| Abdomen 1 View (74018) |
$205.80 |
$294 |
2.4× |
| Abdomen 2 views (74019) |
$268.80 |
$384 |
2.6× |
| Ankle 2 views (73600) |
$240.80 |
$344 |
2.8× |
| Chest 1 view (71045) |
$195.30 |
$279 |
2.3× |
| Chest 2 views (71046) |
$231.70 |
$331 |
2.7× |
| Chest 3 views (71047) |
$410.20 |
$586 |
4.8× |
| Chest 4 or more views (71048) |
$832.30 |
$1,189 |
8.0× |
| Clavicle complete (73000) |
$232.40 |
$332 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,740.70 |
$8,201 |
16.6× |
| CT abdomen and pelvis without contrast (74176) |
$3,756.90 |
$5,367 |
15.9× |
| CT abdomen w contrast (74160) |
$2,213.40 |
$3,162 |
12.7× |
| CT abdomen w wo contrast (74170) |
$2,450 |
$3,500 |
14.1× |
| CT abdomen w/o contrast (74150) |
$1,311.10 |
$1,873 |
12.7× |
| CT Angio Abdomen and Pelvis (74174) |
$5,740.70 |
$8,201 |
16.6× |
| CT Angio Chest (71275) |
$3,420.90 |
$4,887 |
19.7× |
| CT Angio Head (70496) |
$2,158.10 |
$3,083 |
12.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,888.60 |
$2,698 |
10.9× |
| CT Angio Neck (70498) |
$4,174.80 |
$5,964 |
24.0× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,888.60 |
$2,698 |
10.9× |
| CT cervical spine w/o contrast (72125) |
$2,029.30 |
$2,899 |
19.6× |
| CT chest w contrast (71260) |
$2,097.20 |
$2,996 |
12.1× |
| CT chest w/wo contrast (71270) |
$2,513.70 |
$3,591 |
14.5× |
| CT head/brain with contrast (70460) |
$2,060.10 |
$2,943 |
11.9× |
| CT head/brain without and with contrast (70470) |
$2,312.80 |
$3,304 |
13.3× |
| CT iac w contrast (70481) |
$1,738.10 |
$2,483 |
10.0× |
| CT lower ext w/o (73700) |
$1,282.40 |
$1,832 |
12.4× |
| CT lower extremity w/contrast material (73701) |
$1,953.70 |
$2,791 |
11.3× |
| CT lumbar spine w contrast (72132) |
$2,535.40 |
$3,622 |
7.3× |
| CT lumbar spine w/o contrast (72131) |
$1,649.20 |
$2,356 |
15.9× |
| CT maxillofacial w contrast (70487) |
$1,586.90 |
$2,267 |
9.1× |
| CT maxillofacial wo contrast (70486) |
$987 |
$1,410 |
9.5× |
| CT neck tissue combo (70492) |
$2,237.90 |
$3,197 |
12.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,202.20 |
$3,146 |
12.7× |
| CT orbits w/o contrast (70480) |
$1,253.70 |
$1,791 |
12.1× |
| CT pelvis w&w/o contrast (72194) |
$2,797.20 |
$3,996 |
16.1× |
| CT pelvis w/o contrast (72192) |
$1,549.10 |
$2,213 |
15.0× |
| CT scan of leg combo (73702) |
$2,193.10 |
$3,133 |
12.6× |
| CT scans face/jaw combo (70488) |
$2,095.10 |
$2,993 |
12.1× |
| CT soft tissue neck w contrast (70491) |
$1,552.60 |
$2,218 |
8.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,091.30 |
$1,559 |
10.5× |
| CT thoracic spine w contrast (72129) |
$1,751.40 |
$2,502 |
10.1× |
| CT thoracic spine w/o contrast (72128) |
$1,150.80 |
$1,644 |
11.1× |
| CT thorax w/o contrast (71250) |
$1,365 |
$1,950 |
13.2× |
| CT upper ext wo (73200) |
$1,601.60 |
$2,288 |
15.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,088.80 |
$2,984 |
12.0× |
| CT upper extremity with contrast (73201) |
$1,860.60 |
$2,658 |
5.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,510.20 |
$3,586 |
14.5× |
| Cta Abdomen (74175) |
$3,495.80 |
$4,994 |
20.1× |
| Dxa Bone Density Axial (77080) |
$441 |
$630 |
4.3× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$182.70 |
$261 |
2.1× |
| Esophagram (74220) |
$485.10 |
$693 |
2.8× |
| Foot 2 views (73620) |
$431.20 |
$616 |
5.0× |
| Forearm 2 views (73090) |
$298.90 |
$427 |
3.5× |
| Hand 2 views (73120) |
$280 |
$400 |
2.7× |
| Knee 3 Views (73562) |
$328.30 |
$469 |
3.8× |
| Mr safety determination physician/other qhp (76016) |
$60.90 |
$87 |
0.7× |
| Mr safety implant&/fb assmt clin staf 1st 15 min (76014) |
$17.50 |
$25 |
0.6× |
| Mr safety implt electronics prepj supvj phys/qhp (76018) |
$63.70 |
$91 |
0.7× |
| Mr safety implt pos&/immoblj (76019) |
$41.30 |
$59 |
0.7× |
| Mr safety med physics xm customization plng&mntr (76017) |
$166.60 |
$238 |
0.7× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,236.10 |
