| Abdomen 2 views (74019) |
$357 |
$595 |
3.3× |
| Ankle 2 views (73600) |
$240 |
$400 |
2.6× |
| Arthrogram ankle (73615) |
$1,203 |
$2,005 |
3.3× |
| Arthrogram elbow (73085) |
$1,217.40 |
$2,029 |
3.3× |
| Arthrogram hip (73525) |
$1,225.80 |
$2,043 |
3.4× |
| Arthrogram knee (73580) |
$1,203 |
$2,005 |
3.3× |
| Bone age studies (77072) |
$186.60 |
$311 |
1.7× |
| Bone survey complete (77075) |
$543.60 |
$906 |
5.0× |
| Cervical spine 2 or 3 views (72040) |
$323.40 |
$539 |
3.5× |
| Chest 1 view (71045) |
$215.40 |
$359 |
2.4× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,195.80 |
$1,993 |
6.5× |
| Clavicle complete (73000) |
$247.80 |
$413 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,944.40 |
$6,574 |
10.8× |
| CT abdomen and pelvis without contrast (74176) |
$3,016.20 |
$5,027 |
12.1× |
| CT abdomen w contrast (74160) |
$2,244 |
$3,740 |
12.2× |
| CT abdomen w/o contrast (74150) |
$1,824 |
$3,040 |
16.7× |
| CT c-spine w/o contrast (72125) |
$1,234.80 |
$2,058 |
11.3× |
| CT chest w contrast (71260) |
$2,154 |
$3,590 |
11.7× |
| CT iac w contrast (70481) |
$2,361 |
$3,935 |
12.9× |
| CT lower ext w/o (73700) |
$1,857.60 |
$3,096 |
17.0× |
| CT lower extremity w/contrast material (73701) |
$1,900.80 |
$3,168 |
10.3× |
| CT lumbar spine w/o contrast (72131) |
$1,824 |
$3,040 |
16.7× |
| CT maxillofacial w contrast (70487) |
$1,635 |
$2,725 |
8.9× |
| CT maxillofacial wo contrast (70486) |
$1,492.20 |
$2,487 |
13.6× |
| CT orbits w/o contrast (70480) |
$2,153.40 |
$3,589 |
19.7× |
| CT pelvis w/o contrast (72192) |
$1,824 |
$3,040 |
16.7× |
| CT soft tissue neck w contrast (70491) |
$1,824 |
$3,040 |
9.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,824 |
$3,040 |
9.9× |
| CT soft tissue neck w/o contrast (70490) |
$2,000.40 |
$3,334 |
18.3× |
| CT thoracic spine w/o contrast (72128) |
$1,824 |
$3,040 |
16.7× |
| CT thorax w/o contrast (71250) |
$1,824 |
$3,040 |
16.7× |
| CT upper ext wo (73200) |
$1,824 |
$3,040 |
16.7× |
| CTA abdomen pelvis (74174) |
$2,568 |
$4,280 |
7.0× |
| CTA chest (71275) |
$1,900.80 |
$3,168 |
10.3× |
| Cta Head (70496) |
$1,824 |
$3,040 |
9.9× |
| Cta Neck (70498) |
$1,824 |
$3,040 |
9.9× |
| Cystography minimum 3 views rs&i (74430) |
$312.60 |
$521 |
0.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$762.60 |
$1,271 |
7.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$762.60 |
$1,271 |
8.4× |
| Dxa bone density study axial skeleton (77085) |
$782.70 |
$1,304.50 |
7.1× |
| Fluoroscopy up to 1 hr (76000) |
$1,175.40 |
$1,959 |
4.7× |
| Foot 2 views (73620) |
$240 |
$400 |
2.6× |
| Forearm 2 views (73090) |
$307.20 |
$512 |
3.4× |
| Hand 2 views (73120) |
$247.80 |
$413 |
2.3× |
| Knee 3 views (73562) |
$277.20 |
$462 |
3.0× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$5,917.20 |
$9,862 |
7.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,389.40 |
$5,649 |
9.3× |
| MRA head w & w/o contrast (70546) |
$3,473.40 |
$5,789 |
9.5× |
| MRA head w/o contrast (70544) |
$5,427.90 |
$9,046.50 |
21.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,120.60 |
$5,201 |
8.5× |
| MRA neck w/o contrast (70547) |
$7,369.20 |
$12,282 |
29.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$5,719.20 |
$9,532 |
15.7× |
| MRI abdomen w/o contrast (74181) |
$3,389.40 |
$5,649 |
13.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$4,971 |
$8,285 |
6.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$5,066.10 |
$8,443.50 |
13.9× |
| MRI c-spine with contrast (72142) |
$7,074.60 |
$11,791 |
19.4× |
| MRI cervical spine w/o contrast (72141) |
$3,817.80 |
$6,363 |
15.3× |
| MRI chest w/o & w/contrast material (71552) |
$3,546 |
$5,910 |
9.7× |
| MRI chest w/o contrast (71550) |
$3,389.40 |
$5,649 |
13.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,389.40 |
$5,649 |
9.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$5,897.40 |
$9,829 |
23.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$5,893.50 |
$9,822.50 |
23.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,506.10 |
$5,843.50 |
9.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$4,643.40 |
$7,739 |
12.7× |
| MRI pelvis w/o contrast (72195) |
$3,389.40 |
$5,649 |
13.6× |
| MRI spectroscopy (76390) |
$5,562.60 |
$9,271 |
61.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,838 |
$4,730 |
7.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,220 |
$3,700 |
6.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,006 |
$5,010 |
8.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,751.30 |
$4,585.50 |
7.5× |
| MRI thoracic spine w/o contrast (72146) |
$4,454.40 |
$7,424 |
17.8× |
| MRI up ext w/o contrast (73218) |
$3,389.40 |
$5,649 |
