| Abdomen 2 views (74019) |
$313.62 |
$482.50 |
2.5× |
| Ankle 2 views (73600) |
$270.40 |
$416 |
2.6× |
| Arthrogram ankle (73615) |
$988 |
$1,520 |
2.4× |
| Arthrogram elbow (73085) |
$988 |
$1,520 |
2.4× |
| Arthrogram hip (73525) |
$988 |
$1,520 |
2.4× |
| Arthrogram knee (73580) |
$1,233.70 |
$1,898 |
3.0× |
| Arthrogram shoulder (73040) |
$1,233.70 |
$1,898 |
3.0× |
| Arthrogram wrist (73115) |
$1,233.70 |
$1,898 |
3.0× |
| Bone age studies (77072) |
$228.80 |
$352 |
1.9× |
| Bone survey complete (77075) |
$484.90 |
$746 |
3.9× |
| Bone survey infant (77076) |
$377 |
$580 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$316.55 |
$487 |
3.1× |
| Chest 1 view (71045) |
$244.40 |
$376 |
2.4× |
| Chest xray 3 views (71047) |
$367.25 |
$565 |
3.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$460.85 |
$709 |
2.2× |
| Clavicle complete (73000) |
$279.50 |
$430 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$289.90 |
$446 |
2.3× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$373.10 |
$574 |
3.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,935.45 |
$7,593 |
12.0× |
| CT abdomen and pelvis without contrast (74176) |
$3,758.95 |
$5,783 |
13.3× |
| CT abdomen w contrast (74160) |
$1,341.60 |
$2,064 |
6.5× |
| CT abdomen w wo contrast (74170) |
$1,476.80 |
$2,272 |
7.1× |
| CT abdomen w/o contrast (74150) |
$1,965.92 |
$3,024.50 |
15.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,285.05 |
$1,977 |
6.2× |
| CT angiography upper extremity lt (73206) |
$1,285.05 |
$1,977 |
6.2× |
| CT c-spine w/contrast (72126) |
$1,457.95 |
$2,243 |
3.5× |
| CT c-spine w/o contrast (72125) |
$955.50 |
$1,470 |
7.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,214.85 |
$1,869 |
5.9× |
| CT chest w contrast (71260) |
$3,788.20 |
$5,828 |
18.3× |
| CT chest w/wo contrast (71270) |
$4,169.10 |
$6,414 |
20.1× |
| CT head/brain with contrast (70460) |
$1,010.75 |
$1,555 |
4.9× |
| CT head/brain without and with contrast (70470) |
$1,376.70 |
$2,118 |
6.6× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$287.95 |
$443 |
2.8× |
| CT iac w contrast (70481) |
$1,348.10 |
$2,074 |
6.5× |
| CT limited/localized follow up study (76380) |
$409.50 |
$630 |
4.0× |
| CT lower ext w/o (73700) |
$1,073.15 |
$1,651 |
8.7× |
| CT lower extremity w wo contrast (73702) |
$1,445.60 |
$2,224 |
7.0× |
| CT lower extremity w/contrast material (73701) |
$1,214.85 |
$1,869 |
5.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,002.30 |
$1,542 |
4.8× |
| CT lumbar spine w/contrast (72132) |
$1,322.10 |
$2,034 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$716.95 |
$1,103 |
5.8× |
| CT maxillofacial w contrast (70487) |
$2,349.75 |
$3,615 |
11.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,487.88 |
$3,827.50 |
12.0× |
| CT maxillofacial wo contrast (70486) |
$3,027.05 |
$4,657 |
24.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,336.40 |
$2,056 |
6.4× |
| CT orbits w/o contrast (70480) |
$993.20 |
$1,528 |
8.0× |
| CT pelvis w/o contrast (72192) |
$728 |
$1,120 |
5.9× |
| CT pelvis w/wo contrast (72194) |
$1,067.95 |
$1,643 |
5.2× |
| CT scan of arm combo (73202) |
$1,445.60 |
$2,224 |
7.0× |
| CT soft tissue neck w contrast (70491) |
$3,515.20 |
$5,408 |
17.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$3,768.70 |
$5,798 |
18.2× |
| CT soft tissue neck w/o contrast (70490) |
$993.20 |
$1,528 |
8.0× |
| CT thoracic spine w/contrast (72129) |
$1,123.20 |
$1,728 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$955.50 |
$1,470 |
7.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,336.40 |
$2,056 |
6.4× |
| CT thorax w/o contrast (71250) |
$3,085.55 |
$4,747 |
25.0× |
| CT upper ext wo (73200) |
$1,073.15 |
$1,651 |
8.7× |
| CT upper extremity with contrast (73201) |
$1,405.95 |
$2,163 |
3.4× |
| Cta Abdomen (74175) |
$2,842.45 |
$4,373 |
13.7× |
| CTA abdomen pelvis (74174) |
$1,780.35 |
$2,739 |
4.3× |
| CTA chest (71275) |
$4,364.10 |
$6,714 |
21.1× |
| Cta Head (70496) |
$1,164.15 |
$1,791 |
5.6× |
| Cta Neck (70498) |
$1,148.55 |
$1,767 |
5.5× |
| Cta Pelvis (72191) |
$1,257.75 |
$1,935 |
6.1× |
| Cystography minimum 3 views rs&i (74430) |
$724.10 |
$1,114 |
1.8× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$376.35 |
$579 |
3.0× |
| Esophagus (74220) |
$295.10 |
$454 |
1.4× |
| Facial bones min 3 views (70150) |
$448.50 |
$690 |
3.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$267.48 |
$411.50 |
2.2× |
| Fluoroscopy up to 1 hr (76000) |
$516.10 |
$794 |
1.8× |
| Foot 2 views (73620) |
