| Abdomen 1 View (74018) |
$85.50 |
$114 |
1.0× |
| Abdomen 2 views (74019) |
$105 |
$140 |
1.0× |
| Ankle 2 views (73600) |
$99.75 |
$133 |
1.1× |
| Chest 1 view (71045) |
$78.49 |
$104.65 |
0.9× |
| Chest 2 views (71046) |
$108.67 |
$144.90 |
1.2× |
| Clavicle complete (73000) |
$97.50 |
$130 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$737.25 |
$983 |
6.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,446.05 |
$3,261.40 |
6.9× |
| CT abdomen and pelvis without contrast (74176) |
$996.19 |
$1,328.25 |
4.1× |
| CT abdomen w contrast (74160) |
$1,478.25 |
$1,971 |
8.2× |
| CT abdomen w wo contrast (74170) |
$1,675.50 |
$2,234 |
9.3× |
| CT abdomen w/o contrast (74150) |
$830.25 |
$1,107 |
7.8× |
| CT Angio Abdomen and Pelvis (74174) |
$2,346.75 |
$3,129 |
6.6× |
| CT Angio Chest (71275) |
$1,900.09 |
$2,533.45 |
10.6× |
| CT Angio Head (70496) |
$2,006.17 |
$2,674.90 |
11.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,022.75 |
$2,697 |
11.3× |
| CT Angio Neck (70498) |
$2,009.62 |
$2,679.50 |
11.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,846.50 |
$2,462 |
10.3× |
| CT cervical spine w/ contrast (72126) |
$1,238.25 |
$1,651 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$1,118.66 |
$1,491.55 |
10.5× |
| CT cervical spine w/wo cont (72127) |
$1,536 |
$2,048 |
8.6× |
| CT chest w contrast (71260) |
$1,317.04 |
$1,756.05 |
7.3× |
| CT chest w/wo contrast (71270) |
$1,410.75 |
$1,881 |
7.9× |
| CT head/brain with contrast (70460) |
$843 |
$1,124 |
4.7× |
| CT head/brain without and with contrast (70470) |
$1,050 |
$1,400 |
5.9× |
| CT iac w contrast (70481) |
$1,538.25 |
$2,051 |
8.6× |
| CT l-spine w&w/o contrast (72133) |
$1,528.50 |
$2,038 |
8.5× |
| CT lower ext w/o (73700) |
$965.25 |
$1,287 |
9.0× |
| CT lower extremity w/contrast material (73701) |
$1,248.75 |
$1,665 |
7.0× |
| CT lumbar spine w contrast (72132) |
$1,240.50 |
$1,654 |
3.5× |
| CT lumbar spine w/o contrast (72131) |
$1,110.04 |
$1,480.05 |
10.4× |
| CT maxillofacial w contrast (70487) |
$960.75 |
$1,281 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$901.31 |
$1,201.75 |
8.4× |
| CT neck tissue combo (70492) |
$1,406.25 |
$1,875 |
7.8× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,698 |
$2,264 |
9.5× |
| CT orbits w/o contrast (70480) |
$1,257 |
$1,676 |
11.8× |
| CT pelvis w&w/o contrast (72194) |
$1,681.50 |
$2,242 |
9.4× |
| CT pelvis w/o contrast (72192) |
$857.25 |
$1,143 |
8.0× |
| CT scan of leg combo (73702) |
$1,586.25 |
$2,115 |
8.9× |
| CT scans face/jaw combo (70488) |
$1,200 |
$1,600 |
6.7× |
| CT soft tissue neck w contrast (70491) |
$1,137.75 |
$1,517 |
6.3× |
| CT soft tissue neck w/o contrast (70490) |
$882.75 |
$1,177 |
8.3× |
| CT thoracic spine w contrast (72129) |
$1,248.75 |
$1,665 |
7.0× |
| CT thoracic spine w/o contrast (72128) |
$969.75 |
$1,293 |
9.1× |
| CT thoracic spine w/wo cont (72130) |
$1,538.25 |
$2,051 |
8.6× |
| CT thorax w/o contrast (71250) |
$1,019.47 |
$1,359.30 |
9.5× |
| CT upper ext wo (73200) |
$998.25 |
$1,331 |
9.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,678.50 |
$2,238 |
9.4× |
| CT upper extremity with contrast (73201) |
$1,274.25 |
$1,699 |
3.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,536.50 |
$3,382 |
14.2× |
| Cta Abdomen (74175) |
$1,858.50 |
$2,478 |
10.4× |
| CTA pelvis (72191) |
$1,863 |
$2,484 |
10.4× |
| Dxa Bone Density Axial (77080) |
$195 |
$260 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$199.50 |
