| Abdomen 1 View (74018) |
$111.69 |
$219 |
1.0× |
| Abdomen 2 views (74019) |
$191.25 |
$375 |
1.4× |
| Ankle 2 views (73600) |
$116.28 |
$228 |
1.0× |
| Bone age studies (77072) |
$153.51 |
$301 |
1.1× |
| Bone survey infant (77076) |
$174.93 |
$343 |
1.3× |
| Cat Scan Follow-Up Study (76380) |
$631.38 |
$1,238 |
5.6× |
| Cerebrospinal Fluid Scan (78630) |
$868.53 |
$1,703 |
1.2× |
| Chest 1 view (71045) |
$92.82 |
$182 |
0.8× |
| Chest 2 views (71046) |
$141.27 |
$277 |
1.3× |
| Chest 3 views (71047) |
$180.03 |
$353 |
1.6× |
| Chest 4 or more views (71048) |
$185.13 |
$363 |
1.4× |
| Clavicle complete (73000) |
$123.42 |
$242 |
1.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$108.63 |
$213 |
0.8× |
| Contrast X-Ray Bladder (74430) |
$572.73 |
$1,123 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,744.71 |
$3,421 |
3.9× |
| CT abdomen and pelvis without contrast (74176) |
$692.07 |
$1,357 |
2.3× |
| CT abdomen w contrast (74160) |
$1,341.81 |
$2,631 |
5.9× |
| CT abdomen w wo contrast (74170) |
$1,661.07 |
$3,257 |
7.4× |
| CT abdomen w/o contrast (74150) |
$1,113.33 |
$2,183 |
8.3× |
| CT Angio Abdomen and Pelvis (74174) |
$2,489.31 |
$4,881 |
5.5× |
| CT Angio Chest (71275) |
$1,767.66 |
$3,466 |
7.8× |
| CT Angio Head (70496) |
$1,787.04 |
$3,504 |
7.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,491.24 |
$2,924 |
6.6× |
| CT Angio Neck (70498) |
$1,787.04 |
$3,504 |
7.9× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$1,491.24 |
$2,924 |
6.6× |
| CT cervical spine w/ contrast (72126) |
$1,716.15 |
$3,365 |
3.8× |
| CT cervical spine w/o contrast (72125) |
$1,435.14 |
$2,814 |
10.7× |
| CT cervical spine w/wo cont (72127) |
$1,716.15 |
$3,365 |
7.6× |
| CT chest w contrast (71260) |
$1,387.71 |
$2,721 |
6.2× |
| CT chest w/wo contrast (71270) |
$1,729.92 |
$3,392 |
7.7× |
| CT head/brain with contrast (70460) |
$1,377 |
$2,700 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,716.66 |
$3,366 |
7.6× |
| CT iac w contrast (70481) |
$1,379.55 |
$2,705 |
6.1× |
| CT l-spine w&w/o contrast (72133) |
$1,728.90 |
$3,390 |
7.7× |
| CT lower ext w/o (73700) |
$975.63 |
$1,913 |
7.3× |
| CT lower extremity w/contrast material (73701) |
$1,160.25 |
$2,275 |
5.1× |
| CT lumbar spine w contrast (72132) |
$1,387.20 |
$2,720 |
3.1× |
| CT lumbar spine w/o contrast (72131) |
$1,160.25 |
$2,275 |
8.6× |
| CT maxillofacial w contrast (70487) |
$1,379.55 |
$2,705 |
6.1× |
| CT maxillofacial wo contrast (70486) |
$1,151.07 |
$2,257 |
8.6× |
| CT neck tissue combo (70492) |
$1,719.21 |
$3,371 |
7.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,562.64 |
$3,064 |
6.9× |
| CT orbits w/o contrast (70480) |
$1,152.60 |
$2,260 |
8.6× |
| CT pelvis w&w/o contrast (72194) |
$1,659.54 |
$3,254 |
7.4× |
| CT pelvis w/o contrast (72192) |
$1,159.74 |
$2,274 |
8.6× |
| CT scan of leg combo (73702) |
$1,456.05 |
$2,855 |
6.5× |
| CT scans face/jaw combo (70488) |
$1,718.70 |
$3,370 |
7.6× |
| CT soft tissue neck w contrast (70491) |
$1,379.55 |
$2,705 |
6.1× |
| CT soft tissue neck w/o contrast (70490) |
$1,152.60 |
$2,260 |
8.6× |
| CT thoracic spine w contrast (72129) |
$1,387.20 |
$2,720 |
6.1× |
| CT thoracic spine w/o contrast (72128) |
$1,160.25 |
$2,275 |
8.6× |
| CT thoracic spine w/wo cont (72130) |
$1,728.90 |
$3,390 |
7.7× |
| CT thorax w/o contrast (71250) |
$1,160.25 |
$2,275 |
8.6× |
| CT upper ext wo (73200) |
$975.63 |
$1,913 |
7.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,336.20 |
$2,620 |
5.9× |
| CT upper extremity with contrast (73201) |
$1,160.25 |
$2,275 |
2.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,698.81 |
$3,331 |
7.5× |
| Cta Abdomen (74175) |
$1,698.81 |
$3,331 |
7.5× |
| CTA pelvis (72191) |
$1,698.81 |
$3,331 |
7.5× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$435.03 |
$853 |
3.2× |
| Echo Guide For Artery Repair (76936) |
$880.26 |
$1,726 |
3.2× |
| Echograp Trans R Pros Study (76873) |
$500.31 |
$981 |
3.7× |
| Esophagram (74220) |
$205.02 |
$402 |
0.9× |
| Fetal Biophys Profile W/Nst (76818) |
$393.72 |
$772 |
2.9× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$393.72 |
$772 |
2.9× |
| Fluoroscopy up to 1 hr (76000) |
