| Abdomen 2 views (74019) |
$321.94 |
$429.25 |
2.8× |
| Ankle 2 views (73600) |
$223.88 |
$298.50 |
2.3× |
| Arthrogram elbow (73085) |
$700.88 |
$934.50 |
1.8× |
| Arthrogram hip (73525) |
$719.81 |
$959.75 |
1.9× |
| Arthrogram shoulder (73040) |
$796.31 |
$1,061.75 |
2.0× |
| Bone age studies (77072) |
$186.94 |
$249.25 |
1.6× |
| Bone survey complete (77075) |
$886.31 |
$1,181.75 |
7.6× |
| Bone survey infant (77076) |
$383.25 |
$511 |
3.3× |
| Cervical spine 2 or 3 views (72040) |
$311.63 |
$415.50 |
3.2× |
| Chest 1 view (71045) |
$229.50 |
$306 |
2.4× |
| Chest xray 3 views (71047) |
$294.75 |
$393 |
3.0× |
| Clavicle complete (73000) |
$261.56 |
$348.75 |
2.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,407.56 |
$1,876.75 |
12.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,757.13 |
$5,009.50 |
9.7× |
| CT abdomen and pelvis without contrast (74176) |
$2,128.88 |
$2,838.50 |
8.0× |
| CT abdomen w contrast (74160) |
$2,016.38 |
$2,688.50 |
10.3× |
| CT abdomen w wo contrast (74170) |
$2,455.69 |
$3,274.25 |
12.6× |
| CT abdomen w/o contrast (74150) |
$1,427.81 |
$1,903.75 |
12.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,991.94 |
$3,989.25 |
15.3× |
| CT angiography upper extremity lt (73206) |
$3,292.69 |
$4,390.25 |
16.8× |
| CT c-spine w/o contrast (72125) |
$1,619.63 |
$2,159.50 |
13.9× |
| CT chest w contrast (71260) |
$1,859.44 |
$2,479.25 |
9.5× |
| CT chest w/wo contrast (71270) |
$2,253.38 |
$3,004.50 |
11.5× |
| CT head/brain with contrast (70460) |
$1,804.50 |
$2,406 |
9.2× |
| CT head/brain without and with contrast (70470) |
$1,880.25 |
$2,507 |
9.6× |
| CT iac w contrast (70481) |
$2,895.38 |
$3,860.50 |
14.8× |
| CT lower ext w/o (73700) |
$1,900.50 |
$2,534 |
16.3× |
| CT lower extremity w wo contrast (73702) |
$3,205.69 |
$4,274.25 |
16.4× |
| CT lower extremity w/contrast material (73701) |
$2,720.06 |
$3,626.75 |
13.9× |
| CT lumbar spine w & w/o contrast (72133) |
$3,306.75 |
$4,409 |
16.9× |
| CT lumbar spine w/contrast (72132) |
$2,926.31 |
$3,901.75 |
7.5× |
| CT lumbar spine w/o contrast (72131) |
$1,980.94 |
$2,641.25 |
17.0× |
| CT maxillofacial w contrast (70487) |
$1,699.69 |
$2,266.25 |
8.7× |
| CT maxillofacial w/wo contrast (70488) |
$2,283.19 |
$3,044.25 |
11.7× |
| CT maxillofacial wo contrast (70486) |
$1,397.25 |
$1,863 |
12.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,342.81 |
$3,123.75 |
12.0× |
| CT orbits w/o contrast (70480) |
$2,001.19 |
$2,668.25 |
17.2× |
| CT pelvis w/o contrast (72192) |
$1,431.19 |
$1,908.25 |
12.3× |
| CT pelvis w/wo contrast (72194) |
$2,529.38 |
$3,372.50 |
12.9× |
| CT scan of arm combo (73202) |
$3,215.63 |
$4,287.50 |
16.5× |
| CT soft tissue neck w contrast (70491) |
$2,155.31 |
$2,873.75 |
11.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,546.06 |
$3,394.75 |
13.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,822.31 |
$2,429.75 |
15.6× |
| CT thoracic spine w/o contrast (72128) |
$1,641.19 |
$2,188.25 |
14.1× |
| CT thorax w/o contrast (71250) |
$1,530.75 |
$2,041 |
13.1× |
| CT upper ext wo (73200) |
$1,897.31 |
$2,529.75 |
16.3× |
| CT upper extremity with contrast (73201) |
$2,714.25 |
$3,619 |
7.0× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,116.88 |
$2,822.50 |
10.8× |
| Cta Abdomen (74175) |
$2,856.75 |
$3,809 |
14.6× |
| CTA abdomen pelvis (74174) |
$3,589.50 |
$4,786 |
9.2× |
| CTA chest (71275) |
$2,823 |
$3,764 |
14.4× |
