| Abdomen 1 View (74018) |
$100 |
$200 |
1.2× |
| Abdomen 2 views (74019) |
$111.50 |
$223 |
1.1× |
| Ankle 2 views (73600) |
$111 |
$222 |
1.3× |
| Bone age studies (77072) |
$145 |
$290 |
1.5× |
| Chest 1 view (71045) |
$115 |
$230 |
1.4× |
| Chest 2 views (71046) |
$132 |
$264 |
1.6× |
| Clavicle complete (73000) |
$90.50 |
$181 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,982.50 |
$3,965 |
5.9× |
| CT abdomen and pelvis without contrast (74176) |
$1,583 |
$3,166 |
6.9× |
| CT abdomen w contrast (74160) |
$934.50 |
$1,869 |
5.6× |
| CT abdomen w wo contrast (74170) |
$817.50 |
$1,635 |
4.9× |
| CT abdomen w/o contrast (74150) |
$794 |
$1,588 |
7.9× |
| CT Angio Abdomen and Pelvis (74174) |
$408 |
$816 |
1.2× |
| CT Angio Chest (71275) |
$1,238 |
$2,476 |
7.4× |
| CT Angio Head (70496) |
$470.50 |
$941 |
2.8× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$207.50 |
$415 |
1.2× |
| CT Angio Neck (70498) |
$470.50 |
$941 |
2.8× |
| CT cervical spine w/o contrast (72125) |
$885 |
$1,770 |
8.9× |
| CT chest w contrast (71260) |
$921.50 |
$1,843 |
5.5× |
| CT chest w/wo contrast (71270) |
$1,064 |
$2,128 |
6.3× |
| CT head/brain without and with contrast (70470) |
$1,254 |
$2,508 |
7.5× |
| CT lower ext w/o (73700) |
$738.50 |
$1,477 |
7.4× |
| CT lower extremity w/contrast material (73701) |
$751.50 |
$1,503 |
4.5× |
| CT lumbar spine w contrast (72132) |
$470.50 |
$941 |
1.4× |
| CT lumbar spine w/o contrast (72131) |
$923 |
$1,846 |
9.2× |
| CT maxillofacial w contrast (70487) |
$751.50 |
$1,503 |
4.5× |
| CT maxillofacial wo contrast (70486) |
$928.50 |
$1,857 |
9.3× |
| CT neck tissue combo (70492) |
$208 |
$416 |
1.2× |
| CT orbits w/o contrast (70480) |
$738.50 |
$1,477 |
7.4× |
| CT pelvis w&w/o contrast (72194) |
$216 |
$432 |
1.3× |
| CT pelvis w/o contrast (72192) |
$790.50 |
$1,581 |
7.9× |
| CT scans face/jaw combo (70488) |
$208 |
$416 |
1.2× |
| CT soft tissue neck w contrast (70491) |
$736.50 |
$1,473 |
4.4× |
| CT soft tissue neck w/o contrast (70490) |
$738.50 |
$1,477 |
7.4× |
| CT thoracic spine w/o contrast (72128) |
$872.50 |
$1,745 |
8.7× |
| CT thorax w/o contrast (71250) |
$757 |
$1,514 |
7.6× |
| CT upper ext wo (73200) |
$246.50 |
$493 |
2.5× |
| CT upper extremity with contrast (73201) |
$872.50 |
$1,745 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$482 |
$964 |
2.9× |
| Cta Abdomen (74175) |
$482 |
$964 |
2.9× |
| Dxa Bone Density Axial (77080) |
$187 |
$374 |
1.9× |
| Fluoroscopy up to 1 hr (76000) |
$288.50 |
$577 |
1.3× |
| Foot 2 views (73620) |
$109.50 |
$219 |
1.3× |
| Forearm 2 views (73090) |
$110 |
$220 |
1.3× |
| Hand 2 views (73120) |
$95 |
$190 |
1.0× |
| Knee 3 Views (73562) |
$159 |
$318 |
1.9× |
| MRI chest w/o contrast (71550) |
$288.50 |
$577 |
1.3× |
| Neck soft tissue (70360) |
$90.50 |
$181 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$119 |
$238 |
1.2× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$151 |
$302 |
1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$119.50 |
$239 |
1.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$95 |
$190 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$125 |
$250 |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$121 |
$242 |
1.2× |
| Radex fingr minimum 2 views (73140) |
$90.50 |
$181 |
1.1× |
| Radex foot complete minimum 3 views (73630) |
$119 |
$238 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$118 |
$236 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$116 |
$232 |
1.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$131.50 |
$263 |
1.6× |
