| Abdomen 1 View (74018) |
$77 |
$154 |
1.0× |
| Abdomen 2 views (74019) |
$83.50 |
$167 |
0.9× |
| Ankle 2 views (73600) |
$81 |
$162 |
1.1× |
| Bone age studies (77072) |
$77 |
$154 |
0.8× |
| Bone survey infant (77076) |
$243.50 |
$487 |
2.7× |
| Chest 1 view (71045) |
$108 |
$216 |
1.4× |
| Chest 2 views (71046) |
$123.50 |
$247 |
1.6× |
| Chest 3 views (71047) |
$158 |
$316 |
2.1× |
| Chest 4 or more views (71048) |
$406.50 |
$813 |
4.4× |
| Clavicle complete (73000) |
$87.50 |
$175 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,493 |
$2,986 |
16.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,875.50 |
$3,751 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,274 |
$2,548 |
6.1× |
| CT abdomen w contrast (74160) |
$931.50 |
$1,863 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,050 |
$2,100 |
6.8× |
| CT abdomen w/o contrast (74150) |
$662 |
$1,324 |
7.2× |
| CT Angio Abdomen and Pelvis (74174) |
$4,166 |
$8,332 |
13.6× |
| CT Angio Chest (71275) |
$1,146.50 |
$2,293 |
7.5× |
| CT Angio Head (70496) |
$2,353.50 |
$4,707 |
15.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,050 |
$2,100 |
6.8× |
| CT Angio Neck (70498) |
$2,513.50 |
$5,027 |
16.4× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,113 |
$2,226 |
7.2× |
| CT cervical spine w/ contrast (72126) |
$1,831.50 |
$3,663 |
6.0× |
| CT cervical spine w/o contrast (72125) |
$813.50 |
$1,627 |
8.9× |
| CT cervical spine w/wo cont (72127) |
$1,952.50 |
$3,905 |
12.7× |
| CT chest w contrast (71260) |
$908 |
$1,816 |
5.9× |
| CT chest w/wo contrast (71270) |
$1,037 |
$2,074 |
6.7× |
| CT head/brain with contrast (70460) |
$715 |
$1,430 |
4.7× |
| CT head/brain without and with contrast (70470) |
$878 |
$1,756 |
5.7× |
| CT iac w contrast (70481) |
$792 |
$1,584 |
5.2× |
| CT l-spine w&w/o contrast (72133) |
$863 |
$1,726 |
5.6× |
| CT lower ext w/o (73700) |
$593 |
$1,186 |
6.5× |
| CT lower extremity w/contrast material (73701) |
$743.50 |
$1,487 |
4.8× |
| CT lumbar spine w contrast (72132) |
$897 |
$1,794 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$768.50 |
$1,537 |
8.4× |
| CT maxillofacial w contrast (70487) |
$710.50 |
$1,421 |
4.6× |
| CT maxillofacial wo contrast (70486) |
$678 |
$1,356 |
7.4× |
| CT neck tissue combo (70492) |
$933.50 |
$1,867 |
6.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$933 |
$1,866 |
6.1× |
| CT orbits w/o contrast (70480) |
$689 |
$1,378 |
7.5× |
| CT pelvis w&w/o contrast (72194) |
$935.50 |
$1,871 |
6.1× |
| CT pelvis w/o contrast (72192) |
$612 |
$1,224 |
6.7× |
| CT scans face/jaw combo (70488) |
$811 |
$1,622 |
5.3× |
| CT soft tissue neck w contrast (70491) |
$777.50 |
$1,555 |
5.1× |
| CT soft tissue neck w/o contrast (70490) |
$675 |
$1,350 |
7.4× |
| CT thoracic spine w contrast (72129) |
$804.50 |
$1,609 |
5.2× |
| CT thoracic spine w/o contrast (72128) |
$732.50 |
$1,465 |
8.0× |
| CT thoracic spine w/wo cont (72130) |
$1,967.50 |
$3,935 |
12.8× |
| CT thorax w/o contrast (71250) |
$750 |
$1,500 |
8.2× |
| CT upper ext wo (73200) |
$593 |
$1,186 |
6.5× |
| CT upper extremity with contrast (73201) |
$743.50 |
$1,487 |
2.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$5,052.50 |
$10,105 |
32.9× |
| Cta Abdomen (74175) |
$2,286 |
$4,572 |
14.9× |
| CTA pelvis (72191) |
$2,073.28 |
$4,146.55 |
13.5× |
| Dxa Bone Density Axial (77080) |
$198 |
$396 |
2.2× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$149.50 |
$299 |
2.0× |
| Esophagram (74220) |
$181 |
$362 |
1.2× |
| Fluoroscopy up to 1 hr (76000) |
$391 |
$782 |
1.9× |
| Foot 2 views (73620) |
$81 |
$162 |
1.1× |
| Forearm 2 views (73090) |
$81 |
$162 |
1.1× |
| Hand 2 views (73120) |
$81 |
$162 |
0.9× |
| Knee 3 Views (73562) |
$159.50 |
$319 |
2.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$2,674 |
$5,348 |
8.7× |
| MRA head w/o contrast (70544) |
$1,096 |
$2,192 |
5.2× |
| MRA head with contrast (70545) |
$1,146 |
$2,292 |
3.7× |
| MRA neck w/o contrast (70547) |
$1,096 |
$2,192 |
5.2× |
| MRI abdomen w/o contrast (74181) |
$1,189.50 |
$2,379 |
