| Abdomen 2 views (74019) |
$288.90 |
$321 |
2.8× |
| Ankle 2 views (73600) |
$288.90 |
$321 |
3.4× |
| Bone survey complete (77075) |
$444.60 |
$494 |
4.3× |
| Bone survey infant (77076) |
$444.60 |
$494 |
4.3× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,060.90 |
$3,401 |
8.9× |
| Cervical spine 2 or 3 views (72040) |
$288.90 |
$321 |
3.4× |
| Chest 1 view (71045) |
$277.20 |
$308 |
3.2× |
| Chest xray 3 views (71047) |
$277.20 |
$308 |
3.2× |
| Clavicle complete (73000) |
$288.90 |
$321 |
3.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,086.30 |
$1,207 |
10.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,527.20 |
$2,808 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,866.60 |
$2,074 |
7.9× |
| CT abdomen w contrast (74160) |
$1,437.30 |
$1,597 |
8.3× |
| CT abdomen w wo contrast (74170) |
$1,621.80 |
$1,802 |
9.4× |
| CT abdomen w/o contrast (74150) |
$995.85 |
$1,106.50 |
9.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,095.20 |
$2,328 |
12.1× |
| CT angiography upper extremity lt (73206) |
$1,675.80 |
$1,862 |
9.7× |
| CT c-spine w/contrast (72126) |
$1,437.30 |
$1,597 |
4.2× |
| CT c-spine w/o contrast (72125) |
$1,059.30 |
$1,177 |
10.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,663.20 |
$1,848 |
9.6× |
| CT chest w contrast (71260) |
$1,474.20 |
$1,638 |
8.5× |
| CT chest w/wo contrast (71270) |
$1,663.20 |
$1,848 |
9.6× |
| CT head/brain with contrast (70460) |
$1,474.20 |
$1,638 |
8.5× |
| CT head/brain without and with contrast (70470) |
$1,663.20 |
$1,848 |
9.6× |
| CT iac w contrast (70481) |
$1,474.20 |
$1,638 |
8.5× |
| CT limited/localized follow up study (76380) |
$598.50 |
$665 |
7.0× |
| CT lower ext w/o (73700) |
$1,086.30 |
$1,207 |
10.5× |
| CT lower extremity w wo contrast (73702) |
$1,663.20 |
$1,848 |
9.6× |
| CT lower extremity w/contrast material (73701) |
$1,474.20 |
$1,638 |
8.5× |
| CT lumbar spine w & w/o contrast (72133) |
$1,663.20 |
$1,848 |
9.6× |
| CT lumbar spine w/contrast (72132) |
$1,437.30 |
$1,597 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$1,059.30 |
$1,177 |
10.3× |
| CT maxillofacial w contrast (70487) |
$1,474.20 |
$1,638 |
8.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,663.20 |
$1,848 |
9.6× |
| CT maxillofacial wo contrast (70486) |
$1,086.30 |
$1,207 |
10.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,663.20 |
$1,848 |
9.6× |
| CT orbits w/o contrast (70480) |
$1,086.30 |
$1,207 |
10.5× |
| CT pelvis w/o contrast (72192) |
$1,059.30 |
$1,177 |
10.3× |
| CT pelvis w/wo contrast (72194) |
$1,621.80 |
$1,802 |
9.4× |
| CT scan of arm combo (73202) |
$2,046.60 |
$2,274 |
11.8× |
| CT soft tissue neck w contrast (70491) |
$1,474.20 |
$1,638 |
8.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,663.20 |
$1,848 |
9.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,086.30 |
$1,207 |
10.5× |
| CT thoracic spine w/contrast (72129) |
$1,437.30 |
$1,597 |
8.3× |
| CT thoracic spine w/o contrast (72128) |
$1,059.30 |
$1,177 |
10.3× |
| CT thoracic spine w/wo contrast (72130) |
$1,663.20 |
$1,848 |
9.6× |
| CT thorax w/o contrast (71250) |
$1,072.80 |
$1,192 |
10.4× |
| CT upper ext wo (73200) |
$1,337.40 |
$1,486 |
12.9× |
| CT upper extremity with contrast (73201) |
$1,819.80 |
$2,022 |
5.3× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$1,675.80 |
$1,862 |
9.7× |
| Cta Abdomen (74175) |
$1,675.80 |
$1,862 |
9.7× |
| CTA abdomen pelvis (74174) |
$2,558.70 |
$2,843 |
7.4× |
| CTA chest (71275) |
$1,675.80 |
$1,862 |
9.7× |
| Cta Head (70496) |
$1,675.80 |
$1,862 |
9.7× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,965.60 |
$2,184 |
5.7× |
| Cta Neck (70498) |
$1,675.80 |
$1,862 |
9.7× |
| Cta Pelvis (72191) |
$1,675.80 |
$1,862 |
9.7× |
| Dxa bone density study 1/> sites axial skel (77080) |
$462.60 |
$514 |
4.5× |
| Esophagus (74220) |
$436.50 |
$485 |
2.5× |
| Facial bones min 3 views (70150) |
$444.60 |
$494 |
4.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$621.90 |
$691 |
6.0× |
| Fluoroscopy up to 1 hr (76000) |
$544.05 |
$604.50 |
2.3× |
| Foot 2 views (73620) |
$288.90 |
$321 |
3.4× |
| Forearm 2 views (73090) |
$288.90 |
$321 |
3.4× |
| Hand 2 views (73120) |
$288.90 |
$321 |
2.8× |
| Knee 3 views (73562) |
$288.90 |
$321 |
3.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,491.20 |
$2,768 |
3.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,491.20 |
$2,768 |
