| Abdomen 2 views (74019) |
$225.40 |
$245 |
2.1× |
| Ankle 2 views (73600) |
$169.28 |
$184 |
1.9× |
| Arthrogram ankle (73615) |
$154.56 |
$168 |
0.4× |
| Bone age studies (77072) |
$161.92 |
$176 |
1.5× |
| Bone survey complete (77075) |
$470.12 |
$511 |
4.4× |
| Cervical spine 2 or 3 views (72040) |
$224.48 |
$244 |
2.5× |
| Chest 1 view (71045) |
$166.52 |
$181 |
1.9× |
| Chest xray 3 views (71047) |
$259.44 |
$282 |
2.9× |
| Cholecystography, oral contrast Non-Facility (74290) |
$215.74 |
$234.50 |
1.2× |
| Clavicle complete (73000) |
$182.16 |
$198 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$553.84 |
$602 |
5.1× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$127.88 |
$139 |
0.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,186.88 |
$3,464 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,006.98 |
$2,181.50 |
8.1× |
| CT abdomen w contrast (74160) |
$1,863 |
$2,025 |
10.3× |
| CT abdomen w wo contrast (74170) |
$2,466.06 |
$2,680.50 |
13.6× |
| CT abdomen w/o contrast (74150) |
$1,635.76 |
$1,778 |
15.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,582.48 |
$3,894 |
19.8× |
| CT angiography upper extremity lt (73206) |
$2,865.80 |
$3,115 |
15.8× |
| CT c-spine w/contrast (72126) |
$1,863 |
$2,025 |
5.2× |
| CT c-spine w/o contrast (72125) |
$1,635.76 |
$1,778 |
15.2× |
| CT cervical spine w&w/o contrast (72127) |
$2,294.48 |
$2,494 |
12.7× |
| CT chest w contrast (71260) |
$1,863 |
$2,025 |
10.3× |
| CT chest w/wo contrast (71270) |
$2,294.48 |
$2,494 |
12.7× |
| CT head/brain with contrast (70460) |
$1,863 |
$2,025 |
10.3× |
| CT head/brain without and with contrast (70470) |
$2,294.48 |
$2,494 |
12.7× |
| CT iac w contrast (70481) |
$1,863 |
$2,025 |
10.3× |
| CT limited/localized follow up study (76380) |
$663.32 |
$721 |
7.4× |
| CT lower ext w/o (73700) |
$1,635.76 |
$1,778 |
15.2× |
| CT lower extremity w wo contrast (73702) |
$2,294.48 |
$2,494 |
12.7× |
| CT lower extremity w/contrast material (73701) |
$1,863 |
$2,025 |
10.3× |
| CT lumbar spine w & w/o contrast (72133) |
$2,294.48 |
$2,494 |
12.7× |
| CT lumbar spine w/contrast (72132) |
$1,863 |
$2,025 |
5.2× |
| CT lumbar spine w/o contrast (72131) |
$1,635.76 |
$1,778 |
15.2× |
| CT maxillofacial w contrast (70487) |
$1,863 |
$2,025 |
10.3× |
| CT maxillofacial w/wo contrast (70488) |
$2,294.48 |
$2,494 |
12.7× |
| CT maxillofacial wo contrast (70486) |
$1,635.76 |
$1,778 |
15.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,294.48 |
$2,494 |
12.7× |
| CT orbits w/o contrast (70480) |
$1,635.76 |
$1,778 |
15.2× |
| CT pelvis w/o contrast (72192) |
$1,635.76 |
$1,778 |
15.2× |
| CT pelvis w/wo contrast (72194) |
$2,294.48 |
$2,494 |
12.7× |
| CT scan of arm combo (73202) |
$2,294.48 |
$2,494 |
12.7× |
| CT soft tissue neck w contrast (70491) |
$1,863 |
$2,025 |
10.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,294.48 |
$2,494 |
12.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,635.76 |
$1,778 |
15.2× |
| CT thoracic spine w/contrast (72129) |
$1,863 |
$2,025 |
10.3× |
| CT thoracic spine w/o contrast (72128) |
$1,635.76 |
$1,778 |
15.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,294.48 |
$2,494 |
12.7× |
| CT thorax w/o contrast (71250) |
$1,635.76 |
$1,778 |
15.2× |
| CT upper ext wo (73200) |
$1,635.76 |
$1,778 |
15.2× |
| CT upper extremity with contrast (73201) |
$1,863 |
$2,025 |
5.2× |
| CTA abdomen pelvis (74174) |
$3,638.60 |
$3,955 |
10.1× |
| CTA chest (71275) |
$2,919.16 |
$3,173 |
16.1× |
| Cta Head (70496) |
$3,091.20 |
$3,360 |
17.1× |
| Cta Neck (70498) |
$2,704.80 |
$2,940 |
14.9× |
| Cta Pelvis (72191) |
$2,463.76 |
$2,678 |
13.6× |
| Cystography minimum 3 views rs&i (74430) |
$286.12 |
$311 |
0.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$371.68 |
$404 |
3.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$291.64 |
$317 |
3.2× |
| Esophagus (74220) |
$167.44 |
$182 |
0.9× |
| Facial bones min 3 views (70150) |
$239.20 |
$260 |
2.2× |
| Fetal biophysical profile non-stress testing (76818) |
$479.09 |
$520.75 |
4.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$738.76 |
$803 |
6.8× |
| Fluoroscopy up to 1 hr (76000) |
$187.22 |
$203.50 |
0.8× |
| Foot 2 views (73620) |
$169.28 |
$184 |
1.9× |
| Forearm 2 views (73090) |
$178.48 |
$194 |
2.0× |
| Hand 2 views (73120) |
$178.48 |
$194 |
1.7× |
| Knee 3 views (73562) |
$184.92 |
$201 |
