| Abdomen 2 views (74019) |
$51.50 |
$64.37 |
0.5× |
| Ankle 2 views (73600) |
$46.51 |
$58.14 |
0.5× |
| Arthrogram elbow (73085) |
$427.20 |
$534 |
1.2× |
| Arthrogram hip (73525) |
$431.20 |
$539 |
1.3× |
| Arthrogram knee (73580) |
$436.80 |
$546 |
1.3× |
| Arthrogram shoulder (73040) |
$425.60 |
$532 |
1.2× |
| Arthrogram wrist (73115) |
$434.40 |
$543 |
1.3× |
| Bone age studies (77072) |
$35.24 |
$44.04 |
0.3× |
| Bone survey complete (77075) |
$141.38 |
$176.72 |
1.4× |
| Bone survey infant (77076) |
$149.08 |
$186.34 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$55.96 |
$69.95 |
0.7× |
| Chest 1 view (71045) |
$54.82 |
$68.53 |
0.6× |
| Chest xray 3 views (71047) |
$58.92 |
$73.65 |
0.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$229.60 |
$287 |
1.3× |
| Clavicle complete (73000) |
$45.98 |
$57.48 |
0.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$264 |
$330 |
2.6× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$159.20 |
$199 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$688.80 |
$861 |
2.0× |
| CT abdomen and pelvis without contrast (74176) |
$465.60 |
$582 |
2.0× |
| CT abdomen w contrast (74160) |
$476.80 |
$596 |
2.8× |
| CT abdomen w wo contrast (74170) |
$536.80 |
$671 |
3.1× |
| CT abdomen w/o contrast (74150) |
$257.20 |
$321.50 |
2.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$650.80 |
$813.50 |
3.8× |
| CT angiography upper extremity lt (73206) |
$596 |
$745 |
3.4× |
| CT c-spine w/contrast (72126) |
$328 |
$410 |
1.0× |
| CT c-spine w/o contrast (72125) |
$250 |
$312.50 |
2.4× |
| CT cervical spine w&w/o contrast (72127) |
$391.20 |
$489 |
2.3× |
| CT chest w contrast (71260) |
$512 |
$640 |
3.0× |
| CT chest w/wo contrast (71270) |
$515.60 |
$644.50 |
3.0× |
| CT head/brain with contrast (70460) |
$284.57 |
$355.72 |
1.6× |
| CT head/brain without and with contrast (70470) |
$336.94 |
$421.17 |
1.9× |
| CT iac w contrast (70481) |
$359.08 |
$448.84 |
2.1× |
| CT limited/localized follow up study (76380) |
$255.60 |
$319.50 |
3.0× |
| CT lower ext w/o (73700) |
$249.20 |
$311.50 |
2.4× |
| CT lower extremity w wo contrast (73702) |
$388.80 |
$486 |
2.2× |
| CT lower extremity w/contrast material (73701) |
$373.20 |
$466.50 |
2.2× |
| CT lumbar spine w & w/o contrast (72133) |
$392.40 |
$490.50 |
2.3× |
| CT lumbar spine w/contrast (72132) |
$328.80 |
$411 |
1.0× |
| CT lumbar spine w/o contrast (72131) |
$248.40 |
$310.50 |
2.4× |
| CT maxillofacial w contrast (70487) |
$294.02 |
$367.52 |
1.7× |
| CT maxillofacial w/wo contrast (70488) |
$362.38 |
$452.97 |
2.1× |
| CT maxillofacial wo contrast (70486) |
$252.19 |
$315.24 |
2.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$421.59 |
$526.99 |
2.4× |
| CT orbits w/o contrast (70480) |
$301.80 |
$377.26 |
2.9× |
| CT pelvis w/o contrast (72192) |
$253.20 |
$316.50 |
2.5× |
| CT pelvis w/wo contrast (72194) |
$523.60 |
$654.50 |
3.0× |
| CT scan of arm combo (73202) |
$513.60 |
$642 |
3.0× |
| CT soft tissue neck w contrast (70491) |
$356.89 |
$446.12 |
2.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$432 |
$540 |
2.5× |
| CT soft tissue neck w/o contrast (70490) |
$282.90 |
$353.64 |
2.7× |
| CT thoracic spine w/contrast (72129) |
$330.80 |
$413.50 |
1.9× |
| CT thoracic spine w/o contrast (72128) |
$250 |
$312.50 |
2.4× |
| CT thoracic spine w/wo contrast (72130) |
$395.20 |
$494 |
2.3× |
| CT thorax w/o contrast (71250) |
$253.60 |
$317 |
2.5× |
| CT upper ext wo (73200) |
$527.20 |
$659 |
5.1× |
| CT upper extremity with contrast (73201) |
$406.40 |
$508 |
1.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$823.20 |
$1,029 |
4.8× |
| Cta Abdomen (74175) |
$616 |
$770 |
3.6× |
| CTA abdomen pelvis (74174) |
$767.20 |
$959 |
2.2× |
| CTA chest (71275) |
$896 |
$1,120 |
5.2× |
| Cta Head (70496) |
$585.20 |
$731.50 |
3.4× |
| Cta Neck (70498) |
$546.80 |
$683.50 |
3.2× |
| Cta Pelvis (72191) |
$613.20 |
$766.50 |
3.5× |
| Cystography minimum 3 views rs&i (74430) |
$459.60 |
$574.50 |
1.3× |
| Esophagus (74220) |
$221.60 |
$277 |
1.3× |
| Facial bones min 3 views (70150) |
$66.60 |
$83.26 |
0.6× |
| Fluoroscopy up to 1 hr (76000) |
$608 |
$760 |
2.6× |
| Foot 2 views (73620) |
$40.08 |
$50.10 |
0.5× |
| Forearm 2 views (73090) |
$68.66 |
$85.83 |
0.8× |
| Hand 2 views (73120) |
$44.37 |
$55.46 |
0.4× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$97.42 |
$121.77 |
0.9× |
| Knee 3 views (73562) |
$58.63 |
$73.28 |
0.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$643.90 |
