| Abdomen 1 View (74018) |
$175 |
$175 |
2.0× |
| Abdomen 2 views (74019) |
$225 |
$225 |
2.1× |
| Ankle 2 views (73600) |
$200 |
$200 |
2.2× |
| Cat Scan Follow-Up Study (76380) |
$675 |
$675 |
7.6× |
| Chest 1 view (71045) |
$126 |
$126 |
1.4× |
| Chest 2 views (71046) |
$184 |
$184 |
2.1× |
| Clavicle complete (73000) |
$176 |
$176 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$450 |
$450 |
4.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,350 |
$3,350 |
9.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,291 |
$2,291 |
9.4× |
| CT abdomen w contrast (74160) |
$1,680 |
$1,680 |
9.4× |
| CT abdomen w wo contrast (74170) |
$2,016 |
$2,016 |
11.3× |
| CT abdomen w/o contrast (74150) |
$1,400 |
$1,400 |
13.1× |
| CT Angio Abdomen and Pelvis (74174) |
$3,400 |
$3,400 |
9.5× |
| CT Angio Chest (71275) |
$2,420 |
$2,420 |
13.5× |
| CT Angio Head (70496) |
$2,017 |
$2,017 |
11.3× |
| CT Angio Neck (70498) |
$2,195 |
$2,195 |
12.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,900 |
$1,900 |
10.6× |
| CT bone density (77078) |
$350 |
$350 |
3.9× |
| CT cervical spine w/ contrast (72126) |
$1,680 |
$1,680 |
4.7× |
| CT cervical spine w/o contrast (72125) |
$1,400 |
$1,400 |
13.1× |
| CT cervical spine w/wo cont (72127) |
$2,016 |
$2,016 |
11.3× |
| CT chest w contrast (71260) |
$1,560 |
$1,560 |
8.7× |
| CT chest w/wo contrast (71270) |
$1,872 |
$1,872 |
10.4× |
| CT head/brain with contrast (70460) |
$1,560 |
$1,560 |
8.7× |
| CT head/brain without and with contrast (70470) |
$1,872 |
$1,872 |
10.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$150 |
$150 |
1.7× |
| CT iac w contrast (70481) |
$1,800 |
$1,800 |
10.0× |
| CT l-spine w&w/o contrast (72133) |
$2,304 |
$2,304 |
12.9× |
| CT lower ext w/o (73700) |
$1,400 |
$1,400 |
13.1× |
| CT lower extremity w/contrast material (73701) |
$1,680 |
$1,680 |
9.4× |
| CT lumbar spine w contrast (72132) |
$1,920 |
$1,920 |
5.4× |
| CT lumbar spine w/o contrast (72131) |
$1,600 |
$1,600 |
15.0× |
| CT maxillofacial w contrast (70487) |
$1,560 |
$1,560 |
8.7× |
| CT maxillofacial wo contrast (70486) |
$1,300 |
$1,300 |
12.2× |
| CT neck tissue combo (70492) |
$2,016 |
$2,016 |
11.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,160 |
$2,160 |
12.1× |
| CT orbits w/o contrast (70480) |
$1,500 |
$1,500 |
14.0× |
| CT pelvis w&w/o contrast (72194) |
$1,872 |
$1,872 |
10.4× |
| CT pelvis w/o contrast (72192) |
$1,300 |
$1,300 |
12.2× |
| CT scan of leg combo (73702) |
$2,016 |
$2,016 |
11.3× |
| CT scans face/jaw combo (70488) |
$1,872 |
$1,872 |
10.4× |
| CT soft tissue neck w contrast (70491) |
$1,680 |
$1,680 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,400 |
$1,400 |
13.1× |
| CT thoracic spine w contrast (72129) |
$1,680 |
$1,680 |
9.4× |
| CT thoracic spine w/o contrast (72128) |
$1,400 |
$1,400 |
13.1× |
| CT thoracic spine w/wo cont (72130) |
$2,016 |
$2,016 |
11.3× |
| CT thorax w/o contrast (71250) |
$1,300 |
$1,300 |
12.2× |
| CT upper ext wo (73200) |
$1,300 |
$1,300 |
12.2× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,872 |
$1,872 |
10.4× |
| CT upper extremity with contrast (73201) |
$1,560 |
$1,560 |
4.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,871 |
$1,871 |
10.4× |
| Cta Abdomen (74175) |
$2,300 |
$2,300 |
12.8× |
| CTA pelvis (72191) |
