| Abdomen 1 View (74018) |
$396 |
$792 |
4.5× |
| Abdomen 2 views (74019) |
$416 |
$832 |
3.9× |
| Ankle 2 views (73600) |
$272.50 |
$545 |
3.1× |
| Bone age studies (77072) |
$399 |
$798 |
3.8× |
| Chest 1 view (71045) |
$276.50 |
$553 |
3.1× |
| Chest 2 views (71046) |
$442.50 |
$885 |
5.0× |
| Chest 3 views (71047) |
$369.50 |
$739 |
4.2× |
| Clavicle complete (73000) |
$348 |
$696 |
3.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$303.50 |
$607 |
2.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,032.50 |
$10,065 |
14.2× |
| CT abdomen and pelvis without contrast (74176) |
$3,922 |
$7,844 |
16.2× |
| CT abdomen w contrast (74160) |
$2,421.50 |
$4,843 |
13.6× |
| CT abdomen w wo contrast (74170) |
$2,628 |
$5,256 |
14.8× |
| CT abdomen w/o contrast (74150) |
$2,182 |
$4,364 |
20.5× |
| CT Angio Abdomen and Pelvis (74174) |
$1,648.50 |
$3,297 |
4.7× |
| CT Angio Chest (71275) |
$2,392 |
$4,784 |
13.4× |
| CT Angio Head (70496) |
$1,932 |
$3,864 |
10.8× |
| CT angio hrt w/3d image (75574) |
$1,601.50 |
$3,203 |
4.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,609.50 |
$3,219 |
9.0× |
| CT Angio Neck (70498) |
$1,932 |
$3,864 |
10.8× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,202.50 |
$2,405 |
6.7× |
| CT cervical spine w/o contrast (72125) |
$1,782.50 |
$3,565 |
16.8× |
| CT chest w contrast (71260) |
$2,010 |
$4,020 |
11.3× |
| CT chest w/wo contrast (71270) |
$1,990 |
$3,980 |
11.2× |
| CT head/brain without and with contrast (70470) |
$2,787.50 |
$5,575 |
15.6× |
| CT heart no contrast quant eval coronry calcium (75571) |
$360.50 |
$721 |
4.1× |
| CT iac w contrast (70481) |
$1,378 |
$2,756 |
7.7× |
| CT lower ext w/o (73700) |
$2,189 |
$4,378 |
20.6× |
| CT lower extremity w/contrast material (73701) |
$1,577 |
$3,154 |
8.9× |
| CT lumbar spine w/o contrast (72131) |
$2,164 |
$4,328 |
20.4× |
| CT maxillofacial w contrast (70487) |
$1,802.50 |
$3,605 |
10.1× |
| CT maxillofacial wo contrast (70486) |
$1,683.50 |
$3,367 |
15.9× |
| CT orbits w/o contrast (70480) |
$1,159 |
$2,318 |
10.9× |
| CT pelvis w/o contrast (72192) |
$2,105.50 |
$4,211 |
19.8× |
| CT soft tissue neck w contrast (70491) |
$1,773.50 |
$3,547 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,417 |
$2,834 |
13.3× |
| CT thoracic spine w/o contrast (72128) |
$2,575.50 |
$5,151 |
24.3× |
| CT thorax w/o contrast (71250) |
$1,812 |
$3,624 |
17.1× |
| CT upper ext wo (73200) |
$1,989.50 |
$3,979 |
18.7× |
| CT upper extremity with contrast (73201) |
$1,581.50 |
$3,163 |
4.5× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,287.50 |
$2,575 |
7.2× |
| Dxa Bone Density Axial (77080) |
$379.50 |
$759 |
3.6× |
| Esophagram (74220) |
$321 |
$642 |
1.8× |
| Foot 2 views (73620) |
$266.50 |
$533 |
3.0× |
| Forearm 2 views (73090) |
$428 |
$856 |
4.8× |
| Hand 2 views (73120) |
$280.50 |
$561 |
2.6× |
| Knee 3 Views (73562) |
$271 |
$542 |
3.1× |
| Mr safety determination physician/other qhp (76016) |
$164 |
$328 |
1.9× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$45.50 |
$91 |
1.5× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$171 |
$342 |
1.8× |
| Mr safety implt pos&/immoblj (76019) |
$110.50 |
$221 |
1.8× |
| Mr safety med physics xm customization plng&mntr (76017) |
$450.50 |
$901 |
1.9× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,599 |
$5,198 |
7.3× |
| MRA head w/o contrast (70544) |
$920 |
$1,840 |
3.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,149.50 |
$4,299 |
6.1× |
| MRA neck w/o contrast (70547) |
$920 |
$1,840 |
3.8× |
