| Abdomen 2 views (74019) |
$221.20 |
$316 |
1.9× |
| Ankle 2 views (73600) |
$384.30 |
$549 |
4.0× |
| Bone age studies (77072) |
$305.20 |
$436 |
2.6× |
| Bone survey complete (77075) |
$1,041.60 |
$1,488 |
8.9× |
| Bone survey infant (77076) |
$1,149.40 |
$1,642 |
9.9× |
| Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast… (75563) |
$1,591.10 |
$2,273 |
1.8× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$1,591.10 |
$2,273 |
4.1× |
| Cervical spine 2 or 3 views (72040) |
$405.30 |
$579 |
4.2× |
| Chest 1 view (71045) |
$254.10 |
$363 |
2.6× |
| Chest xray 3 views (71047) |
$449.40 |
$642 |
4.6× |
| Clavicle complete (73000) |
$363.30 |
$519 |
3.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$136.50 |
$195 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,691.10 |
$5,273 |
9.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,536.80 |
$3,624 |
9.5× |
| CT abdomen w contrast (74160) |
$1,542.80 |
$2,204 |
7.9× |
| CT abdomen w wo contrast (74170) |
$1,871.80 |
$2,674 |
9.6× |
| CT abdomen w/o contrast (74150) |
$1,294.30 |
$1,849 |
11.1× |
| CT angio hrt w/3d image (75574) |
$1,012.90 |
$1,447 |
2.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,517.20 |
$3,596 |
12.9× |
| CT angiography upper extremity lt (73206) |
$2,236.50 |
$3,195 |
11.4× |
| CT c-spine w/contrast (72126) |
$1,297.80 |
$1,854 |
3.3× |
| CT c-spine w/o contrast (72125) |
$1,108.10 |
$1,583 |
9.5× |
| CT cervical spine w&w/o contrast (72127) |
$1,387.40 |
$1,982 |
7.1× |
| CT chest w contrast (71260) |
$1,288 |
$1,840 |
6.6× |
| CT chest w/wo contrast (71270) |
$1,996.40 |
$2,852 |
10.2× |
| CT head/brain with contrast (70460) |
$1,275.40 |
$1,822 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,481.20 |
$2,116 |
7.6× |
| CT iac w contrast (70481) |
$1,390.20 |
$1,986 |
7.1× |
| CT limited/localized follow up study (76380) |
$497 |
$710 |
5.1× |
| CT lower ext w/o (73700) |
$1,035.30 |
$1,479 |
8.9× |
| CT lower extremity w wo contrast (73702) |
$2,095.80 |
$2,994 |
10.7× |
| CT lower extremity w/contrast material (73701) |
$1,268.40 |
$1,812 |
6.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,740.90 |
$2,487 |
8.9× |
| CT lumbar spine w/contrast (72132) |
$1,243.20 |
$1,776 |
3.2× |
| CT lumbar spine w/o contrast (72131) |
$1,107.40 |
$1,582 |
9.5× |
| CT maxillofacial w contrast (70487) |
$1,311.80 |
$1,874 |
6.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,367.10 |
$1,953 |
7.0× |
| CT maxillofacial wo contrast (70486) |
$1,065.40 |
$1,522 |
9.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,469.30 |
$2,099 |
7.5× |
| CT orbits w/o contrast (70480) |
$1,064 |
$1,520 |
9.1× |
| CT pelvis w/o contrast (72192) |
$1,067.50 |
$1,525 |
9.2× |
| CT pelvis w/wo contrast (72194) |
$1,501.50 |
$2,145 |
7.7× |
| CT scan of arm combo (73202) |
$1,826.30 |
$2,609 |
9.3× |
| CT soft tissue neck w contrast (70491) |
$1,253.70 |
$1,791 |
6.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,410.50 |
$2,015 |
7.2× |
| CT soft tissue neck w/o contrast (70490) |
$936.60 |
$1,338 |
8.0× |
| CT thoracic spine w/contrast (72129) |
$1,453.90 |
$2,077 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$1,337 |
$1,910 |
11.5× |
| CT thoracic spine w/wo contrast (72130) |
$1,740.90 |
$2,487 |
8.9× |
| CT thorax w/o contrast (71250) |
$1,113 |
$1,590 |
9.6× |
| CT upper ext wo (73200) |
$1,220.10 |
$1,743 |
10.5× |
| CT upper extremity with contrast (73201) |
$1,262.80 |
$1,804 |
3.2× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,810.50 |
$4,015 |
14.4× |
| Cta Abdomen (74175) |
$2,567.60 |
$3,668 |
13.1× |
| CTA abdomen pelvis (74174) |
$4,319 |
$6,170 |
11.1× |