$1,800 |
$1,800 |
10.0× |
| Dxa Bone Density Axial (77080) |
$290 |
$290 |
2.7× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$216 |
$216 |
2.4× |
| Echo exam uterus (76831) |
$496.65 |
$496.65 |
2.0× |
| Fetal Biophys Profile W/Nst (76818) |
$486 |
$486 |
4.6× |
| Foot 2 views (73620) |
$175 |
$175 |
2.0× |
| Forearm 2 views (73090) |
$264 |
$264 |
3.0× |
| Hand 2 views (73120) |
$188 |
$188 |
1.8× |
| Knee 3 Views (73562) |
$262 |
$262 |
2.9× |
| Magnetic Image Jaw Joint (70336) |
$2,100 |
$2,100 |
8.6× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,312 |
$3,312 |
9.3× |
| MRA head w/o contrast (70544) |
$2,300 |
$2,300 |
9.4× |
| MRA head with contrast (70545) |
$2,760 |
$2,760 |
7.7× |
| MRA neck w contrast (70548) |
$2,580 |
$2,580 |
7.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,096 |
$3,096 |
8.7× |
| MRA neck w/o contrast (70547) |
$2,150 |
$2,150 |
8.8× |
| MRI abdomen w contrast (74182) |
$2,760 |
$2,760 |
7.7× |
| MRI abdomen w/o contrast (74181) |
$2,300 |
$2,300 |
9.4× |
MRI any jt lower extrem w/contrast material (73722) range across 2 matching MRF lines |
$2,760–$3,312 |
$2,760–$3,312 |
varies |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,312 |
$3,312 |
9.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$2,760 |
$2,760 |
3.4× |
| MRI cervical spine w contrast (72142) |
$2,754 |
$2,754 |
7.7× |
| MRI cervical spine w/o cont (72141) |
$2,295 |
$2,295 |
9.4× |
| MRI chest w/o contrast (71550) |
$2,275 |
$2,275 |
9.3× |
| MRI chest with contrast (71551) |
$2,730 |
$2,730 |
3.4× |
| MRI chest wo w contrast (71552) |
$3,276 |
$3,276 |
9.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,760 |
$2,760 |
7.7× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,312 |
$3,312 |
9.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,300 |
$2,300 |
9.4× |
| MRI lumbar spine w contrast (72149) |
$2,754 |
$2,754 |
7.7× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,305 |
$3,305 |
9.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,300 |
$2,300 |
9.4× |
| MRI orbit face neck w contrast (70542) |
$2,760 |
$2,760 |
7.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,312 |
$3,312 |
9.3× |
| MRI pelvis w contrast (72196) |
$2,760 |
$2,760 |
7.7× |
| MRI pelvis w/o & w contrast (72197) |
$3,312 |
$3,312 |
9.3× |
| MRI pelvis w/o contrast (72195) |
$2,300 |
$2,300 |
9.4× |
| MRI thoracic spine w/o contrast (72146) |
$2,187 |
$2,187 |
9.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,760 |
$2,760 |
7.7× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,300 |
$2,300 |
9.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,312 |
$3,312 |
9.3× |
| MRI, abdomen, combo (74183) |
$3,312 |
$3,312 |
9.3× |
| MRI, dorsal spine combo (72157) |
$3,250 |
$3,250 |
9.1× |
| MRI, dorsal spine contrast (72147) |
$2,624 |
$2,624 |
7.4× |
| MRI, joint upper extrem (73221) |
$2,300 |
$2,300 |
9.4× |
| MRI, joint upper extrem combo (73223) |
$3,312 |
$3,312 |
9.3× |
| MRI, lumbar spine combo (72158) |
$3,305 |
$3,305 |
9.3× |
| Neck soft tissue (70360) |
$225 |
$225 |
2.5× |
| Pelvis 1 or 2 views (72170) |
$220 |
$220 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$400 |
$400 |
3.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$225 |
$225 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$200 |
