| Abdomen 2 views (74019) |
$173.38 |
$173.38 |
1.5× |
| Ankle 2 views (73600) |
$83.26 |
$83.26 |
0.9× |
| Bone age studies (77072) |
$56.04 |
$56.04 |
0.5× |
| Bone survey complete (77075) |
$182.82 |
$182.82 |
1.6× |
| Bone survey infant (77076) |
$148.99 |
$148.99 |
1.3× |
| Cervical spine 2 or 3 views (72040) |
$176.52 |
$176.52 |
1.8× |
| Chest 1 view (71045) |
$80.32 |
$80.32 |
0.8× |
| Chest xray 3 views (71047) |
$134.88 |
$134.88 |
1.4× |
| Clavicle complete (73000) |
$112.09 |
$112.09 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,014.97 |
$1,014.97 |
2.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,226.25 |
$1,226.25 |
4.6× |
| CT abdomen w contrast (74160) |
$802.24 |
$802.24 |
4.1× |
| CT abdomen w wo contrast (74170) |
$925.33 |
$925.33 |
4.7× |
| CT abdomen w/o contrast (74150) |
$665.20 |
$665.20 |
5.7× |
| CT c-spine w/contrast (72126) |
$920.28 |
$920.28 |
2.4× |
| CT c-spine w/o contrast (72125) |
$1,061.52 |
$1,061.52 |
9.1× |
| CT chest w contrast (71260) |
$1,055.22 |
$1,055.22 |
5.4× |
| CT head/brain with contrast (70460) |
$724.46 |
$724.46 |
3.7× |
| CT head/brain without and with contrast (70470) |
$872.88 |
$872.88 |
4.5× |
| CT lower ext w/o (73700) |
$946.06 |
$946.06 |
8.1× |
| CT lumbar spine w/o contrast (72131) |
$879.74 |
$879.74 |
7.6× |
| CT maxillofacial w contrast (70487) |
$1,037.61 |
$1,037.61 |
5.3× |
| CT maxillofacial w/wo contrast (70488) |
$891.36 |
$891.36 |
4.6× |
| CT maxillofacial wo contrast (70486) |
$357.33 |
$357.33 |
3.1× |
| CT orbits w/o contrast (70480) |
$647 |
$647 |
5.6× |
| CT pelvis w/o contrast (72192) |
$762.33 |
$762.33 |
6.5× |
| CT pelvis w/wo contrast (72194) |
$900.44 |
$900.44 |
4.6× |
| CT soft tissue neck w contrast (70491) |
$698.54 |
$698.54 |
3.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$860.45 |
$860.45 |
4.4× |
| CT soft tissue neck w/o contrast (70490) |
$797.42 |
$797.42 |
6.8× |
| CT thoracic spine w/contrast (72129) |
$788.29 |
$788.29 |
4.0× |
| CT thoracic spine w/o contrast (72128) |
$881.22 |
$881.22 |
7.6× |
| CT thorax w/o contrast (71250) |
$727.01 |
$727.01 |
6.2× |
| CT upper ext wo (73200) |
$270.11 |
$270.11 |
2.3× |
| CT upper extremity with contrast (73201) |
$268.46 |
$268.46 |
0.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,042.97 |
$1,042.97 |
5.3× |
| Cta Abdomen (74175) |
$1,021.30 |
$1,021.30 |
5.2× |
| CTA abdomen pelvis (74174) |
$1,021.30 |
$1,021.30 |
2.6× |
| CTA chest (71275) |
$1,098.62 |
$1,098.62 |
5.6× |
| Cta Head (70496) |
$1,458.23 |
$1,458.23 |
7.5× |
| Cta Neck (70498) |
$1,398.66 |
$1,398.66 |
7.2× |
| Cta Pelvis (72191) |
$357.99 |
$357.99 |
1.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$150.14 |
$150.14 |
1.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$45.32 |
$45.32 |
0.5× |
| Facial bones min 3 views (70150) |
$77.18 |
$77.18 |
0.7× |
| Fetal biophysical profile non-stress testing (76818) |
$283.18 |
$283.18 |
2.4× |
| Foot 2 views (73620) |
$83.32 |
$83.32 |
0.9× |
| Forearm 2 views (73090) |
$137.16 |
$137.16 |
1.4× |
| Hand 2 views (73120) |
$80.89 |
$80.89 |
0.7× |
| Knee 3 views (73562) |
$133.96 |
$133.96 |
1.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,785.05 |
$1,785.05 |
2.0× |
| MRA head w & w/o contrast (70546) |
$2,053.96 |
$2,053.96 |
5.3× |
| MRA head w/o contrast (70544) |
$915.08 |
$915.08 |
3.4× |
| MRA head with contrast (70545) |
$1,084.31 |
$1,084.31 |
2.8× |
| MRA neck w contrast (70548) |
$1,169.75 |
$1,169.75 |
3.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,319.14 |
$1,319.14 |
3.4× |
| MRA neck w/o contrast (70547) |
$1,099.74 |
$1,099.74 |
4.1× |
| MRI abdomen w contrast (74182) |
$917.28 |
$917.28 |
2.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,380.88 |
$1,380.88 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$1,030.84 |
$1,030.84 |
3.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,113.52 |
$1,113.52 |
1.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,304.23 |
$2,304.23 |
5.9× |
| MRI c-spine with contrast (72142) |
$970.20 |
$970.20 |
2.5× |
| MRI cervical spine w/o contrast (72141) |
$1,091.48 |
$1,091.48 |
4.1× |
| MRI chest w/o & w/contrast material (71552) |
$1,389.15 |
$1,389.15 |
3.6× |
| MRI chest w/o contrast (71550) |
$1,108.02 |
$1,108.02 |
4.2× |
| MRI chest with contrast (71551) |
$1,605.79 |
$1,605.79 |
1.8× |
| MRI pelvis w/o contrast (72195) |
$1,233.48 |
$1,233.48 |
4.6× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,576.58 |
$1,576.58 |
4.1× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,267.88 |
$1,267.88 |
3.3× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,535.24 |
$1,535.24 |
3.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,245.82 |
$1,245.82 |
3.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,576.58 |
$1,576.58 |
4.1× |
| MRI temporomandibular joint (70336) |
$1,072.18 |
$1,072.18 |
4.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,278.46 |
$1,278.46 |
4.8× |
| MRI up ext w/o contrast (73218) |
$369.34 |
$369.34 |
1.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,144.80 |
$1,144.80 |
4.3× |
| MRI, joint upper extrem combo (73223) |
$1,471.84 |
$1,471.84 |
3.8× |
| Neck soft tissue (70360) |
$83.42 |
$83.42 |
0.9× |
| Osseous survey limited (77074) |
$106.28 |
$106.28 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$112.54 |
$112.54 |
1.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$101.34 |
