| Abdomen 2 views (74019) |
$142.80 |
$297.50 |
1.2× |
| Ankle 2 views (73600) |
$123.60 |
$257.50 |
1.3× |
| Bone age studies (77072) |
$98.16 |
$204.50 |
0.8× |
| Bone survey complete (77075) |
$281.28 |
$586 |
2.4× |
| Bone survey infant (77076) |
$185.76 |
$387 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$158.16 |
$329.50 |
1.6× |
| Chest 1 view (71045) |
$103.20 |
$215 |
1.1× |
| Chest xray 3 views (71047) |
$128.64 |
$268 |
1.3× |
| Clavicle complete (73000) |
$127.44 |
$265.50 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$567.60 |
$1,182.50 |
4.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$142.56 |
$297 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,590.24 |
$3,313 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,147.68 |
$2,391 |
4.3× |
| CT abdomen w contrast (74160) |
$709.92 |
$1,479 |
3.6× |
| CT abdomen w wo contrast (74170) |
$986.16 |
$2,054.50 |
5.0× |
| CT abdomen w/o contrast (74150) |
$655.20 |
$1,365 |
5.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,442.88 |
$3,006 |
7.4× |
| CT angiography upper extremity lt (73206) |
$833.28 |
$1,736 |
4.3× |
| CT c-spine w/contrast (72126) |
$594.24 |
$1,238 |
1.5× |
| CT c-spine w/o contrast (72125) |
$770.88 |
$1,606 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$848.64 |
$1,768 |
4.3× |
| CT chest w contrast (71260) |
$772.32 |
$1,609 |
4.0× |
| CT chest w/wo contrast (71270) |
$852.48 |
$1,776 |
4.4× |
| CT head/brain with contrast (70460) |
$421.20 |
$877.50 |
2.2× |
| CT head/brain without and with contrast (70470) |
$787.44 |
$1,640.50 |
4.0× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$51.12 |
$106.50 |
0.5× |
| CT iac w contrast (70481) |
$582.72 |
$1,214 |
3.0× |
| CT lower ext w/o (73700) |
$621.12 |
$1,294 |
5.3× |
| CT lower extremity w wo contrast (73702) |
$872.88 |
$1,818.50 |
4.5× |
| CT lower extremity w/contrast material (73701) |
$664.32 |
$1,384 |
3.4× |
| CT lumbar spine w & w/o contrast (72133) |
$852.48 |
$1,776 |
4.4× |
| CT lumbar spine w/contrast (72132) |
$754.32 |
$1,571.50 |
1.9× |
| CT lumbar spine w/o contrast (72131) |
$740.40 |
$1,542.50 |
6.4× |
| CT maxillofacial w contrast (70487) |
$515.52 |
$1,074 |
2.6× |
| CT maxillofacial w/wo contrast (70488) |
$610.56 |
$1,272 |
3.1× |
| CT maxillofacial wo contrast (70486) |
$623.28 |
$1,298.50 |
5.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$788.88 |
$1,643.50 |
4.0× |
| CT orbits w/o contrast (70480) |
$573.84 |
$1,195.50 |
4.9× |
| CT pelvis w/o contrast (72192) |
$753.12 |
$1,569 |
6.5× |
| CT pelvis w/wo contrast (72194) |
$820.56 |
$1,709.50 |
4.2× |
| CT scan of arm combo (73202) |
$739.20 |
$1,540 |
3.8× |
| CT soft tissue neck w contrast (70491) |
$722.64 |
$1,505.50 |
3.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$731.52 |
$1,524 |
3.7× |
| CT soft tissue neck w/o contrast (70490) |
$521.52 |
$1,086.50 |
4.5× |
| CT thoracic spine w/contrast (72129) |
$589.20 |
$1,227.50 |
3.0× |
| CT thoracic spine w/o contrast (72128) |
$575.04 |
$1,198 |
4.9× |
| CT thoracic spine w/wo contrast (72130) |
$857.52 |
$1,786.50 |
4.4× |
| CT thorax w/o contrast (71250) |
$1,157.76 |
$2,412 |
9.9× |
| CT upper ext wo (73200) |
$650.64 |
$1,355.50 |
5.6× |
| CT upper extremity with contrast (73201) |
$781.20 |
$1,627.50 |
2.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,330.80 |
$2,772.50 |
6.8× |
| Cta Abdomen (74175) |
$1,213.68 |
$2,528.50 |
6.2× |
| CTA abdomen pelvis (74174) |
$1,835.76 |
$3,824.50 |
4.7× |
| CTA chest (71275) |
$1,182 |
$2,462.50 |
6.0× |
| Cta Head (70496) |
$1,103.04 |
$2,298 |
5.6× |
| Cta Neck (70498) |
$1,103.04 |
$2,298 |
5.6× |
| Cta Pelvis (72191) |
$1,104.24 |
$2,300.50 |
5.6× |
| Cystography minimum 3 views rs&i (74430) |
$33.36 |
$69.50 |
0.1× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$72.72 |
$151.50 |
0.6× |
| Facial bones min 3 views (70150) |
$203.52 |
$424 |
1.7× |
| Fetal biophysical profile non-stress testing (76818) |
$217.68 |
$453.50 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$252 |
$525 |
0.9× |
| Foot 2 views (73620) |
$127.44 |
$265.50 |
1.3× |
| Forearm 2 views (73090) |
$135.12 |
$281.50 |
1.4× |
| Hand 2 views (73120) |
$134.88 |
$281 |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$178.32 |
$371.50 |
1.5× |
| Knee 3 views (73562) |
$178.08 |
$371 |
1.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,046.88 |
$2,181 |
1.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,300.08 |