$417.18 |
$818 |
1.4× |
| Foot 2 views (73620) |
$116.28 |
$228 |
1.0× |
| Forearm 2 views (73090) |
$123.42 |
$242 |
1.1× |
| Hand 2 views (73120) |
$153.51 |
$301 |
1.1× |
| Knee 3 Views (73562) |
$134.13 |
$263 |
1.2× |
| MRI abdomen w contrast (74182) |
$2,415.36 |
$4,736 |
5.4× |
| MRI abdomen w/o contrast (74181) |
$1,780.92 |
$3,492 |
5.8× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,010.42 |
$3,942 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,977.27 |
$3,877 |
6.4× |
| MRI pelvis w/o contrast (72195) |
$1,816.62 |
$3,562 |
5.9× |
| MRI thoracic spine w/o contrast (72146) |
$2,136.90 |
$4,190 |
7.0× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$2,423.01 |
$4,751 |
5.4× |
| MRI, dorsal spine contrast (72147) |
$2,194.53 |
$4,303 |
4.9× |
| MRI, joint upper extrem (73221) |
$1,970.13 |
$3,863 |
6.4× |
| MRI, lumbar spine combo (72158) |
$3,894.36 |
$7,636 |
8.7× |
| Neck soft tissue (70360) |
$78.54 |
$154 |
0.7× |
| Pelvis 1 or 2 views (72170) |
$153.51 |
$301 |
1.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$136.68 |
$268 |
1.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$125.46 |
$246 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$111.69 |
$219 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$134.13 |
$263 |
1.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$185.64 |
$364 |
1.4× |
| Radex fingr minimum 2 views (73140) |
$99.96 |
$196 |
0.9× |
| Radex foot complete minimum 3 views (73630) |
$125.46 |
$246 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$153.51 |
$301 |
1.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$116.28 |
$228 |
1.0× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$123.42 |
$242 |
1.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$135.15 |
$265 |
1.2× |
| Radex shoulder complete minimum 2 views (73030) |
$134.13 |
$263 |
1.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$90.27 |
$177 |
0.8× |
| Radex sm int w/mlt srl imges via enteroclss tube (74251) |
$241.74 |
$474 |
1.1× |
| Radex Spine 1 View Specify Level (72020) |
$100.47 |
$197 |
0.9× |
| Radex Sternum Minimum 2 Views (71120) |
$153.51 |
$301 |
1.4× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$196.86 |
$386 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$99.96 |
$196 |
0.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$153.51 |
$301 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$125.46 |
$246 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$504.90 |
$990 |
3.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$146.88 |
$288 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$206.55 |
$405 |
1.5× |
| Radiologic exam colon double contrast study (74280) |
$355.98 |
$698 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$355.98 |
$698 |
1.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$912.90 |
$1,790 |
4.0× |
| Radiologic exam knee complete 4/more views (73564) |
$146.88 |
$288 |
1.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$157.59 |
$309 |
1.2× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$241.74 |
$474 |
1.1× |
| Radiologic exam swallow function contrast study (74230) |
$240.72 |
$472 |
1.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$304.98 |
$598 |
1.4× |
| Radiologic examination femur 1 view (73551) |
$161.67 |
$317 |
1.4× |
| Radiologic examination femur minimum 2 views (73552) |
$191.76 |
$376 |
1.7× |
| Radiologic examination knee 1/2 views (73560) |
$123.42 |
$242 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$123.42 |
$242 |
1.1× |
| Ribs bilateral 3 views (71110) |
$186.15 |
$365 |
1.4× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$2,371.50 |
$4,650 |
3.4× |
| Scapula (73010) |
$123.42 |
$242 |
0.9× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$55.59 |
$109 |
2.4× |
| Shoulder 1 view (73020) |
$111.69 |
$219 |
1.0× |
| Skull less than 4 views (70250) |
$146.88 |
$288 |
1.1× |
| Sternoclavicular joints (71130) |
$164.22 |
$322 |
1.5× |
| Thoracic spine 2 views (72070) |
$153.51 |
$301 |
1.1× |
| Thoracic spine 3 views (72072) |
$174.42 |
$342 |
1.3× |
| Thoracolumbar 2 views (72080) |
$157.59 |
$309 |
