| Abdomen 2 views (74019) |
$298.29 |
$426.12 |
3.0× |
| Ankle 2 views (73600) |
$244.12 |
$348.74 |
2.9× |
| Bone age studies (77072) |
$107.59 |
$153.70 |
1.1× |
| Bone survey complete (77075) |
$447.43 |
$639.18 |
4.5× |
| Bone survey infant (77076) |
$298.29 |
$426.12 |
3.0× |
| Cervical spine 2 or 3 views (72040) |
$241.90 |
$345.56 |
2.9× |
| Chest 1 view (71045) |
$241.90 |
$345.56 |
2.9× |
| Chest xray 3 views (71047) |
$197 |
$281.43 |
2.4× |
| Cholecystography, oral contrast Non-Facility (74290) |
$220.38 |
$314.82 |
1.3× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$493.43 |
$704.90 |
2.9× |
| Clavicle complete (73000) |
$244.12 |
$348.74 |
2.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,598.27 |
$2,283.24 |
15.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,818.12 |
$4,025.88 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,087.47 |
$4,410.66 |
13.5× |
| CT abdomen w contrast (74160) |
$966.09 |
$1,380.12 |
5.7× |
| CT abdomen w wo contrast (74170) |
$1,834.97 |
$2,621.38 |
10.9× |
| CT abdomen w/o contrast (74150) |
$1,516.65 |
$2,166.64 |
15.1× |
| CT c-spine w/contrast (72126) |
$1,164.94 |
$1,664.20 |
3.5× |
| CT c-spine w/o contrast (72125) |
$1,649.47 |
$2,356.38 |
16.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,299.99 |
$1,857.12 |
7.7× |
| CT chest w contrast (71260) |
$1,693.99 |
$2,419.98 |
10.1× |
| CT chest w/wo contrast (71270) |
$2,021.95 |
$2,888.50 |
12.0× |
| CT head/brain with contrast (70460) |
$1,780.06 |
$2,542.94 |
10.6× |
| CT head/brain without and with contrast (70470) |
$1,771.16 |
$2,530.22 |
10.5× |
| CT limited/localized follow up study (76380) |
$432.22 |
$617.45 |
5.2× |
| CT lower ext w/o (73700) |
$1,693.99 |
$2,419.98 |
16.9× |
| CT lower extremity w wo contrast (73702) |
$829.56 |
$1,185.08 |
4.9× |
| CT lower extremity w/contrast material (73701) |
$1,753.35 |
$2,504.78 |
10.4× |
| CT lumbar spine w & w/o contrast (72133) |
$1,906.94 |
$2,724.20 |
11.3× |
| CT lumbar spine w/o contrast (72131) |
$1,649.47 |
$2,356.38 |
16.4× |
| CT maxillofacial w contrast (70487) |
$1,381.61 |
$1,973.72 |
8.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,207.98 |
$1,725.68 |
7.2× |
| CT maxillofacial wo contrast (70486) |
$1,449.13 |
$2,070.18 |
14.4× |
| CT orbits w/o contrast (70480) |
$1,700.67 |
$2,429.52 |
17.0× |
| CT pelvis w/o contrast (72192) |
$1,571.56 |
$2,245.08 |
15.7× |
| CT pelvis w/wo contrast (72194) |
$1,949.98 |
$2,785.68 |
11.6× |
| CT scan of arm combo (73202) |
$1,753.35 |
$2,504.78 |
10.4× |
| CT soft tissue neck w contrast (70491) |
$1,493.65 |
$2,133.78 |
8.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$939.38 |
$1,341.96 |
5.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,493.65 |
$2,133.78 |
14.9× |
| CT thoracic spine w/o contrast (72128) |
$1,649.47 |
$2,356.38 |
16.4× |
| CT thorax w/o contrast (71250) |
$1,693.99 |
$2,419.98 |
16.9× |
| CT upper ext wo (73200) |
$1,127.10 |
$1,610.14 |
11.2× |
| CT upper extremity with contrast (73201) |
$1,693.99 |
$2,419.98 |
5.1× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,148.09 |
$3,068.70 |
12.8× |
| Cta Abdomen (74175) |
$1,602.72 |
$2,289.60 |
9.5× |
| CTA abdomen pelvis (74174) |
$1,602.72 |
$2,289.60 |
4.8× |
| CTA chest (71275) |
$2,721.66 |
$3,888.08 |
16.2× |
| Cta Head (70496) |
$1,449.13 |
$2,070.18 |
8.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,635.80 |
$5,194 |
10.9× |
| Cta Neck (70498) |
$2,033.08 |
$2,904.40 |
12.1× |
| Cta Pelvis (72191) |
$1,280.70 |
$1,829.56 |
7.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$288.64 |
$412.34 |
2.9× |
| Esophagus (74220) |
$495.66 |
$708.08 |
2.9× |
| Facial bones min 3 views (70150) |
$228.17 |
$325.95 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$640.35 |
$914.78 |
6.4× |
| Fluoroscopy up to 1 hr (76000) |
$212.96 |
$304.22 |
0.9× |
| Foot 2 views (73620) |
$241.90 |
$345.56 |
2.9× |
| Forearm 2 views (73090) |
$244.12 |
$348.74 |
2.9× |
| Hand 2 views (73120) |
$281.96 |
$402.80 |
2.8× |
| Knee 3 views (73562) |
$280.48 |
$400.68 |
3.4× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,715.51 |
$2,450.72 |
2.3× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,618.31 |
$2,311.86 |
4.8× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,459.52 |
$2,085.02 |
4.4× |
