| Abdomen 1 View (74018) |
$174.50 |
$349 |
2.0× |
| Abdomen 2 views (74019) |
$235.50 |
$471 |
2.2× |
| Ankle 2 views (73600) |
$226.50 |
$453 |
2.6× |
| Bone age studies (77072) |
$253.50 |
$507 |
2.4× |
| Bone Imaging Whole Body (78306) |
$2,986.50 |
$5,973 |
7.4× |
| Bone survey infant (77076) |
$400.50 |
$801 |
3.8× |
| Chest 1 view (71045) |
$185 |
$370 |
2.1× |
| Chest 2 views (71046) |
$185 |
$370 |
2.1× |
| Chest 4 or more views (71048) |
$354.50 |
$709 |
3.3× |
| Clavicle complete (73000) |
$226.50 |
$453 |
2.6× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$218.50 |
$437 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$4,411 |
$8,822 |
12.4× |
| CT abdomen and pelvis without contrast (74176) |
$3,896.50 |
$7,793 |
16.1× |
| CT abdomen w contrast (74160) |
$1,721 |
$3,442 |
9.7× |
| CT abdomen w wo contrast (74170) |
$2,029.50 |
$4,059 |
11.4× |
| CT abdomen w/o contrast (74150) |
$1,706 |
$3,412 |
16.1× |
| CT Angio Abdomen and Pelvis (74174) |
$1,186.50 |
$2,373 |
3.3× |
| CT Angio Chest (71275) |
$1,675.50 |
$3,351 |
9.4× |
| CT Angio Head (70496) |
$2,342 |
$4,684 |
13.1× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,263 |
$2,526 |
7.1× |
| CT Angio Neck (70498) |
$2,342 |
$4,684 |
13.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,217.50 |
$2,435 |
6.8× |
| CT cervical spine w/o contrast (72125) |
$2,725 |
$5,450 |
25.7× |
| CT chest w contrast (71260) |
$1,675.50 |
$3,351 |
9.4× |
| CT chest w/wo contrast (71270) |
$1,623.50 |
$3,247 |
9.1× |
| CT head/brain with contrast (70460) |
$2,937 |
$5,874 |
16.5× |
| CT head/brain without and with contrast (70470) |
$3,974.50 |
$7,949 |
22.3× |
| CT iac w contrast (70481) |
$1,352 |
$2,704 |
7.6× |
| CT l-spine w&w/o contrast (72133) |
$1,492 |
$2,984 |
8.4× |
| CT lower ext w/o (73700) |
$1,839.50 |
$3,679 |
17.3× |
| CT lower extremity w/contrast material (73701) |
$1,492.50 |
$2,985 |
8.4× |
| CT lumbar spine w contrast (72132) |
$1,290 |
$2,580 |
3.6× |
| CT lumbar spine w/o contrast (72131) |
$1,569.50 |
$3,139 |
14.8× |
| CT maxillofacial w contrast (70487) |
$2,496.50 |
$4,993 |
14.0× |
| CT maxillofacial wo contrast (70486) |
$2,203 |
$4,406 |
20.7× |
| CT orbits w/o contrast (70480) |
$1,784.50 |
$3,569 |
16.8× |
| CT pelvis w/o contrast (72192) |
$1,623.50 |
$3,247 |
15.3× |
| CT soft tissue neck w contrast (70491) |
$2,642.50 |
$5,285 |
14.8× |
| CT soft tissue neck w/o contrast (70490) |
$2,182 |
$4,364 |
20.5× |
| CT thoracic spine w/o contrast (72128) |
$1,978.50 |
$3,957 |
18.6× |
| CT thoracic spine w/wo cont (72130) |
$2,077.50 |
$4,155 |
11.7× |
| CT thorax w/o contrast (71250) |
$1,373.50 |
$2,747 |
12.9× |
| CT upper ext wo (73200) |
$1,689.50 |
$3,379 |
15.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,595.50 |
$3,191 |
9.0× |
| Dxa Bone Density Axial (77080) |
$281 |
$562 |
2.6× |
| Esophagram (74220) |
$232.50 |
$465 |
1.3× |
| Fluoroscopy up to 1 hr (76000) |
$121.50 |
$243 |
0.5× |
| Foot 2 views (73620) |
$234 |
$468 |
2.6× |
| Forearm 2 views (73090) |
$226.50 |
$453 |
2.6× |
| Gastric emptying imaging study (78264) |
$2,818.50 |
$5,637 |
6.9× |
| Hand 2 views (73120) |
$282 |
$564 |
2.7× |
| Hepatobil Syst Image W/Drug (78227) |
$3,225 |
$6,450 |
5.8× |
| Hepatobiliary System Imaging (78226) |
$2,064 |
$4,128 |
5.1× |
| Knee 3 Views (73562) |
$226.50 |
$453 |
2.6× |
| MRA head w/o contrast (70544) |
$742.50 |
$1,485 |
3.1× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,117.50 |
$4,235 |
6.0× |
| MRA neck w/o contrast (70547) |
$966.50 |
$1,933 |
4.0× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,952.50 |
$3,905 |
