| Abdomen 2 views (74019) |
$178.50 |
$238 |
1.7× |
| Ankle 2 views (73600) |
$74.25 |
$99 |
0.9× |
| Arthrogram hip (73525) |
$777 |
$1,036 |
2.3× |
| Arthrogram knee (73580) |
$486 |
$648 |
1.4× |
| Arthrogram shoulder (73040) |
$700.50 |
$934 |
2.0× |
| Arthrogram wrist (73115) |
$741 |
$988 |
2.1× |
| Basic dosimetry (77300) |
$112.50 |
$150 |
0.8× |
| Bone age studies (77072) |
$94.50 |
$126 |
0.9× |
| Bone survey complete (77075) |
$506.25 |
$675 |
4.9× |
| Bone survey infant (77076) |
$190.50 |
$254 |
1.8× |
| Cervical spine 2 or 3 views (72040) |
$94.12 |
$125.50 |
1.1× |
| Chest 1 view (71045) |
$114.38 |
$152.50 |
1.3× |
| Chest xray 3 views (71047) |
$223.50 |
$298 |
2.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$293.25 |
$391 |
1.7× |
| Clavicle complete (73000) |
$58.88 |
$78.50 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$266.25 |
$355 |
2.6× |
| Continuing medical physics consltj pr wk (77336) |
$307.50 |
$410 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,717.50 |
$2,290 |
5.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,680 |
$2,240 |
7.1× |
| CT abdomen w contrast (74160) |
$1,112.25 |
$1,483 |
6.4× |
| CT abdomen w wo contrast (74170) |
$1,217.25 |
$1,623 |
7.0× |
| CT abdomen w/o contrast (74150) |
$941.25 |
$1,255 |
9.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$769.50 |
$1,026 |
4.4× |
| CT angiography upper extremity lt (73206) |
$641.25 |
$855 |
3.7× |
| CT c-spine w/contrast (72126) |
$1,196.25 |
$1,595 |
3.5× |
| CT c-spine w/o contrast (72125) |
$1,104 |
$1,472 |
10.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,450.50 |
$1,934 |
8.4× |
| CT chest w contrast (71260) |
$1,069.50 |
$1,426 |
6.2× |
| CT chest w/wo contrast (71270) |
$1,556.25 |
$2,075 |
9.0× |
| CT head/brain with contrast (70460) |
$886.50 |
$1,182 |
5.1× |
| CT head/brain without and with contrast (70470) |
$1,287.75 |
$1,717 |
7.4× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$77.25 |
$103 |
0.9× |
| CT iac w contrast (70481) |
$940.50 |
$1,254 |
5.4× |
| CT lower ext w/o (73700) |
$1,015.50 |
$1,354 |
9.8× |
| CT lower extremity w wo contrast (73702) |
$1,002.75 |
$1,337 |
5.8× |
| CT lower extremity w/contrast material (73701) |
$891.75 |
$1,189 |
5.1× |
| CT lumbar spine w & w/o contrast (72133) |
$1,450.50 |
$1,934 |
8.4× |
| CT lumbar spine w/contrast (72132) |
$1,433.25 |
$1,911 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$576 |
$768 |
5.6× |
| CT maxillofacial w contrast (70487) |
$878.25 |
$1,171 |
5.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,069.50 |
$1,426 |
6.2× |
| CT maxillofacial wo contrast (70486) |
$1,005.38 |
$1,340.50 |
9.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,152.75 |
$1,537 |
6.7× |
| CT orbits w/o contrast (70480) |
$1,068 |
$1,424 |
10.3× |
| CT pelvis w/o contrast (72192) |
$922.50 |
$1,230 |
8.9× |
| CT pelvis w/wo contrast (72194) |
$1,145.25 |
$1,527 |
6.6× |
| CT scan of arm combo (73202) |
$1,002.75 |
$1,337 |
5.8× |
| CT soft tissue neck w contrast (70491) |
$1,146.75 |
$1,529 |
6.6× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,632 |
$2,176 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$889.50 |
$1,186 |
8.6× |
| CT thoracic spine w/contrast (72129) |
$1,195.50 |
$1,594 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$1,104 |
$1,472 |
10.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,450.50 |
$1,934 |
8.4× |
| CT thorax w/o contrast (71250) |
$993.75 |
$1,325 |
9.6× |
| CT upper ext wo (73200) |
$1,231.50 |
$1,642 |
11.9× |
| CT upper extremity with contrast (73201) |
$887.25 |
$1,183 |
2.6× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,770 |
$2,360 |
10.2× |
| Cta Abdomen (74175) |
$1,243.50 |
$1,658 |
7.2× |
| CTA abdomen pelvis (74174) |
$3,436.50 |
$4,582 |
10.0× |
| CTA chest (71275) |
$995.25 |
$1,327 |
5.7× |
| Cta Head (70496) |
$1,133.25 |
$1,511 |
6.5× |
| Cta Neck (70498) |
$831 |
$1,108 |
4.8× |
| Cystography minimum 3 views rs&i (74430) |
$518.25 |
$691 |
1.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$294 |
$392 |
2.8× |
| Esophagus (74220) |
$195.75 |
$261 |
1.1× |
| Facial bones min 3 views (70150) |
$258.75 |
$345 |
2.5× |
| Fetal biophysical profile non-stress testing (76818) |
$294.38 |
$392.50 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$337.50 |
$450 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$279 |
$372 |
1.2× |
| Foot 2 views (73620) |
$74.25 |
$99 |
0.9× |
| Forearm 2 views (73090) |
$78.75 |
$105 |
0.9× |
| Hand 2 views (73120) |
$86.25 |
$115 |
0.8× |
| Hysterosalpingogram (74740) |
$472.50 |
$630 |
2.0× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$250.50 |
$334 |
2.4× |
| Knee 3 views (73562) |
$128.25 |
$171 |
1.5× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,162.25 |