$2,708.50 |
3.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,452.72 |
$3,026.50 |
3.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$168 |
$350 |
1.7× |
| MRA head w & w/o contrast (70546) |
$1,584.96 |
$3,302 |
4.1× |
| MRA head w/o contrast (70544) |
$1,002.72 |
$2,089 |
3.8× |
| MRA head with contrast (70545) |
$1,066.32 |
$2,221.50 |
2.7× |
| MRA neck w contrast (70548) |
$1,126.08 |
$2,346 |
2.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,604.16 |
$3,342 |
4.1× |
| MRA neck w/o contrast (70547) |
$1,005.12 |
$2,094 |
3.8× |
| MRI abdomen w contrast (74182) |
$735.36 |
$1,532 |
1.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,202.16 |
$2,504.50 |
3.1× |
| MRI abdomen w/o contrast (74181) |
$921.12 |
$1,919 |
3.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,200.96 |
$2,502 |
1.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,379.04 |
$2,873 |
3.5× |
| MRI breast w/o contrast bilateral (77047) |
$319.44 |
$665.50 |
1.2× |
| MRI c-spine with contrast (72142) |
$1,087.68 |
$2,266 |
2.8× |
| MRI cervical spine w/o contrast (72141) |
$969.36 |
$2,019.50 |
3.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,193.12 |
$4,569 |
5.6× |
| MRI chest w/o contrast (71550) |
$1,632.24 |
$3,400.50 |
6.1× |
| MRI chest with contrast (71551) |
$1,766.88 |
$3,681 |
2.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$908.40 |
$1,892.50 |
2.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,478.16 |
$3,079.50 |
3.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,223.76 |
$2,549.50 |
4.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,040.88 |
$2,168.50 |
3.9× |
| MRI orbit face neck w contrast (70542) |
$1,212.48 |
$2,526 |
3.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,488.48 |
$3,101 |
3.8× |
| MRI pelvis w/contrast (72196) |
$1,195.68 |
$2,491 |
3.1× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,470.72 |
$3,064 |
3.8× |
| MRI pelvis w/o contrast (72195) |
$972 |
$2,025 |
3.7× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,362.48 |
$2,838.50 |
3.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,087.68 |
$2,266 |
2.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,362.48 |
$2,838.50 |
3.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,086.48 |
$2,263.50 |
2.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,362.48 |
$2,838.50 |
3.5× |
| MRI temporomandibular joint (70336) |
$1,229.04 |
$2,560.50 |
4.6× |
| MRI thoracic spine w/o contrast (72146) |
$827.04 |
$1,723 |
3.1× |
| MRI up ext w/o contrast (73218) |
$1,164 |
$2,425 |
4.4× |
| MRI upper ext joint w/o contrast (73221) |
$896.88 |
$1,868.50 |
3.4× |
| MRI, joint upper extrem combo (73223) |
$1,198.32 |
$2,496.50 |
3.1× |
| Neck soft tissue (70360) |
$125.04 |
$260.50 |
1.3× |
| Ob us nuchal meas 1 gest (76813) |
$215.04 |
$448 |
1.8× |
| Osseous survey limited (77074) |
$185.76 |
$387 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$108.24 |
$225.50 |
0.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$155.28 |
$323.50 |
1.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$130.08 |
$271 |
1.3× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$142.56 |
$297 |
1.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$169.20 |
$352.50 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$367.68 |
$766 |
3.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$568.80 |
$1,185 |
4.9× |
| Radex fingr minimum 2 views (73140) |
$155.28 |
$323.50 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$152.88 |
$318.50 |
1.6× |
| Radex Hand Minimum 3 Views (73130) |
$147.60 |
$307.50 |
1.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$131.28 |
$273.50 |
1.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$166.80 |
$347.50 |
1.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$179.52 |
$374 |
1.5× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$181.92 |
$379 |
1.6× |
| Radex Humerus Minimum 2 Views (73060) |
$48.48 |
$101 |
0.5× |
| Radex Kne 1/2 Views (73560) |
$159.12 |
$331.50 |
1.6× |
| Radex Kne Compl 4/More Views (73564) |
$204.96 |
$427 |
1.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$176.88 |
$368.50 |
1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$157.92 |
$329 |
1.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$168 |
$350 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$157.92 |
$329 |
1.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$131.04 |