2.1× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,376.36 |
$2,583 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,482.16 |
$2,698 |
6.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,278.88 |
$3,564 |
9.1× |
| MRA head w/o contrast (70544) |
$2,424.20 |
$2,635 |
9.8× |
| MRA neck w contrast (70548) |
$2,540.12 |
$2,761 |
7.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,792.24 |
$4,122 |
10.5× |
| MRA neck w/o contrast (70547) |
$2,420.52 |
$2,631 |
9.8× |
| MRI abdomen w contrast (74182) |
$2,440.99 |
$2,653.25 |
6.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,294.52 |
$3,581 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$1,569.98 |
$1,706.50 |
6.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,108.68 |
$3,379 |
8.6× |
| MRI c-spine with contrast (72142) |
$2,587.04 |
$2,812 |
7.2× |
| MRI cervical spine w/o contrast (72141) |
$2,070 |
$2,250 |
8.4× |
| MRI chest w/o & w/contrast material (71552) |
$3,717.72 |
$4,041 |
10.3× |
| MRI chest w/o contrast (71550) |
$2,504.24 |
$2,722 |
10.2× |
| MRI chest with contrast (71551) |
$2,824.40 |
$3,070 |
3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,476.64 |
$2,692 |
6.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,282.56 |
$3,568 |
9.1× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,249.40 |
$2,445 |
9.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,216.28 |
$2,409 |
9.0× |
| MRI orbit face neck w contrast (70542) |
$2,478.48 |
$2,694 |
6.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,234.72 |
$3,516 |
9.0× |
| MRI pelvis w/contrast (72196) |
$2,524.48 |
$2,744 |
7.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,288.08 |
$3,574 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$2,279.76 |
$2,478 |
9.3× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,214.48 |
$3,494 |
8.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,547.48 |
$2,769 |
7.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,163.88 |
$3,439 |
8.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,334.96 |
$2,538 |
6.5× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,023.12 |
$3,286 |
8.4× |
| MRI temporomandibular joint (70336) |
$2,001 |
$2,175 |
8.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,100.36 |
$2,283 |
8.5× |
| MRI up ext w/o contrast (73218) |
$2,293.56 |
$2,493 |
9.3× |
| MRI upper ext joint w/o contrast (73221) |
$1,912.91 |
$2,079.25 |
7.8× |
| MRI, joint upper extrem combo (73223) |
$3,115.12 |
$3,386 |
8.7× |
| Neck soft tissue (70360) |
$151.80 |
$165 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$150.88 |
$164 |
1.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$157.78 |
$171.50 |
0.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$188.60 |
$205 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$169.28 |
$184 |
1.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$188.60 |
$205 |
2.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$235.52 |
$256 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$283.36 |
$308 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$165.60 |
$180 |
1.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$188.60 |
$205 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$184 |
$200 |
2.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$169.28 |
$184 |
1.9× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$230.92 |
$251 |
2.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$254.84 |
$277 |
2.4× |
| Radex Humerus Minimum 2 Views (73060) |
$182.16 |
$198 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$178.48 |
$194 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$188.60 |
$205 |
1.7× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$224.48 |
$244 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$188.60 |
$205 |
2.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$241.04 |
$262 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$188.60 |
$205 |
2.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$177.56 |
$193 |
2.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$273.24 |
$297 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$188.60 |
$205 |
2.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$230.92 |
$251 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$188.60 |
$205 |
2.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$140.76 |
$153 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$215.28 |
$234 |