5.7× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,384.50 |
$4,769 |
3.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$1,484 |
$2,968 |
4.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,409.50 |
$2,819 |
2.1× |
| MRI brain functional w/o physician admnistration (70554) |
$1,505 |
$3,010 |
7.2× |
| MRI Breast W/O Contrast Bilateral (77047) |
$2,298 |
$4,596 |
11.0× |
| MRI cervical spine w contrast (72142) |
$1,282.50 |
$2,565 |
4.2× |
| MRI cervical spine w/o cont (72141) |
$1,042.50 |
$2,085 |
5.0× |
| MRI chest with contrast (71551) |
$2,179.10 |
$4,358.19 |
3.2× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$1,235.50 |
$2,471 |
4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$943 |
$1,886 |
4.5× |
| MRI lumbar spine w contrast (72149) |
$1,328.50 |
$2,657 |
4.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,502 |
$3,004 |
4.9× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,073.50 |
$2,147 |
5.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,591.50 |
$3,183 |
5.2× |
| MRI pelvis w/o & w contrast (72197) |
$1,484 |
$2,968 |
4.9× |
| MRI pelvis w/o contrast (72195) |
$1,305 |
$2,610 |
6.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,137 |
$2,274 |
5.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$908.50 |
$1,817 |
4.3× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,235.50 |
$2,471 |
4.0× |
| MRI, abdomen, combo (74183) |
$1,484 |
$2,968 |
4.9× |
| MRI, dorsal spine combo (72157) |
$1,567.50 |
$3,135 |
5.1× |
| MRI, dorsal spine contrast (72147) |
$1,398.50 |
$2,797 |
4.6× |
| MRI, joint upper extrem (73221) |
$885 |
$1,770 |
4.2× |
| MRI, joint upper extrem combo (73223) |
$1,484 |
$2,968 |
4.9× |
| MRI, lumbar spine combo (72158) |
$1,502 |
$3,004 |
4.9× |
| Neck soft tissue (70360) |
$81 |
$162 |
1.1× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$236.50 |
$473 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$85 |
$170 |
0.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$125 |
$250 |
1.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$74.50 |
$149 |
1.0× |
| Radex Calcaneus Minimum 2 Views (73650) |
$81 |
$162 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$125 |
$250 |
1.6× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$128 |
$256 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$63.50 |
$127 |
0.8× |
| Radex foot complete minimum 3 views (73630) |
$74.50 |
$149 |
1.0× |
| Radex Hand Minimum 3 Views (73130) |
$74.50 |
$149 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$81 |
$162 |
1.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$148.50 |
$297 |
1.9× |
| Radex shoulder complete minimum 2 views (73030) |
$114 |
$228 |
1.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$131.50 |
$263 |
1.7× |
| Radex Spine 1 View Specify Level (72020) |
$77 |
$154 |
1.0× |
| Radex Sternum Minimum 2 Views (71120) |
$106 |
$212 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$129 |
$258 |
1.7× |
| Radex Toe Minimum 2 Views (73660) |
$81 |
$162 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$112.50 |
$225 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$123 |
$246 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$239 |
$478 |
2.6× |
| Radiologic exam colon double contrast study (74280) |
$305.50 |
$611 |
2.0× |
| Radiologic exam colon single contrast study (74270) |
$218 |
$436 |
1.4× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$197 |
$394 |
1.3× |
| Radiologic exam knee complete 4/more views (73564) |
$105.50 |
$211 |
1.2× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$225 |
$450 |
2.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$164 |
$328 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$234.50 |
$469 |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$197 |
$394 |
1.3× |
| Radiologic examination femur 1 view (73551) |
$218.50 |
$437 |
2.9× |
| Radiologic examination femur minimum 2 views (73552) |
$197 |
$394 |
2.6× |
| Radiologic examination knee 1/2 views (73560) |
$85 |
$170 |
1.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$249 |
