| Abdomen 2 views (74019) |
$409.83 |
$431.40 |
3.9× |
| Ankle 2 views (73600) |
$321.20 |
$338.10 |
3.7× |
| Bone age studies (77072) |
$324.24 |
$341.30 |
3.1× |
| Bone survey complete (77075) |
$895.19 |
$942.30 |
8.5× |
| Bone survey infant (77076) |
$459.23 |
$483.40 |
4.3× |
| Cervical spine 2 or 3 views (72040) |
$375.63 |
$395.40 |
4.3× |
| Chest 1 view (71045) |
$313.17 |
$329.65 |
3.6× |
| Chest xray 3 views (71047) |
$459.23 |
$483.40 |
5.2× |
| Clavicle complete (73000) |
$318.25 |
$335 |
3.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,884.14 |
$1,983.30 |
17.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,180.13 |
$3,347.50 |
9.0× |
| CT abdomen and pelvis without contrast (74176) |
$1,259.80 |
$1,326.10 |
5.2× |
| CT abdomen w contrast (74160) |
$1,975.72 |
$2,079.70 |
11.1× |
| CT abdomen w wo contrast (74170) |
$2,328.17 |
$2,450.70 |
13.1× |
| CT abdomen w/o contrast (74150) |
$1,455.12 |
$1,531.70 |
13.8× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,939.40 |
$3,094.10 |
16.6× |
| CT angiography upper extremity lt (73206) |
$2,752.15 |
$2,897 |
15.5× |
| CT c-spine w/contrast (72126) |
$1,440.01 |
$1,515.80 |
4.1× |
| CT c-spine w/o contrast (72125) |
$2,175.12 |
$2,289.60 |
20.6× |
| CT cervical spine w&w/o contrast (72127) |
$3,070.31 |
$3,231.90 |
17.3× |
| CT chest w contrast (71260) |
$1,723.97 |
$1,814.70 |
9.7× |
| CT chest w/wo contrast (71270) |
$3,009.89 |
$3,168.30 |
17.0× |
| CT head/brain with contrast (70460) |
$1,899.24 |
$1,999.20 |
10.7× |
| CT head/brain without and with contrast (70470) |
$2,527.57 |
$2,660.60 |
14.3× |
| CT iac w contrast (70481) |
$1,476.30 |
$1,554 |
8.3× |
| CT limited/localized follow up study (76380) |
$606.20 |
$638.10 |
6.9× |
| CT lower ext w/o (73700) |
$1,569.88 |
$1,652.50 |
14.9× |
| CT lower extremity w wo contrast (73702) |
$1,190.26 |
$1,252.90 |
6.7× |
| CT lower extremity w/contrast material (73701) |
$2,056.28 |
$2,164.50 |
11.6× |
| CT lumbar spine w & w/o contrast (72133) |
$2,597.02 |
$2,733.70 |
14.7× |
| CT lumbar spine w/contrast (72132) |
$1,440.01 |
$1,515.80 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$2,190.23 |
$2,305.50 |
20.7× |
| CT maxillofacial w contrast (70487) |
$1,477.25 |
$1,555 |
8.3× |
| CT maxillofacial w/wo contrast (70488) |
$1,901.24 |
$2,001.30 |
10.7× |
| CT maxillofacial wo contrast (70486) |
$1,270.82 |
$1,337.70 |
12.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,842.81 |
$1,939.80 |
10.4× |
| CT orbits w/o contrast (70480) |
$1,314.14 |
$1,383.30 |
12.4× |
| CT pelvis w/o contrast (72192) |
$1,440.01 |
$1,515.80 |
13.6× |
| CT pelvis w/wo contrast (72194) |
$2,604.14 |
$2,741.20 |
14.7× |
| CT scan of arm combo (73202) |
$1,190.26 |
$1,252.90 |
6.7× |
| CT soft tissue neck w contrast (70491) |
$2,136.84 |
$2,249.30 |
12.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,138.83 |
$2,251.40 |
12.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,582.99 |
$1,666.30 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$2,412.81 |
$2,539.80 |
13.6× |
| CT thoracic spine w/o contrast (72128) |
$2,098.55 |
$2,209 |
19.9× |
| CT thoracic spine w/wo contrast (72130) |
$3,077.43 |
$3,239.40 |
17.4× |
| CT thorax w/o contrast (71250) |
$1,884.14 |
$1,983.30 |
17.8× |
| CT upper ext wo (73200) |
$1,569.88 |
$1,652.50 |
14.9× |
| CT upper extremity with contrast (73201) |
$952.66 |
$1,002.80 |
2.7× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$4,426.81 |
$4,659.80 |
