| Abdomen 1 View (74018) |
$167.40 |
$279 |
2.1× |
| Abdomen 2 views (74019) |
$299.40 |
$499 |
3.1× |
| Ankle 2 views (73600) |
$195 |
$325 |
2.4× |
| Arthrogram hip (73525) |
$648 |
$1,080 |
2.0× |
| Bone age studies (77072) |
$150 |
$250 |
1.6× |
| Chest 1 view (71045) |
$180 |
$300 |
2.2× |
| Chest 2 views (71046) |
$225 |
$375 |
2.8× |
| Chest 3 views (71047) |
$255 |
$425 |
3.2× |
| Chest 4 or more views (71048) |
$306 |
$510 |
3.2× |
| Clavicle complete (73000) |
$195 |
$325 |
2.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$540 |
$900 |
5.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,244.80 |
$5,408 |
10.1× |
| CT abdomen and pelvis without contrast (74176) |
$2,700 |
$4,500 |
12.3× |
| CT abdomen w contrast (74160) |
$1,500 |
$2,500 |
9.3× |
| CT abdomen w wo contrast (74170) |
$1,650 |
$2,750 |
10.2× |
| CT abdomen w/o contrast (74150) |
$1,380 |
$2,300 |
14.4× |
| CT Angio Abdomen and Pelvis (74174) |
$2,370 |
$3,950 |
7.4× |
| CT Angio Chest (71275) |
$1,743 |
$2,905 |
10.8× |
| CT Angio Head (70496) |
$1,620 |
$2,700 |
10.0× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,770 |
$2,950 |
11.0× |
| CT Angio Neck (70498) |
$1,590 |
$2,650 |
9.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,380 |
$2,300 |
8.6× |
| CT cervical spine w/o contrast (72125) |
$1,380 |
$2,300 |
14.4× |
| CT chest w contrast (71260) |
$1,500 |
$2,500 |
9.3× |
| CT chest w/wo contrast (71270) |
$1,650 |
$2,750 |
10.2× |
| CT head/brain with contrast (70460) |
$1,500 |
$2,500 |
9.3× |
| CT head/brain without and with contrast (70470) |
$1,800 |
$3,000 |
11.2× |
| CT lower ext w/o (73700) |
$1,380 |
$2,300 |
14.4× |
| CT lower extremity w/contrast material (73701) |
$1,500 |
$2,500 |
9.3× |
| CT lumbar spine w contrast (72132) |
$1,500 |
$2,500 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$1,459.80 |
$2,433 |
15.2× |
| CT maxillofacial w contrast (70487) |
$1,500 |
$2,500 |
9.3× |
| CT maxillofacial wo contrast (70486) |
$1,380 |
$2,300 |
14.4× |
| CT neck tissue combo (70492) |
$1,722.60 |
$2,871 |
10.7× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,800 |
$3,000 |
11.2× |
| CT orbits w/o contrast (70480) |
$1,380 |
$2,300 |
14.4× |
| CT pelvis w/o contrast (72192) |
$1,380 |
$2,300 |
14.4× |
| CT scans face/jaw combo (70488) |
$1,800 |
$3,000 |
11.2× |
| CT soft tissue neck w contrast (70491) |
$1,500 |
$2,500 |
9.3× |
| CT soft tissue neck w/o contrast (70490) |
$1,380 |
$2,300 |
14.4× |
| CT thoracic spine w contrast (72129) |
$1,500 |
$2,500 |
9.3× |
| CT thoracic spine w/o contrast (72128) |
$1,380 |
$2,300 |
14.4× |
| CT thorax w/o contrast (71250) |
$1,380 |
$2,300 |
14.4× |
| CT upper ext wo (73200) |
$1,380 |
$2,300 |
14.4× |
| CT upper extremity with contrast (73201) |
$1,500 |
$2,500 |
4.7× |
| Cta Abdomen (74175) |
$1,710 |
$2,850 |
10.6× |
| Dxa Bone Density Axial (77080) |
$300 |
$500 |
3.1× |
| Esophagram (74220) |
$364.80 |
$608 |
2.3× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$315 |
$525 |
3.3× |
| Fluoroscopy up to 1 hr (76000) |
$310.80 |
$518 |
1.4× |
| Foot 2 views (73620) |
$210 |
$350 |
2.6× |
| Forearm 2 views (73090) |
$187.80 |
$313 |
2.3× |
| Hand 2 views (73120) |
$180 |
$300 |
1.9× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$454.20 |
$757 |
5.7× |
| Knee 3 Views (73562) |
$240 |
$400 |
3.0× |
| MRA head w/o contrast (70544) |
$1,587 |
$2,645 |
7.2× |
| MRA neck w/o contrast (70547) |
