| Abdomen 1 View (74018) |
$180.90 |
$270 |
2.3× |
| Abdomen 2 views (74019) |
$225.79 |
$337 |
2.4× |
| Bone age studies (77072) |
$225.79 |
$337 |
2.4× |
| Cat Scan Follow-Up Study (76380) |
$79.23 |
$118.26 |
1.0× |
| Chest 1 view (71045) |
$180.90 |
$270 |
2.3× |
| Chest 2 views (71046) |
$180.90 |
$270 |
2.3× |
| Chest 3 views (71047) |
$180.90 |
$270 |
2.3× |
| Chest 4 or more views (71048) |
$225.79 |
$337 |
2.4× |
| Clavicle complete (73000) |
$180.90 |
$270 |
2.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$225.79 |
$337 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$716.90 |
$1,070 |
2.3× |
| CT abdomen and pelvis without contrast (74176) |
$489.77 |
$731 |
2.3× |
| CT abdomen w contrast (74160) |
$103.67 |
$154.73 |
0.6× |
| CT abdomen w wo contrast (74170) |
$113.79 |
$169.83 |
0.7× |
| CT abdomen w/o contrast (74150) |
$96.51 |
$144.05 |
1.0× |
| CT Angio Abdomen and Pelvis (74174) |
$716.90 |
$1,070 |
2.3× |
| CT Angio Chest (71275) |
$368.50 |
$550 |
2.3× |
| CT Angio Head (70496) |
$368.50 |
$550 |
2.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$360.46 |
$538 |
2.3× |
| CT Angio Neck (70498) |
$368.50 |
$550 |
2.3× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$360.46 |
$538 |
2.3× |
| CT bone density (77078) |
$180.90 |
$270 |
2.3× |
| CT cervical spine w/ contrast (72126) |
$98.89 |
$147.60 |
0.3× |
| CT cervical spine w/o contrast (72125) |
$93.80 |
$140 |
1.0× |
| CT cervical spine w/wo cont (72127) |
$359.79 |
$537 |
2.3× |
| CT chest w contrast (71260) |
$368.50 |
$550 |
2.3× |
| CT chest w/wo contrast (71270) |
$368.50 |
$550 |
2.3× |
| CT head/brain with contrast (70460) |
$360.46 |
$538 |
2.3× |
| CT head/brain without and with contrast (70470) |
$360.46 |
$538 |
2.3× |
| CT heart no contrast quant eval coronry calcium (75571) |
$180.90 |
$270 |
2.3× |
| CT iac w contrast (70481) |
$368.50 |
$550 |
2.3× |
| CT l-spine w&w/o contrast (72133) |
$360.46 |
$538 |
2.3× |
| CT lower ext w/o (73700) |
$225.79 |
$337 |
2.4× |
| CT lower extremity w/contrast material (73701) |
$360.46 |
$538 |
2.3× |
| CT lumbar spine w contrast (72132) |
$716.90 |
$1,070 |
2.3× |
| CT lumbar spine w/o contrast (72131) |
$225.79 |
$337 |
2.4× |
| CT maxillofacial w contrast (70487) |
$360.46 |
$538 |
2.3× |
| CT maxillofacial wo contrast (70486) |
$225.79 |
$337 |
2.4× |
| CT neck tissue combo (70492) |
$157.45 |
$235 |
1.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$368.50 |
$550 |
2.3× |
| CT orbits w/o contrast (70480) |
$225.79 |
$337 |
2.4× |
| CT pelvis w&w/o contrast (72194) |
$98.89 |
$147.60 |
0.6× |
| CT pelvis w/o contrast (72192) |
$225.79 |
$337 |
2.4× |
| CT scan of leg combo (73702) |
$360.46 |
$538 |
2.3× |
| CT scans face/jaw combo (70488) |
$360.46 |
$538 |
2.3× |
| CT soft tissue neck w contrast (70491) |
$137.35 |
$205 |
0.9× |
| CT soft tissue neck w/o contrast (70490) |
$104.26 |
$155.61 |
1.1× |
| CT thoracic spine w contrast (72129) |
$360.46 |
$538 |
2.3× |
| CT thoracic spine w/o contrast (72128) |
$225.79 |
$337 |
2.4× |
| CT thoracic spine w/wo cont (72130) |
$368.50 |
$550 |
2.3× |
| CT thorax w/o contrast (71250) |
$225.79 |
$337 |
2.4× |
| CT upper ext wo (73200) |
$225.79 |
$337 |
2.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$360.46 |
$538 |
2.3× |
| CT upper extremity with contrast (73201) |
$360.46 |
$538 |
1.1× |
| Cta Abdomen (74175) |
$360.46 |
$538 |
2.3× |
| CTA pelvis (72191) |
$368.50 |
$550 |
2.3× |
| Forearm 2 views (73090) |
$180.90 |
$270 |
2.3× |
| Knee 3 Views (73562) |
$180.90 |
$270 |
2.3× |
| Neck soft tissue (70360) |
$180.90 |
$270 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$225.79 |
$337 |
2.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$225.79 |
$337 |
2.4× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$180.90 |
$270 |
2.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$180.90 |
$270 |
2.3× |
| Radex elbow complete minimum 3 views (73080) |
$180.90 |
$270 |
2.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$225.79 |
$337 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$180.90 |
$270 |
2.3× |
| Radex foot complete minimum 3 views (73630) |
$180.90 |
$270 |
2.3× |
| Radex Hand Minimum 3 Views (73130) |
$180.90 |
$270 |
2.3× |
| Radex lower extremity infant minimum 2 views (73592) |
$180.90 |
$270 |
