| Abdomen 2 views (74019) |
$241.56 |
$335.50 |
2.1× |
| Ankle 2 views (73600) |
$94.14 |
$130.75 |
1.0× |
| Arthrogram hip (73525) |
$283.32 |
$393.50 |
0.7× |
| Arthrogram knee (73580) |
$321.12 |
$446 |
0.8× |
| Arthrogram shoulder (73040) |
$289.80 |
$402.50 |
0.7× |
| Bone age studies (77072) |
$99.36 |
$138 |
0.9× |
| Bone survey complete (77075) |
$169.02 |
$234.75 |
1.5× |
| Bone survey infant (77076) |
$186.12 |
$258.50 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$212.76 |
$295.50 |
2.2× |
| Chest 1 view (71045) |
$169.92 |
$236 |
1.8× |
| Chest xray 3 views (71047) |
$267.48 |
$371.50 |
2.8× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$362.52 |
$503.50 |
1.9× |
| Clavicle complete (73000) |
$104.22 |
$144.75 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,352.88 |
$1,879 |
3.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,741.50 |
$2,418.75 |
6.5× |
| CT abdomen w contrast (74160) |
$2,053.44 |
$2,852 |
10.5× |
| CT abdomen w wo contrast (74170) |
$2,416.68 |
$3,356.50 |
12.4× |
| CT abdomen w/o contrast (74150) |
$1,745.64 |
$2,424.50 |
15.0× |
| CT c-spine w/contrast (72126) |
$1,242.36 |
$1,725.50 |
3.2× |
| CT c-spine w/o contrast (72125) |
$1,934.64 |
$2,687 |
16.6× |
| CT chest w contrast (71260) |
$2,059.56 |
$2,860.50 |
10.5× |
| CT chest w/wo contrast (71270) |
$1,389.96 |
$1,930.50 |
7.1× |
| CT head/brain with contrast (70460) |
$1,868.76 |
$2,595.50 |
9.6× |
| CT head/brain without and with contrast (70470) |
$2,325.24 |
$3,229.50 |
11.9× |
| CT iac w contrast (70481) |
$1,112.76 |
$1,545.50 |
5.7× |
| CT limited/localized follow up study (76380) |
$549.54 |
$763.25 |
5.7× |
| CT lower ext w/o (73700) |
$1,337.04 |
$1,857 |
11.5× |
| CT lower extremity w/contrast material (73701) |
$1,474.56 |
$2,048 |
7.5× |
| CT lumbar spine w/contrast (72132) |
$2,218.32 |
$3,081 |
5.7× |
| CT lumbar spine w/o contrast (72131) |
$1,922.40 |
$2,670 |
16.5× |
| CT maxillofacial w contrast (70487) |
$1,933.20 |
$2,685 |
9.9× |
| CT maxillofacial w/wo contrast (70488) |
$2,334.24 |
$3,242 |
11.9× |
| CT maxillofacial wo contrast (70486) |
$1,703.16 |
$2,365.50 |
14.6× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,306.44 |
$1,814.50 |
6.7× |
| CT orbits w/o contrast (70480) |
$1,796.04 |
$2,494.50 |
15.4× |
| CT pelvis w/o contrast (72192) |
$1,689.84 |
$2,347 |
14.5× |
| CT pelvis w/wo contrast (72194) |
$1,263.60 |
$1,755 |
6.5× |
| CT scan of arm combo (73202) |
$931.68 |
$1,294 |
4.8× |
| CT soft tissue neck w contrast (70491) |
$1,957.68 |
$2,719 |
10.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,214.28 |
$1,686.50 |
6.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,634.04 |
$2,269.50 |
14.0× |
| CT thoracic spine w/contrast (72129) |
$1,232.64 |
$1,712 |
6.3× |
| CT thoracic spine w/o contrast (72128) |
$1,931.04 |
$2,682 |
16.6× |
| CT thorax w/o contrast (71250) |
$1,891.80 |
$2,627.50 |
16.2× |
| CT upper ext wo (73200) |
$1,410.84 |
$1,959.50 |
12.1× |
| CT upper extremity with contrast (73201) |
$1,586.16 |
$2,203 |
4.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,975.40 |
$4,132.50 |
15.2× |
| Cta Abdomen (74175) |
$2,918.16 |
$4,053 |
14.9× |
| CTA abdomen pelvis (74174) |
$3,249.18 |
$4,512.75 |
8.4× |
| CTA chest (71275) |
$3,184.02 |
$4,422.25 |
16.3× |
| Cta Head (70496) |
$2,030.04 |
$2,819.50 |
10.4× |
| Cta Neck (70498) |
$1,160.46 |
$1,611.75 |
5.9× |
| Cta Pelvis (72191) |
$2,874.60 |
$3,992.50 |
14.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$232.92 |
$323.50 |
2.0× |
| Facial bones min 3 views (70150) |
$147.24 |
$204.50 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$427.32 |
$593.50 |
1.6× |
| Foot 2 views (73620) |
$91.98 |
$127.75 |
0.9× |
| Forearm 2 views (73090) |
$170.28 |
$236.50 |
1.8× |
| Hand 2 views (73120) |
$128.52 |
$178.50 |
1.1× |
| Knee 3 views (73562) |
$118.26 |
$164.25 |
1.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,316.34 |
$1,828.25 |
1.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,392.48 |
$1,934 |
3.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,540.62 |