| CTA chest (71275) |
$2,680.30 |
$3,829 |
13.7× |
| Cta Head (70496) |
$1,623.30 |
$2,319 |
8.3× |
| Cta Neck (70498) |
$1,665.30 |
$2,379 |
8.5× |
| Cta Pelvis (72191) |
$2,485.70 |
$3,551 |
12.7× |
| Esophagus (74220) |
$413 |
$590 |
2.1× |
| Facial bones min 3 views (70150) |
$725.20 |
$1,036 |
6.2× |
| Fetal biophysical profile non-stress testing (76818) |
$976.50 |
$1,395 |
8.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$584.50 |
$835 |
5.0× |
| Fluoroscopy up to 1 hr (76000) |
$367.50 |
$525 |
1.4× |
| Foot 2 views (73620) |
$288.40 |
$412 |
3.0× |
| Forearm 2 views (73090) |
$361.90 |
$517 |
3.7× |
| Hand 2 views (73120) |
$384.30 |
$549 |
3.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$399.70 |
$571 |
3.4× |
| Knee 3 views (73562) |
$431.90 |
$617 |
4.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,665.60 |
$3,808 |
6.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,834.30 |
$4,049 |
7.3× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$119 |
$170 |
1.2× |
| MRA head w & w/o contrast (70546) |
$3,267.60 |
$4,668 |
8.4× |
| MRA head w/o contrast (70544) |
$1,957.20 |
$2,796 |
7.4× |
| MRA head with contrast (70545) |
$2,472.40 |
$3,532 |
6.4× |
| MRA neck w contrast (70548) |
$2,608.90 |
$3,727 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,290.70 |
$4,701 |
8.5× |
| MRA neck w/o contrast (70547) |
$2,096.50 |
$2,995 |
7.9× |
| MRI abdomen w contrast (74182) |
$3,157 |
$4,510 |
8.1× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,926.30 |
$5,609 |
10.1× |
| MRI abdomen w/o contrast (74181) |
$2,934.40 |
$4,192 |
11.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,740.50 |
$3,915 |
3.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,332 |
$4,760 |
8.6× |
| MRI bone marrow blood supply (77084) |
$1,378.30 |
$1,969 |
5.2× |
| MRI c-spine with contrast (72142) |
$2,113.30 |
$3,019 |
5.4× |
| MRI cardiac w/o cont stress (75559) |
$1,041.60 |
$1,488 |
1.7× |
| MRI cardiac w/o contrast (75557) |
$1,041.60 |
$1,488 |
3.9× |
| MRI cervical spine w/o contrast (72141) |
$2,021.60 |
$2,888 |
7.6× |
| MRI chest w/o & w/contrast material (71552) |
$2,512.30 |
$3,589 |
6.5× |
| MRI chest w/o contrast (71550) |
$1,726.90 |
$2,467 |
6.5× |
| MRI chest with contrast (71551) |
$2,328.20 |
$3,326 |
2.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,285.50 |
$3,265 |
5.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,232.60 |
$4,618 |
8.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,020.20 |
$2,886 |
7.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,582.70 |
$2,261 |
6.0× |
| MRI orbit face neck w contrast (70542) |
$2,479.40 |
$3,542 |
6.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,028.90 |
$4,327 |
7.8× |
| MRI pelvis w/contrast (72196) |
$2,515.10 |
$3,593 |
6.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,834.60 |
$5,478 |
9.9× |
| MRI pelvis w/o contrast (72195) |
$1,893.50 |
$2,705 |
7.1× |
| MRI spectroscopy (76390) |
$1,352.40 |
$1,932 |
13.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,294.20 |
$4,706 |
8.5× |
| MRI spinal canal lumbar w/contrast material (72149) |
$3,024.70 |
$4,321 |
7.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,847.90 |
$5,497 |
9.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,363.90 |
$3,377 |
6.1× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,262.70 |
$4,661 |
8.4× |
| MRI temporomandibular joint (70336) |
$1,361.50 |
$1,945 |
5.1× |
| MRI thoracic spine w/o contrast (72146) |
$2,118.90 |
$3,027 |
8.0× |
| MRI up ext w/o contrast (73218) |
$1,889.30 |
$2,699 |
7.1× |
| MRI upper ext joint w/o contrast (73221) |
$2,102.80 |
$3,004 |