$200 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$266 |
$266 |
3.0× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$350 |
$350 |
3.3× |
| Radex fingr minimum 2 views (73140) |
$125 |
$125 |
1.4× |
| Radex foot complete minimum 3 views (73630) |
$215 |
$215 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$224 |
$224 |
2.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$250 |
$250 |
2.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$202 |
$202 |
2.3× |
| Radex shoulder complete minimum 2 views (73030) |
$195 |
$195 |
2.2× |
| Radex Spine 1 View Specify Level (72020) |
$200 |
$200 |
2.2× |
| Radex Toe Minimum 2 Views (73660) |
$172 |
$172 |
1.9× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$227 |
$227 |
2.6× |
| Radiologic exam knee complete 4/more views (73564) |
$305 |
$305 |
2.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$320 |
$320 |
3.0× |
| Radiologic examination femur minimum 2 views (73552) |
$200 |
$200 |
2.2× |
| Radiologic examination knee 1/2 views (73560) |
$200 |
$200 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$200 |
$200 |
2.2× |
| Ribs bilateral 3 views (71110) |
$325 |
$325 |
3.0× |
| Scapula (73010) |
$200 |
$200 |
1.9× |
| Shoulder 1 view (73020) |
$154 |
$154 |
1.7× |
| Skull less than 4 views (70250) |
$275 |
$275 |
2.6× |
| Thoracic spine 2 views (72070) |
$251 |
$251 |
2.3× |
| Thoracic spine 3 views (72072) |
$368 |
$368 |
3.4× |
| Thoracolumbar 2 views (72080) |
$275 |
$275 |
3.1× |
| Ultrasound, abdomen limited (76705) |
$424 |
$424 |
4.0× |
| Us breast unilateral complete (76641) |
$427 |
$427 |
4.0× |
| Us complete joint (76881) |
$351.75 |
$351.75 |
3.3× |
| Us exam, pelvic, limited (76857) |
$338 |
$338 |
3.2× |
| Us ob limited 1 or more fetuses (76815) |
$335 |
$335 |
3.1× |
| Us ob transvaginal (76817) |
$387 |
$387 |
3.6× |
| Us pelvic non ob complete (76856) |
$510 |
$510 |
4.8× |
| Us retroperitoneal complete (76770) |
$450 |
$450 |
4.2× |
| Us retroperitoneal limited (76775) |
$385 |
$385 |
3.6× |
| Us scrotum and contents (76870) |
$1,213 |
$1,213 |
11.4× |
| Us thyroid (76536) |
$368 |
$368 |
3.4× |
| Wrist 2 views (73100) |
$175 |
$175 |
2.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$250 |
$250 |
2.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$172 |
$172 |
1.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$195 |
$195 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$235 |
$235 |
2.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$350 |
$350 |
3.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$275 |
$275 |
3.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$475 |
$475 |
4.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$325 |
$325 |
3.0× |
| X-ray humerus (73060) |
$223 |
$223 |
2.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$250 |
$250 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$225 |
$225 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$250 |
$250 |
2.3× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$117.60 |
$117.60 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$290 |
$290 |
3.3× |
| X-Rays Bone Length Studies (77073) |
$600 |
$600 |
5.6× |
| Xr c-spine 4 or 5 views (72050) |
$375 |
$375 |
3.5× |
| Xr orbits complete 4 views (70200) |
$325 |
$325 |
3.0× |