$1,656 |
$2,760 |
7.5× |
| MRI abdomen w contrast (74182) |
$1,800 |
$3,000 |
5.6× |
| MRI abdomen w/o contrast (74181) |
$1,717.80 |
$2,863 |
7.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,160 |
$3,600 |
6.7× |
| MRI cervical spine w/o cont (72141) |
$1,950 |
$3,250 |
8.9× |
| MRI chest w/o contrast (71550) |
$1,950 |
$3,250 |
8.9× |
| MRI chest wo w contrast (71552) |
$2,860.20 |
$4,767 |
8.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,070 |
$3,450 |
6.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,980 |
$3,300 |
9.0× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,250 |
$3,750 |
7.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,980 |
$3,300 |
9.0× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,415 |
$4,025 |
7.5× |
| MRI pelvis w contrast (72196) |
$1,800 |
$3,000 |
5.6× |
| MRI pelvis w/o & w contrast (72197) |
$2,332.20 |
$3,887 |
7.3× |
| MRI pelvis w/o contrast (72195) |
$1,980 |
$3,300 |
9.0× |
| MRI thoracic spine w/o contrast (72146) |
$1,980 |
$3,300 |
9.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,980 |
$3,300 |
9.0× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$1,980 |
$3,300 |
6.2× |
| MRI, abdomen, combo (74183) |
$2,100 |
$3,500 |
6.5× |
| MRI, dorsal spine combo (72157) |
$2,250 |
$3,750 |
7.0× |
| MRI, dorsal spine contrast (72147) |
$1,800 |
$3,000 |
5.6× |
| MRI, joint upper extrem (73221) |
$1,980 |
$3,300 |
9.0× |
| MRI, joint upper extrem combo (73223) |
$2,188.80 |
$3,648 |
6.8× |
| MRI, lumbar spine combo (72158) |
$2,280 |
$3,800 |
7.1× |
| Neck soft tissue (70360) |
$165.60 |
$276 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$190.20 |
$317 |
2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$361.20 |
$602 |
3.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$212.40 |
$354 |
2.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$172.80 |
$288 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$270 |
$450 |
3.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$244.80 |
$408 |
2.5× |
| Radex fingr minimum 2 views (73140) |
$180 |
$300 |
2.2× |
| Radex foot complete minimum 3 views (73630) |
$208.80 |
$348 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$210 |
$350 |
2.6× |
| Radex lower extremity infant minimum 2 views (73592) |
$150 |
$250 |
1.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$204.60 |
$341 |
2.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$202.20 |
$337 |
2.5× |
| Radex shoulder complete minimum 2 views (73030) |
$240 |
$400 |
3.0× |
| Radex Spine 1 View Specify Level (72020) |
$124.20 |
$207 |
1.6× |
| Radex Sternum Minimum 2 Views (71120) |
$180 |
$300 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$174.60 |
$291 |
2.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$180 |
$300 |
1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$210 |
$350 |
2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$252 |
$420 |
2.6× |
| Radiologic exam colon double contrast study (74280) |
$1,048.80 |
$1,748 |
6.5× |
| Radiologic exam colon single contrast study (74270) |
$988.80 |
$1,648 |
6.1× |
| Radiologic exam knee complete 4/more views (73564) |
$270 |
$450 |
2.8× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$252 |
$420 |
2.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$480 |
$800 |
3.0× |
| Radiologic exam upr gi trc double contrast study (74246) |
$607.80 |
$1,013 |
3.8× |
| Radiologic examination femur 1 view (73551) |