2.3× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$180.90 |
$270 |
2.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$180.90 |
$270 |
2.3× |
| Radex shoulder complete minimum 2 views (73030) |
$180.90 |
$270 |
2.3× |
| Radex Spine 1 View Specify Level (72020) |
$180.90 |
$270 |
2.3× |
| Radex Sternum Minimum 2 Views (71120) |
$180.90 |
$270 |
2.3× |
| Radex Toe Minimum 2 Views (73660) |
$180.90 |
$270 |
2.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$225.79 |
$337 |
2.4× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$180.90 |
$270 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$225.79 |
$337 |
2.4× |
| Radiologic exam knee complete 4/more views (73564) |
$225.79 |
$337 |
2.4× |
| Radiologic examination femur 1 view (73551) |
$180.90 |
$270 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$180.90 |
$270 |
2.3× |
| Radiologic examination knee 1/2 views (73560) |
$180.90 |
$270 |
2.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$180.90 |
$270 |
2.3× |
| Ribs bilateral 3 views (71110) |
$225.79 |
$337 |
2.4× |
| Scapula (73010) |
$225.79 |
$337 |
2.4× |
| Shoulder 1 view (73020) |
$180.90 |
$270 |
2.3× |
| Skull less than 4 views (70250) |
$225.79 |
$337 |
2.4× |
| Sternoclavicular joints (71130) |
$180.90 |
$270 |
2.3× |
| Thoracic spine 2 views (72070) |
$225.79 |
$337 |
2.4× |
| Thoracic spine 3 views (72072) |
$214.40 |
$320 |
2.3× |
| Ultrasound Breast Limited (76642) |
$180.90 |
$270 |
2.3× |
| Ultrasound Exam Aaa Screen (76706) |
$214.40 |
$320 |
2.3× |
| Ultrasound, abdomen limited (76705) |
$221.77 |
$331 |
2.3× |
| Unlisted us procedure (76999) |
$180.90 |
$270 |
2.3× |
| Upper gi w/o kub (74240) |
$360.46 |
$538 |
2.3× |
| Us breast unilateral complete (76641) |
$224.45 |
$335 |
2.4× |
| Us chest (76604) |
$217.75 |
$325 |
2.3× |
| Us complete joint (76881) |
$217.75 |
$325 |
2.3× |
| Us exam, pelvic, limited (76857) |
$214.40 |
$320 |
2.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$214.40 |
$320 |
2.3× |
| Us ob detailed single fetus (76811) |
$522.60 |
$780 |
2.4× |
| Us ob limited 1 or more fetuses (76815) |
$214.40 |
$320 |
2.3× |
| Us ob transvaginal (76817) |
$214.40 |
$320 |
2.3× |
| Us pelvic non ob complete (76856) |
$214.40 |
$320 |
2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$234.50 |
$350 |
2.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$214.40 |
$320 |
2.3× |
Us retroperitoneal complete (76770) range across 2 matching MRF lines |
$214.40–$235.07 |
$320–$350.85 |
varies |
| Us scrotum and contents (76870) |
$225.79 |
$337 |
2.4× |
| Us thyroid (76536) |
$214.40 |
$320 |
2.3× |
| Venography extremity bilateral rs&i (75822) |
$3,232.75 |
$4,825 |
2.3× |
| Venography extremity unilateral rs&i (75820) |
$3,232.75 |
$4,825 |
2.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$180.90 |
$270 |
2.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$180.90 |
$270 |
2.3× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$180.90 |
$270 |
2.3× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$225.79 |
$337 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$180.90 |
$270 |
2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$225.79 |
$337 |
2.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$225.79 |
$337 |
2.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$180.90 |
$270 |
2.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$225.79 |
$337 |
2.4× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$225.79 |
$337 |
2.4× |
| X-ray humerus (73060) |
$180.90 |
$270 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$225.79 |
$337 |
2.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$225.79 |
$337 |
2.4× |
| X-ray nose-rectum child f.b. (76010) |
$180.90 |
$270 |
2.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$225.79 |
$337 |
2.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$225.79 |
$337 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$180.90 |
$270 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$180.90 |
$270 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$225.79 |
$337 |
2.4× |
| X-Ray Tmj Unilat (70328) |
$180.90 |
$270 |
2.3× |
| X-Rays Bone Survey Complete (77075) |
$225.79 |
$337 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$225.79 |
$337 |
2.4× |
| Xr orbits complete 4 views (70200) |
$225.79 |
$337 |
2.4× |