$273 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$164.40 |
$342.50 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$220.32 |
$459 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$101.76 |
$212 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$127.44 |
$265.50 |
1.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$128.64 |
$268 |
1.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$590.64 |
$1,230.50 |
5.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$130.08 |
$271 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$158.16 |
$329.50 |
1.4× |
| Radiologic exam chest 2 views (71046) |
$132.72 |
$276.50 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$134.88 |
$281 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$142.80 |
$297.50 |
1.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$221.52 |
$461.50 |
1.9× |
| Radiological examination surgical specimen (76098) |
$506.40 |
$1,055 |
0.8× |
| Ribs bilateral 3 views (71110) |
$171.84 |
$358 |
1.5× |
| Scapula (73010) |
$94.32 |
$196.50 |
0.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$72.72 |
$151.50 |
3.1× |
| Shoulder 1 view (73020) |
$98.16 |
$204.50 |
1.0× |
| Spine thoracic 3 views (72072) |
$163.20 |
$340 |
1.4× |
| Thoracolumbar 2 views (72080) |
$137.52 |
$286.50 |
1.4× |
| Ultrasound breast complete (76641) |
$104.64 |
$218 |
0.9× |
| Ultrasound Exam Aaa Screen (76706) |
$266.16 |
$554.50 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$263.52 |
$549 |
2.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$22.56 |
$47 |
0.2× |
| Unlisted ultrasound procedure (76999) |
$256.08 |
$533.50 |
2.6× |
| Us breast unilateral limited (76642) |
$228.96 |
$477 |
2.4× |
| Us chest (76604) |
$239.28 |
$498.50 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$189.60 |
$395 |
1.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$246.96 |
$514.50 |
2.1× |
| Us ob transvaginal (76817) |
$263.52 |
$549 |
2.3× |
| Us pelvic non ob complete (76856) |
$295.20 |
$615 |
2.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$343.68 |
$716 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$275.04 |
$573 |
2.4× |
| Us retroperitoneal complete (76770) |
$320.64 |
$668 |
2.8× |
| Us retroperitoneal limited (76775) |
$255.84 |
$533 |
2.2× |
| Us scrotum and contents (76870) |
$264.72 |
$551.50 |
2.3× |
| Us soft tissue head/neck (76536) |
$275.04 |
$573 |
2.4× |
| Wrist 2 views (73100) |
$124.80 |
$260 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$196.08 |
$408.50 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$113.52 |
$236.50 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$128.88 |
$268.50 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$161.76 |
$337 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$218.88 |
$456 |
1.9× |
| X-ray exam of femur 2/> (73552) |
$164.40 |
$342.50 |
1.7× |
| X-ray eye for foreign body (70030) |
$131.04 |
$273 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$133.68 |
$278.50 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$159.36 |
$332 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$168 |
$350 |
1.7× |
| X-ray leg, infant (73592) |
$127.44 |
$265.50 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$163.20 |
$340 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$258.24 |
$538 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$204.96 |
$427 |
1.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$157.92 |
$329 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$176.88 |
$368.50 |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$208.80 |
$435 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$158.16 |
$329.50 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$132.48 |
$276 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$151.68 |
$316 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$177.12 |
$369 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$147.84 |
$308 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$94.32 |
$196.50 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$169.44 |
$353 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$135.12 |
$281.50 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$147.60 |
$307.50 |
1.3× |
| Xr bone length studies (77073) |
$122.16 |
$254.50 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$216.24 |
$450.50 |
1.9× |
| Xr c-spine 6 or more views (72052) |
$258.24 |
$538 |
2.2× |
| Xr chest 4+ views (71048) |
$178.32 |
$371.50 |
1.5× |