| Abdomen 2 views (74019) |
$440.84 |
$489.82 |
3.8× |
| Ankle 2 views (73600) |
$211.01 |
$234.46 |
2.2× |
| Bone survey complete (77075) |
$231.75 |
$257.50 |
2.0× |
| Cervical spine 2 or 3 views (72040) |
$375.62 |
$417.36 |
3.9× |
| Chest 1 view (71045) |
$218.94 |
$243.27 |
2.3× |
| Chest xray 3 views (71047) |
$315.38 |
$350.42 |
3.3× |
| Clavicle complete (73000) |
$229.25 |
$254.72 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,030.24 |
$1,144.71 |
8.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,866.63 |
$3,185.14 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,693.17 |
$1,881.30 |
6.4× |
| CT abdomen w contrast (74160) |
$1,363 |
$1,514.44 |
7.0× |
| CT abdomen w wo contrast (74170) |
$1,743.58 |
$1,937.31 |
8.9× |
| CT abdomen w/o contrast (74150) |
$1,065.10 |
$1,183.44 |
9.1× |
| CT c-spine w/o contrast (72125) |
$1,104.71 |
$1,227.46 |
9.5× |
| CT chest w contrast (71260) |
$1,146.73 |
$1,274.14 |
5.9× |
| CT chest w/wo contrast (71270) |
$1,620.41 |
$1,800.45 |
8.3× |
| CT head/brain with contrast (70460) |
$1,211.59 |
$1,346.21 |
6.2× |
| CT head/brain without and with contrast (70470) |
$1,316.88 |
$1,463.20 |
6.7× |
| CT lower ext w/o (73700) |
$1,014.77 |
$1,127.52 |
8.7× |
| CT lower extremity w/contrast material (73701) |
$1,211.94 |
$1,346.60 |
6.2× |
| CT lumbar spine w/contrast (72132) |
$1,309.04 |
$1,454.49 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$1,243.93 |
$1,382.14 |
10.7× |
| CT maxillofacial w contrast (70487) |
$1,243.16 |
$1,381.29 |
6.4× |
| CT maxillofacial wo contrast (70486) |
$1,032.72 |
$1,147.47 |
8.9× |
| CT orbits w/o contrast (70480) |
$1,211.75 |
$1,346.39 |
10.4× |
| CT pelvis w/o contrast (72192) |
$1,063.47 |
$1,181.63 |
9.1× |
| CT pelvis w/wo contrast (72194) |
$1,568.75 |
$1,743.06 |
8.0× |
| CT soft tissue neck w contrast (70491) |
$1,234.28 |
$1,371.42 |
6.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,492.37 |
$1,658.19 |
7.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,032.72 |
$1,147.47 |
8.9× |
| CT thoracic spine w/o contrast (72128) |
$1,104.25 |
$1,226.94 |
9.5× |
| CT thorax w/o contrast (71250) |
$1,251.09 |
$1,390.10 |
10.7× |
| CT upper ext wo (73200) |
$1,014.77 |
$1,127.52 |
8.7× |
| CT upper extremity with contrast (73201) |
$1,206.31 |
$1,340.34 |
3.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,075.18 |
$2,305.76 |
10.6× |
| Cta Abdomen (74175) |
$2,075.18 |
$2,305.76 |
10.6× |
| CTA abdomen pelvis (74174) |
$2,947.79 |
$3,275.32 |
7.6× |
| CTA chest (71275) |
$2,317.32 |
$2,574.80 |
11.9× |
| Cta Head (70496) |
$2,315.99 |
$2,573.32 |
11.8× |
| Cta Neck (70498) |
$2,325.63 |
$2,584.03 |
11.9× |
| Dxa bone density study 1/> sites axial skel (77080) |
$286.53 |
$318.37 |
2.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$86.60 |
$96.22 |
0.9× |
| Dxa bone density study axial skeleton (77085) |
$358.15 |
$397.94 |
3.1× |
| Facial bones min 3 views (70150) |
$732.34 |
$813.71 |
6.3× |
| Fluoroscopy up to 1 hr (76000) |
$699.59 |
$777.32 |
2.6× |
| Foot 2 views (73620) |
$228.77 |
$254.19 |
2.4× |
| Forearm 2 views (73090) |
$263.15 |
$292.39 |
2.7× |
| Hand 2 views (73120) |
$273.56 |
$303.95 |
2.3× |
| Knee 3 views (73562) |
$183.71 |
$204.12 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,398.77 |
$2,665.30 |
2.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,731.20 |
$4,145.78 |
9.6× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$108.29 |
$120.32 |
1.1× |
| MRA head w/o contrast (70544) |
$2,285.43 |
$2,539.37 |
8.6× |
| MRA neck w/o contrast (70547) |
$2,218.50 |
$2,465 |
8.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,750.50 |
$4,167.22 |
9.6× |
| MRI abdomen w/o contrast (74181) |
$2,130.47 |
$2,367.19 |
8.0× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,618.06 |
$4,020.07 |
9.3× |
| MRI cervical spine w/o contrast (72141) |
$2,180.50 |
$2,422.78 |
8.2× |
| MRI chest w/o & w/contrast material (71552) |
$3,978.03 |
$4,420.03 |
10.2× |
| MRI chest w/o contrast (71550) |
$2,345.50 |
$2,606.11 |
8.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,731.20 |
$4,145.78 |
9.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,165.60 |
$2,406.22 |
8.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,704.66 |
$4,116.29 |
9.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,750.50 |
$4,167.22 |
9.6× |
| MRI pelvis w/o contrast (72195) |
$2,205.41 |
$2,450.46 |
8.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,777.99 |
$4,197.77 |
9.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,731.20 |
$4,145.78 |
9.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,658.17 |
$4,064.63 |
9.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,205.41 |
$2,450.46 |
8.3× |
| MRI up ext w/o contrast (73218) |
$2,192.25 |
$2,435.83 |
8.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,965.66 |
$2,184.07 |
7.4× |
| MRI, joint upper extrem combo (73223) |
$3,618.06 |
$4,020.07 |
9.3× |
| Neck soft tissue (70360) |
$280.71 |
$311.90 |
2.9× |
| Pelvis 1 or 2 views (72170) |
$262.92 |
$292.13 |
2.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$288.55 |