| MRI abdomen w/o contrast (74181) |
$1,516 |
$3,032 |
6.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$4,384 |
$8,768 |
12.4× |
| MRI cervical spine w/o cont (72141) |
$1,148 |
$2,296 |
4.7× |
| MRI chest wo w contrast (71552) |
$3,318 |
$6,636 |
9.4× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,338 |
$6,676 |
9.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,205.50 |
$2,411 |
5.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,445.50 |
$4,891 |
6.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,368 |
$4,736 |
6.7× |
| MRI pelvis w/o & w contrast (72197) |
$3,190.50 |
$6,381 |
9.0× |
| MRI pelvis w/o contrast (72195) |
$1,516 |
$3,032 |
6.3× |
| MRI thoracic spine w/o contrast (72146) |
$1,702.50 |
$3,405 |
7.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,508 |
$3,016 |
6.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$4,910 |
$9,820 |
13.9× |
| MRI, abdomen, combo (74183) |
$3,347 |
$6,694 |
9.4× |
| MRI, dorsal spine combo (72157) |
$3,393 |
$6,786 |
9.6× |
| MRI, joint upper extrem (73221) |
$2,376.50 |
$4,753 |
9.8× |
| MRI, lumbar spine combo (72158) |
$3,393 |
$6,786 |
9.6× |
| N-invas est c ffr sw aly CTA (75580) |
$3,148 |
$6,296 |
3.6× |
| Neck soft tissue (70360) |
$181.50 |
$363 |
2.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$320 |
$640 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$404 |
$808 |
3.8× |
| PET imaging CT attenuation skull base mid-thigh (78815) |
$4,139 |
$8,278 |
2.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$594 |
$1,188 |
5.6× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$372.50 |
$745 |
4.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$404 |
$808 |
4.6× |
| Radex elbow complete minimum 3 views (73080) |
$459.50 |
$919 |
5.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$399.50 |
$799 |
3.8× |
| Radex fingr minimum 2 views (73140) |
$320 |
$640 |
3.6× |
| Radex foot complete minimum 3 views (73630) |
$488 |
$976 |
5.5× |
| Radex Hand Minimum 3 Views (73130) |
$486 |
$972 |
5.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$123.50 |
$247 |
1.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$436.50 |
$873 |
4.9× |
| Radex Ribs Unilateral 2 Views (71100) |
$500 |
$1,000 |
5.7× |
| Radex shoulder complete minimum 2 views (73030) |
$474 |
$948 |
5.4× |
| Radex Sinuses Paransl < 3 Views (70210) |
$248.50 |
$497 |
2.8× |
| Radex Spine 1 View Specify Level (72020) |
$181 |
$362 |
2.0× |
| Radex Sternum Minimum 2 Views (71120) |
$384.50 |
$769 |
4.4× |
| Radex Toe Minimum 2 Views (73660) |
$300.50 |
$601 |
3.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$123.50 |
$247 |
1.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$537 |
$1,074 |
6.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$542.50 |
$1,085 |
5.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$429 |
$858 |
4.0× |
| Radiologic exam knee complete 4/more views (73564) |
$594 |
$1,188 |
5.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$725 |
$1,450 |
4.1× |
| Radiologic examination femur 1 view (73551) |
$224 |
$448 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$352 |
$704 |
4.0× |
| Radiologic examination knee 1/2 views (73560) |
$208.50 |
$417 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$446 |
$892 |
5.0× |
| Ribs bilateral 3 views (71110) |
$503.50 |
$1,007 |
4.7× |
| Scapula (73010) |
$317.50 |
$635 |
3.0× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$55.50 |
$111 |
2.4× |
| Shoulder 1 view (73020) |
$218 |
$436 |
2.5× |
