| Abdomen 2 views (74019) |
$280.80 |
$351 |
2.7× |
| Ankle 2 views (73600) |
$89.60 |
$112 |
1.0× |
| Arthrogram elbow (73085) |
$864.80 |
$1,081 |
2.5× |
| Arthrogram hip (73525) |
$661.60 |
$827 |
1.9× |
| Arthrogram shoulder (73040) |
$996.80 |
$1,246 |
2.9× |
| Arthrogram wrist (73115) |
$941.60 |
$1,177 |
2.7× |
| Bone survey complete (77075) |
$396 |
$495 |
3.8× |
| Cervical spine 2 or 3 views (72040) |
$270.40 |
$338 |
3.1× |
| Chest 1 view (71045) |
$244.80 |
$306 |
2.8× |
| Chest xray 3 views (71047) |
$324 |
$405 |
3.8× |
| Cholecystography, oral contrast Non-Facility (74290) |
$173.68 |
$217.10 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$483.20 |
$604 |
2.8× |
| Clavicle complete (73000) |
$214.40 |
$268 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$148.80 |
$186 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,562.40 |
$3,203 |
7.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,811.20 |
$2,264 |
7.7× |
| CT abdomen w contrast (74160) |
$1,512.80 |
$1,891 |
8.7× |
| CT abdomen w wo contrast (74170) |
$1,863.20 |
$2,329 |
10.8× |
| CT abdomen w/o contrast (74150) |
$1,151.20 |
$1,439 |
11.1× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,808.80 |
$2,261 |
10.4× |
| CT c-spine w/contrast (72126) |
$1,875.20 |
$2,344 |
5.4× |
| CT c-spine w/o contrast (72125) |
$1,258.40 |
$1,573 |
12.2× |
| CT cervical spine w&w/o contrast (72127) |
$2,060 |
$2,575 |
11.9× |
| CT chest w contrast (71260) |
$1,545.60 |
$1,932 |
8.9× |
| CT chest w/wo contrast (71270) |
$1,736 |
$2,170 |
10.0× |
| CT head/brain with contrast (70460) |
$1,297.60 |
$1,622 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,473.60 |
$1,842 |
8.5× |
| CT iac w contrast (70481) |
$1,400.80 |
$1,751 |
8.1× |
| CT limited/localized follow up study (76380) |
$747.64 |
$934.55 |
8.7× |
| CT lower ext w/o (73700) |
$1,098 |
$1,372.50 |
10.6× |
| CT lower extremity w wo contrast (73702) |
$1,988.80 |
$2,486 |
11.5× |
| CT lower extremity w/contrast material (73701) |
$1,684 |
$2,105 |
9.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,908 |
$2,385 |
11.0× |
| CT lumbar spine w/contrast (72132) |
$1,795.20 |
$2,244 |
5.2× |
| CT lumbar spine w/o contrast (72131) |
$1,299.20 |
$1,624 |
12.6× |
| CT maxillofacial w contrast (70487) |
$1,394.40 |
$1,743 |
8.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,670.40 |
$2,088 |
9.6× |
| CT maxillofacial wo contrast (70486) |
$1,060.80 |
$1,326 |
10.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,728.92 |
$2,161.15 |
10.0× |
| CT orbits w/o contrast (70480) |
$1,024.80 |
$1,281 |
9.9× |
| CT pelvis w/o contrast (72192) |
$1,156 |
$1,445 |
11.2× |
| CT pelvis w/wo contrast (72194) |
$1,747.20 |
$2,184 |
10.1× |
| CT scan of arm combo (73202) |
$2,019.20 |
$2,524 |
11.7× |
| CT soft tissue neck w contrast (70491) |
$1,303.20 |
$1,629 |
7.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,401.60 |
$1,752 |
8.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,100.80 |
$1,376 |
10.7× |
| CT thoracic spine w/contrast (72129) |
$1,609.60 |
$2,012 |
9.3× |
| CT thoracic spine w/o contrast (72128) |
$1,285.60 |
$1,607 |
12.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,969.60 |
$2,462 |
11.4× |
| CT thorax w/o contrast (71250) |
$1,179.20 |
$1,474 |
11.4× |
| CT upper ext wo (73200) |
$1,060.80 |
$1,326 |
10.3× |
| CT upper extremity with contrast (73201) |
$1,604 |
$2,005 |
4.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,001.60 |
$2,502 |
11.6× |
| Cta Abdomen (74175) |
$1,863.20 |
$2,329 |
10.8× |
| CTA abdomen pelvis (74174) |
$2,808.80 |
$3,511 |
8.1× |
| CTA chest (71275) |
$1,996.80 |
$2,496 |
11.5× |
| Cta Head (70496) |
$1,780 |
$2,225 |
10.3× |
| Cta Neck (70498) |
$1,840 |
$2,300 |
10.6× |
| Cystography minimum 3 views rs&i (74430) |
$395.65 |
$494.56 |
1.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$387.20 |
$484 |
3.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$212.80 |
$266 |
2.5× |
| Dxa bone density study axial skeleton (77085) |
$399.84 |
$499.80 |
3.9× |
| Esophagus (74220) |
$461.60 |
$577 |
2.7× |
| Facial bones min 3 views (70150) |
$243.20 |
$304 |
2.4× |
| Fetal biophysical profile non-stress testing (76818) |
$298.80 |
$373.50 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$243.96 |
$304.95 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$373.60 |
$467 |
1.6× |
| Foot 2 views (73620) |
$89.60 |
$112 |
1.0× |
| Forearm 2 views (73090) |
$243.20 |
$304 |
2.8× |
| Hand 2 views (73120) |
$160 |
$200 |
1.5× |
| Hysterosalpingogram (74740) |
$539.20 |
$674 |
2.3× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$118.20 |
$147.75 |
1.1× |
| Knee 3 views (73562) |
$192 |
$240 |
2.2× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,000 |
$2,500 |