| Cta Head (70496) |
$3,003.94 |
$4,005.25 |
15.4× |
| Cta Neck (70498) |
$3,149.44 |
$4,199.25 |
16.1× |
| Cta Pelvis (72191) |
$2,791.50 |
$3,722 |
14.3× |
| Cystography minimum 3 views rs&i (74430) |
$481.13 |
$641.50 |
1.2× |
| Esophagus (74220) |
$315.75 |
$421 |
1.6× |
| Facial bones min 3 views (70150) |
$388.69 |
$518.25 |
3.3× |
| Fetal biophysical profile non-stress testing (76818) |
$217.13 |
$289.50 |
1.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$504 |
$672 |
4.3× |
| Fluoroscopy up to 1 hr (76000) |
$457.88 |
$610.50 |
1.7× |
| Foot 2 views (73620) |
$247.50 |
$330 |
2.6× |
| Forearm 2 views (73090) |
$250.69 |
$334.25 |
2.6× |
| Hand 2 views (73120) |
$212.25 |
$283 |
1.8× |
| Hysterosalpingogram (74740) |
$698.06 |
$930.75 |
2.6× |
| Knee 3 views (73562) |
$281.81 |
$375.75 |
2.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,719.69 |
$3,626.25 |
3.1× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$3,342.56 |
$4,456.75 |
8.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,402.38 |
$4,536.50 |
8.8× |
| MRA head w & w/o contrast (70546) |
$4,036.88 |
$5,382.50 |
10.4× |
| MRA head w/o contrast (70544) |
$2,556.38 |
$3,408.50 |
9.6× |
| MRA neck w contrast (70548) |
$2,936.44 |
$3,915.25 |
7.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$5,699.06 |
$7,598.75 |
14.7× |
| MRA neck w/o contrast (70547) |
$2,895.75 |
$3,861 |
10.9× |
| MRI abdomen w contrast (74182) |
$3,272.81 |
$4,363.75 |
8.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,784.88 |
$5,046.50 |
9.7× |
| MRI abdomen w/o contrast (74181) |
$2,729.25 |
$3,639 |
10.3× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,746.31 |
$3,661.75 |
3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,914.44 |
$5,219.25 |
10.1× |
| MRI bone marrow blood supply (77084) |
$2,681.25 |
$3,575 |
10.1× |
| MRI c-spine with contrast (72142) |
$3,112.88 |
$4,150.50 |
8.0× |
| MRI cervical spine w/o contrast (72141) |
$2,113.69 |
$2,818.25 |
7.9× |
| MRI chest w/o & w/contrast material (71552) |
$4,169.06 |
$5,558.75 |
10.7× |
| MRI chest w/o contrast (71550) |
$3,074.44 |
$4,099.25 |
11.6× |
| MRI chest with contrast (71551) |
$3,462.56 |
$4,616.75 |
4.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$3,170.81 |
$4,227.75 |
8.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,232.69 |
$4,310.25 |
8.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,476.50 |
$3,302 |
9.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,386.50 |
$3,182 |
9.0× |
| MRI orbit face neck w contrast (70542) |
$3,533.81 |
$4,711.75 |
9.1× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,255.69 |
$5,674.25 |
10.9× |
| MRI pelvis w/contrast (72196) |
$3,170.81 |
$4,227.75 |
8.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,219 |
$4,292 |
8.3× |
| MRI pelvis w/o contrast (72195) |
$2,420.25 |
$3,227 |
9.1× |
| MRI spectroscopy (76390) |
$3,482.44 |
$4,643.25 |
35.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,693.75 |
$4,925 |
9.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,112.88 |
$4,150.50 |
8.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,028.31 |
$4,037.75 |
7.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$3,112.88 |
$4,150.50 |
8.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,693.75 |
$4,925 |
9.5× |
| MRI temporomandibular joint (70336) |
$2,547.56 |
$3,396.75 |
9.6× |
| MRI thoracic spine w/o contrast (72146) |
$2,115.19 |
$2,820.25 |
