| Abdomen 2 views (74019) |
$340.50 |
$454 |
3.3× |
| Ankle 2 views (73600) |
$231 |
$308 |
2.7× |
| Bone age studies (77072) |
$279 |
$372 |
2.7× |
| Bone survey complete (77075) |
$673.50 |
$898 |
6.5× |
| Bone survey infant (77076) |
$325.50 |
$434 |
3.2× |
| Cervical spine 2 or 3 views (72040) |
$340.50 |
$454 |
4.0× |
| Chest 1 view (71045) |
$255.75 |
$341 |
3.0× |
| Chest xray 3 views (71047) |
$329.25 |
$439 |
3.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$537.75 |
$717 |
3.1× |
| Clavicle complete (73000) |
$290.25 |
$387 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$201 |
$268 |
1.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,412.75 |
$3,217 |
7.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,683.75 |
$2,245 |
7.1× |
| CT abdomen w contrast (74160) |
$1,392.75 |
$1,857 |
8.0× |
| CT abdomen w wo contrast (74170) |
$2,146.50 |
$2,862 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,062.75 |
$1,417 |
10.3× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,462.50 |
$1,950 |
8.4× |
| CT angiography upper extremity lt (73206) |
$1,380 |
$1,840 |
8.0× |
| CT c-spine w/contrast (72126) |
$1,419 |
$1,892 |
4.1× |
| CT c-spine w/o contrast (72125) |
$1,159.50 |
$1,546 |
11.2× |
| CT cervical spine w&w/o contrast (72127) |
$1,605.75 |
$2,141 |
9.3× |
| CT chest w contrast (71260) |
$1,384.50 |
$1,846 |
8.0× |
| CT chest w/wo contrast (71270) |
$1,665.75 |
$2,221 |
9.6× |
| CT head/brain with contrast (70460) |
$1,203.75 |
$1,605 |
6.9× |
| CT head/brain without and with contrast (70470) |
$1,485.75 |
$1,981 |
8.6× |
| CT iac w contrast (70481) |
$1,320.75 |
$1,761 |
7.6× |
| CT lower ext w/o (73700) |
$1,042.50 |
$1,390 |
10.1× |
| CT lower extremity w wo contrast (73702) |
$1,497.75 |
$1,997 |
8.6× |
| CT lower extremity w/contrast material (73701) |
$1,272 |
$1,696 |
7.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,670.25 |
$2,227 |
9.6× |
| CT lumbar spine w/contrast (72132) |
$1,425.75 |
$1,901 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$1,155 |
$1,540 |
11.2× |
| CT maxillofacial w contrast (70487) |
$1,321.50 |
$1,762 |
7.6× |
| CT maxillofacial w/wo contrast (70488) |
$1,464 |
$1,952 |
8.4× |
| CT maxillofacial wo contrast (70486) |
$1,025.25 |
$1,367 |
9.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,487.25 |
$1,983 |
8.6× |
| CT orbits w/o contrast (70480) |
$1,014.75 |
$1,353 |
9.8× |
| CT pelvis w/o contrast (72192) |
$1,081.50 |
$1,442 |
10.5× |
| CT pelvis w/wo contrast (72194) |
$1,526.25 |
$2,035 |
8.8× |
| CT scan of arm combo (73202) |
$1,486.50 |
$1,982 |
8.6× |
| CT soft tissue neck w contrast (70491) |
$1,302 |
$1,736 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,498.50 |
$1,998 |
8.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,023.75 |
$1,365 |
9.9× |
| CT thoracic spine w/contrast (72129) |
$1,358.25 |
$1,811 |
7.8× |
| CT thoracic spine w/o contrast (72128) |
$1,128.75 |
$1,505 |
10.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,674.75 |
$2,233 |
9.7× |
| CT thorax w/o contrast (71250) |
$1,019.25 |
$1,359 |
9.9× |
| CT upper ext wo (73200) |
$1,011.75 |
$1,349 |
9.8× |
| CT upper extremity with contrast (73201) |
$1,256.25 |
$1,675 |
3.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,518 |
$2,024 |
8.8× |
| Cta Abdomen (74175) |
$1,545 |
$2,060 |
8.9× |
| CTA abdomen pelvis (74174) |
$2,055 |
$2,740 |
6.0× |
| CTA chest (71275) |
$1,610.25 |
$2,147 |
9.3× |
| Cta Head (70496) |
$1,563 |
$2,084 |
9.0× |
| Cta Neck (70498) |
$1,575.75 |
$2,101 |
9.1× |
| Cystography minimum 3 views rs&i (74430) |
$684.75 |
$913 |
2.0× |
| Dxa bone density study 1/> sites axial skel (77080) |
$302.25 |
$403 |
2.9× |
| Esophagus (74220) |
$534.75 |
$713 |
3.1× |
| Facial bones min 3 views (70150) |
$389.25 |
$519 |
3.8× |
| Fetal biophysical profile non-stress testing (76818) |
$382.50 |
$510 |
3.7× |
| Foot 2 views (73620) |
$281.25 |
$375 |
3.3× |