$101.34 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$85.74 |
$85.74 |
0.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$181.18 |
$181.18 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$63.47 |
$63.47 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$87.92 |
$87.92 |
0.8× |
| Radex fingr minimum 2 views (73140) |
$90.85 |
$90.85 |
0.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$149.67 |
$149.67 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$98.30 |
$98.30 |
1.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$88.28 |
$88.28 |
0.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$96.47 |
$96.47 |
0.8× |
| Radex Humerus Minimum 2 Views (73060) |
$89.60 |
$89.60 |
0.9× |
| Radex Kne 1/2 Views (73560) |
$88.83 |
$88.83 |
0.9× |
| Radex Kne Compl 4/More Views (73564) |
$104.30 |
$104.30 |
0.9× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$221.60 |
$221.60 |
1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$104.45 |
$104.45 |
1.1× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$56.23 |
$56.23 |
0.5× |
| Radex Sho Compl Minimum 2 Views (73030) |
$114.29 |
$114.29 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$94.94 |
$94.94 |
1.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$113.38 |
$113.38 |
1.0× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$131.58 |
$131.58 |
1.4× |
| Radex Toe Minimum 2 Views (73660) |
$90.85 |
$90.85 |
0.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$82.16 |
$82.16 |
0.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$114.68 |
$114.68 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$123.83 |
$123.83 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$132.96 |
$132.96 |
1.1× |
| Radiologic exam chest 2 views (71046) |
$82.85 |
$82.85 |
0.9× |
| Radiologic examination femur 1 view (73551) |
$92.02 |
$92.02 |
0.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$125.69 |
$125.69 |
1.3× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$101.64 |
$101.64 |
0.9× |
| Ribs bilateral 3 views (71110) |
$136.14 |
$136.14 |
1.2× |
| Sacroiliac Joints < 3 Views (72200) |
$106.28 |
$106.28 |
0.9× |
| Scapula (73010) |
$102.69 |
$102.69 |
0.9× |
| Sella turcica (70240) |
$93.60 |
$93.60 |
1.0× |
| Shoulder 1 view (73020) |
$73.72 |
$73.72 |
0.8× |
| Spine thoracic 3 views (72072) |
$126.54 |
$126.54 |
1.1× |
| Thoracolumbar 2 views (72080) |
$111.82 |
$111.82 |
1.2× |
| Tmj unilateral (70328) |
$87.06 |
$87.06 |
0.9× |
| Ultrasound Exam Aaa Screen (76706) |
$338.96 |
$338.96 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$254.50 |
$254.50 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$299.78 |
$299.78 |
2.6× |
| Unlisted ultrasound procedure (76999) |
$286.65 |
$286.65 |
3.0× |
| Us chest (76604) |
$270.38 |
$270.38 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$262.56 |
$262.56 |
2.3× |
| Us ob limited (76815) |
$254.08 |
$254.08 |
2.2× |
| Us ob transvaginal (76817) |
$297.12 |
$297.12 |
2.6× |
| Us pelvic non ob complete (76856) |
$283.78 |
$283.78 |
2.4× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$179.36 |
$179.36 |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$155.98 |
$155.98 |
1.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$243.10 |
$243.10 |
2.1× |
| Us retroperitoneal complete (76770) |
$336.66 |
$336.66 |
2.9× |
| Us retroperitoneal limited (76775) |
$209.80 |
$209.80 |
1.8× |
| Us scrotum and contents (76870) |
$261.96 |
$261.96 |
2.2× |
| Us soft tissue head/neck (76536) |
$260.96 |
$260.96 |
2.2× |
| Wrist 2 views (73100) |
$104.96 |
$104.96 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$159.48 |
$159.48 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$98.86 |
$98.86 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$86.30 |
$86.30 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$118 |
$118 |
1.2× |
| X-ray exam of femur 2/> (73552) |
$92.02 |
$92.02 |
0.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$106.85 |
$106.85 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$103.13 |
$103.13 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$62.80 |
$62.80 |
0.6× |
| X-ray leg, infant (73592) |
$87.75 |
$87.75 |
0.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$160 |
$160 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$224.25 |
$224.25 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$159.86 |
$159.86 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$168.24 |
$168.24 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$112.70 |
$112.70 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$131.28 |
$131.28 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$106.28 |
$106.28 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$106.44 |
$106.44 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$120.06 |
$120.06 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$185.72 |
$185.72 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$164.40 |
$164.40 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$76.54 |
$76.54 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$118.36 |
$118.36 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$101.18 |
$101.18 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$163.74 |
$163.74 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$164.88 |
$164.88 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$174.97 |
$174.97 |
1.5× |
| Xr chest 4+ views (71048) |
$134.88 |
$134.88 |
1.2× |