| Abdomen 2 views (74019) |
$208.60 |
$298 |
1.9× |
| Ankle 2 views (73600) |
$174.30 |
$249 |
1.9× |
| Bone age studies (77072) |
$87.50 |
$125 |
0.8× |
| Bone survey complete (77075) |
$837.20 |
$1,196 |
7.6× |
| Bone survey infant (77076) |
$308 |
$440 |
2.8× |
| Cervical spine 2 or 3 views (72040) |
$216.30 |
$309 |
2.4× |
| Chest 1 view (71045) |
$144.20 |
$206 |
1.6× |
| Chest xray 3 views (71047) |
$193.20 |
$276 |
2.1× |
| Clavicle complete (73000) |
$149.80 |
$214 |
1.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$978.60 |
$1,398 |
8.9× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$243.60 |
$348 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,625.70 |
$3,751 |
7.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,101.40 |
$3,002 |
8.3× |
| CT abdomen w contrast (74160) |
$1,334.90 |
$1,907 |
7.2× |
| CT abdomen w wo contrast (74170) |
$1,513.40 |
$2,162 |
8.2× |
| CT abdomen w/o contrast (74150) |
$1,110.20 |
$1,586 |
10.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,696.80 |
$2,424 |
9.2× |
| CT angiography upper extremity lt (73206) |
$1,696.80 |
$2,424 |
9.2× |
| CT c-spine w/o contrast (72125) |
$1,339.10 |
$1,913 |
12.1× |
| CT chest w contrast (71260) |
$1,253.70 |
$1,791 |
6.8× |
| CT chest w/wo contrast (71270) |
$1,467.90 |
$2,097 |
7.9× |
| CT head/brain with contrast (70460) |
$1,004.50 |
$1,435 |
5.4× |
| CT head/brain without and with contrast (70470) |
$1,315.30 |
$1,879 |
7.1× |
| CT iac w contrast (70481) |
$927.50 |
$1,325 |
5.0× |
| CT lower ext w/o (73700) |
$991.90 |
$1,417 |
9.0× |
| CT lower extremity w wo contrast (73702) |
$1,343.30 |
$1,919 |
7.3× |
| CT lower extremity w/contrast material (73701) |
$1,236.90 |
$1,767 |
6.7× |
| CT lumbar spine w/contrast (72132) |
$1,098.30 |
$1,569 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$1,344 |
$1,920 |
12.2× |
| CT maxillofacial w contrast (70487) |
$1,157.10 |
$1,653 |
6.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,570.10 |
$2,243 |
8.5× |
| CT maxillofacial wo contrast (70486) |
$996.80 |
$1,424 |
9.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,343.30 |
$1,919 |
7.3× |
| CT orbits w/o contrast (70480) |
$996.10 |
$1,423 |
9.0× |
| CT pelvis w/o contrast (72192) |
$1,047.20 |
$1,496 |
9.5× |
| CT pelvis w/wo contrast (72194) |
$1,444.10 |
$2,063 |
7.8× |
| CT scan of arm combo (73202) |
$1,343.30 |
$1,919 |
7.3× |
| CT soft tissue neck w contrast (70491) |
$1,197 |
$1,710 |
6.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,442.70 |
$2,061 |
7.8× |
| CT soft tissue neck w/o contrast (70490) |
$770.70 |
$1,101 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$1,297.80 |
$1,854 |
11.8× |
| CT thorax w/o contrast (71250) |
$978.60 |
$1,398 |
8.9× |
| CT upper ext wo (73200) |
$973.70 |
$1,391 |
8.8× |
| CT upper extremity with contrast (73201) |
$1,236.90 |
$1,767 |
3.4× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,692.55 |
$3,846.50 |
14.5× |
| CTA abdomen pelvis (74174) |
$1,478.40 |
$2,112 |
4.0× |
| CTA chest (71275) |
$1,965.60 |
$2,808 |
10.6× |
| Cta Head (70496) |
$1,751.40 |
$2,502 |
9.5× |
| Cta Neck (70498) |
$1,751.40 |
$2,502 |
9.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$385.70 |
$551 |
3.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$284.20 |
$406 |
3.1× |
| Esophagus (74220) |
$345.80 |
$494 |
1.9× |
| Facial bones min 3 views (70150) |
$231 |
$330 |
2.1× |
| Foot 2 views (73620) |
$152.60 |
$218 |
1.7× |
| Forearm 2 views (73090) |
$166.60 |
$238 |
1.8× |
| Hand 2 views (73120) |
$191.10 |
$273 |
1.7× |
| Knee 3 views (73562) |
$253.40 |
$362 |
2.8× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,444.10 |
$2,063 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,444.10 |
$2,063 |
3.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,992.90 |
$2,847 |
5.4× |
| MRA head w/o contrast (70544) |
$1,446.20 |
$2,066 |
5.7× |
| MRA neck w contrast (70548) |
$1,802.50 |
$2,575 |
4.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,668.80 |
$2,384 |
4.5× |
| MRA neck w/o contrast (70547) |
$1,395.80 |
$1,994 |
5.5× |
| MRI abdomen w contrast (74182) |
$1,444.10 |
$2,063 |
3.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,466.10 |
$3,523 |
6.7× |
| MRI abdomen w/o contrast (74181) |
$1,285.90 |
$1,837 |
5.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,444.10 |
$2,063 |
1.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,668.80 |
$2,384 |
4.5× |
| MRI c-spine with contrast (72142) |
$848.40 |
$1,212 |
2.3× |
| MRI cervical spine w/o contrast (72141) |
$1,690.50 |
$2,415 |
6.7× |
| MRI chest w/o & w/contrast material (71552) |
$935.90 |
$1,337 |
2.5× |
| MRI chest w/o contrast (71550) |
$689.50 |
$985 |
2.7× |
| MRI chest with contrast (71551) |
$826 |
$1,180 |
1.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,444.10 |
$2,063 |
3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,668.80 |
$2,384 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,320.20 |
$1,886 |
5.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,285.90 |
$1,837 |
5.1× |
| MRI orbit face neck w contrast (70542) |
$1,444.10 |
$2,063 |
3.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,528.40 |
$3,612 |
6.9× |
| MRI pelvis w/contrast (72196) |
$1,444.10 |
$2,063 |
3.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,668.80 |
$2,384 |
4.5× |
| MRI pelvis w/o contrast (72195) |
$1,312.15 |
$1,874.50 |
5.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,358.30 |
$3,369 |