2.6× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,026.40 |
$2,533 |
5.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,872 |
$2,340 |
5.4× |
| Mammary ductogram or galactogram single (77053) |
$353.06 |
$441.32 |
1.5× |
| MRA head w & w/o contrast (70546) |
$2,338.40 |
$2,923 |
6.8× |
| MRA head w/o contrast (70544) |
$1,384.80 |
$1,731 |
5.9× |
| MRA head with contrast (70545) |
$1,844 |
$2,305 |
5.4× |
| MRA neck w contrast (70548) |
$1,928 |
$2,410 |
5.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,312 |
$2,890 |
6.7× |
| MRA neck w/o contrast (70547) |
$1,816 |
$2,270 |
7.7× |
| MRI abdomen w contrast (74182) |
$1,973.60 |
$2,467 |
5.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,090.40 |
$2,613 |
6.1× |
| MRI abdomen w/o contrast (74181) |
$1,987.20 |
$2,484 |
8.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,210.40 |
$2,763 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,828 |
$2,285 |
5.3× |
| MRI c-spine with contrast (72142) |
$1,936 |
$2,420 |
5.6× |
| MRI cervical spine w/o contrast (72141) |
$1,426.40 |
$1,783 |
6.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,964 |
$3,705 |
8.6× |
| MRI chest w/o contrast (71550) |
$1,890.40 |
$2,363 |
8.0× |
| MRI chest with contrast (71551) |
$1,964.80 |
$2,456 |
2.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,717.60 |
$2,147 |
5.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,877.60 |
$2,347 |
5.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,390.40 |
$1,738 |
5.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,700.80 |
$2,126 |
7.2× |
| MRI orbit face neck w contrast (70542) |
$1,628 |
$2,035 |
4.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,946.40 |
$2,433 |
5.6× |
| MRI pelvis w/contrast (72196) |
$1,999.20 |
$2,499 |
5.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,116.80 |
$2,646 |
6.1× |
| MRI pelvis w/o contrast (72195) |
$1,603.20 |
$2,004 |
6.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,051.20 |
$2,564 |
6.0× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,563.20 |
$1,954 |
4.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,013.60 |
$2,517 |
5.8× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,839.20 |
$2,299 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,979.20 |
$2,474 |
5.7× |
| MRI temporomandibular joint (70336) |
$1,696.80 |
$2,121 |
7.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,403.20 |
$1,754 |
6.0× |
| MRI up ext w/o contrast (73218) |
$1,391.20 |
$1,739 |
5.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,362.40 |
$1,703 |
5.8× |
| MRI, joint upper extrem combo (73223) |
$1,882.40 |
$2,353 |
5.5× |
| Myelogram Lumbar (72265) |
$1,359.02 |
$1,698.77 |
1.8× |
| Neck soft tissue (70360) |
$276.80 |
$346 |
3.2× |
| Nonvascular shunt X-ray (75809) |
$96.40 |
$120.50 |
0.9× |
| Ob us nuchal meas 1 gest (76813) |
$277.40 |
$346.75 |
2.7× |
| Osseous survey limited (77074) |
$278.40 |
$348 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$276.80 |
$346 |
2.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$424.84 |
$531.05 |
0.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$219.20 |
$274 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$168.80 |
$211 |
2.0× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$269.60 |
$337 |
3.1× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$288 |
$360 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$338.40 |
$423 |
3.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$412 |
$515 |
4.0× |
| Radex fingr minimum 2 views (73140) |
$165.60 |
$207 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$190.40 |
$238 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$330.80 |
$413.50 |
3.8× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$196.80 |
$246 |
2.3× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$226.40 |
$283 |
2.2× |
| Radex Humerus Minimum 2 Views (73060) |
$249.60 |
$312 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$168.80 |
$211 |
2.0× |
| Radex Kne Compl 4/More Views (73564) |
$219.20 |
$274 |
2.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$282.40 |
$353 |
2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$140.80 |
$176 |
1.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$329.60 |
$412 |
3.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$219.20 |
$274 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$108 |
$135 |
1.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$368.80 |
$461 |
3.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$291.20 |
$364 |
3.4× |
| Radex Toe Minimum 2 Views (73660) |
$196 |
$245 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$93.60 |
$117 |
0.9× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$250.40 |
$313 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$197.60 |
