| Abdomen 2 views (74019) |
$283.20 |
$354 |
2.4× |
| Ankle 2 views (73600) |
$421.60 |
$527 |
4.3× |
| Arthrogram hip (73525) |
$1,253.60 |
$1,567 |
3.2× |
| Arthrogram knee (73580) |
$1,168.80 |
$1,461 |
2.9× |
| Arthrogram shoulder (73040) |
$763.20 |
$954 |
1.9× |
| Arthrogram wrist (73115) |
$908.80 |
$1,136 |
2.3× |
| Bone age studies (77072) |
$123.20 |
$154 |
1.0× |
| Bone survey complete (77075) |
$610.40 |
$763 |
5.1× |
| Bone survey infant (77076) |
$484.80 |
$606 |
4.1× |
| Cervical spine 2 or 3 views (72040) |
$421.60 |
$527 |
4.3× |
| Chest 1 view (71045) |
$288 |
$360 |
2.9× |
| Clavicle complete (73000) |
$364 |
$455 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,033.60 |
$6,292 |
12.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,997.60 |
$3,747 |
11.0× |
| CT abdomen w contrast (74160) |
$3,184 |
$3,980 |
15.9× |
| CT abdomen w wo contrast (74170) |
$3,885.60 |
$4,857 |
19.5× |
| CT abdomen w/o contrast (74150) |
$2,168 |
$2,710 |
18.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,200 |
$4,000 |
16.0× |
| CT angiography upper extremity lt (73206) |
$1,391.20 |
$1,739 |
7.0× |
| CT c-spine w/contrast (72126) |
$3,246.40 |
$4,058 |
8.2× |
| CT c-spine w/o contrast (72125) |
$1,647.20 |
$2,059 |
13.8× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$1,228 |
$1,535 |
6.1× |
| CT cervical spine w&w/o contrast (72127) |
$3,716 |
$4,645 |
18.6× |
| CT chest w contrast (71260) |
$2,660.80 |
$3,326 |
13.3× |
| CT chest w/wo contrast (71270) |
$2,942.40 |
$3,678 |
14.7× |
| CT head/brain with contrast (70460) |
$2,216 |
$2,770 |
11.1× |
| CT head/brain without and with contrast (70470) |
$2,785.60 |
$3,482 |
13.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$156 |
$195 |
1.6× |
| CT iac w contrast (70481) |
$1,826.40 |
$2,283 |
9.1× |
| CT limited/localized follow up study (76380) |
$627.20 |
$784 |
6.3× |
| CT lower ext w/o (73700) |
$1,920 |
$2,400 |
16.1× |
| CT lower extremity w wo contrast (73702) |
$3,040 |
$3,800 |
15.2× |
| CT lower extremity w/contrast material (73701) |
$2,560 |
$3,200 |
12.8× |
| CT lumbar spine w & w/o contrast (72133) |
$2,772 |
$3,465 |
13.9× |
| CT lumbar spine w/contrast (72132) |
$2,728 |
$3,410 |
6.9× |
| CT lumbar spine w/o contrast (72131) |
$2,200 |
$2,750 |
18.5× |
| CT maxillofacial w contrast (70487) |
$2,143.20 |
$2,679 |
10.7× |
| CT maxillofacial w/wo contrast (70488) |
$2,364.40 |
$2,955.50 |
11.8× |
| CT maxillofacial wo contrast (70486) |
$1,609.60 |
$2,012 |
13.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,464 |
$3,080 |
12.3× |
| CT orbits w/o contrast (70480) |
$1,720.80 |
$2,151 |
14.5× |
| CT pelvis w/o contrast (72192) |
$1,794.40 |
$2,243 |
15.1× |
| CT pelvis w/wo contrast (72194) |
$2,822.40 |
$3,528 |
14.1× |
| CT scan of arm combo (73202) |
$2,267.20 |
$2,834 |
11.4× |
| CT soft tissue neck w contrast (70491) |
$2,598.40 |
$3,248 |
13.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,779.20 |
$3,474 |
13.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,941.60 |
$2,427 |
16.3× |
| CT thoracic spine w/contrast (72129) |
$2,480 |
$3,100 |
12.4× |
| CT thoracic spine w/o contrast (72128) |
$2,000 |
$2,500 |
16.8× |
| CT thoracic spine w/wo contrast (72130) |
$2,640 |
$3,300 |
13.2× |
| CT thorax w/o contrast (71250) |
$1,578.40 |
$1,973 |
13.3× |
| CT upper ext wo (73200) |
$1,560.80 |
$1,951 |
13.1× |
| CT upper extremity with contrast (73201) |
$2,404 |
$3,005 |
6.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,621.60 |
$3,277 |
13.1× |
| Cta Abdomen (74175) |
$2,973.60 |
$3,717 |
14.9× |
| CTA abdomen pelvis (74174) |
$4,233.60 |
$5,292 |
10.7× |
| CTA chest (71275) |
$2,612 |
$3,265 |
13.1× |
| Cta Head (70496) |
$2,628 |
$3,285 |
13.2× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,456 |
$3,070 |
6.2× |
| Cta Neck (70498) |
$2,628 |
$3,285 |
13.2× |
| Cta Pelvis (72191) |
$1,568.80 |
$1,961 |
7.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$561.60 |
$702 |
4.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$301.60 |
$377 |
3.0× |
| Facial bones min 3 views (70150) |
$541.60 |
$677 |
4.5× |
| Fetal biophysical profile non-stress testing (76818) |
$683.20 |
$854 |
5.7× |
| Fluoroscopy up to 1 hr (76000) |
$840 |
$1,050 |
3.1× |
| Foot 2 views (73620) |
$304.80 |
$381 |
3.1× |
| Forearm 2 views (73090) |
$420.80 |
$526 |
4.2× |
| Hand 2 views (73120) |
$295.20 |