$2,139.75 |
4.0× |
| MRA head w & w/o contrast (70546) |
$2,963.16 |
$4,115.50 |
7.6× |
| MRA head w/o contrast (70544) |
$2,302.20 |
$3,197.50 |
8.7× |
| MRA head with contrast (70545) |
$1,431.72 |
$1,988.50 |
3.7× |
| MRA neck w contrast (70548) |
$1,950.66 |
$2,709.25 |
5.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,939.84 |
$5,472 |
10.1× |
| MRA neck w/o contrast (70547) |
$1,793.16 |
$2,490.50 |
6.7× |
| MRI abdomen w contrast (74182) |
$972.18 |
$1,350.25 |
2.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,274.94 |
$1,770.75 |
3.3× |
| MRI abdomen w/o contrast (74181) |
$769.32 |
$1,068.50 |
2.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,354.50 |
$1,881.25 |
1.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,330.38 |
$1,847.75 |
3.4× |
| MRI c-spine with contrast (72142) |
$1,465.74 |
$2,035.75 |
3.8× |
| MRI cervical spine w/o contrast (72141) |
$2,347.20 |
$3,260 |
8.8× |
| MRI chest w/o & w/contrast material (71552) |
$1,504.98 |
$2,090.25 |
3.9× |
| MRI chest w/o contrast (71550) |
$979.74 |
$1,360.75 |
3.7× |
| MRI chest with contrast (71551) |
$1,114.74 |
$1,548.25 |
1.3× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,361.34 |
$1,890.75 |
3.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,828.16 |
$3,928 |
7.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,152.80 |
$2,990 |
8.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,188.72 |
$1,651 |
4.5× |
| MRI orbit face neck w contrast (70542) |
$1,406.52 |
$1,953.50 |
3.6× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,600.20 |
$2,222.50 |
4.1× |
| MRI pelvis w/contrast (72196) |
$1,274.22 |
$1,769.75 |
3.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,437.48 |
$1,996.50 |
3.7× |
| MRI pelvis w/o contrast (72195) |
$2,092.32 |
$2,906 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$3,218.04 |
$4,469.50 |
8.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,391.04 |
$1,932 |
3.6× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,828.16 |
$3,928 |
7.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,426.86 |
$1,981.75 |
3.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,309.48 |
$4,596.50 |
8.5× |
| MRI temporomandibular joint (70336) |
$770.40 |
$1,070 |
2.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,211.48 |
$3,071.50 |
8.3× |
| MRI up ext w/o contrast (73218) |
$2,106 |
$2,925 |
7.9× |
| MRI upper ext joint w/o contrast (73221) |
$2,017.08 |
$2,801.50 |
7.6× |
| MRI, joint upper extrem combo (73223) |
$2,632.32 |
$3,656 |
6.8× |
| Neck soft tissue (70360) |
$98.82 |
$137.25 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$222.84 |
$309.50 |
1.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$180 |
$250 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$91.08 |
$126.50 |
0.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$193.32 |
$268.50 |
2.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$205.92 |
$286 |
2.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$329.76 |
$458 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$136.44 |
$189.50 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$177.84 |
$247 |
1.8× |
| Radex Hand Minimum 3 Views (73130) |
$182.16 |
$253 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$108.72 |
$151 |
0.9× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$152.82 |
$212.25 |
1.3× |
| Radex Humerus Minimum 2 Views (73060) |
$115.20 |
$160 |
1.2× |
| Radex Kne 1/2 Views (73560) |
$100.62 |
$139.75 |
1.0× |
| Radex Kne Compl 4/More Views (73564) |
$143.82 |
$199.75 |
1.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$130.68 |
$181.50 |
1.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$89.82 |
$124.75 |
0.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$218.16 |
$303 |
2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$171.90 |
$238.75 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$83.34 |
$115.75 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$183.24 |
$254.50 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$194.76 |
$270.50 |
