| Abdomen 2 views (74019) |
$267.80 |
$412 |
2.3× |
| Ankle 2 views (73600) |
$241.48 |
$371.50 |
2.5× |
| Bone age studies (77072) |
$168.35 |
$259 |
1.4× |
| Bone survey complete (77075) |
$566.80 |
$872 |
4.9× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$2,237.95 |
$3,443 |
5.8× |
| Cervical spine 2 or 3 views (72040) |
$333.45 |
$513 |
3.4× |
| Chest 1 view (71045) |
$159.25 |
$245 |
1.6× |
| Chest xray 3 views (71047) |
$310.70 |
$478 |
3.2× |
| Clavicle complete (73000) |
$223.60 |
$344 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$205.40 |
$316 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,448.25 |
$5,305 |
8.9× |
| CT abdomen and pelvis without contrast (74176) |
$2,025.40 |
$3,116 |
7.6× |
| CT abdomen w contrast (74160) |
$2,388.10 |
$3,674 |
12.2× |
| CT abdomen w wo contrast (74170) |
$2,789.80 |
$4,292 |
14.3× |
| CT abdomen w/o contrast (74150) |
$1,458.60 |
$2,244 |
12.5× |
| CT angio hrt w/3d image (75574) |
$1,543.75 |
$2,375 |
4.0× |
| CT angio lwr extr w/o&w/dye (73706) |
$3,610.75 |
$5,555 |
18.5× |
| CT angiography upper extremity lt (73206) |
$1,545.70 |
$2,378 |
7.9× |
| CT c-spine w/contrast (72126) |
$1,568.45 |
$2,413 |
4.0× |
| CT c-spine w/o contrast (72125) |
$1,891.50 |
$2,910 |
16.2× |
| CT cere prfu aly c+wo CT/CTA (70473) |
$2,821.65 |
$4,341 |
14.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,755.65 |
$2,701 |
9.0× |
| CT chest w contrast (71260) |
$2,338.70 |
$3,598 |
12.0× |
| CT chest w/wo contrast (71270) |
$2,876.90 |
$4,426 |
14.7× |
| CT head/brain with contrast (70460) |
$1,079 |
$1,660 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,352 |
$2,080 |
6.9× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$169.65 |
$261 |
1.7× |
| CT iac w contrast (70481) |
$1,310.40 |
$2,016 |
6.7× |
| CT lower ext w/o (73700) |
$1,867.45 |
$2,873 |
16.0× |
| CT lower extremity w wo contrast (73702) |
$1,177.15 |
$1,811 |
6.0× |
| CT lower extremity w/contrast material (73701) |
$2,345.85 |
$3,609 |
12.0× |
| CT lumbar spine w & w/o contrast (72133) |
$2,169.70 |
$3,338 |
11.1× |
| CT lumbar spine w/contrast (72132) |
$1,833 |
$2,820 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,863.55 |
$2,867 |
16.0× |
| CT maxillofacial w contrast (70487) |
$2,448.55 |
$3,767 |
12.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,108.25 |
$1,705 |
5.7× |
| CT maxillofacial wo contrast (70486) |
$2,007.85 |
$3,089 |
17.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,609.40 |
$2,476 |
8.2× |
| CT orbits w/o contrast (70480) |
$791.70 |
$1,218 |
6.8× |
| CT pelvis w/o contrast (72192) |
$1,454.70 |
$2,238 |
12.5× |
| CT pelvis w/wo contrast (72194) |
$1,391 |
$2,140 |
7.1× |
| CT scan of arm combo (73202) |
$1,500.20 |
$2,308 |
7.7× |
| CT soft tissue neck w contrast (70491) |
$2,342.60 |
$3,604 |
12.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,238.90 |
$1,906 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,895.40 |
$2,916 |
16.3× |
| CT thoracic spine w/contrast (72129) |
$1,414.40 |
$2,176 |
7.2× |
| CT thoracic spine w/o contrast (72128) |
$1,873.95 |
$2,883 |
16.1× |
| CT thorax w/o contrast (71250) |
$1,859.65 |
$2,861 |
16.0× |
| CT unlisted procedure (76497) |
$190.45 |
$293 |
2.0× |
| CT upper ext wo (73200) |
$1,859.65 |
$2,861 |
16.0× |
| CT upper extremity with contrast (73201) |
$1,043.90 |
$1,606 |
2.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$3,898.70 |
$5,998 |
19.9× |
| Cta Abdomen (74175) |
$826.15 |
$1,271 |
4.2× |
| CTA abdomen pelvis (74174) |
$4,508.40 |
$6,936 |
11.6× |
| CTA chest (71275) |
$3,596.45 |
$5,533 |
18.4× |
| Cta Head (70496) |
$5,635.18 |
$8,669.50 |
28.8× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$4,214.60 |
$6,484 |
10.8× |
| Cta Neck (70498) |
$4,860.70 |
$7,478 |
24.9× |
| Cta Pelvis (72191) |
$2,528.50 |
$3,890 |
12.9× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$273 |
$420 |
2.3× |
| Dxa bone density study 1/> sites axial skel (77080) |
$434.20 |
$668 |
3.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$202.15 |
$311 |
2.1× |
| Dxa bone density study axial skeleton (77085) |
$378.30 |
$582 |
3.2× |
| Facial bones min 3 views (70150) |
$339.95 |
$523 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$482.30 |
$742 |
4.1× |
| Fluoroscopy up to 1 hr (76000) |
$228.15 |
$351 |
0.9× |
