| Abdomen 2 views (74019) |
$54.50 |
$109 |
0.6× |
| Ankle 2 views (73600) |
$50.50 |
$101 |
0.7× |
| Arthrogram shoulder (73040) |
$168.75 |
$337.50 |
0.6× |
| Bone age studies (77072) |
$21.75 |
$43.50 |
0.2× |
| Bone survey complete (77075) |
$144 |
$288 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$456 |
$912 |
6.0× |
| Chest 1 view (71045) |
$60.48 |
$120.96 |
0.8× |
| Clavicle complete (73000) |
$50.50 |
$101 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$92.64 |
$185.28 |
1.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$212.75 |
$425.50 |
0.7× |
| CT abdomen and pelvis without contrast (74176) |
$515.04 |
$1,030.08 |
2.5× |
| CT abdomen w contrast (74160) |
$343 |
$686 |
2.2× |
| CT abdomen w wo contrast (74170) |
$161.50 |
$323 |
1.1× |
| CT abdomen w/o contrast (74150) |
$293.75 |
$587.50 |
3.2× |
| CT c-spine w/o contrast (72125) |
$318.01 |
$636.02 |
3.5× |
| CT cervical spine w&w/o contrast (72127) |
$338.25 |
$676.50 |
2.2× |
| CT cervical spine with contrast (72126) |
$113.50 |
$227 |
0.4× |
| CT chest w/wo contrast (71270) |
$258.50 |
$517 |
1.7× |
| CT chest with contrast (71260) |
$418.50 |
$837 |
2.7× |
| CT head/brain with contrast (70460) |
$44 |
$88 |
0.3× |
| CT head/brain without and with contrast (70470) |
$114.25 |
$228.50 |
0.7× |
| CT iac w contrast (70481) |
$338.25 |
$676.50 |
2.2× |
| CT lower ext w/o (73700) |
$67.50 |
$135 |
0.7× |
| CT lower extremity w wo contrast (73702) |
$338.25 |
$676.50 |
2.2× |
| CT lower extremity with contrast (73701) |
$338.25 |
$676.50 |
2.2× |
| CT lumbar spine w & w/o contrast (72133) |
$338.25 |
$676.50 |
2.2× |
| CT lumbar spine w/o contrast (72131) |
$318.01 |
$636.02 |
3.5× |
| CT lumbar spine with contrast (72132) |
$195.75 |
$391.50 |
0.6× |
| CT maxillofacial w contrast (70487) |
$147.25 |
$294.50 |
1.0× |
| CT maxillofacial w/o contrast (70486) |
$262.15 |
$524.30 |
2.9× |
| CT maxillofacial w/wo contrast (70488) |
$338.25 |
$676.50 |
2.2× |
| CT neck soft tissue w contrast (70491) |
$494.75 |
$989.50 |
3.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$143.25 |
$286.50 |
0.9× |
| CT orbits w/o contrast (70480) |
$186 |
$372 |
2.0× |
| CT pelvis w & w/o contrast (72194) |
$338.25 |
$676.50 |
2.2× |
| CT pelvis w/o contrast (72192) |
$114.25 |
$228.50 |
1.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$258.50 |
$517 |
1.7× |
| CT soft tissue neck w/o contrast (70490) |
$99 |
$198 |
1.1× |
| CT thoracic spine w/contrast (72129) |
$203 |
$406 |
1.3× |
| CT thoracic spine w/o contrast (72128) |
$315 |
$630 |
3.4× |
| CT thoracic spine w/wo contrast (72130) |
$338.25 |
$676.50 |
2.2× |
| CT thorax w/o contrast (71250) |
$162.92 |
$325.85 |
1.8× |
| CT unlisted procedure (76497) |
$258.50 |
$517 |
3.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$338.25 |
$676.50 |
2.2× |
| CT upper extremity w/o contrast rt (73200) |
$103.50 |
$207 |
1.1× |
| CT upper extremity with contrast (73201) |
$168.75 |
$337.50 |
0.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$178.50 |
$357 |
1.2× |
| CTA chest (71275) |
$583.92 |
$1,167.84 |
3.8× |
| Cta Head (70496) |
$403.50 |
$807 |
2.6× |
| Cta Neck (70498) |
$405 |
$810 |
2.6× |
| Cystography minimum 3 views rs&i (74430) |
$19.50 |
$39 |
0.1× |
| Dxa bone density study 1/> sites axial skel (77080) |
$54.50 |
$109 |
0.6× |
| Fetal biophysical profile non-stress testing (76818) |
$144 |
$288 |
1.6× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$82.25 |
$164.50 |
0.9× |
| Fluoroscopy up to 1 hr (76000) |
$84.75 |
$169.50 |
0.4× |
| Foot 2 views (73620) |
$112.25 |
$224.50 |
1.5× |
| Forearm 2 views (73090) |
$321.75 |
