| Abdomen 2 views (74019) |
$148 |
$148 |
1.3× |
| Ankle 2 views (73600) |
$135 |
$135 |
1.4× |
| Bone age studies (77072) |
$130 |
$130 |
1.1× |
| Bone survey complete (77075) |
$380 |
$380 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$137 |
$137 |
1.4× |
| Chest 1 view (71045) |
$158 |
$158 |
1.6× |
| Chest xray 3 views (71047) |
$158 |
$158 |
1.6× |
| Clavicle complete (73000) |
$119 |
$119 |
1.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$730 |
$730 |
6.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,971 |
$1,971 |
5.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,800 |
$1,800 |
6.8× |
| CT abdomen w contrast (74160) |
$1,303 |
$1,303 |
6.7× |
| CT abdomen w wo contrast (74170) |
$1,499 |
$1,499 |
7.7× |
| CT abdomen w/o contrast (74150) |
$701 |
$701 |
6.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,400 |
$1,400 |
7.2× |
| CT angiography upper extremity lt (73206) |
$1,857 |
$1,857 |
9.5× |
| CT c-spine w/contrast (72126) |
$1,300 |
$1,300 |
3.3× |
| CT c-spine w/o contrast (72125) |
$1,021 |
$1,021 |
8.8× |
| CT chest w contrast (71260) |
$1,250 |
$1,250 |
6.4× |
| CT chest w/wo contrast (71270) |
$1,109 |
$1,109 |
5.7× |
| CT colonography screening (74263) |
$5,062 |
$5,062 |
19.0× |
| CT head/brain with contrast (70460) |
$828 |
$828 |
4.2× |
| CT head/brain without and with contrast (70470) |
$996 |
$996 |
5.1× |
| CT iac w contrast (70481) |
$1,609 |
$1,609 |
8.2× |
| CT lower ext w/o (73700) |
$1,010 |
$1,010 |
8.7× |
| CT lower extremity w wo contrast (73702) |
$1,664 |
$1,664 |
8.5× |
| CT lower extremity w/contrast material (73701) |
$1,305 |
$1,305 |
6.7× |
| CT lumbar spine w/contrast (72132) |
$1,300 |
$1,300 |
3.3× |
| CT lumbar spine w/o contrast (72131) |
$1,010 |
$1,010 |
8.7× |
| CT maxillofacial w contrast (70487) |
$867 |
$867 |
4.4× |
| CT maxillofacial wo contrast (70486) |
$751 |
$751 |
6.4× |
| CT orbits w/o contrast (70480) |
$1,317 |
$1,317 |
11.3× |
| CT pelvis w/o contrast (72192) |
$712 |
$712 |
6.1× |
| CT soft tissue neck w contrast (70491) |
$1,043 |
$1,043 |
5.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,276 |
$1,276 |
6.5× |
| CT soft tissue neck w/o contrast (70490) |
$809 |
$809 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$1,016 |
$1,016 |
8.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,623 |
$1,623 |
8.3× |
| CT thorax w/o contrast (71250) |
$985 |
$985 |
8.5× |
| CT upper ext wo (73200) |
$1,007 |
$1,007 |
8.6× |
| CT upper extremity with contrast (73201) |
$1,281 |
$1,281 |
3.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,514 |
$2,514 |
12.9× |
| Cta Abdomen (74175) |
$1,689 |
$1,689 |
8.6× |
| CTA abdomen pelvis (74174) |
$2,175 |
$2,175 |
5.6× |
| CTA chest (71275) |
$1,628 |
$1,628 |
8.3× |
| Cta Head (70496) |
$1,601 |
$1,601 |
8.2× |
| Cta Neck (70498) |
$1,595 |
$1,595 |
8.2× |
| Cta Pelvis (72191) |
$1,681 |
$1,681 |
8.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$320 |
$320 |
2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$149 |
$149 |
1.5× |
| Facial bones min 3 views (70150) |
$176 |
$176 |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$336 |
$336 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$243 |
$243 |
0.9× |
| Foot 2 views (73620) |
$114 |
$114 |
1.2× |
| Forearm 2 views (73090) |
$136.50 |
$136.50 |
1.4× |
| Hand 2 views (73120) |
$110 |
$110 |
0.9× |
| Hysterosalpingogram (74740) |
$486 |
$486 |
1.8× |
| Knee 3 views (73562) |
$164 |
$164 |
1.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,485 |
$2,485 |
2.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,400 |
$2,400 |
6.2× |
| MRA head w/o contrast (70544) |
$3,117 |
$3,117 |
11.7× |
| MRA head with contrast (70545) |
$3,060 |
$3,060 |
7.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,726 |
$4,726 |
12.2× |
| MRA neck w/o contrast (70547) |
$2,678 |
$2,678 |
10.1× |
| MRI abdomen w contrast (74182) |
$3,673 |
$3,673 |
9.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,658 |
$3,658 |
9.4× |
| MRI abdomen w/o contrast (74181) |
$2,383 |
$2,383 |
9.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,488 |
$2,488 |
2.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,387 |
$3,387 |
8.7× |
| MRI c-spine with contrast (72142) |
$3,086 |
$3,086 |
7.9× |
| MRI cervical spine w/o contrast (72141) |
$2,361 |
$2,361 |
8.9× |
| MRI chest w/o & w/contrast material (71552) |
$3,845 |
$3,845 |
9.9× |
| MRI chest w/o contrast (71550) |
$2,709 |
$2,709 |
10.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,676 |
$3,676 |
9.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,720 |
$2,720 |
10.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,660 |
$2,660 |
10.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,578 |
$3,578 |
9.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,307 |
$3,307 |
8.5× |
| MRI pelvis w/o contrast (72195) |
$2,400 |
$2,400 |
9.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,113 |
$3,113 |
8.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,069 |
$3,069 |
7.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,395 |
$3,395 |
8.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,649 |
$2,649 |
6.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,870 |
$2,870 |
7.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,365 |
$2,365 |
8.9× |
| MRI up ext w/o contrast (73218) |
$2,737 |
$2,737 |
10.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,642 |
$1,642 |
6.2× |
| MRI, joint upper extrem combo (73223) |
$3,385 |
$3,385 |
8.7× |
| Neck soft tissue (70360) |
$124 |
$124 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$144 |
$144 |
1.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$142 |
$142 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$119 |
$119 |
1.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$139 |
$139 |