$286 |
$440 |
2.8× |
| Forearm 2 views (73090) |
$286 |
$440 |
2.8× |
| Hand 2 views (73120) |
$286 |
$440 |
2.3× |
| Hysterosalpingogram (74740) |
$694.20 |
$1,068 |
2.5× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$272.35 |
$419 |
2.2× |
| Knee 3 views (73562) |
$341.25 |
$525 |
3.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,391.35 |
$3,679 |
2.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,602.25 |
$2,465 |
3.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,640.60 |
$2,524 |
4.0× |
| Mammary ductogram or galactogram multiple (77054) |
$481 |
$740 |
1.7× |
| Mammary ductogram or galactogram single (77053) |
$481 |
$740 |
1.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,391.35 |
$3,679 |
2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,907.10 |
$2,934 |
4.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,602.25 |
$2,465 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,640.60 |
$2,524 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,509.30 |
$2,322 |
5.4× |
| MRI up ext w/o contrast (73218) |
$1,509.30 |
$2,322 |
5.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,509.30 |
$2,322 |
5.4× |
| MRI, joint upper extrem combo (73223) |
$1,907.10 |
$2,934 |
4.6× |
| Myelogram Cervical (72240) |
$1,030.25 |
$1,585 |
1.1× |
| Myelogram Lumbar (72265) |
$1,030.25 |
$1,585 |
1.1× |
| Myelogram thoracic (72255) |
$1,030.25 |
$1,585 |
1.1× |
| Myelography 2 or more regions (72270) |
$1,030.25 |
$1,585 |
1.1× |
| Neck soft tissue (70360) |
$235.95 |
$363 |
2.3× |
| Osseous survey limited (77074) |
$348.40 |
$536 |
2.8× |
| Pelvis 1 or 2 views (72170) |
$250.90 |
$386 |
2.0× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$707.85 |
$1,089 |
1.1× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$312.65 |
$481 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$199.55 |
$307 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$341.25 |
$525 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$299.65 |
$461 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$354.25 |
$545 |
2.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$384.80 |
$592 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$211.25 |
$325 |
2.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$286 |
$440 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$341.25 |
$525 |
3.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$263.90 |
$406 |
2.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$395.85 |
$609 |
3.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$434.85 |
$669 |
3.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$502.45 |
$773 |
4.1× |
| Radex Humerus Minimum 2 Views (73060) |
$286 |
$440 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$367.25 |
$565 |
3.6× |
| Radex Kne Compl 4/More Views (73564) |
$561.60 |
$864 |
4.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$412.75 |
$635 |
3.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$271.05 |
$417 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$356.20 |
$548 |
2.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$341.25 |
$525 |
3.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$340.60 |
$524 |
3.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$460.20 |
$708 |
3.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$299.65 |
$461 |
2.9× |
| Radex Toe Minimum 2 Views (73660) |
$182 |
$280 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$282.75 |
$435 |
2.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$341.25 |
$525 |
3.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$502.45 |
$773 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$238.55 |
$367 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$280.15 |
$431 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$287.95 |
$443 |
2.8× |
| Radiologic exam colon single contrast study (74270) |
$689.65 |
$1,061 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$689.65 |
$1,061 |
3.3× |
| Radiologic exam upr gi trc single contrast study (74240) |
$572 |
$880 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$258.70 |
$398 |
2.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$280.15 |
$431 |
2.7× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$207.35 |
$319 |
1.7× |
| Radiological examination surgical specimen (76098) |
$2,635.10 |
$4,054 |
4.1× |
| Ribs bilateral 3 views (71110) |
$375.70 |
$578 |
3.0× |
| Sacroiliac Joints < 3 Views (72200) |
$272.35 |
$419 |
2.2× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$629.20 |