$2,883 |
2.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,400 |
$3,200 |
7.0× |
| MRA head w & w/o contrast (70546) |
$1,703.25 |
$2,271 |
4.9× |
| MRA head w/o contrast (70544) |
$1,165.50 |
$1,554 |
4.9× |
| MRA neck w contrast (70548) |
$1,474.50 |
$1,966 |
4.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,111.75 |
$4,149 |
9.0× |
| MRA neck w/o contrast (70547) |
$1,153.50 |
$1,538 |
4.9× |
| MRI abdomen w contrast (74182) |
$2,748 |
$3,664 |
8.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,949 |
$3,932 |
8.6× |
| MRI abdomen w/o contrast (74181) |
$2,317.88 |
$3,090.50 |
9.8× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,055 |
$2,740 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,131.50 |
$2,842 |
6.2× |
| MRI c-spine with contrast (72142) |
$1,925.25 |
$2,567 |
5.6× |
| MRI cervical spine w/o contrast (72141) |
$1,905 |
$2,540 |
8.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,250 |
$3,000 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,691.25 |
$2,255 |
7.2× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,603.50 |
$2,138 |
6.8× |
| MRI orbit face neck w contrast (70542) |
$2,991 |
$3,988 |
8.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,026.50 |
$2,702 |
5.9× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,149.25 |
$4,199 |
9.1× |
| MRI pelvis w/o contrast (72195) |
$2,129.25 |
$2,839 |
9.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,861.25 |
$3,815 |
8.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,673.25 |
$2,231 |
4.9× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,851.50 |
$3,802 |
8.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,210.25 |
$2,947 |
6.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,381 |
$4,508 |
9.8× |
| MRI temporomandibular joint (70336) |
$1,707.75 |
$2,277 |
7.2× |
| MRI thoracic spine w/o contrast (72146) |
$2,307.75 |
$3,077 |
9.8× |
| MRI up ext w/o contrast (73218) |
$2,029.50 |
$2,706 |
8.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,691.25 |
$2,255 |
7.2× |
| MRI, joint upper extrem combo (73223) |
$3,044.25 |
$4,059 |
8.8× |
| Myelogram Lumbar (72265) |
$865.50 |
$1,154 |
1.1× |
| Neck soft tissue (70360) |
$135 |
$180 |
1.6× |
| Ntsty modul radthx pln dose-vol histos (77301) |
$1.50 |
$2 |
0.0× |
| Osseous survey limited (77074) |
$458.25 |
$611 |
4.4× |
| Pelvis 1 or 2 views (72170) |
$73.50 |
$98 |
0.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$115.50 |
$154 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$92.25 |
$123 |
1.1× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$102.75 |
$137 |
1.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$91.12 |
$121.50 |
1.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$246 |
$328 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$56.62 |
$75.50 |
0.7× |
| Radex Foot Compl Minimum 3 Views (73630) |
$93.75 |
$125 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$93.75 |
$125 |
1.1× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$90.38 |
$120.50 |
1.1× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$85.88 |
$114.50 |
0.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$122.25 |
$163 |
1.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$122.25 |
$163 |
1.2× |
| Radex Humerus Minimum 2 Views (73060) |
$162 |
$216 |
1.9× |
| Radex Kne 1/2 Views (73560) |
$118.50 |
$158 |
1.4× |
| Radex Kne Compl 4/More Views (73564) |
$146.62 |
$195.50 |
1.4× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$179.25 |
$239 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$135 |
$180 |
1.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$141 |
$188 |
1.4× |
| Radex Sho Compl Minimum 2 Views (73030) |
$124.50 |
$166 |
1.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$369 |
$492 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$319.50 |
$426 |
3.7× |
| Radex Toe Minimum 2 Views (73660) |
$57.75 |
$77 |
0.7× |
| Radex upper extremity infant minimum 2 views (73092) |
$76.50 |
$102 |
0.7× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$102 |
$136 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90.38 |
$120.50 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$178.50 |
$238 |
1.7× |
| Radiologic exam chest 2 views (71046) |
$169.50 |
$226 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$310.50 |
$414 |
1.8× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$246 |
$328 |
1.4× |
| Radiologic exam upr gi trc double contrast study (74246) |
$423.75 |
$565 |
2.4× |
| Radiologic exam upr gi trc single contrast study (74240) |
$599.25 |
$799 |
3.5× |
| Radiologic examination femur 1 view (73551) |
$85.88 |
$114.50 |
1.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$115.50 |
$154 |
1.3× |