2.0× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$288.72 |
$401 |
2.5× |
| Radiologic exam chest 2 views (71046) |
$218.52 |
$303.50 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$99.90 |
$138.75 |
1.0× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$166.32 |
$231 |
1.4× |
| Radiological examination surgical specimen (76098) |
$104.40 |
$145 |
0.2× |
| Ribs bilateral 3 views (71110) |
$164.52 |
$228.50 |
1.4× |
| Scapula (73010) |
$117.72 |
$163.50 |
1.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$94.68 |
$131.50 |
4.0× |
| Sella turcica (70240) |
$142.20 |
$197.50 |
1.5× |
| Shoulder 1 view (73020) |
$85.32 |
$118.50 |
0.9× |
| Spine thoracic 3 views (72072) |
$245.88 |
$341.50 |
2.1× |
| Ultrasound breast complete (76641) |
$363.60 |
$505 |
3.1× |
| Ultrasound Exam Aaa Screen (76706) |
$404.10 |
$561.25 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$498.96 |
$693 |
4.3× |
| Unlisted fluoroscopic procedure (76496) |
$236.16 |
$328 |
2.4× |
| Unlisted ultrasound procedure (76999) |
$288.90 |
$401.25 |
3.0× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$400.32 |
$556 |
2.0× |
| Us breast unilateral limited (76642) |
$477.36 |
$663 |
4.9× |
| Us chest (76604) |
$575.28 |
$799 |
4.9× |
| Us compl joint r-t w/image documentation (76881) |
$358.56 |
$498 |
3.1× |
| Us infant hips w manipulation (76885) |
$346.68 |
$481.50 |
3.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$160.20 |
$222.50 |
1.4× |
| Us ob detailed single fetus (76811) |
$676.98 |
$940.25 |
2.5× |
| Us ob limited (76815) |
$384.48 |
$534 |
3.3× |
| Us ob transvaginal (76817) |
$307.08 |
$426.50 |
2.6× |
| Us pelvic non ob complete (76856) |
$545.76 |
$758 |
4.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$519.84 |
$722 |
4.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$574.92 |
$798.50 |
4.9× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$259.74 |
$360.75 |
2.2× |
| Us retroperitoneal complete (76770) |
$667.08 |
$926.50 |
5.7× |
| Us retroperitoneal limited (76775) |
$297 |
$412.50 |
2.5× |
| Us scrotum and contents (76870) |
$486 |
$675 |
4.2× |
| Us soft tissue head/neck (76536) |
$470.88 |
$654 |
4.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$381.78 |
$530.25 |
3.3× |
| Wrist 2 views (73100) |
$95.76 |
$133 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$158.76 |
$220.50 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.50 |
$181.25 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$97.74 |
$135.75 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$204.48 |
$284 |
2.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$133.56 |
$185.50 |
1.1× |
| X-ray exam of femur 2/> (73552) |
$190.44 |
$264.50 |
2.0× |
| X-ray eye for foreign body (70030) |
$274.32 |
$381 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$99.18 |
$137.75 |
1.0× |
| X-ray leg, infant (73592) |
$94.68 |
$131.50 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$218.16 |
$303 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$220.32 |
$306 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$149.94 |
$208.25 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$126.90 |
$176.25 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$132.48 |
$184 |
1.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$264.96 |
$368 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$132.66 |
$184.25 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$163.98 |
$227.75 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$171.90 |
$238.75 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$122.58 |
$170.25 |
1.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$88.02 |
$122.25 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$141.30 |
$196.25 |
1.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$221.04 |
$307 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$122.04 |
$169.50 |
1.0× |
| Xr bone length studies (77073) |
$120.96 |
$168 |
1.0× |
| Xr c-spine 4 or 5 views (72050) |
$349.92 |
$486 |
3.0× |
| Xr chest 4+ views (71048) |
$173.16 |
$240.50 |
1.5× |