7.2× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,060.90 |
$3,401 |
8.9× |
| MRA head w & w/o contrast (70546) |
$3,061.80 |
$3,402 |
8.9× |
| MRA head w/o contrast (70544) |
$2,115.90 |
$2,351 |
9.0× |
| MRA head with contrast (70545) |
$2,491.20 |
$2,768 |
7.2× |
| MRA neck w contrast (70548) |
$2,491.20 |
$2,768 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,060.90 |
$3,401 |
8.9× |
| MRA neck w/o contrast (70547) |
$2,115.90 |
$2,351 |
9.0× |
| MRI abdomen w contrast (74182) |
$2,491.20 |
$2,768 |
7.2× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,060.90 |
$3,401 |
8.9× |
| MRI abdomen w/o contrast (74181) |
$2,115 |
$2,350 |
9.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,491.20 |
$2,768 |
3.2× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,060.90 |
$3,401 |
8.9× |
| MRI c-spine with contrast (72142) |
$2,491.20 |
$2,768 |
7.2× |
| MRI cardiac w/o cont stress (75559) |
$2,115 |
$2,350 |
3.9× |
| MRI cardiac w/o contrast (75557) |
$2,115 |
$2,350 |
9.0× |
| MRI cervical spine w/o contrast (72141) |
$2,115 |
$2,350 |
9.0× |
| MRI chest w/o & w/contrast material (71552) |
$3,060.90 |
$3,401 |
8.9× |
| MRI chest w/o contrast (71550) |
$2,115 |
$2,350 |
9.0× |
| MRI chest with contrast (71551) |
$2,491.20 |
$2,768 |
3.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,491.20 |
$2,768 |
7.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,060.90 |
$3,401 |
8.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,115 |
$2,350 |
9.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,115 |
$2,350 |
9.0× |
| MRI orbit face neck w contrast (70542) |
$2,491.20 |
$2,768 |
7.2× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,715.30 |
$3,017 |
7.9× |
| MRI pelvis w/contrast (72196) |
$2,491.20 |
$2,768 |
7.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,060.90 |
$3,401 |
8.9× |
| MRI pelvis w/o contrast (72195) |
$2,115 |
$2,350 |
9.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,874.60 |
$3,194 |
8.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,491.20 |
$2,768 |
7.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$3,060.90 |
$3,401 |
8.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,491.20 |
$2,768 |
7.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$3,060.90 |
$3,401 |
8.9× |
| MRI temporomandibular joint (70336) |
$2,115 |
$2,350 |
9.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,115 |
$2,350 |
9.0× |
| MRI up ext w/o contrast (73218) |
$2,115 |
$2,350 |
9.0× |
| MRI upper ext joint w/o contrast (73221) |
$2,115 |
$2,350 |
9.0× |
| MRI, joint upper extrem combo (73223) |
$3,060.90 |
$3,401 |
8.9× |
| Neck soft tissue (70360) |
$288.90 |
$321 |
3.4× |
| Pelvis 1 or 2 views (72170) |
$288.90 |
$321 |
2.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$288.90 |
$321 |
3.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$288.90 |
$321 |
3.4× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$295.20 |
$328 |
3.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$288.90 |
$321 |
3.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$288.90 |
$321 |
2.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$288.90 |
$321 |
2.8× |
| Radex fingr minimum 2 views (73140) |
$288.90 |
$321 |
3.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$288.90 |
$321 |
3.4× |
| Radex Hand Minimum 3 Views (73130) |
$288.90 |
$321 |
3.4× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$288.90 |
$321 |
3.4× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$288.90 |
$321 |
2.8× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$444.60 |
$494 |
4.3× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$444.60 |
$494 |
4.3× |
| Radex Humerus Minimum 2 Views (73060) |
$288.90 |
$321 |
3.4× |
| Radex Kne 1/2 Views (73560) |
$288.90 |
$321 |
3.4× |
| Radex Kne Compl 4/More Views (73564) |
$444.60 |
$494 |
4.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$453.60 |
$504 |
4.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$288.90 |
$321 |
3.4× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$288.90 |
$321 |
2.8× |
| Radex Sho Compl Minimum 2 Views (73030) |
$288.90 |
$321 |
3.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$288.90 |
$321 |
3.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$288.90 |
$321 |
3.4× |
| Radex Toe Minimum 2 Views (73660) |
$288.90 |
$321 |
3.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$288.90 |
$321 |
2.8× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$288.90 |