$247 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$276.80 |
$346 |
3.2× |
| Radiologic exam colon single contrast study (74270) |
$332.62 |
$415.78 |
1.9× |
| Radiologic exam upr gi trc double contrast study (74246) |
$500.80 |
$626 |
2.9× |
| Radiologic exam upr gi trc single contrast study (74240) |
$464.80 |
$581 |
2.7× |
| Radiologic examination femur 1 view (73551) |
$251.20 |
$314 |
2.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$252.80 |
$316 |
2.9× |
| Ribs bilateral 3 views (71110) |
$347.20 |
$434 |
3.4× |
| Scapula (73010) |
$228.80 |
$286 |
2.2× |
| Sella turcica (70240) |
$109.76 |
$137.20 |
1.3× |
| Shoulder 1 view (73020) |
$195.20 |
$244 |
2.3× |
| Small bowel series (74250) |
$428.80 |
$536 |
2.5× |
| Speech evaluation complex (70371) |
$393.96 |
$492.45 |
1.7× |
| Spine thoracic 3 views (72072) |
$335.20 |
$419 |
3.2× |
| Tmj unilateral (70328) |
$163.60 |
$204.50 |
1.9× |
| Ultrasound bone density measurement and interpretation, peripheral site(s), any method Non-Facility (76977) |
$180 |
$225 |
1.7× |
| Ultrasound breast complete (76641) |
$504 |
$630 |
4.9× |
| Ultrasound Exam Aaa Screen (76706) |
$418.40 |
$523 |
4.1× |
| Ultrasound, abdomen limited (76705) |
$486.40 |
$608 |
4.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$157.60 |
$197 |
1.8× |
| Urethrocystogram voiding (74455) |
$447.24 |
$559.05 |
1.9× |
| Urethrocystography retrograde rs&i (74450) |
$474.28 |
$592.85 |
2.0× |
| Us breast unilateral limited (76642) |
$377.60 |
$472 |
4.4× |
| Us compl joint r-t w/image documentation (76881) |
$444.40 |
$555.50 |
4.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$388 |
$485 |
3.8× |
| Us ob detailed single fetus (76811) |
$672.80 |
$841 |
2.9× |
| Us ob limited (76815) |
$204.80 |
$256 |
2.0× |
| Us ob transvaginal (76817) |
$428.80 |
$536 |
4.2× |
| Us pelvic non ob complete (76856) |
$604 |
$755 |
5.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$375.20 |
$469 |
3.6× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$544.80 |
$681 |
5.3× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$193.60 |
$242 |
1.9× |
| Us retroperitoneal complete (76770) |
$544.80 |
$681 |
5.3× |
| Us scrotum and contents (76870) |
$476.80 |
$596 |
4.6× |
| Us soft tissue head/neck (76536) |
$495.20 |
$619 |
4.8× |
| Vertebral fracture assessment via dxa (77086) |
$196 |
$245 |
2.3× |
| Wrist 2 views (73100) |
$176.80 |
$221 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$352.80 |
$441 |
3.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$197.60 |
$247 |
2.3× |
| X-ray b.e. reductn intuss (74283) |
$225.12 |
$281.40 |
1.3× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$602.18 |
$752.73 |
3.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$211.20 |
$264 |
2.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$204.80 |
$256 |
2.4× |
| X-ray exam of femur 2/> (73552) |
$252.80 |
$316 |
2.9× |
| X-ray eye for foreign body (70030) |
$95.20 |
$119 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$93.72 |
$117.15 |
1.1× |
| X-ray IV pyelogram (ivp) (74400) |
$715.88 |
$894.85 |
4.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$199.14 |
$248.92 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$140.80 |
$176 |
1.6× |
| X-ray leg, infant (73592) |
$153.60 |
$192 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$301.60 |
$377 |
2.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$340 |
$425 |
3.3× |
| X-ray nose-rectum child f.b. (76010) |
$147.20 |
$184 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$240.80 |
$301 |
2.3× |
| X-ray retrograde pyelogram (74420) |
$592.70 |
$740.87 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$249.60 |
$312 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$293.60 |
$367 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$460 |
$575 |
4.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$168.80 |
$211 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$294.40 |
$368 |
3.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$311.20 |
$389 |
3.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$476 |
$595 |
4.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$278.40 |
$348 |
2.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$276.80 |
$346 |
3.2× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$225.60 |
$282 |
2.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$218.40 |
$273 |
2.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$309.60 |
$387 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$374.40 |
$468 |
3.6× |
| Xr bone length studies (77073) |
$337.20 |
$421.50 |
3.3× |
| Xr c-spine 4 or 5 views (72050) |
$380 |
$475 |
3.7× |
| Xr c-spine 6 or more views (72052) |
$474.40 |
$593 |
4.6× |
| Xr chest 4+ views (71048) |
$413.22 |
$516.52 |
4.0× |