$150 |
$250 |
1.9× |
| Radiologic examination femur minimum 2 views (73552) |
$240 |
$400 |
3.0× |
| Radiologic examination knee 1/2 views (73560) |
$210 |
$350 |
2.6× |
| Radiologic Examination Osseous Survey Limited (77074) |
$445.20 |
$742 |
4.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$189.60 |
$316 |
2.4× |
| Scapula (73010) |
$180 |
$300 |
1.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$67.20 |
$112 |
2.9× |
| Shoulder 1 view (73020) |
$180 |
$300 |
2.2× |
| Skull less than 4 views (70250) |
$196.80 |
$328 |
2.0× |
| Thoracic spine 2 views (72070) |
$231 |
$385 |
2.4× |
| Thoracic spine 3 views (72072) |
$286.80 |
$478 |
3.0× |
| Ultrasound Breast Limited (76642) |
$300 |
$500 |
3.7× |
| Ultrasound Exam Aaa Screen (76706) |
$366 |
$610 |
3.8× |
| Ultrasound, abdomen limited (76705) |
$375 |
$625 |
3.9× |
| Upper gi w/o kub (74240) |
$479.40 |
$799 |
3.0× |
| Us breast unilateral complete (76641) |
$300 |
$500 |
3.1× |
| Us chest (76604) |
$365.40 |
$609 |
3.8× |
| Us complete joint (76881) |
$408 |
$680 |
4.2× |
| Us exam, pelvic, limited (76857) |
$276 |
$460 |
2.9× |
| Us head (76506) |
$432 |
$720 |
4.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$408 |
$680 |
4.2× |
| Us ob limited 1 or more fetuses (76815) |
$315 |
$525 |
3.3× |
| Us ob transvaginal (76817) |
$244.80 |
$408 |
2.5× |
| Us pelvic non ob complete (76856) |
$468.60 |
$781 |
4.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$408 |
$680 |
4.2× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$315 |
$525 |
3.3× |
| Us retroperitoneal complete (76770) |
$480 |
$800 |
5.0× |
| Us retroperitoneal limited (76775) |
$366 |
$610 |
3.8× |
| Us scrotum and contents (76870) |
$465 |
$775 |
4.8× |
| Us thyroid (76536) |
$534.60 |
$891 |
5.6× |
| Wrist 2 views (73100) |
$175.20 |
$292 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$252 |
$420 |
3.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$180 |
$300 |
2.2× |
| X-Ray Exam Breast Specimen (76098) |
$339 |
$565 |
0.7× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$210 |
$350 |
2.6× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$420 |
$700 |
4.4× |
| X-Ray Exam Hip Uni 1 View (73501) |
$180 |
$300 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$240 |
$400 |
3.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$291 |
$485 |
3.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$371.40 |
$619 |
3.9× |
| X-Ray Exam L-S Spine Bending (72114) |
$531.60 |
$886 |
5.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$270 |
$450 |
3.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$378 |
$630 |
3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$241.80 |
$403 |
2.5× |
| X-ray humerus (73060) |
$225 |
$375 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$240 |
$400 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$270 |
$450 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$310.80 |
$518 |
3.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$224.40 |
$374 |
2.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$213.60 |
$356 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$303 |
$505 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$257.40 |
$429 |
2.7× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$480 |
$800 |
1.5× |
| Xr c-spine 4 or 5 views (72050) |
$360 |
$600 |
3.7× |
| Xr orbits complete 4 views (70200) |
$216 |
$360 |
2.2× |