| Foot 2 views (73620) |
$208 |
$320 |
2.1× |
| Forearm 2 views (73090) |
$252.85 |
$389 |
2.6× |
| Hand 2 views (73120) |
$255.45 |
$393 |
2.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$261.95 |
$403 |
2.2× |
| Knee 3 views (73562) |
$334.10 |
$514 |
3.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,054 |
$3,160 |
5.3× |
| MRA head w & w/o contrast (70546) |
$3,972.15 |
$6,111 |
10.2× |
| MRA head w/o contrast (70544) |
$2,768.35 |
$4,259 |
10.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,195.75 |
$6,455 |
10.8× |
| MRA neck w/o contrast (70547) |
$2,839.85 |
$4,369 |
10.7× |
| MRI abdomen w contrast (74182) |
$1,890.85 |
$2,909 |
4.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,324.75 |
$5,115 |
8.6× |
| MRI abdomen w/o contrast (74181) |
$2,165.15 |
$3,331 |
8.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,167.10 |
$3,334 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,565.20 |
$2,408 |
4.0× |
| MRI bone marrow blood supply (77084) |
$1,131 |
$1,740 |
4.3× |
| MRI c-spine with contrast (72142) |
$2,210 |
$3,400 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$2,162.55 |
$3,327 |
8.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,321.15 |
$3,571 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,862.25 |
$2,865 |
7.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,330.60 |
$5,124 |
8.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,505.40 |
$2,316 |
5.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,616.55 |
$2,487 |
4.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,326.70 |
$5,118 |
8.6× |
| MRI pelvis w/o contrast (72195) |
$2,548 |
$3,920 |
9.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,153.15 |
$4,851 |
8.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,899 |
$4,460 |
7.5× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,883.70 |
$2,898 |
4.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,170.35 |
$3,339 |
5.6× |
| MRI temporomandibular joint (70336) |
$1,317.55 |
$2,027 |
5.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,267.85 |
$3,489 |
8.5× |
| MRI up ext w/o contrast (73218) |
$2,458.95 |
$3,783 |
9.2× |
| MRI upper ext joint w/o contrast (73221) |
$1,805.05 |
$2,777 |
6.8× |
| MRI, joint upper extrem combo (73223) |
$2,251.60 |
$3,464 |
5.8× |
| N-invas est c ffr sw aly CTA (75580) |
$3,070.60 |
$4,724 |
3.2× |
| Neck soft tissue (70360) |
$208 |
$320 |
2.1× |
| Ophthalmic ultrasound, diagnostic; quantitative A-scan only Non-Facility (76511) |
$283.40 |
$436 |
2.4× |
| Osseous survey limited (77074) |
$472.55 |
$727 |
4.1× |
| Pelvis 1 or 2 views (72170) |
$270.08 |
$415.50 |
2.3× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$288.60 |
$444 |
3.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$229.12 |
$352.50 |
2.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$260 |
$400 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$205.40 |
$316 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$359.12 |
$552.50 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$426.40 |
$656 |
3.7× |
| Radex fingr minimum 2 views (73140) |
$274.95 |
$423 |
2.8× |
| Radex Foot Compl Minimum 3 Views (73630) |
$241.80 |
$372 |
2.5× |
| Radex Hand Minimum 3 Views (73130) |
$250.25 |
$385 |
2.6× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$196.95 |
$303 |
2.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$262.60 |
$404 |
2.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$442.65 |
$681 |
3.8× |
| Radex Humerus Minimum 2 Views (73060) |
$257.40 |
$396 |
2.7× |
| Radex Kne 1/2 Views (73560) |
$238.55 |
$367 |
2.5× |
| Radex Kne Compl 4/More Views (73564) |
$440.05 |
$677 |
3.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$307.45 |
$473 |
2.6× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$252.20 |
$388 |
2.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$348.08 |
$535.50 |
3.0× |
| Radex Sho Compl Minimum 2 Views (73030) |
$258.05 |
$397 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$176.80 |
$272 |
1.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$317.20 |
$488 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$294.45 |
$453 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$250.25 |
$385 |
2.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$332.15 |
$511 |