2.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,024.50 |
$4,049 |
5.7× |
| MRI cervical spine w/o cont (72141) |
$839.50 |
$1,679 |
3.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,005.50 |
$4,011 |
5.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,376.50 |
$4,753 |
6.7× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,489 |
$2,978 |
6.1× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,705 |
$3,410 |
4.8× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,105 |
$4,210 |
5.9× |
| MRI pelvis w/o & w contrast (72197) |
$2,383 |
$4,766 |
6.7× |
| MRI pelvis w/o contrast (72195) |
$1,079.50 |
$2,159 |
4.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,339.50 |
$2,679 |
5.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,654 |
$5,308 |
7.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$858.50 |
$1,717 |
3.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,112.50 |
$4,225 |
6.0× |
| MRI, abdomen, combo (74183) |
$2,030.50 |
$4,061 |
5.7× |
| MRI, dorsal spine combo (72157) |
$2,416 |
$4,832 |
6.8× |
| MRI, joint upper extrem (73221) |
$1,861.50 |
$3,723 |
7.7× |
| MRI, joint upper extrem combo (73223) |
$1,998 |
$3,996 |
5.6× |
| MRI, lumbar spine combo (72158) |
$2,416 |
$4,832 |
6.8× |
| Neck soft tissue (70360) |
$305 |
$610 |
3.5× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$319.50 |
$639 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$305 |
$610 |
2.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$235.50 |
$471 |
2.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$226.50 |
$453 |
2.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$335 |
$670 |
3.8× |
| Radex elbow complete minimum 3 views (73080) |
$226.50 |
$453 |
2.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$305 |
$610 |
2.9× |
| Radex fingr minimum 2 views (73140) |
$226.50 |
$453 |
2.6× |
| Radex foot complete minimum 3 views (73630) |
$226.50 |
$453 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$226.50 |
$453 |
2.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$539 |
$1,078 |
6.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$305 |
$610 |
3.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$226.50 |
$453 |
2.6× |
| Radex shoulder complete minimum 2 views (73030) |
$226.50 |
$453 |
2.6× |
| Radex Sinuses Paransl < 3 Views (70210) |
$205.50 |
$411 |
2.3× |
| Radex Spine 1 View Specify Level (72020) |
$139 |
$278 |
1.6× |
| Radex Sternum Minimum 2 Views (71120) |
$580.50 |
$1,161 |
6.6× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$193 |
$386 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$209.50 |
$419 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$70 |
$140 |
0.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$226.50 |
$453 |
2.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$288 |
$576 |
2.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$305 |
$610 |
2.9× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$235.50 |
$471 |
2.2× |
| Radiologic exam colon double contrast study (74280) |
$600 |
$1,200 |
3.4× |
| Radiologic exam colon single contrast study (74270) |
$514 |
$1,028 |
2.9× |
| Radiologic exam knee complete 4/more views (73564) |
$277 |
$554 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$391 |
$782 |
2.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$668 |
$1,336 |
3.7× |
| Radiologic examination femur minimum 2 views (73552) |
$226.50 |
$453 |
2.6× |
| Radiologic examination knee 1/2 views (73560) |
$226.50 |
$453 |
2.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$226.50 |
$453 |
2.6× |
| Ribs bilateral 3 views (71110) |
$277 |
$554 |