7.9× |
| MRI, joint upper extrem combo (73223) |
$3,660.30 |
$5,229 |
9.4× |
| Neck soft tissue (70360) |
$172.20 |
$246 |
1.8× |
| Ob us nuchal meas 1 gest (76813) |
$648.90 |
$927 |
5.6× |
| Osseous survey limited (77074) |
$459.20 |
$656 |
3.9× |
| Pelvis 1 or 2 views (72170) |
$343.70 |
$491 |
3.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$405.30 |
$579 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$314.30 |
$449 |
3.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$387.80 |
$554 |
4.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$483.70 |
$691 |
5.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$560.70 |
$801 |
4.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$639.10 |
$913 |
5.5× |
| Radex fingr minimum 2 views (73140) |
$266 |
$380 |
2.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$394.80 |
$564 |
4.1× |
| Radex Hand Minimum 3 Views (73130) |
$438.90 |
$627 |
4.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$310.10 |
$443 |
3.2× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$439.60 |
$628 |
3.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$584.50 |
$835 |
5.0× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$584.50 |
$835 |
5.0× |
| Radex Humerus Minimum 2 Views (73060) |
$352.80 |
$504 |
3.6× |
| Radex Kne 1/2 Views (73560) |
$328.30 |
$469 |
3.4× |
| Radex Kne Compl 4/More Views (73564) |
$457.80 |
$654 |
3.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$627.20 |
$896 |
5.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$416.50 |
$595 |
4.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$411.60 |
$588 |
3.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$420.70 |
$601 |
4.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$343.70 |
$491 |
3.5× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$218.40 |
$312 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$457.10 |
$653 |
4.7× |
| Radex Toe Minimum 2 Views (73660) |
$266 |
$380 |
2.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$189.70 |
$271 |
1.6× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$403.20 |
$576 |
4.2× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$793.80 |
$1,134 |
6.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$176.40 |
$252 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$291.20 |
$416 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$329 |
$470 |
3.4× |
| Radiologic examination femur 1 view (73551) |
$464.10 |
$663 |
4.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$345.10 |
$493 |
3.6× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$645.40 |
$922 |
5.5× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$411.60 |
$588 |
3.5× |
| Ribs bilateral 3 views (71110) |
$762.30 |
$1,089 |
6.5× |
| Sacroiliac Joints < 3 Views (72200) |
$347.90 |
$497 |
3.0× |
| Scapula (73010) |
$385 |
$550 |
3.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.20 |
$66 |
2.0× |
| Sella turcica (70240) |
$375.90 |
$537 |
3.9× |
| Shoulder 1 view (73020) |
$295.40 |
$422 |
3.0× |
| Small bowel series (74250) |
$487.90 |
$697 |
2.5× |
| Spine thoracic 3 views (72072) |
$564.20 |
$806 |
4.8× |
| Thoracolumbar 2 views (72080) |
$580.30 |
$829 |
6.0× |
| Tmj unilateral (70328) |
$170.80 |
$244 |
1.8× |
| Ultrasound breast complete (76641) |
$217.70 |
$311 |
1.9× |
| Ultrasound elastography first target lesion (76982) |
$711.20 |
$1,016 |
6.1× |
| Ultrasound Exam Aaa Screen (76706) |
$217.70 |
$311 |
1.9× |
| Ultrasound trgt dynamic microbubble 1st lesion (76978) |
$479.50 |
$685 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$499.80 |
$714 |
4.3× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$702.10 |