$321 |
3.4× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$444.60 |
$494 |
4.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$288.90 |
$321 |
3.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$288.90 |
$321 |
2.8× |
| Radiologic exam chest 2 views (71046) |
$277.20 |
$308 |
3.2× |
| Radiologic examination femur 1 view (73551) |
$288.90 |
$321 |
3.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$288.90 |
$321 |
3.4× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$444.60 |
$494 |
4.3× |
| Ribs bilateral 3 views (71110) |
$444.60 |
$494 |
4.3× |
| Sacroiliac Joints < 3 Views (72200) |
$288.90 |
$321 |
2.8× |
| Scapula (73010) |
$288.90 |
$321 |
2.8× |
| Sella turcica (70240) |
$288.90 |
$321 |
3.4× |
| Shoulder 1 view (73020) |
$288.90 |
$321 |
3.4× |
| Spine thoracic 3 views (72072) |
$444.60 |
$494 |
4.3× |
| Thoracolumbar 2 views (72080) |
$288.90 |
$321 |
3.4× |
| Tmj unilateral (70328) |
$288.90 |
$321 |
3.4× |
| Ultrasound breast complete (76641) |
$505.35 |
$561.50 |
4.9× |
| Ultrasound Exam Aaa Screen (76706) |
$198.90 |
$221 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$621.90 |
$691 |
6.0× |
| Us chest (76604) |
$404.10 |
$449 |
3.9× |
| Us compl joint r-t w/image documentation (76881) |
$621.90 |
$691 |
6.0× |
| Us hips infant static (76886) |
$404.10 |
$449 |
4.7× |
| Us infant hips w manipulation (76885) |
$404.10 |
$449 |
4.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$404.10 |
$449 |
3.9× |
| Us ob detailed single fetus (76811) |
$968.40 |
$1,076 |
4.1× |
| Us ob limited (76815) |
$404.10 |
$449 |
3.9× |
| Us ob transvaginal (76817) |
$513 |
$570 |
5.0× |
| Us pelvic non ob complete (76856) |
$621.90 |
$691 |
6.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$404.10 |
$449 |
3.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$621.90 |
$691 |
6.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$404.10 |
$449 |
3.9× |
| Us retroperitoneal complete (76770) |
$621.90 |
$691 |
6.0× |
| Us retroperitoneal limited (76775) |
$621.90 |
$691 |
6.0× |
| Us scrotum and contents (76870) |
$621.90 |
$691 |
6.0× |
| Us soft tissue head/neck (76536) |
$621.90 |
$691 |
6.0× |
| Us spinal canal and contents (76800) |
$621.90 |
$691 |
6.0× |
| Wrist 2 views (73100) |
$288.90 |
$321 |
3.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$444.60 |
$494 |
4.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$288.90 |
$321 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$288.90 |
$321 |
3.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$288.90 |
$321 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$444.60 |
$494 |
4.3× |
| X-ray exam of femur 2/> (73552) |
$288.90 |
$321 |
3.4× |
| X-ray eye for foreign body (70030) |
$288.90 |
$321 |
3.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$288.90 |
$321 |
3.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$288.90 |
$321 |
3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$288.90 |
$321 |
3.4× |
| X-ray leg, infant (73592) |
$288.90 |
$321 |
3.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$288.90 |
$321 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$444.60 |
$494 |
4.3× |
| X-ray nose-rectum child f.b. (76010) |
$288.90 |
$321 |
3.4× |
| X-ray optic foramen (70190) |
$288.90 |
$321 |
3.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$444.60 |
$494 |
4.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$288.90 |
$321 |
3.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$444.60 |
$494 |
4.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$288.90 |
$321 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$288.90 |
$321 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$444.60 |
$494 |
5.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$444.60 |
$494 |
4.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$288.90 |
$321 |
2.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$288.90 |
$321 |
3.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$288.90 |
$321 |
3.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$288.90 |
$321 |
3.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$288.90 |
$321 |
2.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$444.60 |
$494 |
4.3× |
| Xr c-spine 4 or 5 views (72050) |
$444.60 |
$494 |
4.3× |
| Xr c-spine 6 or more views (72052) |
$444.60 |
$494 |
4.3× |
| Xr chest 4+ views (71048) |
$427.50 |
$475 |
4.1× |