| Abdomen 2 views (74019) |
$370.55 |
$370.55 |
3.2× |
| Ankle 2 views (73600) |
$394.35 |
$394.35 |
4.1× |
| Arthrogram hip (73525) |
$856.45 |
$856.45 |
2.2× |
| Arthrogram shoulder (73040) |
$720.82 |
$720.82 |
1.9× |
| Bone age studies (77072) |
$224.20 |
$224.20 |
1.9× |
| Bone survey complete (77075) |
$872.85 |
$872.85 |
7.5× |
| Bone survey infant (77076) |
$576.10 |
$576.10 |
4.9× |
| Cervical spine 2 or 3 views (72040) |
$380.70 |
$380.70 |
3.9× |
| Chest 1 view (71045) |
$244.50 |
$244.50 |
2.5× |
| Clavicle complete (73000) |
$280 |
$280 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,480.45 |
$2,480.45 |
6.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,523.52 |
$1,523.52 |
5.7× |
| CT abdomen w contrast (74160) |
$1,604.32 |
$1,604.32 |
8.2× |
| CT abdomen w wo contrast (74170) |
$2,422.75 |
$2,422.75 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,156.48 |
$1,156.48 |
9.9× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,800.85 |
$2,800.85 |
14.3× |
| CT angiography upper extremity lt (73206) |
$1,155.15 |
$1,155.15 |
5.9× |
| CT c-spine w/contrast (72126) |
$1,293.48 |
$1,293.48 |
3.3× |
| CT c-spine w/o contrast (72125) |
$1,215.85 |
$1,215.85 |
10.4× |
| CT chest w contrast (71260) |
$1,524.90 |
$1,524.90 |
7.8× |
| CT chest w/wo contrast (71270) |
$1,815.18 |
$1,815.18 |
9.3× |
| CT head/brain with contrast (70460) |
$1,238.78 |
$1,238.78 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,477.85 |
$1,477.85 |
7.6× |
| CT limited/localized follow up study (76380) |
$618.20 |
$618.20 |
6.4× |
| CT lower ext w/o (73700) |
$1,270.32 |
$1,270.32 |
10.9× |
| CT lower extremity w wo contrast (73702) |
$123.40 |
$123.40 |
0.6× |
| CT lower extremity w/contrast material (73701) |
$1,411.75 |
$1,411.75 |
7.2× |
| CT lumbar spine w & w/o contrast (72133) |
$2,103.85 |
$2,103.85 |
10.8× |
| CT lumbar spine w/contrast (72132) |
$2,727.80 |
$2,727.80 |
7.0× |
| CT lumbar spine w/o contrast (72131) |
$1,179.92 |
$1,179.92 |
10.1× |
| CT maxillofacial w contrast (70487) |
$1,191.18 |
$1,191.18 |
6.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,299.75 |
$1,299.75 |
6.6× |
| CT maxillofacial wo contrast (70486) |
$1,068.02 |
$1,068.02 |
9.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,929.45 |
$2,929.45 |
15.0× |
| CT orbits w/o contrast (70480) |
$1,228.92 |
$1,228.92 |
10.5× |
| CT pelvis w/o contrast (72192) |
$1,164.92 |
$1,164.92 |
10.0× |
| CT pelvis w/wo contrast (72194) |
$977.70 |
$977.70 |
5.0× |
| CT scan of arm combo (73202) |
$1,327.30 |
$1,327.30 |
6.8× |
| CT soft tissue neck w contrast (70491) |
$1,465.12 |
$1,465.12 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,419.32 |
$1,419.32 |
7.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,084.02 |
$1,084.02 |
9.3× |
| CT thoracic spine w/contrast (72129) |
$2,625.65 |
$2,625.65 |
13.4× |
| CT thoracic spine w/o contrast (72128) |
$1,271.25 |
$1,271.25 |
10.9× |
| CT thoracic spine w/wo contrast (72130) |
$2,566.95 |
$2,566.95 |
13.1× |
| CT thorax w/o contrast (71250) |
$1,274.65 |
$1,274.65 |
10.9× |
| CT upper ext wo (73200) |
$1,304.05 |
$1,304.05 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,454.78 |
$1,454.78 |
3.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,217.55 |
$2,217.55 |
11.3× |
| Cta Abdomen (74175) |
$2,136.18 |
$2,136.18 |
10.9× |
| CTA abdomen pelvis (74174) |
$2,136.18 |
$2,136.18 |
5.5× |
| CTA chest (71275) |
$2,061.40 |
$2,061.40 |
10.5× |
| Cta Head (70496) |
$2,077.38 |
$2,077.38 |
10.6× |
| Cta Neck (70498) |
$2,056.88 |
$2,056.88 |
10.5× |
| Cta Pelvis (72191) |
$2,255.92 |
$2,255.92 |
11.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$255.28 |
$255.28 |
2.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$556.50 |
$556.50 |
4.8× |
| Echo exam of eye (76529) |
$319.70 |
$319.70 |
3.3× |
| Facial bones min 3 views (70150) |
$404.95 |
$404.95 |
3.5× |
| Fetal biophysical profile non-stress testing (76818) |
$458.68 |
$458.68 |
3.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$339.42 |
$339.42 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$700.20 |
$700.20 |
2.6× |
| Foot 2 views (73620) |
$339 |
$339 |
3.5× |
| Forearm 2 views (73090) |
$281.45 |
$281.45 |
2.9× |
| Hand 2 views (73120) |
$336.80 |
$336.80 |
2.9× |
| Hysterosalpingogram (74740) |
$301.60 |
$301.60 |
1.1× |
| Knee 3 views (73562) |
$342.50 |
$342.50 |
3.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,013.82 |