$804.88 |
0.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$687.18 |
$858.98 |
2.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$843.04 |
$1,053.81 |
2.4× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$125.60 |
$157 |
1.5× |
| MRA head w & w/o contrast (70546) |
$682.87 |
$853.58 |
2.0× |
| MRA head w/o contrast (70544) |
$436.07 |
$545.08 |
1.8× |
| MRA head with contrast (70545) |
$463.27 |
$579.09 |
1.3× |
| MRA neck w contrast (70548) |
$492.24 |
$615.30 |
1.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$697.49 |
$871.86 |
2.0× |
| MRA neck w/o contrast (70547) |
$436.79 |
$545.99 |
1.9× |
| MRI abdomen w contrast (74182) |
$614.33 |
$767.91 |
1.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$675.58 |
$844.46 |
2.0× |
| MRI abdomen w/o contrast (74181) |
$381.78 |
$477.22 |
1.6× |
| MRI any jt lower extrem w/contrast material (73722) |
$644.63 |
$805.78 |
0.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$787.80 |
$984.76 |
2.3× |
| MRI c-spine with contrast (72142) |
$547.64 |
$684.56 |
1.6× |
| MRI cervical spine w/o contrast (72141) |
$367.07 |
$458.84 |
1.6× |
| MRI chest w/o & w/contrast material (71552) |
$979.84 |
$1,224.80 |
2.8× |
| MRI chest w/o contrast (71550) |
$708.14 |
$885.18 |
3.0× |
| MRI chest with contrast (71551) |
$777.89 |
$972.36 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$527.20 |
$658.99 |
1.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$675.13 |
$843.92 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$449.99 |
$562.49 |
1.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$456.12 |
$570.16 |
1.9× |
| MRI orbit face neck w contrast (70542) |
$541.01 |
$676.26 |
1.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$678.38 |
$847.98 |
2.0× |
| MRI pelvis w/contrast (72196) |
$536.24 |
$670.30 |
1.6× |
| MRI pelvis w/o & w/contrast material (72197) |
$649.52 |
$811.90 |
1.9× |
| MRI pelvis w/o contrast (72195) |
$457.38 |
$571.72 |
1.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$627.56 |
$784.44 |
1.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$537.06 |
$671.32 |
1.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$978.36 |
$1,222.95 |
2.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$542.88 |
$678.60 |
1.6× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$629.01 |
$786.26 |
1.8× |
| MRI temporomandibular joint (70336) |
$540.02 |
$675.02 |
2.3× |
| MRI thoracic spine w/o contrast (72146) |
$367.07 |
$458.84 |
1.6× |
| MRI up ext w/o contrast (73218) |
$634.28 |
$792.85 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$398.37 |
$497.96 |
1.7× |
| MRI, joint upper extrem combo (73223) |
$790.38 |
$987.98 |
2.3× |
| Myelogram Cervical (72240) |
$830 |
$1,037.50 |
1.1× |
| Myelogram Lumbar (72265) |
$1,588 |
$1,015 |
2.1× |
| Myelogram thoracic (72255) |
$830 |
$1,037.50 |
1.1× |
| Neck soft tissue (70360) |
$44.50 |
$55.62 |
0.5× |
| Osseous survey limited (77074) |
$89.79 |
$112.24 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$62.28 |
$77.85 |
0.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$91.04 |
$113.80 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$66.55 |
$83.19 |
0.8× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$46.30 |
$57.88 |
0.5× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$114.64 |
$143.30 |
1.1× |
| Radex fingr minimum 2 views (73140) |
$99.55 |
$124.44 |
1.2× |
| Radex Foot Compl Minimum 3 Views (73630) |
$83.58 |
$104.47 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$91.04 |
$113.80 |
1.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$46.38 |
$57.98 |
0.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$147.46 |
$184.33 |
1.4× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$58.62 |
$73.28 |
0.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$88.66 |
$110.82 |
0.9× |
| Radex Humerus Minimum 2 Views (73060) |
$45.98 |
$57.48 |
0.5× |
| Radex Kne 1/2 Views (73560) |
$83.58 |
$104.47 |
1.0× |
| Radex Kne Compl 4/More Views (73564) |
$66.90 |
$83.62 |
0.6× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$61.19 |
$76.48 |
0.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$55.34 |
$69.18 |
0.6× |
| Radex Sho Compl Minimum 2 Views (73030) |
$81.45 |
$101.81 |
0.9× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$57.91 |
$72.39 |
0.6× |
| Radex Toe Minimum 2 Views (73660) |
$42.28 |
$52.86 |
0.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$45.15 |
$56.44 |