1.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$160 |
$160 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$290 |
$290 |
2.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$315 |
$315 |
2.7× |
| Radex fingr minimum 2 views (73140) |
$153 |
$153 |
1.6× |
| Radex Foot Compl Minimum 3 Views (73630) |
$180 |
$180 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$137 |
$137 |
1.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$128 |
$128 |
1.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$234 |
$234 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$178 |
$178 |
1.5× |
| Radex Humerus Minimum 2 Views (73060) |
$128 |
$128 |
1.3× |
| Radex Kne 1/2 Views (73560) |
$142 |
$142 |
1.5× |
| Radex Kne Compl 4/More Views (73564) |
$300 |
$300 |
2.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$158 |
$158 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$149 |
$149 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$171 |
$171 |
1.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$121 |
$121 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$131 |
$131 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$319 |
$319 |
3.3× |
| Radex Toe Minimum 2 Views (73660) |
$135 |
$135 |
1.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$184 |
$184 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$166 |
$166 |
1.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$378 |
$378 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90 |
$90 |
0.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$148 |
$148 |
1.3× |
| Radiologic exam chest 2 views (71046) |
$202 |
$202 |
2.1× |
| Radiologic examination femur 1 view (73551) |
$122 |
$122 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$126 |
$126 |
1.3× |
| Radiological examination surgical specimen (76098) |
$54 |
$54 |
0.1× |
| Ribs bilateral 3 views (71110) |
$149 |
$149 |
1.3× |
| Sacroiliac Joints < 3 Views (72200) |
$167 |
$167 |
1.4× |
| Scapula (73010) |
$130 |
$130 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$160 |
$160 |
6.8× |
| Shoulder 1 view (73020) |
$94 |
$94 |
1.0× |
| Spine thoracic 3 views (72072) |
$148 |
$148 |
1.3× |
| Thoracolumbar 2 views (72080) |
$124 |
$124 |
1.3× |
| Ultrasound breast complete (76641) |
$484 |
$484 |
4.2× |
| Ultrasound elastography first target lesion (76982) |
$467 |
$467 |
4.0× |
| Ultrasound Exam Aaa Screen (76706) |
$483 |
$483 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$421 |
$421 |
3.6× |
| Umbilical-artery Doppler (OB) (76820) |
$397 |
$397 |
3.4× |
| Unlisted ultrasound procedure (76999) |
$220 |
$220 |
2.3× |
| Us breast unilateral limited (76642) |
$370 |
$370 |
3.8× |
| Us chest (76604) |
$257 |
$257 |
2.2× |
| Us compl joint r-t w/image documentation (76881) |
$321 |
$321 |
2.8× |
| Us elastography parenchyma (76981) |
$561 |
$561 |
4.8× |
| Us encephalogram (76506) |
$607 |
$607 |
5.2× |
| Us hips infant static (76886) |
$506 |
$506 |
5.2× |
| Us infant hips w manipulation (76885) |
$742 |
$742 |
7.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$157.50 |
$157.50 |
1.4× |
| Us ob detailed single fetus (76811) |
$536 |
$536 |
2.0× |
| Us ob limited (76815) |
$353 |
$353 |
3.0× |
| Us ob transvaginal (76817) |
$404 |
$404 |
3.5× |
| Us pelvic non ob complete (76856) |
$515 |
$515 |
4.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$105.50 |
$105.50 |
0.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$501 |
$501 |
4.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$489 |
$489 |
4.2× |
| Us retroperitoneal complete (76770) |
$520 |
$520 |
4.5× |
| Us retroperitoneal limited (76775) |
$198 |
$198 |
1.7× |
| Us scrotum and contents (76870) |
$242 |
$242 |
2.1× |
| Us soft tissue head/neck (76536) |
$600 |
$600 |
5.2× |
| Us spinal canal and contents (76800) |
$857 |
$857 |
7.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$1,060 |
$1,060 |
9.1× |
| Wrist 2 views (73100) |
$130 |
$130 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$178 |
$178 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$160 |
$160 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$112.50 |
$112.50 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$189 |
$189 |
1.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$212 |
$212 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$144 |
$144 |
1.5× |
| X-ray eye for foreign body (70030) |
$122 |
$122 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$119 |
$119 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$245 |
$245 |
2.5× |
| X-ray leg, infant (73592) |
$124 |
$124 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$148 |
$148 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$288 |
$288 |
2.5× |
| X-ray nose-rectum child f.b. (76010) |
$106 |
$106 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$176 |
$176 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$145 |
$145 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$142 |
$142 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$196 |
$196 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$146 |
$146 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$121 |
$121 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$155 |
$155 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$176 |
$176 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$146 |
$146 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$113 |
$113 |
1.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$155 |
$155 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$122 |
$122 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$142 |
$142 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$250 |
$250 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$182 |
$182 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$238 |
$238 |
2.0× |