25.0× |
| Cta Abdomen (74175) |
$2,884.01 |
$3,035.80 |
16.3× |
| CTA abdomen pelvis (74174) |
$3,778.25 |
$3,977.10 |
10.7× |
| CTA chest (71275) |
$3,145.83 |
$3,311.40 |
17.8× |
| Cta Head (70496) |
$3,074.39 |
$3,236.20 |
17.3× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,074.39 |
$3,236.20 |
8.7× |
| Cta Neck (70498) |
$3,023 |
$3,182.10 |
17.1× |
| Cta Pelvis (72191) |
$2,777.33 |
$2,923.50 |
15.7× |
| Facial bones min 3 views (70150) |
$528.68 |
$556.50 |
5.0× |
| Fetal biophysical profile non-stress testing (76818) |
$626.34 |
$659.30 |
5.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$540.74 |
$569.20 |
5.1× |
| Fluoroscopy up to 1 hr (76000) |
$807.60 |
$850.10 |
3.3× |
| Foot 2 views (73620) |
$264.86 |
$278.80 |
3.0× |
| Forearm 2 views (73090) |
$315.21 |
$331.80 |
3.6× |
| Hand 2 views (73120) |
$237.69 |
$250.20 |
2.3× |
| Knee 3 views (73562) |
$470.25 |
$495 |
5.3× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,299 |
$2,420 |
2.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,268.79 |
$2,388.20 |
6.4× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$3,657.41 |
$3,849.90 |
10.4× |
| MRA head w & w/o contrast (70546) |
$3,758.11 |
$3,955.90 |
10.7× |
| MRA head w/o contrast (70544) |
$1,923.37 |
$2,024.60 |
8.0× |
| MRA head with contrast (70545) |
$1,923.37 |
$2,024.60 |
5.5× |
| MRA neck w contrast (70548) |
$1,923.37 |
$2,024.60 |
5.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,802.47 |
$4,002.60 |
10.8× |
| MRA neck w/o contrast (70547) |
$1,923.37 |
$2,024.60 |
8.0× |
| MRI abdomen w contrast (74182) |
$2,304.04 |
$2,425.30 |
6.5× |
| MRI abdomen w/o & w/contrast material (74183) |
$4,258.57 |
$4,482.70 |
12.1× |
| MRI abdomen w/o contrast (74181) |
$1,923.37 |
$2,024.60 |
8.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,268.79 |
$2,388.20 |
2.9× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,201.19 |
$4,422.30 |
11.9× |
| MRI c-spine with contrast (72142) |
$2,491.28 |
$2,622.40 |
7.1× |
| MRI cardiac w/o contrast (75557) |
$1,940.47 |
$2,042.60 |
8.0× |
| MRI cervical spine w/o contrast (72141) |
$2,301.52 |
$2,422.65 |
9.5× |
| MRI chest w/o & w/contrast material (71552) |
$4,311.01 |
$4,537.90 |
12.2× |
| MRI chest w/o contrast (71550) |
$1,923.37 |
$2,024.60 |
8.0× |
| MRI chest with contrast (71551) |
$2,304.04 |
$2,425.30 |
2.9× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,268.79 |
$2,388.20 |
6.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,657.41 |
$3,849.90 |
10.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,893.16 |
$1,992.80 |
7.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,914.35 |
$2,015.10 |
7.9× |
| MRI orbit face neck w contrast (70542) |
$2,297.01 |
$2,417.90 |
6.5× |
| MRI orbit/face/neck w&w/o cont (70543) |
$4,248.50 |
$4,472.10 |
12.1× |
| MRI pelvis w/contrast (72196) |
$2,204.29 |
$2,320.30 |
6.3× |
| MRI pelvis w/o & w/contrast material (72197) |
$3,450.02 |
$3,631.60 |
9.8× |
| MRI pelvis w/o contrast (72195) |
$1,901.24 |
$2,001.30 |
7.9× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$4,010.90 |
$4,222 |
11.4× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,635.30 |
$2,774 |
7.5× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$4,182.10 |
$4,402.20 |
11.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,446.49 |
$2,575.25 |
6.9× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$4,106.57 |
$4,322.70 |
11.6× |
| MRI temporomandibular joint (70336) |
$1,940.47 |