2.4× |
| Radiologic exam colon single contrast study (74270) |
$273.70 |
$297.50 |
1.5× |
| Radiologic exam upr gi trc single contrast study (74240) |
$240.58 |
$261.50 |
1.3× |
| Radiologic examination femur 1 view (73551) |
$159.16 |
$173 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$178.48 |
$194 |
2.0× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$313.72 |
$341 |
0.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$318.32 |
$346 |
3.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$204.24 |
$222 |
1.9× |
| Ribs bilateral 3 views (71110) |
$228.16 |
$248 |
2.1× |
| Sacroiliac Joints < 3 Views (72200) |
$169.28 |
$184 |
1.6× |
| Scapula (73010) |
$182.16 |
$198 |
1.7× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$73.60 |
$80 |
3.1× |
| Sella turcica (70240) |
$169.28 |
$184 |
1.9× |
| Shoulder 1 view (73020) |
$178.48 |
$194 |
2.0× |
| Small bowel series (74250) |
$220.34 |
$239.50 |
1.2× |
| Spine thoracic 3 views (72072) |
$209.76 |
$228 |
1.9× |
| Tomogram (76100) |
$176.41 |
$191.75 |
1.6× |
| Ultrasound breast complete (76641) |
$555.68 |
$604 |
5.1× |
| Ultrasound Exam Aaa Screen (76706) |
$465.52 |
$506 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$497.72 |
$541 |
4.6× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$103.73 |
$112.75 |
1.2× |
| Unlisted ultrasound procedure (76999) |
$555.68 |
$604 |
6.2× |
| Urethrocystogram voiding (74455) |
$192.28 |
$209 |
0.8× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$442.52 |
$481 |
2.4× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$102.12 |
$111 |
0.6× |
| Us compl joint r-t w/image documentation (76881) |
$555.68 |
$604 |
5.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$546.02 |
$593.50 |
5.1× |
| Us ob limited (76815) |
$444.36 |
$483 |
4.1× |
| Us ob transvaginal (76817) |
$530.84 |
$577 |
4.9× |
| Us pelvic non ob complete (76856) |
$457.58 |
$497.38 |
4.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$379.96 |
$413 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$555.68 |
$604 |
5.1× |
| Us retroperitoneal complete (76770) |
$457.58 |
$497.38 |
4.2× |
| Us retroperitoneal limited (76775) |
$497.72 |
$541 |
4.6× |
| Us scrotum and contents (76870) |
$457.58 |
$497.38 |
4.2× |
| Us soft tissue head/neck (76536) |
$555.68 |
$604 |
5.1× |
| Venogram Extremity Unilateral (75820) |
$420.90 |
$457.50 |
0.3× |
| Wrist 2 views (73100) |
$169.28 |
$184 |
1.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$269.56 |
$293 |
2.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$226.32 |
$246 |
2.5× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$320.62 |
$348.50 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$178.48 |
$194 |
2.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$248.40 |
$270 |
2.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$239.66 |
$260.50 |
2.2× |
| X-ray exam of femur 2/> (73552) |
$188.60 |
$205 |
2.1× |
| X-ray eye for foreign body (70030) |
$161.92 |
$176 |
1.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$170.20 |
$185 |
1.9× |
| X-ray IV pyelogram (ivp) (74400) |
$358.80 |
$390 |
2.0× |
| X-ray leg, infant (73592) |
$158.24 |
$172 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$208.84 |
$227 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$242.88 |
$264 |
2.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$224.48 |
$244 |
2.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$219.88 |
$239 |
2.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$249.78 |
$271.50 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$193.20 |
$210 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$163.76 |
$178 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$219.88 |
$239 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$264.04 |
$287 |
2.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$207 |
$225 |
1.9× |
| X-Ray Spine One View - Xr Spine (72020) |
$189.52 |
$206 |
2.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$209.76 |
$228 |
2.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$178.48 |
$194 |
2.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$189.52 |
$206 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$248.40 |
$270 |
2.3× |
| Xr c-spine 4 or 5 views (72050) |
$297.16 |
$323 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$379.96 |
$413 |
3.5× |
| Xr chest 4+ views (71048) |
$293.48 |
$319 |
2.7× |