6.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,444.10 |
$2,063 |
3.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,324.70 |
$3,321 |
6.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,444.10 |
$2,063 |
3.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,668.80 |
$2,384 |
4.5× |
| MRI temporomandibular joint (70336) |
$699.30 |
$999 |
2.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,285.90 |
$1,837 |
5.1× |
| MRI up ext w/o contrast (73218) |
$1,285.90 |
$1,837 |
5.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,271.90 |
$1,817 |
5.1× |
| MRI, joint upper extrem combo (73223) |
$1,668.80 |
$2,384 |
4.5× |
| Neck soft tissue (70360) |
$153.30 |
$219 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$173.60 |
$248 |
1.6× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$189 |
$270 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$136.50 |
$195 |
1.5× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$188.30 |
$269 |
2.1× |
| Radex fingr minimum 2 views (73140) |
$128.80 |
$184 |
1.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$212.10 |
$303 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$181.30 |
$259 |
2.0× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$239.40 |
$342 |
2.2× |
| Radex Humerus Minimum 2 Views (73060) |
$182 |
$260 |
2.0× |
| Radex Kne 1/2 Views (73560) |
$211.40 |
$302 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$224.70 |
$321 |
2.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$325.50 |
$465 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$137.20 |
$196 |
1.5× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$130.90 |
$187 |
1.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$205.10 |
$293 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$85.40 |
$122 |
0.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$338.80 |
$484 |
3.7× |
| Radex Toe Minimum 2 Views (73660) |
$119 |
$170 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$196.70 |
$281 |
1.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$207.20 |
$296 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$423.50 |
$605 |
3.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$147 |
$210 |
1.6× |
| Radiologic exam chest 2 views (71046) |
$168.70 |
$241 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$176.40 |
$252 |
1.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$218.40 |
$312 |
2.0× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$179.20 |
$256 |
1.6× |
| Scapula (73010) |
$188.30 |
$269 |
1.7× |
| Shoulder 1 view (73020) |
$191.10 |
$273 |
2.1× |
| Small bowel series (74250) |
$633.50 |
$905 |
3.4× |
| Spine thoracic 3 views (72072) |
$258.30 |
$369 |
2.3× |
| Thoracolumbar 2 views (72080) |
$127.40 |
$182 |
1.4× |
| Ultrasound Exam Aaa Screen (76706) |
$467.60 |
$668 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$320.60 |
$458 |
2.9× |
| Us chest (76604) |
$343 |
$490 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$323.05 |
$461.50 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$233.80 |
$334 |
2.1× |
| Us ob limited (76815) |
$347.20 |
$496 |
3.1× |
| Us ob transvaginal (76817) |
$350.70 |
$501 |
3.2× |
| Us pelvic non ob complete (76856) |
$389.90 |
$557 |
3.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$389.90 |
$557 |
3.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$455.70 |
$651 |
4.1× |
| Us retroperitoneal complete (76770) |
$506.80 |
$724 |
4.6× |
| Us retroperitoneal limited (76775) |
$427 |
$610 |
3.9× |
| Us scrotum and contents (76870) |
$428.40 |
$612 |
3.9× |
| Us soft tissue head/neck (76536) |
$440.30 |
$629 |
4.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$389.90 |
$557 |
3.5× |
| Wrist 2 views (73100) |
$138.60 |
$198 |
1.5× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$283.50 |
$405 |
2.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$196 |
$280 |
2.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$156.80 |
$224 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$221.90 |
$317 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$212.80 |
$304 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$196 |
$280 |
2.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$151.20 |
$216 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$161.70 |
$231 |
1.8× |
| X-ray leg, infant (73592) |
$133.70 |
$191 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$267.75 |
$382.50 |
2.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$85.40 |
$122 |
0.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$174.30 |
$249 |
1.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$238 |
$340 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$282.10 |
$403 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$158.90 |
$227 |
1.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$188.30 |
$269 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$272.30 |
$389 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$256.20 |
$366 |
2.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$139.30 |
$199 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$214.90 |
$307 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$221.20 |
$316 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$176.40 |
$252 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$176.40 |
$252 |
1.6× |
| Xr c-spine 4 or 5 views (72050) |
$336.70 |
$481 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$322.70 |
$461 |
2.9× |
| Xr chest 4+ views (71048) |
$213.50 |
$305 |
1.9× |