$2,013.82 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,301.02 |
$1,301.02 |
3.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,644.95 |
$2,644.95 |
6.8× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$456.70 |
$456.70 |
4.7× |
| MRA head w & w/o contrast (70546) |
$2,058.05 |
$2,058.05 |
5.3× |
| MRA head w/o contrast (70544) |
$3,209.35 |
$3,209.35 |
12.1× |
| MRA head with contrast (70545) |
$1,618.35 |
$1,618.35 |
4.2× |
| MRA neck w contrast (70548) |
$1,440.72 |
$1,440.72 |
3.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,776.08 |
$2,776.08 |
7.1× |
| MRA neck w/o contrast (70547) |
$1,543.20 |
$1,543.20 |
5.8× |
| MRI abdomen w contrast (74182) |
$2,708.30 |
$2,708.30 |
7.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,956.12 |
$2,956.12 |
7.6× |
| MRI abdomen w/o contrast (74181) |
$2,050.32 |
$2,050.32 |
7.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,576.62 |
$2,576.62 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,780.78 |
$2,780.78 |
7.2× |
| MRI bone marrow blood supply (77084) |
$1,701.70 |
$1,701.70 |
6.4× |
| MRI c-spine with contrast (72142) |
$3,077.10 |
$3,077.10 |
7.9× |
| MRI cervical spine w/o contrast (72141) |
$1,803.80 |
$1,803.80 |
6.8× |
| MRI chest w/o & w/contrast material (71552) |
$2,163.98 |
$2,163.98 |
5.6× |
| MRI chest w/o contrast (71550) |
$2,422.75 |
$2,422.75 |
9.1× |
| MRI chest with contrast (71551) |
$2,155.10 |
$2,155.10 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,984.58 |
$1,984.58 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,608.02 |
$2,608.02 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,831.02 |
$1,831.02 |
6.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,993.55 |
$1,993.55 |
7.5× |
| MRI orbit face neck w contrast (70542) |
$5,868.45 |
$5,868.45 |
15.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,079.40 |
$3,079.40 |
7.9× |
| MRI pelvis w/contrast (72196) |
$1,691.65 |
$1,691.65 |
4.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,859.85 |
$2,859.85 |
7.4× |
| MRI pelvis w/o contrast (72195) |
$2,094.30 |
$2,094.30 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,727.98 |
$2,727.98 |
7.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,740.85 |
$1,740.85 |
4.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,849.32 |
$2,849.32 |
7.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,687.58 |
$1,687.58 |
4.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,865.40 |
$2,865.40 |
7.4× |
| MRI thoracic spine w/o contrast (72146) |
$1,743.95 |
$1,743.95 |
6.6× |
| MRI up ext w/o contrast (73218) |
$1,974.65 |
$1,974.65 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,582 |
$1,582 |
6.0× |
| MRI, joint upper extrem combo (73223) |
$2,716.22 |
$2,716.22 |
7.0× |
| Neck soft tissue (70360) |
$279.45 |
$279.45 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$455.10 |
$455.10 |
3.9× |
| Osseous survey limited (77074) |
$408.85 |
$408.85 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$336.80 |
$336.80 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$322.35 |
$322.35 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$294.15 |
$294.15 |
3.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$197.52 |
$197.52 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$115.58 |
$115.58 |
1.0× |
| Radex fingr minimum 2 views (73140) |
$109.35 |
$109.35 |
1.1× |
| Radex Foot Compl Minimum 3 Views (73630) |
$367.35 |
$367.35 |
3.8× |
| Radex Hand Minimum 3 Views (73130) |
$452.10 |
$452.10 |
4.7× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$264.85 |
$264.85 |
2.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$377.45 |
$377.45 |
3.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$428.98 |
$428.98 |
3.7× |
| Radex Humerus Minimum 2 Views (73060) |
$285.80 |
$285.80 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$280.15 |
$280.15 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$396.60 |
$396.60 |
3.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$129.95 |
$129.95 |
1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$225.40 |
$225.40 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$277.95 |
$277.95 |
2.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$338.35 |
$338.35 |
3.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$304.60 |
$304.60 |
3.1× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$371.45 |
$371.45 |
3.2× |