$2,042.60 |
8.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,155.98 |
$2,269.45 |
8.9× |
| MRI up ext w/o contrast (73218) |
$1,893.16 |
$1,992.80 |
7.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,914.35 |
$2,015.10 |
7.9× |
| MRI, joint upper extrem combo (73223) |
$4,250.59 |
$4,474.30 |
12.1× |
| Neck soft tissue (70360) |
$365.56 |
$384.80 |
4.2× |
| Ob us nuchal meas 1 gest (76813) |
$225.53 |
$237.40 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$302.10 |
$318 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$453.15 |
$477 |
5.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$321.20 |
$338.10 |
3.7× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$318.25 |
$335 |
3.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$285.95 |
$301 |
3.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$635.46 |
$668.90 |
6.0× |
| Radex fingr minimum 2 views (73140) |
$210.43 |
$221.50 |
2.4× |
| Radex Foot Compl Minimum 3 Views (73630) |
$394.73 |
$415.50 |
4.5× |
| Radex Hand Minimum 3 Views (73130) |
$394.73 |
$415.50 |
4.5× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$237.69 |
$250.20 |
2.7× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$610.28 |
$642.40 |
5.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$247.76 |
$260.80 |
2.3× |
| Radex Humerus Minimum 2 Views (73060) |
$331.27 |
$348.70 |
3.8× |
| Radex Kne 1/2 Views (73560) |
$237.69 |
$250.20 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$477.28 |
$502.40 |
4.5× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$408.88 |
$430.40 |
3.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$346.37 |
$364.60 |
3.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$408.88 |
$430.40 |
3.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$394.73 |
$415.50 |
4.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$382.66 |
$402.80 |
4.4× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$564.97 |
$594.70 |
5.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$525.64 |
$553.30 |
6.0× |
| Radex Toe Minimum 2 Views (73660) |
$247.76 |
$260.80 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$266.86 |
$280.90 |
2.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$377.63 |
$397.50 |
4.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$388.74 |
$409.20 |
4.4× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$247.76 |
$260.80 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$431.97 |
$454.70 |
4.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$371.55 |
$391.10 |
4.2× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$488.40 |
$514.10 |
4.6× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$382.66 |
$402.80 |
3.6× |
| Ribs bilateral 3 views (71110) |
$685.81 |
$721.90 |
6.5× |
| Sacroiliac Joints < 3 Views (72200) |
$324.24 |
$341.30 |
3.1× |
| Scapula (73010) |
$403.85 |
$425.10 |
3.8× |
| Sella turcica (70240) |
$260.78 |
$274.50 |
3.0× |
| Shoulder 1 view (73020) |
$239.69 |
$252.30 |
2.7× |
| Small bowel series (74250) |
$807.60 |
$850.10 |
4.6× |
| Spine thoracic 3 views (72072) |
$558.89 |
$588.30 |
5.3× |
| Thoracolumbar 2 views (72080) |
$412.87 |
$434.60 |
4.7× |
| Tmj unilateral (70328) |
$274.93 |
$289.40 |
3.1× |
| Ultrasound Exam Aaa Screen (76706) |
$480.32 |
$505.60 |
4.5× |
| Ultrasound, abdomen limited (76705) |
$560.88 |
$590.40 |
5.3× |
| Us breast unilateral limited (76642) |
$330.32 |
$347.70 |
3.8× |
| Us chest (76604) |
$533.71 |
$561.80 |
5.1× |