| Skull less than 4 views (70250) |
$526.50 |
$1,053 |
5.0× |
| Sternoclavicular joints (71130) |
$192 |
$384 |
2.2× |
| Thoracic spine 2 views (72070) |
$398.50 |
$797 |
3.8× |
| Thoracic spine 3 views (72072) |
$594 |
$1,188 |
5.6× |
| Thoracolumbar 2 views (72080) |
$362 |
$724 |
4.1× |
| Ultrasound Breast Limited (76642) |
$579.50 |
$1,159 |
6.6× |
| Ultrasound Exam Aaa Screen (76706) |
$410 |
$820 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$992.50 |
$1,985 |
9.3× |
| Unlisted us procedure (76999) |
$442.50 |
$885 |
5.0× |
| Upper gi w/o kub (74240) |
$547.50 |
$1,095 |
3.1× |
| Us breast unilateral complete (76641) |
$746 |
$1,492 |
7.0× |
| Us chest (76604) |
$559 |
$1,118 |
5.3× |
| Us complete joint (76881) |
$619.50 |
$1,239 |
5.8× |
| Us exam, pelvic, limited (76857) |
$522.50 |
$1,045 |
4.9× |
| Us kidney transplant (76776) |
$437.50 |
$875 |
4.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$495.50 |
$991 |
4.7× |
| Us ob limited 1 or more fetuses (76815) |
$619.50 |
$1,239 |
5.8× |
| Us ob transvaginal (76817) |
$459 |
$918 |
4.3× |
| Us pelvic non ob complete (76856) |
$680 |
$1,360 |
6.4× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$768 |
$1,536 |
7.2× |
| Us retroperitoneal complete (76770) |
$977 |
$1,954 |
9.2× |
| Us retroperitoneal limited (76775) |
$918.50 |
$1,837 |
8.6× |
| Us scrotum and contents (76870) |
$992.50 |
$1,985 |
9.3× |
| Us thyroid (76536) |
$686.50 |
$1,373 |
6.5× |
| Wrist 2 views (73100) |
$281.50 |
$563 |
3.2× |
| X-Ray Bend Only L-S Spine (72120) |
$413 |
$826 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$280.50 |
$561 |
3.2× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$563.50 |
$1,127 |
6.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$468.50 |
$937 |
4.4× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$691.50 |
$1,383 |
6.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$260 |
$520 |
2.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$494 |
$988 |
5.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$394.50 |
$789 |
3.7× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$507 |
$1,014 |
4.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$637.50 |
$1,275 |
6.0× |
| X-Ray Exam L-S Spine Bending (72114) |
$617 |
$1,234 |
5.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$399 |
$798 |
4.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$682.50 |
$1,365 |
6.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$620.50 |
$1,241 |
5.8× |
| X-ray humerus (73060) |
$404 |
$808 |
4.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$299 |
$598 |
3.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$210.50 |
$421 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$500 |
$1,000 |
4.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$799 |
$1,598 |
7.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$186 |
$372 |
1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$251.50 |
$503 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$456.50 |
$913 |
5.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$656.50 |
$1,313 |
7.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$673.50 |
$1,347 |
6.3× |
| X-ray thoracic spine 4 vw (72074) |
$139.50 |
$279 |
1.3× |
| X-Rays Bone Length Studies (77073) |
$289.50 |
$579 |
2.7× |
| X-Rays Bone Survey Complete (77075) |
$722 |
$1,444 |
6.8× |
| Xr c-spine 4 or 5 views (72050) |
$850 |
$1,700 |
8.0× |
| Xr facial bones less than 3 views (70140) |
$328 |
$656 |
3.7× |
| Xr orbits complete 4 views (70200) |
$497 |
$994 |
4.7× |