$1,003 |
7.2× |
| Unlisted ultrasound procedure (76999) |
$464.10 |
$663 |
4.8× |
| Us breast unilateral limited (76642) |
$207.90 |
$297 |
2.1× |
| Us chest (76604) |
$612.15 |
$874.50 |
5.3× |
| Us compl joint r-t w/image documentation (76881) |
$262.50 |
$375 |
2.3× |
| Us elastography parenchyma (76981) |
$711.20 |
$1,016 |
6.1× |
| Us encephalogram (76506) |
$989.80 |
$1,414 |
8.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$162.40 |
$232 |
1.4× |
| Us ob detailed single fetus (76811) |
$886.20 |
$1,266 |
3.3× |
| Us ob limited (76815) |
$662.20 |
$946 |
5.7× |
| Us ob transvaginal (76817) |
$754.60 |
$1,078 |
6.5× |
| Us pelvic non ob complete (76856) |
$851.90 |
$1,217 |
7.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$615.30 |
$879 |
5.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$921.20 |
$1,316 |
7.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$839.30 |
$1,199 |
7.2× |
| Us retroperitoneal complete (76770) |
$784.70 |
$1,121 |
6.7× |
| Us retroperitoneal limited (76775) |
$644 |
$920 |
5.5× |
| Us scrotum and contents (76870) |
$723.80 |
$1,034 |
6.2× |
| Us soft tissue head/neck (76536) |
$683.55 |
$976.50 |
5.9× |
| Us transrectal (76872) |
$247.10 |
$353 |
2.1× |
| Us,transplanted kidney, real time/ doppler (76776) |
$755.30 |
$1,079 |
6.5× |
| Wrist 2 views (73100) |
$346.50 |
$495 |
3.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$319.20 |
$456 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$485.80 |
$694 |
5.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$356.30 |
$509 |
3.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$439.60 |
$628 |
4.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$584.50 |
$835 |
5.0× |
| X-ray exam of femur 2/> (73552) |
$464.10 |
$663 |
4.8× |
| X-ray eye for foreign body (70030) |
$167.30 |
$239 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$541.10 |
$773 |
5.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$351.40 |
$502 |
3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$382.90 |
$547 |
3.9× |
| X-ray leg, infant (73592) |
$189.70 |
$271 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$454.30 |
$649 |
3.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$746.90 |
$1,067 |
6.4× |
| X-ray nose-rectum child f.b. (76010) |
$296.10 |
$423 |
3.1× |
| X-ray optic foramen (70190) |
$375.90 |
$537 |
3.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$569.80 |
$814 |
4.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$464.10 |
$663 |
4.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$584.50 |
$835 |
5.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$762.30 |
$1,089 |
6.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$411.60 |
$588 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$429.80 |
$614 |
4.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$552.30 |
$789 |
5.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$652.40 |
$932 |
5.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$537.60 |
$768 |
4.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$374.50 |
$535 |
3.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$471.80 |
$674 |
4.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$413 |
$590 |
4.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$541.10 |
$773 |
4.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$620.90 |
$887 |
5.3× |
| Xr bone length studies (77073) |
$162.40 |
$232 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$648.90 |
$927 |
5.6× |
| Xr c-spine 6 or more views (72052) |
$965.30 |
$1,379 |
8.3× |
| Xr chest 4+ views (71048) |
$495.60 |
$708 |
4.3× |