$968 |
2.2× |
| Scapula (73010) |
$340.60 |
$524 |
2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$48.75 |
$75 |
2.1× |
| Sella turcica (70240) |
$207.35 |
$319 |
2.0× |
| Shoulder 1 view (73020) |
$258.05 |
$397 |
2.5× |
| Sialogram (70390) |
$481 |
$740 |
1.7× |
| Small bowel series (74250) |
$601.25 |
$925 |
2.9× |
| Spine thoracic 3 views (72072) |
$359.45 |
$553 |
2.9× |
| Thoracolumbar 2 views (72080) |
$375.70 |
$578 |
3.7× |
| Tmj unilateral (70328) |
$272.35 |
$419 |
2.6× |
| Ultrasound breast complete (76641) |
$605.80 |
$932 |
4.9× |
| Ultrasound Exam Aaa Screen (76706) |
$183.95 |
$283 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$460.20 |
$708 |
3.7× |
| Umbilical-artery Doppler (OB) (76820) |
$440.70 |
$678 |
3.6× |
| Urethrocystogram voiding (74455) |
$724.10 |
$1,114 |
2.6× |
| Urethrocystography retrograde rs&i (74450) |
$802.10 |
$1,234 |
2.8× |
| Us breast unilateral limited (76642) |
$568.10 |
$874 |
5.5× |
| Us chest (76604) |
$541.45 |
$833 |
4.4× |
| Us compl joint r-t w/image documentation (76881) |
$492.70 |
$758 |
4.0× |
| Us encephalogram (76506) |
$352.95 |
$543 |
2.9× |
| Us infant hips w manipulation (76885) |
$492.70 |
$758 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$492.70 |
$758 |
4.0× |
| Us ob detailed single fetus (76811) |
$775.45 |
$1,193 |
2.8× |
| Us ob limited (76815) |
$460.20 |
$708 |
3.7× |
| Us ob transvaginal (76817) |
$492.70 |
$758 |
4.0× |
| Us pelvic non ob complete (76856) |
$511.55 |
$787 |
4.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$460.20 |
$708 |
3.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$492.70 |
$758 |
4.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$382.20 |
$588 |
3.1× |
| Us retroperitoneal complete (76770) |
$557.70 |
$858 |
4.5× |
| Us retroperitoneal limited (76775) |
$492.70 |
$758 |
4.0× |
| Us scrotum and contents (76870) |
$526.18 |
$809.50 |
4.3× |
| Us soft tissue head/neck (76536) |
$460.20 |
$708 |
3.7× |
| Us spinal canal and contents (76800) |
$819 |
$1,260 |
6.6× |
| Us, eye b-scan (76512) |
$294.12 |
$452.50 |
2.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,187.55 |
$1,827 |
9.6× |
| Venogram extremity bilateral (75822) |
$2,042.95 |
$3,143 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$2,042.95 |
$3,143 |
1.1× |
| Wrist 2 views (73100) |
$377 |
$580 |
3.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$460.20 |
$708 |
3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$339.95 |
$523 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$725.40 |
$1,116 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$212.55 |
$327 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$263.90 |
$406 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$434.85 |
$669 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$284.70 |
$438 |
2.8× |
| X-ray eye for foreign body (70030) |
$256.10 |
$394 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$375.70 |
$578 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$338.65 |
$521 |
3.3× |
| X-ray leg, infant (73592) |
$247.65 |
$381 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$375.70 |
$578 |
3.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$460.20 |
$708 |
3.7× |
| X-ray nose-rectum child f.b. (76010) |
$299.65 |
$461 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$317.20 |
$488 |
2.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$280.15 |
$431 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$341.25 |
$525 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$433.55 |
$667 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$360.10 |
$554 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$267.15 |
$411 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$348.40 |
$536 |
3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$406.25 |
$625 |
3.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$340.60 |
$524 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$339.95 |
$523 |
3.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$339.95 |
$523 |
3.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$339.95 |
$523 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$334.75 |
$515 |
2.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$356.20 |
$548 |
2.9× |
| Xr bone length studies (77073) |
$460.20 |
$708 |
3.7× |
| Xr c-spine 4 or 5 views (72050) |
$384.15 |
$591 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$483.60 |
$744 |
3.9× |
| Xr chest 4+ views (71048) |
$393.90 |
$606 |
3.2× |