| Abdomen 1 View (74018) |
$10 |
$410 |
0.1× |
| Abdomen 2 views (74019) |
$10 |
$521 |
0.1× |
| Ankle 2 views (73600) |
$10 |
$328 |
0.1× |
| Chest 1 view (71045) |
$10 |
$482 |
0.1× |
| Chest 2 views (71046) |
$10 |
$482 |
0.1× |
| Clavicle complete (73000) |
$10 |
$307 |
0.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$10 |
$2,634 |
0.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$10 |
$4,921 |
0.0× |
| CT abdomen and pelvis without contrast (74176) |
$10 |
$3,878 |
0.0× |
| CT abdomen w wo contrast (74170) |
$10 |
$3,421 |
0.1× |
| CT Angio Abdomen and Pelvis (74174) |
$10 |
$5,405 |
0.0× |
| CT Angio Chest (71275) |
$10 |
$2,634 |
0.1× |
| CT Angio Head (70496) |
$10 |
$3,038 |
0.1× |
| CT Angio Neck (70498) |
$10 |
$3,038 |
0.1× |
| CT cervical spine w/o contrast (72125) |
$10 |
$2,771 |
0.1× |
| CT chest w contrast (71260) |
$10 |
$2,970 |
0.1× |
| CT head/brain with contrast (70460) |
$10 |
$2,587 |
0.1× |
| CT head/brain without and with contrast (70470) |
$10 |
$3,038 |
0.1× |
| CT lower ext w/o (73700) |
$10 |
$2,867 |
0.1× |
| CT lumbar spine w/o contrast (72131) |
$10 |
$3,609 |
0.1× |
| CT maxillofacial wo contrast (70486) |
$10 |
$2,601 |
0.1× |
| CT pelvis w/o contrast (72192) |
$10 |
$2,569 |
0.1× |
| CT soft tissue neck w contrast (70491) |
$10 |
$3,909 |
0.1× |
| CT soft tissue neck w/o contrast (70490) |
$10 |
$2,377 |
0.1× |
| CT thoracic spine w/o contrast (72128) |
$10 |
$2,377 |
0.1× |
| CT thorax w/o contrast (71250) |
$10 |
$2,634 |
0.1× |
| Dxa Bone Density Axial (77080) |
$10 |
$990 |
0.1× |
| Foot 2 views (73620) |
$10 |
$410 |
0.1× |
| Forearm 2 views (73090) |
$10 |
$327 |
0.1× |
| Hand 2 views (73120) |
$10 |
$373 |
0.1× |
| Hepatobil Syst Image W/Drug (78227) |
$10 |
$2,144 |
0.0× |
| Hepatobiliary System Imaging (78226) |
$10 |
$2,144 |
0.0× |
| Knee 3 Views (73562) |
$10 |
$479 |
0.1× |
| MRI abdomen w/o contrast (74181) |
$10 |
$5,017 |
0.0× |
| MRI cervical spine w/o cont (72141) |
$10 |
$5,017 |
0.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$10 |
$6,082 |
0.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$10 |
$5,017 |
0.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$10 |
$5,017 |
0.0× |
| MRI, abdomen, combo (74183) |
$10 |
$6,082 |
0.0× |
| MRI, joint upper extrem (73221) |
$10 |
$5,017 |
0.0× |
| MRI, lumbar spine combo (72158) |
$10 |
$6,082 |
0.0× |
| Pelvis 1 or 2 views (72170) |
$10 |
$390 |
0.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$10 |
$456 |
0.1× |
| Radex elbow complete minimum 3 views (73080) |
$10 |
$479 |
0.1× |
| Radex fingr minimum 2 views (73140) |
$10 |
$400 |
0.1× |
| Radex foot complete minimum 3 views (73630) |
$10 |
$459 |
0.1× |
| Radex Hand Minimum 3 Views (73130) |
$10 |
$459 |
0.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$10 |
$485 |
0.1× |
| Radex shoulder complete minimum 2 views (73030) |
$10 |
$475 |
0.1× |
| Radex Toe Minimum 2 Views (73660) |
$10 |
$479 |
0.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$10 |
$459 |
0.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$10 |
$459 |
0.1× |
| Radiologic examination femur minimum 2 views (73552) |
$10 |
$469 |
0.1× |
| Radiologic examination knee 1/2 views (73560) |
$10 |
$433 |
0.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$10 |
$479 |
0.1× |
| Scapula (73010) |
$10 |
$469 |
0.1× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$10 |
$328 |
0.4× |
| Shoulder 1 view (73020) |
$10 |
$307 |
0.1× |
| Thoracic spine 2 views (72070) |
$10 |
$479 |
0.1× |
| Thoracic spine 3 views (72072) |
$10 |
$605 |
0.1× |
| Ultrasound Exam Aaa Screen (76706) |
$10 |
$1,042 |
0.1× |
| Ultrasound, abdomen limited (76705) |
$10 |
$1,074 |
0.1× |
| Us chest (76604) |
$10 |
$902 |
0.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$10 |
$902 |
0.1× |
| Us ob transvaginal (76817) |
$10 |
$1,002 |
0.1× |
| Us pelvic non ob complete (76856) |
$10 |
$990 |
0.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$10 |
$1,002 |
0.1× |
| Us retroperitoneal complete (76770) |
$10 |
$1,206 |
0.1× |
| Us retroperitoneal limited (76775) |
$10 |
$1,042 |
0.1× |
| Us scrotum and contents (76870) |
$10 |
$1,005 |
0.1× |
| Us thyroid (76536) |
$10 |
$1,032 |
0.1× |
| Wrist 2 views (73100) |
$10 |
$327 |
0.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$10 |
$479 |
0.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$10 |
$312 |
0.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$10 |
$479 |
0.1× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$10 |
$531 |
0.1× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$10 |
$636 |
0.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$10 |
$954 |
0.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$10 |
$521 |
0.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$10 |
$485 |
0.1× |
| X-ray eye for foreign body (70030) |
$10 |
$312 |
0.1× |
| X-ray humerus (73060) |
$10 |
$469 |
0.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$10 |
$504 |
0.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$10 |
$469 |
0.1× |
| Xr c-spine 4 or 5 views (72050) |
$10 |
$693 |
0.1× |
| Xr orbits complete 4 views (70200) |
$10 |
$327 |
0.1× |