$4,623 |
9.4× |
| MRA head w/o contrast (70544) |
$2,113.30 |
$3,019 |
8.9× |
| MRA head with contrast (70545) |
$2,563.40 |
$3,662 |
7.4× |
| MRA neck w contrast (70548) |
$2,564.10 |
$3,663 |
7.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,236.10 |
$4,623 |
9.4× |
| MRA neck w/o contrast (70547) |
$2,307.90 |
$3,297 |
9.8× |
| MRI abdomen w/o contrast (74181) |
$1,601.60 |
$2,288 |
6.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,967.30 |
$4,239 |
8.6× |
| MRI cervical spine w/o cont (72141) |
$2,307.90 |
$3,297 |
9.8× |
| MRI chest wo w contrast (71552) |
$2,338.70 |
$3,341 |
6.8× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,452.10 |
$3,503 |
7.1× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,052 |
$4,360 |
8.8× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,851.50 |
$2,645 |
7.8× |
| MRI lumbar spine w contrast (72149) |
$2,338.70 |
$3,341 |
6.8× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,167.90 |
$3,097 |
6.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,113.30 |
$3,019 |
8.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,236.10 |
$4,623 |
9.4× |
| MRI pelvis w/o & w contrast (72197) |
$4,884.60 |
$6,978 |
14.1× |
| MRI pelvis w/o contrast (72195) |
$2,401 |
$3,430 |
10.2× |
| MRI thoracic spine w/o contrast (72146) |
$1,950.20 |
$2,786 |
8.3× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,639.70 |
$3,771 |
7.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,123.50 |
$1,605 |
4.8× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,535.70 |
$5,051 |
10.2× |
| MRI, abdomen, combo (74183) |
$2,526.30 |
$3,609 |
7.3× |
| MRI, dorsal spine combo (72157) |
$2,516.50 |
$3,595 |
7.3× |
| MRI, joint upper extrem (73221) |
$1,990.10 |
$2,843 |
8.4× |
| MRI, joint upper extrem combo (73223) |
$2,993.90 |
$4,277 |
8.7× |
| MRI, lumbar spine combo (72158) |
$2,738.40 |
$3,912 |
7.9× |
| Neck soft tissue (70360) |
$274.40 |
$392 |
3.2× |
| Pelvis 1 or 2 views (72170) |
$379.40 |
$542 |
3.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$422.80 |
$604 |
4.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$323.40 |
$462 |
3.8× |
| Radex Calcaneus Minimum 2 Views (73650) |
$294 |
$420 |
3.4× |
| Radex elbow complete minimum 3 views (73080) |
$418.60 |
$598 |
4.9× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$531.30 |
$759 |
5.1× |
| Radex fingr minimum 2 views (73140) |
$264.60 |
$378 |
3.1× |
| Radex foot complete minimum 3 views (73630) |
$497 |
$710 |
5.8× |
| Radex Hand Minimum 3 Views (73130) |
$291.90 |
$417 |
3.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$665.70 |
$951 |
7.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$350.70 |
$501 |
4.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$342.30 |
$489 |
4.0× |
| Radex shoulder complete minimum 2 views (73030) |
$249.20 |
$356 |
2.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$242.20 |
$346 |
2.8× |
| Radex Sternum Minimum 2 Views (71120) |
$361.20 |
$516 |
4.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$455.70 |
$651 |
5.3× |
| Radex Toe Minimum 2 Views (73660) |
$263.90 |
$377 |
3.1× |
| Radex upper extremity infant minimum 2 views (73092) |
$631.40 |
$902 |
6.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$320.60 |
$458 |
3.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$466.90 |
$667 |
4.5× |
| Radiologic exam colon double contrast study (74280) |
$910 |
$1,300 |
5.2× |
| Radiologic exam colon single contrast study (74270) |
$578.20 |
$826 |
3.3× |
| Radiologic exam knee complete 4/more views (73564) |
$378 |
$540 |
3.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$627.90 |
$897 |
6.1× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$578.20 |
$826 |
3.3× |
| Radiologic exam upr gi trc double contrast study (74246) |
$706.30 |
$1,009 |
4.1× |
| Radiologic examination femur minimum 2 views (73552) |
$237.30 |
$339 |
2.8× |