$643.50 |
4.2× |
| Hand 2 views (73120) |
$123.50 |
$247 |
1.3× |
| Hand 3 views (73130) |
$361.25 |
$722.50 |
4.7× |
| Humerus Min 2 Views Left (73060) |
$128.75 |
$257.50 |
1.7× |
| Knee 3 views (73562) |
$361.25 |
$722.50 |
4.7× |
| MRA head w/o contrast (70544) |
$473 |
$946 |
2.3× |
| MRA neck w/o contrast (70547) |
$473 |
$946 |
2.3× |
| MRI abdomen w contrast (74182) |
$543.75 |
$1,087.50 |
1.8× |
| MRI abdomen w/o & w/contrast material (74183) |
$543.75 |
$1,087.50 |
1.8× |
| MRI abdomen w/o contrast (74181) |
$525 |
$1,050 |
2.5× |
| MRI any jnt lwr ext with con lt (73722) |
$837.50 |
$1,675 |
1.2× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$837.50 |
$1,675 |
1.2× |
| MRI c-spine with contrast (72142) |
$543.75 |
$1,087.50 |
1.8× |
| MRI cervical spine w/o contrast (72141) |
$630 |
$1,260 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$449.25 |
$898.50 |
2.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$584.50 |
$1,169 |
2.8× |
| MRI pelvis w contrast (72196) |
$543.75 |
$1,087.50 |
1.8× |
| MRI pelvis w/o & w/contrast material (72197) |
$326.25 |
$652.50 |
1.1× |
| MRI pelvis w/o contrast (72195) |
$154 |
$308 |
0.7× |
| MRI scan of arm joint before and after contrast (73223) |
$543.75 |
$1,087.50 |
1.8× |
| MRI scan of leg joint before and after contrast (73723) |
$543.75 |
$1,087.50 |
1.8× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$710.75 |
$1,421.50 |
2.3× |
| MRI spinal canal lumbar w/contrast material (72149) |
$543.75 |
$1,087.50 |
1.8× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$213.25 |
$426.50 |
0.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$543.75 |
$1,087.50 |
1.8× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$214 |
$428 |
0.7× |
| MRI thoracic spine w/o contrast (72146) |
$473 |
$946 |
2.3× |
| MRI upper ext joint w/o contrast (73221) |
$629.75 |
$1,259.50 |
3.0× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$473 |
$946 |
2.3× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$66.25 |
$132.50 |
0.7× |
| Osseous survey limited (77074) |
$144 |
$288 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$54.50 |
$109 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$28.75 |
$57.50 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$108.75 |
$217.50 |
1.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$144 |
$288 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$49.25 |
$98.50 |
0.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$229.92 |
$459.84 |
3.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$198.75 |
$397.50 |
2.6× |
| Radiologic exam colon single contrast study (74270) |
$86.50 |
$173 |
0.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$70 |
$140 |
0.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$50.50 |
$101 |
0.7× |
| Radiological examination surgical specimen (76098) |
$573.25 |
$1,146.50 |
1.2× |
| Sacroiliac Joints < 3 Views (72200) |
$82.25 |
$164.50 |
0.9× |
| Scapula complete (73010) |
$76.50 |
$153 |
0.8× |
| Screening digital breast tomosynthesis (77063) |
$61 |
$122 |
2.6× |
| Sella turcica (70240) |
$76.50 |
$153 |
1.0× |
| Spine thoracic 3 views (72072) |
$295 |
$590 |
3.2× |
| Tmj unilateral (70328) |
$46 |
$92 |
0.6× |
| Ultrasound, abdomen limited (76705) |
$532.75 |
$1,065.50 |
5.8× |
| Unlisted Ultrasound Procedure (76999) |
$22.50 |
$45 |
0.3× |
| Upper Extremity Infant (73092) |
$42.50 |
$85 |
0.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$288.25 |
$576.50 |
1.9× |
| Us breast unilateral complete (76641) |
$467 |
$934 |
5.1× |
| Us chest (76604) |
$82.25 |
$164.50 |
0.9× |
| Us compl joint r-t w/image documentation (76881) |