$498 |
2.7× |
| Radiologic examination tibia & fibula 2 views (73590) |
$81 |
$162 |
1.1× |
| Ribs bilateral 3 views (71110) |
$145 |
$290 |
1.6× |
| Scapula (73010) |
$222 |
$444 |
2.4× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$35.50 |
$71 |
1.5× |
| Shoulder 1 view (73020) |
$63 |
$126 |
0.8× |
| Skull less than 4 views (70250) |
$91.50 |
$183 |
1.0× |
| Special treatment procedure (77470) |
$1,965 |
$3,930 |
4.1× |
| Sternoclavicular joints (71130) |
$166.50 |
$333 |
2.2× |
| Thoracic spine 2 views (72070) |
$263.50 |
$527 |
2.9× |
| Thoracic spine 3 views (72072) |
$117 |
$234 |
1.3× |
| Thoracolumbar 2 views (72080) |
$638 |
$1,276 |
8.4× |
| Ultrasound Breast Limited (76642) |
$424.50 |
$849 |
5.6× |
| Ultrasound Exam Aaa Screen (76706) |
$239.50 |
$479 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$235 |
$470 |
2.6× |
| Unlisted us procedure (76999) |
$444 |
$888 |
5.8× |
| Upper gi w/o kub (74240) |
$194.50 |
$389 |
1.3× |
| Us breast unilateral complete (76641) |
$207.50 |
$415 |
2.3× |
| Us chest (76604) |
$201.50 |
$403 |
2.2× |
| Us complete joint (76881) |
$248 |
$496 |
2.7× |
| Us exam, pelvic, limited (76857) |
$183.50 |
$367 |
2.0× |
| Us kidney transplant (76776) |
$211.50 |
$423 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$222 |
$444 |
2.4× |
| Us ob limited 1 or more fetuses (76815) |
$404.50 |
$809 |
4.4× |
| Us ob transvaginal (76817) |
$269 |
$538 |
2.9× |
| Us pelvic non ob complete (76856) |
$305.50 |
$611 |
3.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$293 |
$586 |
3.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$395.50 |
$791 |
4.3× |
| Us retroperitoneal complete (76770) |
$207 |
$414 |
2.3× |
| Us retroperitoneal limited (76775) |
$272 |
$544 |
3.0× |
| Us scrotum and contents (76870) |
$245.50 |
$491 |
2.7× |
| Us thyroid (76536) |
$209 |
$418 |
2.3× |
| Wrist 2 views (73100) |
$81 |
$162 |
1.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$95 |
$190 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$156 |
$312 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$81 |
$162 |
1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$103.50 |
$207 |
1.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$103.50 |
$207 |
1.1× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) |
$96 |
$192 |
1.0× |
| X-Ray Exam Hip Uni 1 View (73501) |
$66 |
$132 |
0.9× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$106.50 |
$213 |
1.4× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$280.50 |
$561 |
3.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$250 |
$500 |
2.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$250 |
$500 |
2.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$295.50 |
$591 |
3.2× |
| X-Ray Exam L-S Spine Bending (72114) |
$216.50 |
$433 |
2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$104.50 |
$209 |
1.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$171 |
$342 |
1.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$101.50 |
$203 |
1.1× |
| X-ray humerus (73060) |
$81 |
$162 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$106 |
$212 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$85 |
$170 |
0.9× |
| X-ray nose-rectum child f.b. (76010) |
$164 |
$328 |
2.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$198.50 |
$397 |
2.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$117.50 |
$235 |
1.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$205.50 |
$411 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$101.50 |
$203 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$128 |
$256 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$132 |
$264 |
1.4× |
| X-ray thoracic spine 4 vw (72074) |
$371 |
$742 |
4.0× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$158 |
$316 |
0.5× |
| X-Rays Bone Survey Complete (77075) |
$245.50 |
$491 |
2.7× |
| Xr c-spine 4 or 5 views (72050) |
$138.50 |
$277 |
1.5× |
| Xr facial bones less than 3 views (70140) |
$160 |
$320 |
2.1× |
| Xr orbits complete 4 views (70200) |
$117 |
$234 |
1.3× |