2.6× |
| Scapula (73010) |
$277 |
$554 |
2.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$66.50 |
$133 |
2.8× |
| Shoulder 1 view (73020) |
$580.50 |
$1,161 |
6.6× |
| Skull less than 4 views (70250) |
$394.50 |
$789 |
3.7× |
| Sternoclavicular joints (71130) |
$570.50 |
$1,141 |
6.5× |
| Thoracic spine 2 views (72070) |
$305 |
$610 |
2.9× |
| Thoracic spine 3 views (72072) |
$277 |
$554 |
2.6× |
| Thoracolumbar 2 views (72080) |
$192 |
$384 |
2.2× |
| Ultrasound Breast Limited (76642) |
$746 |
$1,492 |
8.4× |
| Ultrasound Exam Aaa Screen (76706) |
$262.50 |
$525 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$571.50 |
$1,143 |
5.4× |
| Unlisted us procedure (76999) |
$392.50 |
$785 |
4.4× |
| Upper gi w/o kub (74240) |
$619 |
$1,238 |
3.5× |
| Us breast unilateral complete (76641) |
$746 |
$1,492 |
7.0× |
| Us chest (76604) |
$559 |
$1,118 |
5.3× |
| Us complete joint (76881) |
$620 |
$1,240 |
5.8× |
| Us exam, pelvic, limited (76857) |
$475.50 |
$951 |
4.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$497 |
$994 |
4.7× |
| Us ob detailed single fetus (76811) |
$443.50 |
$887 |
1.8× |
| Us ob limited 1 or more fetuses (76815) |
$587.50 |
$1,175 |
5.5× |
| Us ob transvaginal (76817) |
$399 |
$798 |
3.8× |
| Us pelvic non ob complete (76856) |
$552.50 |
$1,105 |
5.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$447.50 |
$895 |
4.2× |
| Us retroperitoneal complete (76770) |
$295.50 |
$591 |
2.8× |
| Us retroperitoneal limited (76775) |
$706 |
$1,412 |
6.6× |
| Us scrotum and contents (76870) |
$904 |
$1,808 |
8.5× |
| Us thyroid (76536) |
$294 |
$588 |
2.8× |
| Wrist 2 views (73100) |
$226.50 |
$453 |
2.6× |
| X-Ray Bend Only L-S Spine (72120) |
$401 |
$802 |
3.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$226.50 |
$453 |
2.6× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$408 |
$816 |
4.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$305 |
$610 |
2.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$464.50 |
$929 |
5.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$226.50 |
$453 |
2.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$305 |
$610 |
2.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$305 |
$610 |
2.9× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$305 |
$610 |
2.9× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$305 |
$610 |
2.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$305 |
$610 |
2.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$226.50 |
$453 |
2.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$305 |
$610 |
2.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$305 |
$610 |
2.9× |
| X-ray eye for foreign body (70030) |
$311.50 |
$623 |
3.5× |
| X-ray humerus (73060) |
$226.50 |
$453 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$539 |
$1,078 |
6.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$305 |
$610 |
2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$305 |
$610 |
2.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$464.50 |
$929 |
4.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$169.50 |
$339 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$226.50 |
$453 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$226.50 |
$453 |
2.6× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$421.50 |
$843 |
4.0× |
| X-ray thoracic spine 4 vw (72074) |
$168.50 |
$337 |
1.6× |
| X-Ray Tmj Unilat (70328) |
$592.50 |
$1,185 |
6.7× |
| Xr c-spine 4 or 5 views (72050) |
$305 |
$610 |
2.9× |
| Xr facial bones less than 3 views (70140) |
$592.50 |
$1,185 |
6.7× |
| Xr orbits complete 4 views (70200) |
$305 |
$610 |
2.9× |