| Radex shoulder complete minimum 2 views (73030) |
$126.50 |
$253 |
1.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$107.50 |
$215 |
1.3× |
| Radex Sternum Minimum 2 Views (71120) |
$129.50 |
$259 |
1.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$103 |
$206 |
1.2× |
| Radex Toe Minimum 2 Views (73660) |
$90.50 |
$181 |
1.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$124.50 |
$249 |
1.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$118 |
$236 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$129.50 |
$259 |
1.3× |
| Radiologic exam knee complete 4/more views (73564) |
$173 |
$346 |
1.7× |
| Radiologic examination femur minimum 2 views (73552) |
$120 |
$240 |
1.4× |
| Radiologic examination knee 1/2 views (73560) |
$103 |
$206 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$122 |
$244 |
1.5× |
| Ribs bilateral 3 views (71110) |
$124.50 |
$249 |
1.2× |
| Scapula (73010) |
$111.50 |
$223 |
1.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$28 |
$56 |
1.2× |
| Skull less than 4 views (70250) |
$106.50 |
$213 |
1.1× |
| Sternoclavicular joints (71130) |
$89.50 |
$179 |
1.1× |
| Thoracic spine 2 views (72070) |
$126.50 |
$253 |
1.3× |
| Thoracic spine 3 views (72072) |
$129.50 |
$259 |
1.3× |
| Thoracolumbar 2 views (72080) |
$126.50 |
$253 |
1.5× |
| Ultrasound Breast Limited (76642) |
$105 |
$210 |
1.3× |
| Ultrasound Exam Aaa Screen (76706) |
$263.50 |
$527 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$334.50 |
$669 |
3.3× |
| Us chest (76604) |
$116.50 |
$233 |
1.2× |
| Us complete joint (76881) |
$193 |
$386 |
1.9× |
| Us exam, pelvic, limited (76857) |
$127 |
$254 |
1.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$173.50 |
$347 |
1.7× |
| Us pelvic non ob complete (76856) |
$405 |
$810 |
4.1× |
| Us retroperitoneal complete (76770) |
$254.50 |
$509 |
2.5× |
| Us retroperitoneal limited (76775) |
$254.50 |
$509 |
2.5× |
| Us scrotum and contents (76870) |
$211 |
$422 |
2.1× |
| Us thyroid (76536) |
$232 |
$464 |
2.3× |
| Wrist 2 views (73100) |
$108.50 |
$217 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$94.50 |
$189 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$129.50 |
$259 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$93.50 |
$187 |
1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$107.50 |
$215 |
1.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$100 |
$200 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$106.50 |
$213 |
1.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$274 |
$548 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$124.50 |
$249 |
1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$124.50 |
$249 |
1.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$126 |
$252 |
1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$200 |
$400 |
2.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$175.50 |
$351 |
1.8× |
| X-ray humerus (73060) |
$125.50 |
$251 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$134.50 |
$269 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$186 |
$372 |
1.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$95 |
$190 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$101.50 |
$203 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$131.50 |
$263 |
1.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$145 |
$290 |
1.5× |
| X-ray thoracic spine 4 vw (72074) |
$136.50 |
$273 |
1.4× |
| X-Rays Bone Length Studies (77073) |
$129 |
$258 |
1.3× |
| X-Rays Bone Survey Complete (77075) |
$289.50 |
$579 |
2.9× |
| Xr c-spine 4 or 5 views (72050) |
$165 |
$330 |
1.7× |