| Radiologic examination knee 1/2 views (73560) |
$187.60 |
$268 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$303.80 |
$434 |
3.5× |
| Ribs bilateral 3 views (71110) |
$467.60 |
$668 |
4.5× |
| Scapula (73010) |
$301 |
$430 |
2.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$229.60 |
$328 |
9.8× |
| Shoulder 1 view (73020) |
$217 |
$310 |
2.5× |
| Skull less than 4 views (70250) |
$386.40 |
$552 |
3.7× |
| Sternoclavicular joints (71130) |
$392 |
$560 |
4.6× |
| Tbs techl prep&transmis data alys pfrmd elsewhr (77090) |
$546 |
$780 |
6.3× |
| Thoracic spine 2 views (72070) |
$371.70 |
$531 |
3.6× |
| Thoracic spine 3 views (72072) |
$387.10 |
$553 |
3.7× |
| Thoracolumbar 2 views (72080) |
$410.20 |
$586 |
4.8× |
| Ultrasound Breast Limited (76642) |
$312.20 |
$446 |
3.6× |
| Ultrasound Exam Aaa Screen (76706) |
$97.30 |
$139 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$336.70 |
$481 |
3.3× |
| Upper gi w/o kub (74240) |
$613.20 |
$876 |
3.5× |
| Us chest (76604) |
$333.90 |
$477 |
3.2× |
| Us complete joint (76881) |
$97.30 |
$139 |
0.9× |
| Us exam, pelvic, limited (76857) |
$151.20 |
$216 |
1.5× |
| Us head (76506) |
$333.90 |
$477 |
3.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$605.50 |
$865 |
5.9× |
| Us ob limited 1 or more fetuses (76815) |
$311.50 |
$445 |
3.0× |
| Us ob transvaginal (76817) |
$311.50 |
$445 |
3.0× |
| Us pelvic non ob complete (76856) |
$516.60 |
$738 |
5.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$484.40 |
$692 |
4.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$562.10 |
$803 |
5.4× |
| Us retroperitoneal complete (76770) |
$459.20 |
$656 |
4.4× |
| Us retroperitoneal limited (76775) |
$392.70 |
$561 |
3.8× |
| Us scrotum and contents (76870) |
$334.60 |
$478 |
3.2× |
| Us thyroid (76536) |
$423.50 |
$605 |
4.1× |
| Wrist 2 views (73100) |
$239.40 |
$342 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$627.90 |
$897 |
7.3× |
| X-Ray Bend Only L-S Spine (72120) |
$283.50 |
$405 |
2.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$253.40 |
$362 |
2.9× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$256.20 |
$366 |
3.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$256.20 |
$366 |
2.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$193.90 |
$277 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$289.80 |
$414 |
3.4× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$380.10 |
$543 |
3.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$406.70 |
$581 |
3.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$845.60 |
$1,208 |
8.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$338.80 |
$484 |
3.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$624.40 |
$892 |
6.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$487.20 |
$696 |
4.7× |
| X-ray humerus (73060) |
$341.60 |
$488 |
4.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$409.50 |
$585 |
4.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$343.70 |
$491 |
4.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$396.90 |
$567 |
3.8× |
| X-ray nose-rectum child f.b. (76010) |
$210 |
$300 |
2.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$542.50 |
$775 |
5.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$406.70 |
$581 |
3.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$392 |
$560 |
3.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$372.40 |
$532 |
4.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$410.20 |
$586 |
4.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$471.10 |
$673 |
4.6× |
| X-ray thoracic spine 4 vw (72074) |
$387.10 |
$553 |
3.7× |
| X-Ray Tmj Unilat (70328) |
$416.50 |
$595 |
4.8× |
| X-Rays Bone Survey Complete (77075) |
$632.80 |
$904 |
6.1× |
| Xr c-spine 4 or 5 views (72050) |
$494.20 |
$706 |
4.8× |
| Xr facial bones less than 3 views (70140) |
$310.10 |
$443 |
3.6× |
| Xr orbits complete 4 views (70200) |
$448.70 |
$641 |
4.3× |