218 |
1.6× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,058.89 |
$3,207 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,239.06 |
$1,930 |
3.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,333.03 |
$3,634 |
6.5× |
| MRA head w/o contrast (70544) |
$1,884.27 |
$2,935 |
7.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,379.89 |
$3,707 |
6.6× |
| MRI abdomen w/o contrast (74181) |
$1,920.86 |
$2,992 |
7.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,138.50 |
$3,331 |
2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,296.43 |
$3,577 |
6.4× |
| MRI c-spine with contrast (72142) |
$1,492.01 |
$2,324 |
4.1× |
| MRI cervical spine w/o contrast (72141) |
$1,887.48 |
$2,940 |
7.7× |
| MRI chest w/o contrast (71550) |
$1,631.32 |
$2,541 |
6.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,343.30 |
$3,650 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,883.63 |
$2,934 |
7.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,380.54 |
$3,708 |
6.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,480.69 |
$3,864 |
6.9× |
| MRI pelvis w/o contrast (72195) |
$1,861.16 |
$2,899 |
7.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,443.45 |
$3,806 |
6.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,002.40 |
$3,119 |
5.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,493.53 |
$3,884 |
6.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,031.29 |
$3,164 |
5.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,403.01 |
$3,743 |
6.7× |
| MRI thoracic spine w/o contrast (72146) |
$1,890.05 |
$2,944 |
7.7× |
| MRI up ext w/o contrast (73218) |
$1,897.75 |
$2,956 |
7.7× |
| MRI upper ext joint w/o contrast (73221) |
$1,866.29 |
$2,907 |
7.6× |
| MRI, joint upper extrem combo (73223) |
$2,382.46 |
$3,711 |
6.6× |
| Myocardial Spect Multiple Studies (78452) |
$2,492.24 |
$3,882 |
1.9× |
| Myocardial spect single study at rest or stress (78451) |
$1,000.88 |
$1,559 |
0.7× |
| Neck soft tissue (70360) |
$141.24 |
$220 |
1.6× |
| Osseous survey limited (77074) |
$124.55 |
$194 |
1.2× |
| Parathyroid planar imaging w/wo subtraction (78071) |
$987.40 |
$1,538 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$171.41 |
$267 |
1.6× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$365.94 |
$570 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$125.83 |
$196 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$116.20 |
$181 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$231.76 |
$361 |
2.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$52 |
$81 |
0.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$124.55 |
$194 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$127.12 |
$198 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$148.30 |
$231 |
1.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$127.76 |
$199 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$215.07 |
$335 |
2.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$93.09 |
$145 |
1.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$145.09 |
$226 |
1.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$98.23 |
$153 |
0.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$157.29 |
$245 |
1.5× |
| Radex Humerus Minimum 2 Views (73060) |
$218.28 |
$340 |
2.4× |
| Radex Kne 1/2 Views (73560) |
$121.98 |
$190 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$160.50 |
$250 |
1.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$94.37 |
$147 |
0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$87.95 |
$137 |
1.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$193.24 |
$301 |
1.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$226.63 |
$353 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$64.20 |
$100 |
0.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$181.69 |
$283 |
1.7× |
| Radex Toe Minimum 2 Views (73660) |
$110.42 |
$172 |
1.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$89.24 |
$139 |
0.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$222.13 |
$346 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$116.20 |
$181 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$137.39 |
$214 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$247.17 |
$385 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$380.06 |
$592 |
2.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$281.84 |
$439 |
1.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$496.91 |
$774 |
2.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$426.29 |
$664 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$99.51 |
$155 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$121.98 |
$190 |
1.4× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$91.81 |
$143 |
0.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$91.81 |
$143 |
0.9× |
| Radiological examination surgical specimen (76098) |
$369.79 |
$576 |
0.7× |
| Ribs bilateral 3 views (71110) |
$231.12 |
$360 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$132.89 |
$207 |
1.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$485.35 |
$756 |
2.0× |
| Scapula (73010) |
$219.56 |
$342 |
2.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$61.63 |
$96 |
2.6× |
| Shoulder 1 view (73020) |
$162.43 |
$253 |
1.8× |
| Small bowel series (74250) |
$449.40 |
$700 |
2.5× |
| Spine thoracic 3 views (72072) |
$206.72 |
$322 |
1.9× |
| Thoracolumbar 2 views (72080) |
$149.59 |
$233 |
1.7× |
| Tmj unilateral (70328) |
$64.84 |
$101 |
0.7× |
| Ultrasound breast complete (76641) |
$277.99 |
$433 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$359.52 |
$560 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$466.73 |
$727 |
4.3× |
| Umbilical-artery Doppler (OB) (76820) |
$219.56 |
$342 |
2.0× |
| Urethrocystogram voiding (74455) |
$501.40 |
$781 |
2.0× |
| Urethrocystography retrograde rs&i (74450) |
$327.42 |
$510 |
1.3× |
| Us breast unilateral limited (76642) |
$240.75 |
$375 |
2.7× |
| Us chest (76604) |
$286.33 |
$446 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$289.54 |
$451 |
2.7× |
| Us encephalogram (76506) |
$267.07 |
$416 |
2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$343.47 |
$535 |
3.2× |
| Us ob limited (76815) |
$313.30 |
$488 |
2.9× |
| Us ob transvaginal (76817) |
$260.65 |
$406 |
2.4× |
| Us pelvic non ob complete (76856) |
$489.20 |
$762 |
4.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$328.70 |
$512 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$344.11 |
$536 |
3.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$405.74 |
$632 |
3.8× |
| Us retroperitoneal complete (76770) |
$373 |
$581 |
3.5× |
| Us retroperitoneal limited (76775) |
$364.01 |
$567 |
3.4× |
| Us scrotum and contents (76870) |
$428.86 |
$668 |
4.0× |
| Us soft tissue head/neck (76536) |
$348.61 |
$543 |
3.2× |
| Us transrectal (76872) |
$390.98 |
$609 |
3.6× |
| Wrist 2 views (73100) |
$200.95 |
$313 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$148.94 |
$232 |
1.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$329.35 |
$513 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$196.45 |
$306 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$240.11 |
$374 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$143.17 |
$223 |
1.3× |
| X-ray exam of femur 2/> (73552) |
$123.26 |
$192 |
1.4× |
| X-ray eye for foreign body (70030) |
$98.87 |
$154 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$66.77 |
$104 |
0.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$68.05 |
$106 |
0.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$92.45 |
$144 |
1.0× |
| X-ray leg, infant (73592) |
$82.18 |
$128 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$187.46 |
$292 |
1.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$342.19 |
$533 |
3.2× |
| X-ray nose-rectum child f.b. (76010) |
$86.03 |
$134 |
1.0× |
| X-ray retrograde pyelogram (74420) |
$623.38 |
$971 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$99.51 |
$155 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$136.75 |
$213 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$128.40 |
$200 |
1.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$150.87 |
$235 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$95.66 |
$149 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$104 |
$162 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$166.28 |
$259 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$132.25 |
$206 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$57.14 |
$89 |
0.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$145.73 |
$227 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$129.68 |
$202 |
1.2× |
| Xr bone length studies (77073) |
$102.08 |
$159 |
0.9× |
| Xr c-spine 4 or 5 views (72050) |
$197.09 |
$307 |
1.8× |
| Xr c-spine 6 or more views (72052) |
$335.77 |
$523 |
3.1× |