| Abdomen 2 views (74019) |
$436.80 |
$624 |
3.5× |
| Ankle 2 views (73600) |
$240.10 |
$343 |
2.3× |
| Bone age studies (77072) |
$247.10 |
$353 |
2.0× |
| Bone survey complete (77075) |
$799.75 |
$1,142.50 |
6.5× |
| Bone survey infant (77076) |
$254.80 |
$364 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$243.25 |
$347.50 |
2.4× |
| Chest 1 view (71045) |
$367.50 |
$525 |
3.6× |
| Chest xray 3 views (71047) |
$387.10 |
$553 |
3.8× |
| Clavicle complete (73000) |
$360.50 |
$515 |
3.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$301.35 |
$430.50 |
2.4× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$483.70 |
$691 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,975.35 |
$4,250.50 |
7.2× |
| CT abdomen and pelvis without contrast (74176) |
$2,073.75 |
$2,962.50 |
7.4× |
| CT abdomen w contrast (74160) |
$1,863.40 |
$2,662 |
9.0× |
| CT abdomen w wo contrast (74170) |
$2,162.65 |
$3,089.50 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,605.80 |
$2,294 |
13.0× |
| CT angio hrt w/3d image (75574) |
$2,174.90 |
$3,107 |
5.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,218.30 |
$3,169 |
10.7× |
| CT angiography upper extremity lt (73206) |
$875.70 |
$1,251 |
4.2× |
| CT c-spine w/contrast (72126) |
$2,380 |
$3,400 |
5.8× |
| CT c-spine w/o contrast (72125) |
$1,819.65 |
$2,599.50 |
14.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,599.50 |
$2,285 |
7.7× |
| CT chest w contrast (71260) |
$1,790.95 |
$2,558.50 |
8.6× |
| CT chest w/wo contrast (71270) |
$2,480.10 |
$3,543 |
12.0× |
| CT colonography screening (74263) |
$2,811.90 |
$4,017 |
10.0× |
| CT colonography w/dye (74262) |
$2,062.20 |
$2,946 |
10.0× |
| CT colonography w/o cntrst (74261) |
$1,332.10 |
$1,903 |
10.8× |
| CT head/brain with contrast (70460) |
$1,864.80 |
$2,664 |
9.0× |
| CT head/brain without and with contrast (70470) |
$1,934.45 |
$2,763.50 |
9.3× |
| CT heart contrast eval cardiac structure&morph (75572) |
$1,371.30 |
$1,959 |
3.3× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$1,914.50 |
$2,735 |
18.6× |
| CT hrt w/3d image congen (75573) |
$476.70 |
$681 |
1.2× |
| CT iac w contrast (70481) |
$1,759.80 |
$2,514 |
8.5× |
| CT limited/localized follow up study (76380) |
$611.80 |
$874 |
6.0× |
| CT lower ext w/o (73700) |
$1,324.40 |
$1,892 |
10.7× |
| CT lower extremity w wo contrast (73702) |
$2,171.40 |
$3,102 |
10.5× |
| CT lower extremity w/contrast material (73701) |
$1,642.55 |
$2,346.50 |
7.9× |
| CT lumbar spine w & w/o contrast (72133) |
$2,483.60 |
$3,548 |
12.0× |
| CT lumbar spine w/contrast (72132) |
$2,797.90 |
$3,997 |
6.8× |
| CT lumbar spine w/o contrast (72131) |
$1,659 |
$2,370 |
13.4× |
| CT maxillofacial w contrast (70487) |
$1,666.70 |
$2,381 |
8.0× |
| CT maxillofacial w/wo contrast (70488) |
$2,490.60 |
$3,558 |
12.0× |
| CT maxillofacial wo contrast (70486) |
$1,428.70 |
$2,041 |
11.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$987.70 |
$1,411 |
4.8× |
| CT orbits w/o contrast (70480) |
$1,473.15 |
$2,104.50 |
11.9× |
| CT pelvis w/o contrast (72192) |
$1,445.85 |
$2,065.50 |
11.7× |
| CT pelvis w/wo contrast (72194) |
$1,761.90 |
$2,517 |
8.5× |
| CT scan of arm combo (73202) |
$1,841 |
$2,630 |
8.9× |
| CT soft tissue neck w contrast (70491) |
$1,702.75 |
$2,432.50 |
8.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$987.70 |
$1,411 |
4.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,473.15 |
$2,104.50 |
11.9× |
| CT thoracic spine w/contrast (72129) |
$3,199 |
$4,570 |
15.4× |
| CT thoracic spine w/o contrast (72128) |
$1,614.90 |
$2,307 |
13.1× |
| CT thoracic spine w/wo contrast (72130) |
$2,486.40 |
$3,552 |
12.0× |
| CT thorax w/o contrast (71250) |
$1,565.55 |
$2,236.50 |
12.7× |
| CT upper ext wo (73200) |
$1,343.30 |
$1,919 |
10.9× |
| CT upper extremity with contrast (73201) |
$4,365.20 |
$6,236 |
10.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,330.30 |
$3,329 |
11.2× |
| Cta Abdomen (74175) |
$2,335.90 |
$3,337 |