0.4× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$103.82 |
$129.77 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$41.84 |
$52.29 |
0.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$60.01 |
$75.01 |
0.6× |
| Radiologic exam chest 2 views (71046) |
$73.98 |
$92.48 |
0.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$240.40 |
$300.50 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$54.52 |
$68.16 |
0.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$76.12 |
$95.15 |
0.9× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$86.92 |
$108.65 |
0.2× |
| Ribs bilateral 3 views (71110) |
$60.95 |
$76.18 |
0.6× |
| Sacroiliac Joints < 3 Views (72200) |
$47.07 |
$58.84 |
0.5× |
| Scapula (73010) |
$31.68 |
$39.60 |
0.3× |
| Sella turcica (70240) |
$46.41 |
$58.02 |
0.5× |
| Shoulder 1 view (73020) |
$29.40 |
$36.74 |
0.3× |
| Small bowel series (74250) |
$438.40 |
$548 |
2.5× |
| Spine thoracic 3 views (72072) |
$55.47 |
$69.34 |
0.5× |
| Thoracolumbar 2 views (72080) |
$48.42 |
$60.52 |
0.6× |
| Tmj unilateral (70328) |
$49.29 |
$61.61 |
0.6× |
| Ultrasound breast complete (76641) |
$142.40 |
$178 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$153.20 |
$191.50 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$192.80 |
$241 |
1.9× |
| Unlisted magnetic resonance procedure (76498) |
$411.86 |
$514.83 |
4.8× |
| Unlisted ultrasound procedure (76999) |
$199.60 |
$249.50 |
2.3× |
| Us breast unilateral limited (76642) |
$114.40 |
$143 |
1.3× |
| Us chest (76604) |
$72.40 |
$90.50 |
0.7× |
| Us compl joint r-t w/image documentation (76881) |
$57.60 |
$72 |
0.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$56 |
$70 |
0.5× |
| Us ob limited (76815) |
$129.60 |
$162 |
1.3× |
| Us ob transvaginal (76817) |
$124.80 |
$156 |
1.2× |
| Us pelvic non ob complete (76856) |
$158.80 |
$198.50 |
1.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$72.80 |
$91 |
0.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$183.20 |
$229 |
1.8× |
| Us retroperitoneal complete (76770) |
$188 |
$235 |
1.8× |
| Us retroperitoneal limited (76775) |
$76 |
$95 |
0.7× |
| Us scrotum and contents (76870) |
$141.60 |
$177 |
1.4× |
| Us soft tissue head/neck (76536) |
$270.40 |
$338 |
2.6× |
| Us transrectal (76872) |
$339.20 |
$424 |
3.3× |
| Wrist 2 views (73100) |
$48.64 |
$60.80 |
0.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$69.28 |
$86.60 |
0.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$39.46 |
$49.32 |
0.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$41.18 |
$51.48 |
0.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$84.16 |
$105.20 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$76.14 |
$95.18 |
0.7× |
| X-ray exam of femur 2/> (73552) |
$50.88 |
$63.60 |
0.6× |
| X-ray eye for foreign body (70030) |
$46.09 |
$57.61 |
0.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$57.98 |
$72.46 |
0.7× |
| X-ray leg, infant (73592) |
$58.86 |
$73.58 |
0.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$56.50 |
$70.62 |
0.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$88.86 |
$111.06 |
0.9× |
| X-ray nose-rectum child f.b. (76010) |
$114.83 |
$143.54 |
1.3× |
| X-ray optic foramen (70190) |
$62.06 |
$77.57 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$67.54 |
$84.43 |
0.7× |
| X-ray retrograde pyelogram (74420) |
$161.60 |
$202 |
0.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$51.70 |
$64.62 |
0.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$58.94 |
$73.68 |
0.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$73.54 |
$91.92 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$46.30 |
$57.88 |
0.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$53 |
$66.26 |
0.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$62.22 |
$77.78 |
0.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$51.42 |
$64.26 |
0.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$33.97 |
$42.46 |
0.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$58.87 |
$73.58 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$47.28 |
$59.10 |
0.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$45.96 |
$57.46 |
0.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$62.80 |
$78.49 |
0.6× |
| Xr bone length studies (77073) |
$62.78 |
$78.48 |
0.6× |
| Xr c-spine 4 or 5 views (72050) |
$76.27 |
$95.34 |
0.7× |
| Xr c-spine 6 or more views (72052) |
$89.63 |
$112.04 |
0.9× |
| Xr chest 4+ views (71048) |
$100.61 |
$125.76 |
1.0× |