$266 |
1.9× |
| Foot 2 views (73620) |
$85.50 |
$114 |
1.0× |
| Forearm 2 views (73090) |
$86.25 |
$115 |
1.0× |
| Hand 2 views (73120) |
$93 |
$124 |
0.9× |
| Joint Survey Single View (77077) |
$123 |
$164 |
1.2× |
| Knee 3 Views (73562) |
$126.75 |
$169 |
1.4× |
| MRA head w/o contrast (70544) |
$2,277 |
$3,036 |
9.3× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,279.25 |
$3,039 |
6.4× |
| MRA neck w/o contrast (70547) |
$1,399.50 |
$1,866 |
5.7× |
| MRI abdomen w/o contrast (74181) |
$1,145.25 |
$1,527 |
4.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,633.25 |
$3,511 |
7.4× |
| MRI cervical spine w/o cont (72141) |
$1,711.20 |
$2,281.60 |
7.0× |
| MRI chest w/o contrast (71550) |
$2,481.75 |
$3,309 |
10.2× |
| MRI chest wo w contrast (71552) |
$3,384 |
$4,512 |
9.5× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,688.75 |
$3,585 |
7.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,038.50 |
$2,718 |
8.4× |
| Mri Neck Spine W/O & W/Dye (72156) |
$2,461.50 |
$3,282 |
6.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$2,571 |
$3,428 |
7.2× |
| MRI pelvis w/o & w contrast (72197) |
$2,688.75 |
$3,585 |
7.5× |
| MRI pelvis w/o contrast (72195) |
$2,071.50 |
$2,762 |
8.5× |
| MRI thoracic spine w/o contrast (72146) |
$1,587.75 |
$2,117 |
6.5× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,175.75 |
$2,901 |
8.9× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$2,842.50 |
$3,790 |
8.0× |
| MRI, dorsal spine combo (72157) |
$2,457.75 |
$3,277 |
6.9× |
| MRI, dorsal spine contrast (72147) |
$1,720.50 |
$2,294 |
4.8× |
| MRI, joint upper extrem (73221) |
$1,845.75 |
$2,461 |
7.6× |
| MRI, joint upper extrem combo (73223) |
$2,604.75 |
$3,473 |
7.3× |
| MRI, lumbar spine combo (72158) |
$2,457.75 |
$3,277 |
6.9× |
| Neck soft tissue (70360) |
$92.25 |
$123 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$97.50 |
$130 |
0.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$139.50 |
$186 |
1.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$114 |
$152 |
1.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$85.50 |
$114 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$95.25 |
$127 |
1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$141 |
$188 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$123.75 |
$165 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$106.50 |
$142 |
1.2× |
| Radex Hand Minimum 3 Views (73130) |
$113.25 |
$151 |
1.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$95.25 |
$127 |
1.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$105 |
$140 |
1.2× |
| Radex shoulder complete minimum 2 views (73030) |
$102 |
$136 |
1.1× |
| Radex Sinuses Paransl < 3 Views (70210) |
$95.25 |
$127 |
1.1× |
| Radex Spine 1 View Specify Level (72020) |
$68.25 |
$91 |
0.8× |
| Radex Sternum Minimum 2 Views (71120) |
$97.50 |
$130 |
1.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$169.50 |
$226 |
1.9× |
| Radex Toe Minimum 2 Views (73660) |
$92.25 |
$123 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$95.25 |
$127 |
0.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$129.75 |
$173 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$128.25 |
$171 |
1.2× |
| Radiologic exam knee complete 4/more views (73564) |
$141.75 |
$189 |
1.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$120.75 |
$161 |
1.1× |
| Radiologic examination femur 1 view (73551) |
$86.25 |