8.0× |
| MRI up ext w/o contrast (73218) |
$2,565.19 |
$3,420.25 |
9.6× |
| MRI upper ext joint w/o contrast (73221) |
$2,182.13 |
$2,909.50 |
8.2× |
| MRI, joint upper extrem combo (73223) |
$3,915.38 |
$5,220.50 |
10.1× |
| Neck soft tissue (70360) |
$257.44 |
$343.25 |
2.7× |
| Osseous survey limited (77074) |
$628.13 |
$837.50 |
5.4× |
| Pelvis 1 or 2 views (72170) |
$261.56 |
$348.75 |
2.2× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$284.25 |
$379 |
2.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$260.44 |
$347.25 |
2.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$305.81 |
$407.75 |
3.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$234.19 |
$312.25 |
2.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$531.94 |
$709.25 |
4.6× |
| Radex fingr minimum 2 views (73140) |
$257.81 |
$343.75 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$273.56 |
$364.75 |
2.8× |
| Radex Hand Minimum 3 Views (73130) |
$282.38 |
$376.50 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$239.06 |
$318.75 |
2.5× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$348.56 |
$464.75 |
3.0× |
| Radex Humerus Minimum 2 Views (73060) |
$269.81 |
$359.75 |
2.8× |
| Radex Kne 1/2 Views (73560) |
$242.44 |
$323.25 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$340.31 |
$453.75 |
2.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$377.25 |
$503 |
3.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$293.25 |
$391 |
3.0× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$317.44 |
$423.25 |
2.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$270.19 |
$360.25 |
2.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$261.19 |
$348.25 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$431.06 |
$574.75 |
4.4× |
| Radex Toe Minimum 2 Views (73660) |
$241.69 |
$322.25 |
2.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$271.50 |
$362 |
2.3× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$314.06 |
$418.75 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$236.63 |
$315.50 |
2.4× |
| Radiologic exam chest 2 views (71046) |
$259.88 |
$346.50 |
2.7× |
| Radiologic exam colon single contrast study (74270) |
$1,068.19 |
$1,424.25 |
5.5× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$630.56 |
$840.75 |
3.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$979.50 |
$1,306 |
5.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$270.75 |
$361 |
2.8× |
| Radiological examination surgical specimen (76098) |
$154.13 |
$205.50 |
0.3× |
| Sacroiliac Joints < 3 Views (72200) |
$396.56 |
$528.75 |
3.4× |
| Scapula (73010) |
$277.69 |
$370.25 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$67.88 |
$90.50 |
2.9× |
| Shoulder 1 view (73020) |
$228.75 |
$305 |
2.4× |
| Small bowel series (74250) |
$710.63 |
$947.50 |
3.6× |
| Spine thoracic 3 views (72072) |
$327.75 |
$437 |
2.8× |
| Thoracolumbar 2 views (72080) |
$308.25 |
$411 |
3.2× |
| Ultrasound breast complete (76641) |
$491.44 |
$655.25 |
4.2× |
| Ultrasound elastography first target lesion (76982) |
$354.94 |
$473.25 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$359.63 |
$479.50 |
3.1× |
| Ultrasound, abdomen limited (76705) |
$508.69 |
$678.25 |
4.4× |
| Umbilical-artery Doppler (OB) (76820) |
$396.19 |
$528.25 |
3.4× |
| Unlisted ultrasound procedure (76999) |
$204.38 |
$272.50 |
2.1× |
| Urethrocystogram voiding (74455) |
$750 |
$1,000 |