1.4× |
| Thyroid Imaging With Vascular Flow (78013) |
$737.46 |
$1,446 |
1.4× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$1,126.59 |
$2,209 |
2.2× |
| Ultrasound Breast Limited (76642) |
$431.46 |
$846 |
3.9× |
| Ultrasound Elastography Parenchyma (76981) |
$107.10 |
$210 |
0.8× |
| Ultrasound Exam Aaa Screen (76706) |
$373.83 |
$733 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$340.17 |
$667 |
2.5× |
| Umbilical-artery Doppler (OB) (76820) |
$353.94 |
$694 |
2.6× |
| Unlisted us procedure (76999) |
$475.32 |
$932 |
4.2× |
| Upper gi w/o kub (74240) |
$182.07 |
$357 |
0.8× |
| Urethrocystogram voiding (74455) |
$395.76 |
$776 |
1.3× |
| Urethrocystography retrograde (74450) |
$267.75 |
$525 |
0.9× |
| Us breast unilateral complete (76641) |
$553.35 |
$1,085 |
4.1× |
| Us chest (76604) |
$313.14 |
$614 |
2.3× |
| Us complete joint (76881) |
$546.21 |
$1,071 |
4.1× |
| Us exam, pelvic, limited (76857) |
$252.45 |
$495 |
1.9× |
| Us head (76506) |
$293.76 |
$576 |
2.2× |
| Us kidney transplant (76776) |
$448.80 |
$880 |
3.3× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$142.29 |
$279 |
1.1× |
| Us ob detailed single fetus (76811) |
$812.94 |
$1,594 |
2.6× |
| Us ob limited 1 or more fetuses (76815) |
$325.38 |
$638 |
2.4× |
| Us ob transvaginal (76817) |
$374.34 |
$734 |
2.8× |
| Us pelvic non ob complete (76856) |
$367.20 |
$720 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$262.65 |
$515 |
2.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$230.52 |
$452 |
1.7× |
| Us retroperitoneal complete (76770) |
$472.26 |
$926 |
3.5× |
| Us retroperitoneal limited (76775) |
$340.17 |
$667 |
2.5× |
| Us scrotum and contents (76870) |
$328.95 |
$645 |
2.4× |
| Us spinal canal and contents (76800) |
$345.27 |
$677 |
2.6× |
| Us thyroid (76536) |
$340.17 |
$667 |
2.5× |
| Wrist 2 views (73100) |
$116.28 |
$228 |
1.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$157.59 |
$309 |
1.4× |
| X-Ray Bend Only L-S Spine (72120) |
$210.12 |
$412 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$123.42 |
$242 |
1.1× |
| X-Ray Exam Breast Specimen (76098) |
$803.76 |
$1,576 |
1.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$336.09 |
$659 |
2.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$161.67 |
$317 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$203.49 |
$399 |
1.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$312.12 |
$612 |
2.3× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$236.64 |
$464 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$282.54 |
$554 |
2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$367.20 |
$720 |
2.7× |
| X-Ray Exam L-S Spine Bending (72114) |
$279.48 |
$548 |
2.1× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$153.51 |
$301 |
1.4× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$267.24 |
$524 |
2.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$159.12 |
$312 |
1.2× |
| X-ray eye for foreign body (70030) |
$78.54 |
$154 |
0.7× |
| X-ray humerus (73060) |
$134.13 |
$263 |
1.2× |
| X-ray IV pyelogram (ivp) (74400) |
$310.08 |
$608 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$123.42 |
$242 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$116.28 |
$228 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$157.59 |
$309 |
1.2× |
| X-ray nose-rectum child f.b. (76010) |
$215.73 |
$423 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$210.63 |
$413 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$153.51 |
$301 |
1.1× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$153.51 |
$301 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$134.13 |
$263 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$185.64 |
$364 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$211.65 |
$415 |
1.6× |
| X-ray thoracic spine 4 vw (72074) |
$214.20 |
$420 |
1.6× |
| X-Ray Tmj Unilat (70328) |
$110.67 |
$217 |
1.0× |
| X-Rays Bone Survey Complete (77075) |
$339.66 |
$666 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$211.65 |
$415 |
1.6× |
| Xr facial bones less than 3 views (70140) |
$146.37 |
$287 |
1.3× |
| Xr orbits complete 4 views (70200) |
$186.15 |
$365 |
1.4× |