11.3× |
| CTA abdomen pelvis (74174) |
$3,032.40 |
$4,332 |
7.4× |
| CTA chest (71275) |
$2,135 |
$3,050 |
10.3× |
| Cta Head (70496) |
$2,072.70 |
$2,961 |
10.0× |
| Cta Neck (70498) |
$2,083.55 |
$2,976.50 |
10.1× |
| Cta Pelvis (72191) |
$2,325.40 |
$3,322 |
11.2× |
| Dxa bone density study 1/> sites axial skel (77080) |
$452.20 |
$646 |
3.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$256.90 |
$367 |
2.5× |
| Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode… (76826) |
$732.20 |
$1,046 |
2.6× |
| Facial bones min 3 views (70150) |
$384.30 |
$549 |
3.1× |
| Fetal biophysical profile non-stress testing (76818) |
$451.15 |
$644.50 |
3.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$422.80 |
$604 |
3.4× |
| Fetal Echo (76825) |
$949.90 |
$1,357 |
1.5× |
| Foot 2 views (73620) |
$355.25 |
$507.50 |
3.5× |
| Forearm 2 views (73090) |
$266 |
$380 |
2.6× |
| Hand 2 views (73120) |
$301.35 |
$430.50 |
2.4× |
| Knee 3 views (73562) |
$346.85 |
$495.50 |
3.4× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$236.60 |
$338 |
2.3× |
| Neck soft tissue (70360) |
$352.45 |
$503.50 |
3.4× |
| Ob us nuchal meas 1 gest (76813) |
$335.30 |
$479 |
2.7× |
| Osseous survey limited (77074) |
$236.60 |
$338 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$291.20 |
$416 |
2.4× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$288.40 |
$412 |
2.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$256.20 |
$366 |
2.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$289.80 |
$414 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$321.30 |
$459 |
3.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$436.45 |
$623.50 |
3.5× |
| Radex fingr minimum 2 views (73140) |
$274.40 |
$392 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$298.55 |
$426.50 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$291.20 |
$416 |
2.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$159.60 |
$228 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$294 |
$420 |
2.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$387.10 |
$553 |
3.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$920.50 |
$1,315 |
7.5× |
| Radex Humerus Minimum 2 Views (73060) |
$268.45 |
$383.50 |
2.6× |
| Radex Kne 1/2 Views (73560) |
$355.25 |
$507.50 |
3.5× |
| Radex Kne Compl 4/More Views (73564) |
$436.80 |
$624 |
3.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$366.10 |
$523 |
3.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$239.05 |
$341.50 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$444.50 |
$635 |
3.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$355.25 |
$507.50 |
3.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$192.50 |
$275 |
1.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$385 |
$550 |
3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$409.50 |
$585 |
4.0× |
| Radex Toe Minimum 2 Views (73660) |
$245 |
$350 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$450.80 |
$644 |
3.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$289.80 |
$414 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$355.25 |
$507.50 |
3.5× |
| Radiologic exam chest 2 views (71046) |
$358.75 |
$512.50 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$193.90 |
$277 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$288.40 |
$412 |
2.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$455 |
$650 |
0.7× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$350.70 |
$501 |
2.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$88.20 |
$126 |
0.7× |
| Ribs bilateral 3 views (71110) |
$321.30 |
$459 |
2.6× |
| Sacroiliac Joints < 3 Views (72200) |
$222.60 |
$318 |
1.8× |
| Scapula (73010) |
$386.05 |
$551.50 |
3.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$101.50 |
$145 |
4.3× |
| Sella turcica (70240) |
$266.70 |
$381 |
2.6× |
| Shoulder 1 view (73020) |
$367.50 |
$525 |
3.6× |
| Small bowel series (74250) |
$509.60 |
$728 |
2.5× |
| Spine thoracic 3 views (72072) |