| Forearm 2 views (73090) |
$306.75 |
$409 |
3.6× |
| Hand 2 views (73120) |
$310.50 |
$414 |
3.0× |
| Knee 3 views (73562) |
$358.50 |
$478 |
4.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,919.25 |
$2,559 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,208.75 |
$2,945 |
6.4× |
| MRA head w & w/o contrast (70546) |
$2,318.25 |
$3,091 |
6.7× |
| MRA head w/o contrast (70544) |
$1,581 |
$2,108 |
6.7× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,216.25 |
$2,955 |
6.4× |
| MRA neck w/o contrast (70547) |
$1,550.25 |
$2,067 |
6.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,373.75 |
$3,165 |
6.9× |
| MRI abdomen w/o contrast (74181) |
$1,679.25 |
$2,239 |
7.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,857 |
$2,476 |
2.4× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,291.25 |
$3,055 |
6.6× |
| MRI c-spine with contrast (72142) |
$1,874.25 |
$2,499 |
5.4× |
| MRI cervical spine w/o contrast (72141) |
$1,629 |
$2,172 |
6.9× |
| MRI chest w/o & w/contrast material (71552) |
$2,275.50 |
$3,034 |
6.6× |
| MRI chest w/o contrast (71550) |
$1,494 |
$1,992 |
6.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,249.25 |
$2,999 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,553.25 |
$2,071 |
6.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,527 |
$2,036 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,293.50 |
$3,058 |
6.7× |
| MRI pelvis w/contrast (72196) |
$1,976.25 |
$2,635 |
5.7× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,335.50 |
$3,114 |
6.8× |
| MRI pelvis w/o contrast (72195) |
$1,606.50 |
$2,142 |
6.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,416.50 |
$3,222 |
7.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,782.75 |
$2,377 |
5.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,431.50 |
$3,242 |
7.1× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,994.25 |
$2,659 |
5.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,450.25 |
$3,267 |
7.1× |
| MRI temporomandibular joint (70336) |
$1,396.50 |
$1,862 |
5.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,654.50 |
$2,206 |
7.0× |
| MRI up ext w/o contrast (73218) |
$1,554 |
$2,072 |
6.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,559.25 |
$2,079 |
6.6× |
| MRI, joint upper extrem combo (73223) |
$2,219.25 |
$2,959 |
6.4× |
| Neck soft tissue (70360) |
$288.75 |
$385 |
3.4× |
| Pelvis 1 or 2 views (72170) |
$207 |
$276 |
2.0× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$339.75 |
$453 |
4.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$266.25 |
$355 |
3.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$336.75 |
$449 |
3.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$252.75 |
$337 |
2.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$376.50 |
$502 |
3.6× |
| Radex fingr minimum 2 views (73140) |
$255 |
$340 |
3.0× |
| Radex Foot Compl Minimum 3 Views (73630) |
$338.25 |
$451 |
3.9× |
| Radex Hand Minimum 3 Views (73130) |
$342 |
$456 |
4.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$243.75 |
$325 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$392.25 |
$523 |
3.8× |
| Radex Humerus Minimum 2 Views (73060) |
$303 |
$404 |
3.5× |
| Radex Kne 1/2 Views (73560) |
$297.75 |
$397 |
3.5× |
| Radex Kne Compl 4/More Views (73564) |
$421.50 |
$562 |
4.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$381.75 |
$509 |
3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$316.50 |
$422 |
3.7× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$234.75 |
$313 |
2.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$343.50 |
$458 |
4.0× |
| Radex Sinuses Paransl < 3 Views (70210) |
$227.25 |
$303 |
2.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$382.50 |
$510 |
4.4× |
| Radex Toe Minimum 2 Views (73660) |
$252 |
$336 |
2.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$218.25 |
$291 |
2.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$320 |
$426.66 |