$320.61 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$199.08 |
$221.20 |
2.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$319.48 |
$354.98 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$265.44 |
$294.93 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$268.83 |
$298.70 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$190.30 |
$211.44 |
2.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$304.78 |
$338.64 |
3.1× |
| Radex Hand Minimum 3 Views (73130) |
$325.31 |
$361.45 |
3.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$149.33 |
$165.92 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$322.53 |
$358.37 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$206.96 |
$229.96 |
1.8× |
| Radex Humerus Minimum 2 Views (73060) |
$294.46 |
$327.18 |
3.0× |
| Radex Kne 1/2 Views (73560) |
$215.78 |
$239.76 |
2.2× |
| Radex Kne Compl 4/More Views (73564) |
$439.88 |
$488.76 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$185.40 |
$206 |
1.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$424.60 |
$471.78 |
4.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$218.37 |
$242.63 |
1.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$265.92 |
$295.47 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$206.72 |
$229.69 |
2.1× |
| Radex Toe Minimum 2 Views (73660) |
$181.41 |
$201.57 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$322.53 |
$358.37 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$270.59 |
$300.66 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$233.45 |
$259.39 |
2.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$206.72 |
$229.69 |
1.8× |
| Radiologic exam chest 2 views (71046) |
$299.05 |
$332.28 |
3.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$227.12 |
$252.35 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$274.79 |
$305.32 |
2.8× |
| Ribs bilateral 3 views (71110) |
$412 |
$457.78 |
3.5× |
| Sacroiliac Joints < 3 Views (72200) |
$310.50 |
$345 |
2.7× |
| Scapula (73010) |
$279 |
$310 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$30.93 |
$34.37 |
1.3× |
| Shoulder 1 view (73020) |
$201.56 |
$223.95 |
2.1× |
| Spine thoracic 3 views (72072) |
$323.78 |
$359.75 |
2.8× |
| Tbs technical calculation only (77091) |
$115.88 |
$128.75 |
1.2× |
| Thoracolumbar 2 views (72080) |
$370.47 |
$411.63 |
3.8× |
| Ultrasound breast complete (76641) |
$420.12 |
$466.80 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$496.69 |
$551.88 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$629.79 |
$699.77 |
5.4× |
| Us chest (76604) |
$420.12 |
$466.80 |
3.6× |
| Us compl joint r-t w/image documentation (76881) |
$533.55 |
$592.83 |
4.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$159.74 |
$177.49 |
1.4× |
| Us ob limited (76815) |
$544.91 |
$605.45 |
4.7× |
| Us ob transvaginal (76817) |
$383.54 |
$426.16 |
3.3× |
| Us pelvic non ob complete (76856) |
$735.30 |
$817 |
6.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$478.36 |
$531.51 |
4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$560.28 |
$622.53 |
4.8× |
| Us retroperitoneal complete (76770) |
$808.92 |
$898.80 |
6.9× |
| Us retroperitoneal limited (76775) |
$374.28 |
$415.87 |
3.2× |
| Us scrotum and contents (76870) |
$690.04 |
$766.71 |
5.9× |
| Us soft tissue head/neck (76536) |
$559.23 |
$621.37 |
4.8× |
| Wrist 2 views (73100) |
$230.49 |
$256.10 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$206.72 |
$229.69 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.31 |
$222.57 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$257.33 |
$285.92 |
2.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$155.45 |
$172.72 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$322.63 |
$358.48 |
2.8× |
| X-ray exam of femur 2/> (73552) |
$322.63 |
$358.48 |
3.3× |
| X-ray eye for foreign body (70030) |
$191.34 |
$212.60 |
2.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$232.97 |
$258.86 |
2.4× |
| X-ray leg, infant (73592) |
$274.79 |
$305.32 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$419.64 |
$466.27 |
3.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$696.15 |
$773.50 |
6.0× |
| X-ray nose-rectum child f.b. (76010) |
$154.68 |
$171.87 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$348.51 |
$387.23 |
3.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$422.69 |
$469.66 |
3.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$596.47 |
$662.74 |
5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$411.24 |
$456.93 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$305.06 |
$338.96 |
3.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$446.27 |
$495.86 |
4.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$674.10 |
$749 |
5.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$231.75 |
$257.50 |
2.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$51.27 |
$56.97 |
0.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$321.77 |
$357.52 |
3.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$373.62 |
$415.13 |
3.2× |
| Xr c-spine 4 or 5 views (72050) |
$408.94 |
$454.38 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$735.20 |
$816.89 |
6.3× |