3.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$488.15 |
$751 |
4.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$256.42 |
$394.50 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$390.65 |
$601 |
3.4× |
| Radiologic exam chest 2 views (71046) |
$234 |
$360 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$213.85 |
$329 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$205.40 |
$316 |
2.1× |
| Ribs bilateral 3 views (71110) |
$333.12 |
$512.50 |
2.9× |
| Sacroiliac Joints < 3 Views (72200) |
$240.50 |
$370 |
2.1× |
| Scapula (73010) |
$269.10 |
$414 |
2.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$40.30 |
$62 |
1.7× |
| Shoulder 1 view (73020) |
$174.20 |
$268 |
1.8× |
| Spine thoracic 3 views (72072) |
$312.98 |
$481.50 |
2.7× |
| Thoracolumbar 2 views (72080) |
$284.38 |
$437.50 |
2.9× |
| Ultrasound breast complete (76641) |
$421.20 |
$648 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$182 |
$280 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$489.45 |
$753 |
4.2× |
| Umbilical-artery Doppler (OB) (76820) |
$371.15 |
$571 |
3.2× |
| Us breast unilateral limited (76642) |
$317.20 |
$488 |
3.3× |
| Us chest (76604) |
$406.25 |
$625 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$553.80 |
$852 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$189.15 |
$291 |
1.6× |
| Us ob detailed single fetus (76811) |
$671.45 |
$1,033 |
2.5× |
| Us ob limited (76815) |
$377 |
$580 |
3.2× |
| Us ob transvaginal (76817) |
$423.80 |
$652 |
3.6× |
| Us pelvic non ob complete (76856) |
$560.30 |
$862 |
4.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$456.30 |
$702 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$514.80 |
$792 |
4.4× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$493.35 |
$759 |
4.2× |
| Us retroperitoneal complete (76770) |
$595.40 |
$916 |
5.1× |
| Us retroperitoneal limited (76775) |
$440.05 |
$677 |
3.8× |
| Us scrotum and contents (76870) |
$568.10 |
$874 |
4.9× |
| Us soft tissue head/neck (76536) |
$572 |
$880 |
4.9× |
| Us, eye b-scan (76512) |
$354.25 |
$545 |
3.0× |
| Vertebral fracture assessment via dxa (77086) |
$167.70 |
$258 |
1.7× |
| Wrist 2 views (73100) |
$250.25 |
$385 |
2.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$354.25 |
$545 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$200.20 |
$308 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$254.80 |
$392 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$290.55 |
$447 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$258.70 |
$398 |
2.2× |
| X-ray exam of femur 2/> (73552) |
$221 |
$340 |
2.3× |
| X-ray eye for foreign body (70030) |
$249.60 |
$384 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$217.75 |
$335 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$248.95 |
$383 |
2.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$206.70 |
$318 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$269.75 |
$415 |
2.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$511.55 |
$787 |
4.4× |
| X-ray nose-rectum child f.b. (76010) |
$265.20 |
$408 |
2.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$347.10 |
$534 |
3.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$253.50 |
$390 |
2.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$315.90 |
$486 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$362.70 |
$558 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$286.65 |
$441 |
2.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$207.35 |
$319 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$307.45 |
$473 |
3.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$440.70 |
$678 |
3.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$273 |
$420 |
2.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$170.95 |
$263 |
1.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$174.52 |
$268.50 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$249.28 |
$383.50 |
2.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$276.25 |
$425 |
2.4× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$391.95 |
$603 |
3.4× |
| Xr bone length studies (77073) |
$307.45 |
$473 |
2.6× |
| Xr c-spine 4 or 5 views (72050) |
$425.10 |
$654 |
3.6× |
| Xr c-spine 6 or more views (72052) |
$522.60 |
$804 |
4.5× |
| Xr chest 4+ views (71048) |
$384.15 |
$591 |
3.3× |