3.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$274.50 |
$366 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$398.25 |
$531 |
3.9× |
| Radiologic exam chest 2 views (71046) |
$298.50 |
$398 |
3.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$705.75 |
$941 |
4.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$667.50 |
$890 |
3.9× |
| Radiologic examination femur 1 view (73551) |
$236.25 |
$315 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$318.75 |
$425 |
3.7× |
| Ribs bilateral 3 views (71110) |
$414 |
$552 |
4.0× |
| Scapula (73010) |
$309 |
$412 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$48.75 |
$65 |
2.1× |
| Shoulder 1 view (73020) |
$253.50 |
$338 |
2.9× |
| Small bowel series (74250) |
$637.50 |
$850 |
3.7× |
| Spine thoracic 3 views (72072) |
$397.50 |
$530 |
3.8× |
| Thoracolumbar 2 views (72080) |
$325.50 |
$434 |
3.8× |
| Tmj unilateral (70328) |
$255 |
$340 |
3.0× |
| Ultrasound breast complete (76641) |
$333.75 |
$445 |
3.2× |
| Ultrasound Exam Aaa Screen (76706) |
$445.50 |
$594 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$445.50 |
$594 |
4.3× |
| Us breast unilateral limited (76642) |
$264 |
$352 |
3.1× |
| Us chest (76604) |
$336.75 |
$449 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$260.25 |
$347 |
2.5× |
| Us ob limited (76815) |
$320.25 |
$427 |
3.1× |
| Us ob transvaginal (76817) |
$359.25 |
$479 |
3.5× |
| Us pelvic non ob complete (76856) |
$483 |
$644 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$318 |
$424 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$396.75 |
$529 |
3.8× |
| Us retroperitoneal complete (76770) |
$482.25 |
$643 |
4.7× |
| Us retroperitoneal limited (76775) |
$383.25 |
$511 |
3.7× |
| Us scrotum and contents (76870) |
$448.50 |
$598 |
4.3× |
| Us soft tissue head/neck (76536) |
$435.75 |
$581 |
4.2× |
| Us,transplanted kidney, real time/ doppler (76776) |
$471 |
$628 |
4.6× |
| Wrist 2 views (73100) |
$285 |
$380 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$283.50 |
$378 |
3.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$889.50 |
$1,186 |
5.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$281.25 |
$375 |
3.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$356.62 |
$475.50 |
3.5× |
| X-ray exam of femur 2/> (73552) |
$294 |
$392 |
3.4× |
| X-ray eye for foreign body (70030) |
$248.25 |
$331 |
2.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$291 |
$388 |
3.4× |
| X-ray IV pyelogram (ivp) (74400) |
$792 |
$1,056 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$255 |
$340 |
3.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$264 |
$352 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$378 |
$504 |
3.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$582.75 |
$777 |
5.6× |
| X-ray nose-rectum child f.b. (76010) |
$298.50 |
$398 |
3.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$384 |
$512 |
3.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$315 |
$420 |
3.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$400.50 |
$534 |
3.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$509.25 |
$679 |
4.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$327.75 |
$437 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$314.25 |
$419 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$365.25 |
$487 |
4.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$441 |
$588 |
4.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$330 |
$440 |
3.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$274.50 |
$366 |
3.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$306 |
$408 |
3.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$344.25 |
$459 |
3.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$419.25 |
$559 |
4.1× |
| Xr c-spine 4 or 5 views (72050) |
$474.75 |
$633 |
4.6× |
| Xr c-spine 6 or more views (72052) |
$544.50 |
$726 |
5.3× |
| Xr chest 4+ views (71048) |
$392.25 |
$523 |
3.8× |