| Us compl joint r-t w/image documentation (76881) |
$247.76 |
$260.80 |
2.3× |
| Us encephalogram (76506) |
$360.53 |
$379.50 |
3.4× |
| Us hips infant static (76886) |
$252.80 |
$266.10 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$506.54 |
$533.20 |
4.8× |
| Us ob limited (76815) |
$441.09 |
$464.30 |
4.2× |
| Us ob transvaginal (76817) |
$426.93 |
$449.40 |
4.0× |
| Us pelvic non ob complete (76856) |
$601.16 |
$632.80 |
5.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$546.82 |
$575.60 |
5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$312.17 |
$328.60 |
3.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$387.70 |
$408.10 |
3.7× |
| Us retroperitoneal complete (76770) |
$720.01 |
$757.90 |
6.8× |
| Us retroperitoneal limited (76775) |
$480.32 |
$505.60 |
4.5× |
| Us scrotum and contents (76870) |
$480.32 |
$505.60 |
4.5× |
| Us soft tissue head/neck (76536) |
$480.32 |
$505.60 |
4.5× |
| Us spinal canal and contents (76800) |
$404.80 |
$426.10 |
3.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$247.76 |
$260.80 |
2.3× |
| Wrist 2 views (73100) |
$247.76 |
$260.80 |
2.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$848.92 |
$893.60 |
8.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$346.37 |
$364.60 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$247.76 |
$260.80 |
2.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$330.32 |
$347.70 |
3.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$420.95 |
$443.10 |
4.0× |
| X-ray exam of femur 2/> (73552) |
$382.66 |
$402.80 |
4.4× |
| X-ray eye for foreign body (70030) |
$150.01 |
$157.90 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$293.08 |
$308.50 |
3.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$318.25 |
$335 |
3.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$296.02 |
$311.60 |
3.4× |
| X-ray leg, infant (73592) |
$308.18 |
$324.40 |
3.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$424.94 |
$447.30 |
4.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$1,044.24 |
$1,099.20 |
9.9× |
| X-ray nose-rectum child f.b. (76010) |
$247.76 |
$260.80 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$482.32 |
$507.70 |
4.6× |
| X-ray retrograde pyelogram (74420) |
$1,617.28 |
$1,702.40 |
4.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$521.65 |
$549.10 |
5.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$676.69 |
$712.30 |
6.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$759.24 |
$799.20 |
7.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$382.66 |
$402.80 |
3.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$394.73 |
$415.50 |
4.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$382.66 |
$402.80 |
4.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$691.79 |
$728.20 |
6.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$426.93 |
$449.40 |
4.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$247.76 |
$260.80 |
2.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$436.05 |
$459 |
5.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$401.76 |
$422.90 |
4.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$401.76 |
$422.90 |
3.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$563.92 |
$593.60 |
5.3× |
| Xr bone length studies (77073) |
$488.40 |
$514.10 |
4.6× |
| Xr c-spine 4 or 5 views (72050) |
$648.47 |
$682.60 |
6.1× |
| Xr c-spine 6 or more views (72052) |
$648.47 |
$682.60 |
6.1× |
| Xr chest 4+ views (71048) |
$459.23 |
$483.40 |
4.3× |