| Abdomen 1 View (74018) |
$100.10 |
$143 |
1.1× |
| Abdomen 2 views (74019) |
$122.50 |
$175 |
1.2× |
| Chest 1 view (71045) |
$81.90 |
$117 |
0.9× |
| Chest 2 views (71046) |
$109.20 |
$156 |
1.2× |
| Clavicle complete (73000) |
$114.10 |
$163 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,436.40 |
$2,052 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,003.10 |
$1,433 |
4.2× |
| CT abdomen w wo contrast (74170) |
$1,120.70 |
$1,601 |
6.4× |
| CT abdomen w/o contrast (74150) |
$480.20 |
$686 |
4.6× |
| CT Angio Chest (71275) |
$1,137.50 |
$1,625 |
6.5× |
| CT Angio Head (70496) |
$1,122.10 |
$1,603 |
6.4× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,403.50 |
$2,005 |
8.0× |
| CT Angio Neck (70498) |
$1,120.70 |
$1,601 |
6.4× |
| CT cervical spine w/o contrast (72125) |
$633.50 |
$905 |
6.0× |
| CT chest w contrast (71260) |
$1,986.60 |
$2,838 |
11.3× |
| CT chest w/wo contrast (71270) |
$876.40 |
$1,252 |
5.0× |
| CT head/brain without and with contrast (70470) |
$1,185.80 |
$1,694 |
6.7× |
| CT l-spine w&w/o contrast (72133) |
$891.10 |
$1,273 |
5.1× |
| CT lower ext w/o (73700) |
$833 |
$1,190 |
7.9× |
| CT lower extremity w/contrast material (73701) |
$728.70 |
$1,041 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$562.10 |
$803 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$798.70 |
$1,141 |
7.6× |
| CT pelvis w/o contrast (72192) |
$641.20 |
$916 |
6.1× |
| CT soft tissue neck w contrast (70491) |
$926.10 |
$1,323 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$562.10 |
$803 |
5.4× |
| CT thorax w/o contrast (71250) |
$950.60 |
$1,358 |
9.1× |
| CT upper ext wo (73200) |
$690.20 |
$986 |
6.6× |
| CT upper extremity with contrast (73201) |
$883.40 |
$1,262 |
2.5× |
| Dxa Bone Density Axial (77080) |
$192.50 |
$275 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$194.60 |
$278 |
1.9× |
| Forearm 2 views (73090) |
$101.50 |
$145 |
1.2× |
| Hysterosalpingogram (74740) |
$358.40 |
$512 |
1.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$131.60 |
$188 |
1.5× |
| Knee 3 Views (73562) |
$148.40 |
$212 |
1.7× |
| MRI cervical spine w/o cont (72141) |
$621.60 |
$888 |
2.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$1,103.20 |
$1,576 |
3.1× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$1,232 |
$1,760 |
3.5× |
| MRI pelvis w/o & w contrast (72197) |
$1,226.40 |
$1,752 |
3.5× |
| MRI pelvis w/o contrast (72195) |
$840.70 |
$1,201 |
3.5× |
| MRI thoracic spine w/o contrast (72146) |
$621.60 |
$888 |
2.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,244.60 |
$1,778 |
5.2× |
| MRI, abdomen, combo (74183) |
$1,229.20 |
$1,756 |
3.5× |
| MRI, dorsal spine combo (72157) |
$1,106 |
$1,580 |
3.2× |
| MRI, joint upper extrem (73221) |
$1,575 |
$2,250 |
6.6× |
| MRI, lumbar spine combo (72158) |
$1,100.40 |
$1,572 |
3.1× |
| Neck soft tissue (70360) |
$107.10 |
$153 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$98 |
$140 |
0.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$130.20 |
$186 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$100.10 |
$143 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$110.60 |
$158 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$142.80 |
$204 |
1.6× |
| Radex foot complete minimum 3 views (73630) |
$123.90 |
$177 |
1.4× |
| Radex Hand Minimum 3 Views (73130) |
$247.80 |
$354 |
2.8× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$137.90 |
$197 |
1.6× |
| Radex Ribs Unilateral 2 Views (71100) |
$121.80 |
$174 |
1.4× |
| Radex shoulder complete minimum 2 views (73030) |
$123.90 |
$177 |
1.4× |
| Radex Toe Minimum 2 Views (73660) |
$117.60 |
$168 |
1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$150.50 |
$215 |
1.7× |
| Radiologic exam knee complete 4/more views (73564) |
$182 |
$260 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$469.70 |
$671 |
2.7× |
| Radiologic examination femur minimum 2 views (73552) |
$186.20 |
$266 |
2.1× |
| Radiologic examination knee 1/2 views (73560) |
$247.80 |
$354 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$112.70 |
$161 |
1.3× |
| Ribs bilateral 3 views (71110) |
$141.40 |
$202 |
1.3× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$46.20 |
$66 |
2.0× |
| Skull less than 4 views (70250) |
$126.70 |
$181 |
1.2× |
| Thoracic spine 3 views (72072) |
$173.60 |
$248 |
1.7× |
| Ultrasound Breast Limited (76642) |
$216.30 |
$309 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$249.20 |
$356 |
2.4× |
| Unlisted Dx Radiographic Procedure (76499) |
$105 |
$150 |
1.2× |
| Us breast unilateral complete (76641) |
$285.60 |
$408 |
2.7× |
| Us exam, pelvic, limited (76857) |
$95.90 |
$137 |
0.9× |
| Us head (76506) |
$335.30 |
$479 |
3.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$131.60 |
$188 |
1.3× |
| Us ob detailed single fetus (76811) |
$357 |
$510 |
1.5× |
| Us ob limited 1 or more fetuses (76815) |
$207.90 |
$297 |
2.0× |
| Us ob transvaginal (76817) |
$235.20 |
$336 |
2.2× |
| Us pelvic non ob complete (76856) |
$303.80 |
$434 |
2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$292.60 |
$418 |
2.8× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$285.60 |
$408 |
2.7× |
| Us retroperitoneal complete (76770) |
$308 |
$440 |
2.9× |
| Us scrotum and contents (76870) |
$295.40 |
$422 |
2.8× |
| Us thyroid (76536) |
$354.20 |
$506 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$100.10 |
$143 |
1.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$141.40 |
$202 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$170.10 |
$243 |
1.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$142.80 |
$204 |
1.4× |
| X-Ray Exam L-S Spine Bending (72114) |
$221.90 |
$317 |
2.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$134.40 |
$192 |
1.5× |
| X-ray humerus (73060) |
$123.90 |
$177 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$151.90 |
$217 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$173.60 |
$248 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$112.70 |
$161 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$126.70 |
$181 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$148.40 |
$212 |
1.4× |
| Xr c-spine 4 or 5 views (72050) |
$184.10 |
$263 |
1.8× |