| MRA head w & w/o contrast (70546) |
$2,013.05 |
$2,875.78 |
6.0× |
| MRA head w/o contrast (70544) |
$1,502.55 |
$2,146.50 |
6.6× |
| MRA head with contrast (70545) |
$1,605.69 |
$2,293.84 |
4.8× |
| MRA neck w contrast (70548) |
$1,618.31 |
$2,311.86 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,013.05 |
$2,875.78 |
6.0× |
| MRA neck w/o contrast (70547) |
$1,426.87 |
$2,038.38 |
6.2× |
| MRI abdomen w contrast (74182) |
$1,797.13 |
$2,567.32 |
5.4× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,711.27 |
$3,873.24 |
8.1× |
| MRI abdomen w/o contrast (74181) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,707.35 |
$2,439.06 |
2.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,617.04 |
$3,738.62 |
7.8× |
| MRI c-spine with contrast (72142) |
$1,904.72 |
$2,721.02 |
5.7× |
| MRI cervical spine w/o contrast (72141) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI chest w/o & w/contrast material (71552) |
$2,013.05 |
$2,875.78 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI chest with contrast (71551) |
$1,799.35 |
$2,570.50 |
2.4× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,715.51 |
$2,450.72 |
5.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,174.06 |
$3,105.80 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,426.87 |
$2,038.38 |
6.2× |
| MRI orbit face neck w contrast (70542) |
$1,138.97 |
$1,627.10 |
3.4× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,013.05 |
$2,875.78 |
6.0× |
| MRI pelvis w/contrast (72196) |
$1,807.52 |
$2,582.16 |
5.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,421.15 |
$3,458.78 |
7.2× |
| MRI pelvis w/o contrast (72195) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,657.11 |
$3,795.86 |
7.9× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,904.72 |
$2,721.02 |
5.7× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,657.11 |
$3,795.86 |
7.9× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,904.72 |
$2,721.02 |
5.7× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,657.11 |
$3,795.86 |
7.9× |
| MRI temporomandibular joint (70336) |
$943.83 |
$1,348.32 |
4.1× |
| MRI thoracic spine w/o contrast (72146) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI up ext w/o contrast (73218) |
$1,618.31 |
$2,311.86 |
7.1× |
| MRI upper ext joint w/o contrast (73221) |
$1,094.45 |
$1,563.50 |
4.8× |
| MRI, joint upper extrem combo (73223) |
$2,013.05 |
$2,875.78 |
6.0× |
| Neck soft tissue (70360) |
$241.90 |
$345.56 |
2.9× |
| Ob us nuchal meas 1 gest (76813) |
$254.51 |
$363.58 |
2.5× |
| Osseous survey limited (77074) |
$244.86 |
$349.80 |
2.4× |
| Pelvis 1 or 2 views (72170) |
$281.96 |
$402.80 |
2.8× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$244.12 |
$348.74 |
2.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$244.12 |
$348.74 |
2.9× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$244.12 |
$348.74 |
2.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$151.37 |
$216.24 |
1.8× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$323.14 |
$461.63 |
3.2× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$222.98 |
$318.53 |
2.2× |
| Radex fingr minimum 2 views (73140) |
$244.12 |
$348.74 |
2.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$241.90 |
$345.56 |
2.9× |
| Radex Hand Minimum 3 Views (73130) |
$244.12 |
$348.74 |
2.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$133.56 |
$190.80 |
1.6× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$296.06 |
$422.94 |
3.0× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$281.96 |
$402.80 |
2.8× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$179.57 |
$256.52 |
1.8× |
| Radex Humerus Minimum 2 Views (73060) |
$244.12 |
$348.74 |
2.9× |
| Radex Kne 1/2 Views (73560) |
$244.12 |
$348.74 |
2.9× |
| Radex Kne Compl 4/More Views (73564) |
$280.48 |
$400.68 |
2.8× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$172.15 |
$245.92 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$241.90 |
$345.56 |
2.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$169.18 |
$241.68 |
1.7× |
| Radex Sho Compl Minimum 2 Views (73030) |
$146.92 |
$209.88 |
1.8× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$281.96 |
$402.80 |
2.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$154.34 |
$220.48 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$244.12 |