$369 |
2.5× |
| Hysterosalpingogram (74740) |
$1,004 |
$1,255 |
3.7× |
| Knee 3 views (73562) |
$404.80 |
$506 |
4.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$4,358.40 |
$5,448 |
4.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,182.40 |
$2,728 |
5.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,173.60 |
$3,967 |
8.0× |
| MRA head w & w/o contrast (70546) |
$3,248.80 |
$4,061 |
8.2× |
| MRA head w/o contrast (70544) |
$2,200 |
$2,750 |
8.1× |
| MRA neck w contrast (70548) |
$2,279.20 |
$2,849 |
5.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,860 |
$3,575 |
7.2× |
| MRA neck w/o contrast (70547) |
$1,812 |
$2,265 |
6.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,042.40 |
$6,303 |
12.7× |
| MRI abdomen w/o contrast (74181) |
$3,024.80 |
$3,781 |
11.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$3,911.20 |
$4,889 |
4.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,331.20 |
$5,414 |
10.9× |
| MRI c-spine with contrast (72142) |
$4,003.20 |
$5,004 |
10.1× |
| MRI cervical spine w/o contrast (72141) |
$2,744.40 |
$3,430.50 |
10.1× |
| MRI chest w/o & w/contrast material (71552) |
$4,224.80 |
$5,281 |
10.6× |
| MRI chest w/o contrast (71550) |
$2,529.60 |
$3,162 |
9.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,330.40 |
$2,913 |
5.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,829.60 |
$4,787 |
9.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,315.20 |
$2,894 |
8.5× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,237.60 |
$2,797 |
8.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,426.40 |
$4,283 |
8.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,988 |
$6,235 |
12.6× |
| MRI pelvis w/o contrast (72195) |
$2,993.60 |
$3,742 |
11.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$5,084 |
$6,355 |
12.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$4,195.20 |
$5,244 |
10.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$5,072.80 |
$6,341 |
12.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,600 |
$4,500 |
9.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,480 |
$5,600 |
11.3× |
| MRI thoracic spine w/o contrast (72146) |
$3,120 |
$3,900 |
11.5× |
| MRI up ext w/o contrast (73218) |
$2,152.80 |
$2,691 |
7.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,948 |
$3,685 |
10.8× |
| MRI, joint upper extrem combo (73223) |
$4,875.20 |
$6,094 |
12.3× |
| Neck soft tissue (70360) |
$328 |
$410 |
3.3× |
| Nonvascular shunt X-ray (75809) |
$306.40 |
$383 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$301.60 |
$377 |
2.5× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$470.40 |
$588 |
4.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$240.80 |
$301 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$360.80 |
$451 |
3.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$198.40 |
$248 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$276.80 |
$346 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$286.40 |
$358 |
2.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$353.60 |
$442 |
3.6× |
| Radex Hand Minimum 3 Views (73130) |
$351.20 |
$439 |
3.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$250.40 |
$313 |
2.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$265.60 |
$332 |
2.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$362.40 |
$453 |
3.0× |
| Radex Humerus Minimum 2 Views (73060) |
$319.20 |
$399 |
3.2× |
| Radex Kne 1/2 Views (73560) |
$329.60 |
$412 |
3.3× |
| Radex Kne Compl 4/More Views (73564) |
$460 |
$575 |
3.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$500.80 |
$626 |
4.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$378.40 |
$473 |
3.8× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$372.80 |
$466 |
3.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$371.20 |
$464 |
3.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$413.60 |
$517 |
4.2× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$388 |
$485 |
3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$374.40 |
$468 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$276 |
$345 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$214.40 |
$268 |
1.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$480.80 |
$601 |
4.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$258.40 |
$323 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$390.40 |
$488 |
3.3× |