| Radex Toe Minimum 2 Views (73660) |
$184.12 |
$184.12 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$231.15 |
$231.15 |
2.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$471.30 |
$471.30 |
4.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$295.20 |
$295.20 |
3.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$465.05 |
$465.05 |
4.0× |
| Radiologic exam chest 2 views (71046) |
$305.75 |
$305.75 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$260.62 |
$260.62 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$299.35 |
$299.35 |
3.1× |
| Ribs bilateral 3 views (71110) |
$376.32 |
$376.32 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$336.80 |
$336.80 |
2.9× |
| Scapula (73010) |
$438.65 |
$438.65 |
3.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$98.38 |
$98.38 |
4.2× |
| Shoulder 1 view (73020) |
$164.35 |
$164.35 |
1.7× |
| Spine thoracic 3 views (72072) |
$264.45 |
$264.45 |
2.3× |
| Thoracolumbar 2 views (72080) |
$261.50 |
$261.50 |
2.7× |
| Ultrasound breast complete (76641) |
$329.22 |
$329.22 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$730.85 |
$730.85 |
6.3× |
| Ultrasound, abdomen limited (76705) |
$514.08 |
$514.08 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$254.52 |
$254.52 |
2.2× |
| Unlisted ultrasound procedure (76999) |
$57.75 |
$57.75 |
0.6× |
| Us breast unilateral limited (76642) |
$310 |
$310 |
3.2× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$393.95 |
$393.95 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$446.75 |
$446.75 |
3.8× |
| Us encephalogram (76506) |
$466.50 |
$466.50 |
4.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$351.52 |
$351.52 |
3.0× |
| Us ob limited (76815) |
$537.75 |
$537.75 |
4.6× |
| Us ob transvaginal (76817) |
$395.35 |
$395.35 |
3.4× |
| Us pelvic non ob complete (76856) |
$576.55 |
$576.55 |
4.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$136.75 |
$136.75 |
1.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$471.82 |
$471.82 |
4.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$348.35 |
$348.35 |
3.0× |
| Us retroperitoneal complete (76770) |
$594.10 |
$594.10 |
5.1× |
| Us retroperitoneal limited (76775) |
$299.78 |
$299.78 |
2.6× |
| Us scrotum and contents (76870) |
$504.90 |
$504.90 |
4.3× |
| Us soft tissue head/neck (76536) |
$560.18 |
$560.18 |
4.8× |
| Us spinal canal and contents (76800) |
$237.15 |
$237.15 |
2.0× |
| Wrist 2 views (73100) |
$286.15 |
$286.15 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$477.65 |
$477.65 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$363.10 |
$363.10 |
3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$282.70 |
$282.70 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$360.55 |
$360.55 |
3.7× |
| X-ray exam of femur 2/> (73552) |
$392.05 |
$392.05 |
4.0× |
| X-ray eye for foreign body (70030) |
$179.68 |
$179.68 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$239.35 |
$239.35 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$565.92 |
$565.92 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$229.92 |
$229.92 |
2.4× |
| X-ray leg, infant (73592) |
$188.02 |
$188.02 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$388 |
$388 |
3.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$724.50 |
$724.50 |
6.2× |
| X-ray nose-rectum child f.b. (76010) |
$270 |
$270 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$327.15 |
$327.15 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$303.70 |
$303.70 |
3.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$271.48 |
$271.48 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$430.85 |
$430.85 |
3.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$400.40 |
$400.40 |
3.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$304.75 |
$304.75 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$250.92 |
$250.92 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$343.95 |
$343.95 |
3.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$368.15 |
$368.15 |
3.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$299.45 |
$299.45 |
3.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$303.28 |
$303.28 |
3.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$353.85 |
$353.85 |
3.0× |
| Xr bone length studies (77073) |
$400.25 |
$400.25 |
3.4× |
| Xr c-spine 4 or 5 views (72050) |
$474 |
$474 |
4.1× |
| Xr c-spine 6 or more views (72052) |
$611.40 |
$611.40 |
5.2× |