$348.74 |
2.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$296.06 |
$422.94 |
3.0× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$244.12 |
$348.74 |
2.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$222.98 |
$318.53 |
2.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$241.90 |
$345.56 |
2.9× |
| Radiologic exam chest 2 views (71046) |
$241.90 |
$345.56 |
2.9× |
| Radiologic examination femur 1 view (73551) |
$105.37 |
$150.52 |
1.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$244.12 |
$348.74 |
2.9× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$185.50 |
$265 |
1.8× |
| Ribs bilateral 3 views (71110) |
$281.96 |
$402.80 |
2.8× |
| Scapula (73010) |
$296.06 |
$422.94 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$106.85 |
$152.64 |
4.6× |
| Small bowel series (74250) |
$427.40 |
$610.56 |
2.5× |
| Spine thoracic 3 views (72072) |
$281.96 |
$402.80 |
2.8× |
| Thoracolumbar 2 views (72080) |
$230.77 |
$329.66 |
2.8× |
| Ultrasound breast complete (76641) |
$298.29 |
$426.12 |
3.0× |
| Ultrasound Exam Aaa Screen (76706) |
$419.23 |
$598.90 |
4.2× |
| Ultrasound, abdomen limited (76705) |
$392.52 |
$560.74 |
3.9× |
| Us breast unilateral limited (76642) |
$203.31 |
$290.44 |
2.4× |
| Us chest (76604) |
$235.22 |
$336.02 |
2.3× |
| Us compl joint r-t w/image documentation (76881) |
$320.92 |
$458.45 |
3.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$324.26 |
$463.22 |
3.2× |
| Us ob limited (76815) |
$298.29 |
$426.12 |
3.0× |
| Us ob transvaginal (76817) |
$186.99 |
$267.12 |
1.9× |
| Us pelvic non ob complete (76856) |
$305.71 |
$436.72 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$309.42 |
$442.02 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$298.29 |
$426.12 |
3.0× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$201.83 |
$288.32 |
2.0× |
| Us retroperitoneal complete (76770) |
$333.54 |
$476.47 |
3.3× |
| Us retroperitoneal limited (76775) |
$371.75 |
$531.06 |
3.7× |
| Us scrotum and contents (76870) |
$298.29 |
$426.12 |
3.0× |
| Us soft tissue head/neck (76536) |
$298.29 |
$426.12 |
3.0× |
| Us,transplanted kidney, real time/ doppler (76776) |
$540.92 |
$772.74 |
5.4× |
| Wrist 2 views (73100) |
$244.12 |
$348.74 |
2.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$299.03 |
$427.18 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$241.90 |
$345.56 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$244.12 |
$348.74 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$244.12 |
$348.74 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$179.57 |
$256.52 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$244.12 |
$348.74 |
2.9× |
| X-ray eye for foreign body (70030) |
$230.02 |
$328.60 |
2.8× |
| X-ray IV pyelogram (ivp) (74400) |
$323.14 |
$461.63 |
1.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$244.12 |
$348.74 |
2.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$244.12 |
$348.74 |
2.9× |
| X-ray leg, infant (73592) |
$244.12 |
$348.74 |
2.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$281.96 |
$402.80 |
2.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$281.96 |
$402.80 |
2.8× |
| X-ray nose-rectum child f.b. (76010) |
$244.12 |
$348.74 |
2.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$281.96 |
$402.80 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$241.90 |
$345.56 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$281.96 |
$402.80 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$281.96 |
$402.80 |
2.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$281.96 |
$402.80 |
2.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$117.24 |
$167.48 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$241.90 |
$345.56 |
2.9× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$263.41 |
$376.30 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$138.02 |
$197.16 |
1.4× |
| X-Ray Small Bowel Enteroclysis (74251) |
$716.03 |
$1,022.90 |
4.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$77.17 |
$110.24 |
0.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$241.90 |
$345.56 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$241.90 |
$345.56 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$281.96 |
$402.80 |
2.8× |
| Xr c-spine 6 or more views (72052) |
$295.32 |
$421.88 |
2.9× |