| Radiologic exam chest 2 views (71046) |
$336 |
$420 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$750.40 |
$938 |
3.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$840 |
$1,050 |
4.2× |
| Radiologic exam upr gi trc single contrast study (74240) |
$484 |
$605 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$368.80 |
$461 |
3.7× |
| Ribs bilateral 3 views (71110) |
$450.40 |
$563 |
3.8× |
| Sacroiliac Joints < 3 Views (72200) |
$291.20 |
$364 |
2.4× |
| Scapula (73010) |
$131.20 |
$164 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$70.40 |
$88 |
3.0× |
| Shoulder 1 view (73020) |
$276.80 |
$346 |
2.8× |
| Small bowel series (74250) |
$941.60 |
$1,177 |
4.7× |
| Spine thoracic 3 views (72072) |
$456 |
$570 |
3.8× |
| Thoracolumbar 2 views (72080) |
$258.40 |
$323 |
2.6× |
| Tmj unilateral (70328) |
$249.60 |
$312 |
2.5× |
| Ultrasound breast complete (76641) |
$534.40 |
$668 |
4.5× |
| Ultrasound Exam Aaa Screen (76706) |
$312 |
$390 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$678.40 |
$848 |
5.7× |
| Urethrocystography retrograde rs&i (74450) |
$778.40 |
$973 |
2.9× |
| Us breast unilateral limited (76642) |
$534.40 |
$668 |
5.4× |
| Us chest (76604) |
$662.40 |
$828 |
5.6× |
| Us compl joint r-t w/image documentation (76881) |
$2,196.80 |
$2,746 |
18.5× |
| Us encephalogram (76506) |
$472 |
$590 |
4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$348.80 |
$436 |
2.9× |
| Us ob limited (76815) |
$288 |
$360 |
2.4× |
| Us ob transvaginal (76817) |
$323.20 |
$404 |
2.7× |
| Us pelvic non ob complete (76856) |
$799.20 |
$999 |
6.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$512 |
$640 |
4.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$635.20 |
$794 |
5.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$368 |
$460 |
3.1× |
| Us retroperitoneal complete (76770) |
$883.20 |
$1,104 |
7.4× |
| Us retroperitoneal limited (76775) |
$484.80 |
$606 |
4.1× |
| Us scrotum and contents (76870) |
$765.60 |
$957 |
6.4× |
| Us soft tissue head/neck (76536) |
$703.20 |
$879 |
5.9× |
| Us,transplanted kidney, real time/ doppler (76776) |
$722.40 |
$903 |
6.1× |
| Wrist 2 views (73100) |
$412 |
$515 |
4.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$515.20 |
$644 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$283.20 |
$354 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$303.20 |
$379 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$362.40 |
$453 |
3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$384 |
$480 |
3.2× |
| X-ray exam of femur 2/> (73552) |
$412.80 |
$516 |
4.2× |
| X-ray eye for foreign body (70030) |
$327.20 |
$409 |
3.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$378.40 |
$473 |
3.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$436 |
$545 |
4.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$369.60 |
$462 |
3.7× |
| X-ray leg, infant (73592) |
$214.40 |
$268 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$403.20 |
$504 |
3.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$714.40 |
$893 |
6.0× |
| X-ray nose-rectum child f.b. (76010) |
$286.40 |
$358 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$304.80 |
$381 |
2.6× |
| X-ray retrograde pyelogram (74420) |
$860 |
$1,075 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$364 |
$455 |
3.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$437.60 |
$547 |
3.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$591.20 |
$739 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$400 |
$500 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$350.40 |
$438 |
3.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$524 |
$655 |
5.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$317.60 |
$397 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$293.60 |
$367 |
2.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$119.20 |
$149 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$354.40 |
$443 |
3.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$352 |
$440 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$384 |
$480 |
3.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$267.20 |
$334 |
2.2× |
| Xr bone length studies (77073) |
$496.80 |
$621 |
4.2× |
| Xr c-spine 4 or 5 views (72050) |
$568.80 |
$711 |
4.8× |
| Xr c-spine 6 or more views (72052) |
$618.40 |
$773 |
5.2× |
| Xr chest 4+ views (71048) |
$476 |
$595 |
4.0× |