$115 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$107.25 |
$143 |
1.2× |
| Radiologic examination knee 1/2 views (73560) |
$106.50 |
$142 |
1.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$95.25 |
$127 |
1.1× |
| Scapula (73010) |
$92.25 |
$123 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$102 |
$136 |
4.4× |
| Shoulder 1 view (73020) |
$63.75 |
$85 |
0.7× |
| Skull less than 4 views (70250) |
$108.75 |
$145 |
1.0× |
| Sternoclavicular joints (71130) |
$125.25 |
$167 |
1.4× |
| Thoracic spine 2 views (72070) |
$92.25 |
$123 |
0.9× |
| Thoracic spine 3 views (72072) |
$114 |
$152 |
1.1× |
| Ultrasound Breast Limited (76642) |
$222.75 |
$297 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$357 |
$476 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$284.25 |
$379 |
2.7× |
| Us breast unilateral complete (76641) |
$290.25 |
$387 |
2.7× |
| Us chest (76604) |
$159.75 |
$213 |
1.5× |
| Us exam, pelvic, limited (76857) |
$313.50 |
$418 |
2.9× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$135 |
$180 |
1.3× |
| Us ob limited 1 or more fetuses (76815) |
$254.25 |
$339 |
2.4× |
| Us ob transvaginal (76817) |
$243.75 |
$325 |
2.3× |
| Us pelvic non ob complete (76856) |
$333 |
$444 |
3.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$300 |
$400 |
2.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$294.75 |
$393 |
2.8× |
| Us retroperitoneal complete (76770) |
$362.25 |
$483 |
3.4× |
| Us retroperitoneal limited (76775) |
$315.75 |
$421 |
3.0× |
| Us scrotum and contents (76870) |
$336.75 |
$449 |
3.2× |
| Us thyroid (76536) |
$362.25 |
$483 |
3.4× |
| Wrist 2 views (73100) |
$105 |
$140 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$108 |
$144 |
1.2× |
| X-Ray Bend Only L-S Spine (72120) |
$122.25 |
$163 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$85.50 |
$114 |
1.0× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$126.75 |
$169 |
1.4× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$222.75 |
$297 |
2.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$93 |
$124 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$144.75 |
$193 |
1.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$183.75 |
$245 |
1.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$159 |
$212 |
1.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$187.50 |
$250 |
1.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$115.50 |
$154 |
1.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$192.75 |
$257 |
1.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$118.50 |
$158 |
1.1× |
| X-ray eye for foreign body (70030) |
$94.50 |
$126 |
1.1× |
| X-ray humerus (73060) |
$97.50 |
$130 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$130.50 |
$174 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$116.25 |
$155 |
1.1× |
| X-ray nose-rectum child f.b. (76010) |
$85.50 |
$114 |
1.0× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$150.75 |
$201 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$100.50 |
$134 |
0.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$100.50 |
$134 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$95.25 |
$127 |
1.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$109.50 |
$146 |
1.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$126.75 |
$169 |
1.2× |
| X-Ray Tmj Unilat (70328) |
$105 |
$140 |
1.2× |
| Xr c-spine 4 or 5 views (72050) |
$160.50 |
$214 |
1.5× |
| Xr facial bones less than 3 views (70140) |
$90.75 |
$121 |
1.0× |