$358.05 |
$511.50 |
2.9× |
| Thoracolumbar 2 views (72080) |
$351.40 |
$502 |
3.4× |
| Tmj unilateral (70328) |
$72.80 |
$104 |
0.7× |
| Ultrasound Exam Aaa Screen (76706) |
$451.15 |
$644.50 |
3.7× |
| Ultrasound, abdomen limited (76705) |
$573.30 |
$819 |
4.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$340.20 |
$486 |
3.3× |
| Unlisted ultrasound procedure (76999) |
$239.40 |
$342 |
2.3× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$397.60 |
$568 |
1.9× |
| Us breast unilateral limited (76642) |
$448.70 |
$641 |
4.4× |
| Us chest (76604) |
$483 |
$690 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$313.60 |
$448 |
2.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$367.50 |
$525 |
3.0× |
| Us ob detailed single fetus (76811) |
$658 |
$940 |
2.3× |
| Us ob limited (76815) |
$393.40 |
$562 |
3.2× |
| Us ob transvaginal (76817) |
$402.50 |
$575 |
3.3× |
| Us pelvic non ob complete (76856) |
$448.70 |
$641 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$364.35 |
$520.50 |
3.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$455.70 |
$651 |
3.7× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$682.50 |
$975 |
5.5× |
| Us retroperitoneal complete (76770) |
$647.85 |
$925.50 |
5.2× |
| Us retroperitoneal limited (76775) |
$421.40 |
$602 |
3.4× |
| Us scrotum and contents (76870) |
$419.65 |
$599.50 |
3.4× |
| Us soft tissue head/neck (76536) |
$499.45 |
$713.50 |
4.0× |
| Us spinal canal and contents (76800) |
$291.90 |
$417 |
2.4× |
| Us transrectal (76872) |
$1,123.50 |
$1,605 |
9.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$387.80 |
$554 |
3.1× |
| Wrist 2 views (73100) |
$245 |
$350 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$496.65 |
$709.50 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$408.10 |
$583 |
4.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$259.35 |
$370.50 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$324.10 |
$463 |
3.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$624.40 |
$892 |
5.1× |
| X-ray exam of femur 2/> (73552) |
$566.30 |
$809 |
5.5× |
| X-ray eye for foreign body (70030) |
$252.70 |
$361 |
2.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$221.20 |
$316 |
2.2× |
| X-ray IV pyelogram (ivp) (74400) |
$555.10 |
$793 |
2.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$217 |
$310 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$338.10 |
$483 |
3.3× |
| X-ray leg, infant (73592) |
$777.70 |
$1,111 |
7.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$346.85 |
$495.50 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$449.75 |
$642.50 |
3.6× |
| X-ray nose-rectum child f.b. (76010) |
$422.10 |
$603 |
4.1× |
| X-ray optic foramen (70190) |
$72.80 |
$104 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$450.80 |
$644 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$298.20 |
$426 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$436.80 |
$624 |
3.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$311.50 |
$445 |
2.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$218.40 |
$312 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$283.85 |
$405.50 |
2.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$289.80 |
$414 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$422.80 |
$604 |
3.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$450.80 |
$644 |
3.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$219.10 |
$313 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$374.50 |
$535 |
3.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$355.60 |
$508 |
3.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$301.35 |
$430.50 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$374.50 |
$535 |
3.0× |
| Xr bone length studies (77073) |
$88.20 |
$126 |
0.7× |
| Xr c-spine 4 or 5 views (72050) |
$436.80 |
$624 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$422.10 |
$603 |
3.4× |
| Xr chest 4+ views (71048) |
$361.90 |
$517 |
2.9× |