| Radiological examination surgical specimen (76098) |
$78 |
$104 |
0.1× |
| Ribs bilateral 3 views (71110) |
$107.62 |
$143.50 |
1.0× |
| Sacroiliac Joints < 3 Views (72200) |
$102 |
$136 |
1.0× |
| Saline Infus Sonohysterography W/Color Doppler (76831) |
$175.88 |
$234.50 |
0.7× |
| Scapula (73010) |
$79.88 |
$106.50 |
0.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$128.25 |
$171 |
5.5× |
| Shoulder 1 view (73020) |
$81.38 |
$108.50 |
0.9× |
| Small bowel series (74250) |
$265.50 |
$354 |
1.5× |
| Spine thoracic 3 views (72072) |
$205.50 |
$274 |
2.0× |
| Ther rad simulaj-aided field setting complex (77290) |
$451.50 |
$602 |
1.2× |
| Thoracolumbar 2 views (72080) |
$189.75 |
$253 |
2.2× |
| Tmj unilateral (70328) |
$191.25 |
$255 |
2.2× |
| Treatment device complex (77334) |
$227.25 |
$303 |
0.6× |
| Ultrasound breast complete (76641) |
$270.75 |
$361 |
2.6× |
| Ultrasound Exam Aaa Screen (76706) |
$298.50 |
$398 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$148.88 |
$198.50 |
1.4× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$39 |
$52 |
0.5× |
| Ureteral reflux study (78740) |
$611.25 |
$815 |
1.5× |
| Urethrocystogram voiding (74455) |
$454.50 |
$606 |
1.9× |
| Us breast unilateral limited (76642) |
$204 |
$272 |
2.4× |
| Us chest (76604) |
$133.88 |
$178.50 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$578.25 |
$771 |
5.6× |
| Us encephalogram (76506) |
$309 |
$412 |
3.0× |
| Us infant hips w manipulation (76885) |
$242.25 |
$323 |
2.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$325.50 |
$434 |
3.2× |
| Us ob detailed single fetus (76811) |
$280.50 |
$374 |
1.2× |
| Us ob limited (76815) |
$176.25 |
$235 |
1.7× |
| Us ob transvaginal (76817) |
$322.88 |
$430.50 |
3.1× |
| Us pelvic non ob complete (76856) |
$302.62 |
$403.50 |
2.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$141 |
$188 |
1.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$267 |
$356 |
2.6× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$154.50 |
$206 |
1.5× |
| Us retroperitoneal complete (76770) |
$351.75 |
$469 |
3.4× |
| Us retroperitoneal limited (76775) |
$261 |
$348 |
2.5× |
| Us scrotum and contents (76870) |
$168.75 |
$225 |
1.6× |
| Us soft tissue head/neck (76536) |
$340.50 |
$454 |
3.3× |
| Us spinal canal and contents (76800) |
$260.25 |
$347 |
2.5× |
| Us transrectal (76872) |
$360.75 |
$481 |
3.5× |
| Wrist 2 views (73100) |
$82.50 |
$110 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$246.75 |
$329 |
2.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94.12 |
$125.50 |
1.1× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$405 |
$540 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$74.25 |
$99 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$85.88 |
$114.50 |
1.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$122.25 |
$163 |
1.2× |
| X-ray exam of femur 2/> (73552) |
$85.88 |
$114.50 |
1.0× |
| X-ray eye for foreign body (70030) |
$64.50 |
$86 |
0.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$146.25 |
$195 |
1.7× |
| X-ray IV pyelogram (ivp) (74400) |
$414.75 |
$553 |
2.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$65.62 |
$87.50 |
0.8× |
| X-ray leg, infant (73592) |
$126 |
$168 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$141.75 |
$189 |
1.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$405 |
$540 |
3.9× |
| X-ray nose-rectum child f.b. (76010) |
$126 |
$168 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$107.25 |
$143 |
1.0× |
| X-ray retrograde pyelogram (74420) |
$301.50 |
$402 |
0.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$111.38 |
$148.50 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$259.50 |
$346 |
2.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$338.25 |
$451 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$313.50 |
$418 |
3.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$87.75 |
$117 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$203.25 |
$271 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$131.62 |
$175.50 |
1.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$136.50 |
$182 |
1.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$127.50 |
$170 |
1.5× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$158.25 |
$211 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$162 |
$216 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$124.88 |
$166.50 |
1.2× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$225 |
$300 |
2.2× |
| Xr bone length studies (77073) |
$193.88 |
$258.50 |
1.9× |
| Xr c-spine 4 or 5 views (72050) |
$179.62 |
$239.50 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$300.75 |
$401 |
2.9× |
| Xr chest 4+ views (71048) |
$186.75 |
$249 |
1.8× |
| Xr urogram antegrade (74425) |
$744.75 |
$993 |
2.2× |