13.6× |
| MRI upper ext joint w/o contrast (73221) |
$5,897.40 |
$9,829 |
23.6× |
| MRI, joint upper extrem combo (73223) |
$3,389.40 |
$5,649 |
9.3× |
| Neck soft tissue (70360) |
$212.40 |
$354 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$228.60 |
$381 |
2.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$281.40 |
$469 |
3.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$204.60 |
$341 |
2.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$281.40 |
$469 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$438.60 |
$731 |
4.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$693.60 |
$1,156 |
6.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$498.60 |
$831 |
4.6× |
| Radex fingr minimum 2 views (73140) |
$256.80 |
$428 |
2.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$281.40 |
$469 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$271.80 |
$453 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$232.20 |
$387 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$406.20 |
$677 |
3.7× |
| Radex Humerus Minimum 2 Views (73060) |
$258.30 |
$430.50 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$240 |
$400 |
2.6× |
| Radex Kne Compl 4/More Views (73564) |
$300 |
$500 |
2.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$339 |
$565 |
3.1× |
| Radex Sho Compl Minimum 2 Views (73030) |
$283.20 |
$472 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$681.60 |
$1,136 |
6.2× |
| Radex Toe Minimum 2 Views (73660) |
$256.80 |
$428 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$283.20 |
$472 |
2.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$271.80 |
$453 |
3.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$230.40 |
$384 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$283.20 |
$472 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$1,436.40 |
$2,394 |
7.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$1,175.40 |
$1,959 |
6.4× |
| Radiologic examination femur 1 view (73551) |
$212.40 |
$354 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$307.20 |
$512 |
3.4× |
| Radiologic examination, teeth; complete, full mouth Non-Facility (70320) |
$251.40 |
$419 |
1.0× |
| Shoulder 1 view (73020) |
$199.80 |
$333 |
2.2× |
| Thoracolumbar 2 views (72080) |
$681.60 |
$1,136 |
7.5× |
| Ultrasound, abdomen limited (76705) |
$820.20 |
$1,367 |
7.5× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$283.20 |
$472 |
3.1× |
| Us breast unilateral limited (76642) |
$453.60 |
$756 |
5.0× |
| Us chest (76604) |
$954.60 |
$1,591 |
8.7× |
| Us compl joint r-t w/image documentation (76881) |
$995.40 |
$1,659 |
9.1× |
| Us encephalogram (76506) |
$1,047.60 |
$1,746 |
9.6× |
| Us hips infant static (76886) |
$995.40 |
$1,659 |
10.9× |
| Us infant hips w manipulation (76885) |
$1,325.40 |
$2,209 |
14.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$502.20 |
$837 |
4.6× |
| Us pelvic non ob complete (76856) |
$954.60 |
$1,591 |
8.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$954.60 |
$1,591 |
8.7× |
| Us retroperitoneal complete (76770) |
$1,150.80 |
$1,918 |
10.5× |
| Us retroperitoneal limited (76775) |
$954.60 |
$1,591 |
8.7× |
| Us scrotum and contents (76870) |
$995.40 |
$1,659 |
9.1× |
| Us soft tissue head/neck (76536) |
$844.20 |
$1,407 |
7.7× |
| Us spinal canal and contents (76800) |
$707.40 |
$1,179 |
6.5× |
| Wrist 2 views (73100) |
$256.80 |
$428 |
2.8× |
| X-ray b.e. reductn intuss (74283) |
$1,511.40 |
$2,519 |
8.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$256.80 |
$428 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$313.20 |
$522 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$366.90 |
$611.50 |
3.4× |
| X-ray exam of femur 2/> (73552) |
$307.20 |
$512 |
3.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$280.20 |
$467 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$330.60 |
$551 |
3.6× |
| X-ray leg, infant (73592) |
$231.60 |
$386 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$318 |
$530 |
2.9× |
| X-ray retrograde pyelogram (74420) |
$1,052.40 |
$1,754 |
2.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$257.40 |
$429 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$280.20 |
$467 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$257.40 |
$429 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$411.60 |
$686 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$291 |
$485 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$219.30 |
$365.50 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$280.20 |
$467 |
2.6× |
| Xr bone length studies (77073) |
$647.40 |
$1,079 |
5.9× |
| Xr c-spine 4 or 5 views (72050) |
$451.20 |
$752 |
4.1× |