2.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$919.13 |
$1,225.50 |
4.7× |
| Us breast unilateral limited (76642) |
$268.88 |
$358.50 |
2.8× |
| Us chest (76604) |
$484.88 |
$646.50 |
4.2× |
| Us compl joint r-t w/image documentation (76881) |
$532.31 |
$709.75 |
4.6× |
| Us elastography parenchyma (76981) |
$422.25 |
$563 |
3.6× |
| Us encephalogram (76506) |
$555 |
$740 |
4.8× |
| Us infant hips w manipulation (76885) |
$673.31 |
$897.75 |
6.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$417.38 |
$556.50 |
3.6× |
| Us ob detailed single fetus (76811) |
$711 |
$948 |
2.7× |
| Us ob limited (76815) |
$454.13 |
$605.50 |
3.9× |
| Us ob transvaginal (76817) |
$700.88 |
$934.50 |
6.0× |
| Us pelvic non ob complete (76856) |
$626.44 |
$835.25 |
5.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$377.63 |
$503.50 |
3.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$670.50 |
$894 |
5.8× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$351.19 |
$468.25 |
3.0× |
| Us retroperitoneal complete (76770) |
$719.25 |
$959 |
6.2× |
| Us retroperitoneal limited (76775) |
$505.13 |
$673.50 |
4.3× |
| Us scrotum and contents (76870) |
$548.63 |
$731.50 |
4.7× |
| Us soft tissue head/neck (76536) |
$561.94 |
$749.25 |
4.8× |
| Us spinal canal and contents (76800) |
$746.25 |
$995 |
6.4× |
| Us,transplanted kidney, real time/ doppler (76776) |
$791.81 |
$1,055.75 |
6.8× |
| Wrist 2 views (73100) |
$231.19 |
$308.25 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$387.75 |
$517 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$702.75 |
$937 |
7.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$877.69 |
$1,170.25 |
4.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$218.44 |
$291.25 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$342.38 |
$456.50 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$274.50 |
$366 |
2.8× |
| X-ray eye for foreign body (70030) |
$192.38 |
$256.50 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$274.88 |
$366.50 |
2.8× |
| X-ray IV pyelogram (ivp) (74400) |
$726.75 |
$969 |
3.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$228.75 |
$305 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$319.88 |
$426.50 |
3.3× |
| X-ray leg, infant (73592) |
$273.56 |
$364.75 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$327.38 |
$436.50 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$574.69 |
$766.25 |
4.9× |
| X-ray nose-rectum child f.b. (76010) |
$212.25 |
$283 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$267.75 |
$357 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$326.63 |
$435.50 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$372 |
$496 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$439.69 |
$586.25 |
3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$265.31 |
$353.75 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$370.13 |
$493.50 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$345.19 |
$460.25 |
3.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$381.38 |
$508.50 |
3.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$233.63 |
$311.50 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$263.25 |
$351 |
2.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$300.38 |
$400.50 |
2.6× |
| Xr c-spine 4 or 5 views (72050) |
$411.94 |
$549.25 |
3.5× |
| Xr c-spine 6 or more views (72052) |
$489.75 |
$653 |
4.2× |
| Xr chest 4+ views (71048) |
$399 |
$532 |
3.4× |