| Abdomen 2 views (74019) |
$363 |
$484 |
3.5× |
| Bone survey complete (77075) |
$382.85 |
$510.46 |
3.7× |
| Cervical spine 2 or 3 views (72040) |
$345.64 |
$460.85 |
4.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$889.72 |
$1,186.29 |
5.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,142.25 |
$1,523 |
11.1× |
| Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Non-Facility (77078) |
$100.70 |
$134.26 |
1.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,907.75 |
$3,877 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,079.75 |
$2,773 |
8.8× |
| CT abdomen w contrast (74160) |
$1,091.62 |
$1,455.50 |
6.3× |
| CT abdomen w wo contrast (74170) |
$1,314.38 |
$1,752.50 |
7.6× |
| CT abdomen w/o contrast (74150) |
$883.50 |
$1,178 |
8.6× |
| CT angio lwr extr w/o&w/dye (73706) |
$1,369.88 |
$1,826.50 |
7.9× |
| CT angiography upper extremity lt (73206) |
$233.25 |
$311 |
1.3× |
| CT c-spine w/contrast (72126) |
$1,057.88 |
$1,410.50 |
3.1× |
| CT c-spine w/o contrast (72125) |
$959.62 |
$1,279.50 |
9.3× |
| CT cervical spine w&w/o contrast (72127) |
$1,101.38 |
$1,468.50 |
6.4× |
| CT chest w contrast (71260) |
$168.75 |
$225 |
1.0× |
| CT chest w/wo contrast (71270) |
$1,245.75 |
$1,661 |
7.2× |
| CT head/brain with contrast (70460) |
$1,791.75 |
$2,389 |
10.3× |
| CT head/brain without and with contrast (70470) |
$2,124 |
$2,832 |
12.3× |
| CT iac w contrast (70481) |
$1,615.50 |
$2,154 |
9.3× |
| CT lower ext w/o (73700) |
$135.75 |
$181 |
1.3× |
| CT lower extremity w wo contrast (73702) |
$165 |
$220 |
1.0× |
| CT lower extremity w/contrast material (73701) |
$157.50 |
$210 |
0.9× |
| CT lumbar spine w/contrast (72132) |
$1,153.50 |
$1,538 |
3.3× |
| CT lumbar spine w/o contrast (72131) |
$968.62 |
$1,291.50 |
9.4× |
| CT maxillofacial w contrast (70487) |
$1,770.75 |
$2,361 |
10.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,047 |
$1,396 |
6.0× |
| CT maxillofacial wo contrast (70486) |
$817.88 |
$1,090.50 |
7.9× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,800.75 |
$2,401 |
10.4× |
| CT orbits w/o contrast (70480) |
$1,547.25 |
$2,063 |
15.0× |
| CT pelvis w/o contrast (72192) |
$859.88 |
$1,146.50 |
8.3× |
| CT pelvis w/wo contrast (72194) |
$1,206.75 |
$1,609 |
7.0× |
| CT scan of arm combo (73202) |
$165 |
$220 |
1.0× |
| CT soft tissue neck w contrast (70491) |
$1,761 |
$2,348 |
10.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,107.50 |
$2,810 |
12.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,511.25 |
$2,015 |
14.6× |
| CT thoracic spine w/contrast (72129) |
$2,149.50 |
$2,866 |
12.4× |
| CT thoracic spine w/o contrast (72128) |
$926.25 |
$1,235 |
9.0× |
| CT thorax w/o contrast (71250) |
$1,587.75 |
$2,117 |
15.4× |
| CT upper ext wo (73200) |
$812.25 |
$1,083 |
7.9× |
| CT upper extremity with contrast (73201) |
$157.50 |
$210 |
0.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,062.88 |
$2,750.50 |
11.9× |
| Cta Abdomen (74175) |
$3,114 |
$4,152 |
18.0× |
| CTA abdomen pelvis (74174) |
$5,142.75 |
$6,857 |
14.9× |
| CTA chest (71275) |
$3,207.75 |
$4,277 |
18.5× |
| Cta Head (70496) |
$1,390.88 |
$1,854.50 |
8.0× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$1,275.56 |
$1,700.75 |
3.7× |
| Cta Neck (70498) |
$1,369.12 |
$1,825.50 |
7.9× |
| Cta Pelvis (72191) |
$3,249.75 |
$4,333 |
18.8× |
| Esophagus (74220) |
$501.92 |
$669.22 |
2.9× |
| Facial bones min 3 views (70150) |
$422.54 |
$563.38 |
4.1× |
| Fetal biophysical profile non-stress testing (76818) |
$517.39 |
$689.85 |
5.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$429.19 |
$572.25 |
4.2× |
| Fluoroscopy up to 1 hr (76000) |
$438.25 |
$584.33 |
1.9× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$1,313.62 |
$1,751.50 |
1.7× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$1,341.38 |
$1,788.50 |
3.9× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$1,548 |
$2,064 |
4.5× |
| MRA head w & w/o contrast (70546) |
$1,489.12 |
$1,985.50 |
4.3× |
| MRA head w/o contrast (70544) |
$1,359 |
$1,812 |
5.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,519.50 |
$2,026 |
4.4× |
| MRA neck w/o contrast (70547) |
$1,013.25 |
$1,351 |
4.3× |
| MRI abdomen w contrast (74182) |
$1,151.62 |
$1,535.50 |
3.3× |
| MRI abdomen w/o & w/contrast material (74183) |
$3,129 |
$4,172 |
9.1× |
| MRI abdomen w/o contrast (74181) |
$1,166.62 |
$1,555.50 |
4.9× |
| MRI any jt lower extrem w/contrast material (73722) |
$228.75 |
$305 |
0.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$303.75 |
$405 |
0.9× |
| MRI cervical spine w/o contrast (72141) |
$1,264.88 |
$1,686.50 |
5.4× |
| MRI chest w/o & w/contrast material (71552) |
$1,714.12 |
$2,285.50 |
5.0× |
| MRI chest with contrast (71551) |
$1,326.38 |
$1,768.50 |
1.7× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,179 |
$1,572 |
3.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,503 |
$2,004 |
4.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,159.88 |