$45.50 |
$91 |
0.5× |
| Us ob transvaginal (76817) |
$144 |
$288 |
1.6× |
| Us pelvic non ob complete (76856) |
$289.24 |
$578.48 |
3.2× |
| Us pregnancy ltd (76815) |
$49.25 |
$98.50 |
0.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$213.84 |
$427.68 |
2.3× |
| Us retroperitoneal complete (76770) |
$69.25 |
$138.50 |
0.8× |
| Us retroperitoneal limited (76775) |
$54.50 |
$109 |
0.6× |
| Us scrotum and contents (76870) |
$498 |
$996 |
5.4× |
| Us soft tissue head/neck (76536) |
$753.48 |
$1,506.96 |
8.2× |
| Us transrectal (76872) |
$144 |
$288 |
1.6× |
| Venogram extremity bilateral (75822) |
$872.25 |
$1,744.50 |
0.6× |
| Venography extremity unilateral rs&i (75820) |
$872.25 |
$1,744.50 |
0.6× |
| Wrist 2 views (73100) |
$31.75 |
$63.50 |
0.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$82.81 |
$165.62 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$33.75 |
$67.50 |
0.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$334 |
$668 |
4.4× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$144 |
$288 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$139.25 |
$278.50 |
1.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$182.50 |
$365 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$110.64 |
$221.28 |
1.5× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$65.50 |
$131 |
0.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$350.75 |
$701.50 |
4.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$132.25 |
$264.50 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$21.25 |
$42.50 |
0.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$107.75 |
$215.50 |
1.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$40.75 |
$81.50 |
0.5× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$44.75 |
$89.50 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$323 |
$646 |
3.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$314.50 |
$629 |
3.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$21 |
$42 |
0.3× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$28.75 |
$57.50 |
0.4× |
| X-ray of voice box or throat (70370) |
$51.75 |
$103.50 |
0.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$141 |
$282 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$54.50 |
$109 |
0.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$36 |
$72 |
0.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$51.75 |
$103.50 |
0.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$18 |
$36 |
0.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$391.25 |
$782.50 |
5.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$92 |
$184 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$34.50 |
$69 |
0.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$249.25 |
$498.50 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$20.50 |
$41 |
0.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$76.50 |
$153 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$76.50 |
$153 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$76.50 |
$153 |
1.0× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$91.80 |
$183.60 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$34.75 |
$69.50 |
0.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$193 |
$386 |
2.5× |
| Xr c-spine 6 or more views (72052) |
$372.50 |
$745 |
4.1× |
| Xr finger(s) 2+ views (73140) |
$138.25 |
$276.50 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$265 |
$530 |
2.9× |
| Xr tibia/fibula 2 views (73590) |
$129.25 |
$258.50 |
1.7× |
| Xr tmj bilateral (70330) |
$76.50 |
$153 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$154 |
$308 |
2.0× |