$1,546.50 |
4.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,196.75 |
$2,929 |
9.3× |
| MRI orbit/face/neck w&w/o cont (70543) |
$3,099.75 |
$4,133 |
9.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,698.38 |
$2,264.50 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,183.12 |
$1,577.50 |
5.0× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,819.88 |
$2,426.50 |
5.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,427.25 |
$1,903 |
4.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,814.25 |
$2,419 |
5.3× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,812.75 |
$2,417 |
5.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,263 |
$1,684 |
5.4× |
| MRI up ext w/o contrast (73218) |
$1,153.12 |
$1,537.50 |
4.9× |
| MRI upper ext joint w/o contrast (73221) |
$1,176.38 |
$1,568.50 |
5.0× |
| MRI, joint upper extrem combo (73223) |
$1,641.38 |
$2,188.50 |
4.8× |
| Neck soft tissue (70360) |
$272.04 |
$362.72 |
3.2× |
| Nonvascular shunt X-ray (75809) |
$552.35 |
$736.47 |
5.3× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$29.93 |
$39.90 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$279.49 |
$372.65 |
2.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$423.36 |
$564.48 |
4.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$632.56 |
$843.41 |
6.1× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$422.54 |
$563.38 |
4.1× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$841.76 |
$1,122.35 |
8.1× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$382.02 |
$509.36 |
3.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$311.73 |
$415.64 |
3.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$358.87 |
$478.49 |
3.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$135.61 |
$180.81 |
1.6× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$418.40 |
$557.87 |
4.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$275.35 |
$367.13 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$203.41 |
$271.22 |
2.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$1,092.30 |
$1,456.40 |
6.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$714.42 |
$952.56 |
4.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$892.20 |
$1,189.60 |
5.1× |
| Sacroiliac Joints < 3 Views (72200) |
$247.24 |
$329.65 |
2.4× |
| Small bowel series (74250) |
$331.99 |
$442.66 |
1.9× |
| Spine thoracic 3 views (72072) |
$404.34 |
$539.12 |
3.9× |
| Thoracolumbar 2 views (72080) |
$360.52 |
$480.69 |
4.2× |
| Ultrasound Exam Aaa Screen (76706) |
$638.66 |
$851.55 |
6.2× |
| Ultrasound, abdomen limited (76705) |
$618.19 |
$824.25 |
6.0× |
| Us breast unilateral limited (76642) |
$121.67 |
$162.22 |
1.4× |
| Us chest (76604) |
$628.43 |
$837.90 |
6.1× |
| Us compl joint r-t w/image documentation (76881) |
$418.95 |
$558.60 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$323.66 |
$431.55 |
3.1× |
| Us ob limited (76815) |
$169.51 |
$226.01 |
1.6× |
| Us ob transvaginal (76817) |
$492.98 |
$657.30 |
4.8× |
| Us pelvic non ob complete (76856) |
$395.32 |
$527.10 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$425.25 |
$567 |
4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$563.85 |
$751.80 |
5.5× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$350.04 |
$466.72 |
3.4× |
| Us retroperitoneal complete (76770) |
$681.19 |
$908.25 |
6.6× |
| Us scrotum and contents (76870) |
$360.28 |
$480.38 |
3.5× |
| Us soft tissue head/neck (76536) |
$459.90 |
$613.20 |
4.5× |
| Us spinal canal and contents (76800) |
$404.38 |
$539.18 |
3.9× |
| Us, eye b-scan (76512) |
$218.30 |
$291.06 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$485.38 |
$647.17 |
4.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$631.73 |
$842.31 |
6.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$300.98 |
$401.31 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$350.60 |
$467.46 |
4.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$377.88 |
$503.84 |
3.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$597.01 |
$796.01 |
5.8× |
| X-ray nose-rectum child f.b. (76010) |
$223.26 |
$297.68 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$515.15 |
$686.86 |
5.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$329.10 |
$438.80 |
3.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$322.49 |
$429.98 |
3.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$416.75 |
$555.66 |
4.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$320 |
$426.67 |
3.1× |
| X-Ray Spine One View - Xr Spine (72020) |
$263.78 |
$351.70 |
3.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$292.72 |
$390.29 |
3.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$320 |
$426.67 |
3.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$338.19 |
$450.92 |
3.3× |
| Xr c-spine 4 or 5 views (72050) |
$501.09 |
$668.12 |
4.9× |
| Xr c-spine 6 or more views (72052) |
$558.97 |
$745.29 |
5.4× |
| Xr chest 4+ views (71048) |
$391.94 |
$522.59 |
3.8× |