| Abdomen 1 View (74018) |
$92.70 |
$185.40 |
1.1× |
| Abdomen 2 views (74019) |
$154.50 |
$309 |
1.5× |
| Ankle 2 views (73600) |
$103 |
$206 |
1.2× |
| Bone survey infant (77076) |
— |
$566.50 |
— |
| Chest 1 view (71045) |
$90 |
$180 |
1.1× |
Chest 2 views (71046)
range across 2 matching MRF lines |
$108.15 |
$49–$216.30 |
1.3× |
| Chest 3 views (71047) |
$175.10 |
$350.20 |
2.1× |
| Chest 4 or more views (71048) |
$175.10 |
$350.20 |
1.7× |
| Clavicle complete (73000) |
$128.75 |
$257.50 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,576 |
$3,152 |
4.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,321 |
$2,642 |
5.8× |
| CT abdomen w contrast (74160) |
$1,162.09 |
$2,324.18 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,545 |
$3,090 |
9.2× |
| CT abdomen w/o contrast (74150) |
$1,029.50 |
$2,059 |
10.2× |
| CT Angio Chest (71275) |
$1,388 |
$2,776 |
8.2× |
| CT Angio Head (70496) |
$1,267.53 |
$2,535.06 |
7.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,150.92 |
$2,301.84 |
6.8× |
| CT Angio Neck (70498) |
$690.50 |
$1,381 |
4.1× |
| CT cervical spine w/ contrast (72126) |
— |
$1,952.64 |
— |
| CT cervical spine w/o contrast (72125) |
— |
$1,656.13 |
— |
| CT cervical spine w/wo cont (72127) |
$1,175.20 |
$2,350.40 |
7.0× |
| CT chest w contrast (71260) |
— |
$1,952.64 |
— |
| CT chest w/wo contrast (71270) |
$1,175.20 |
$2,350.40 |
7.0× |
| CT head/brain with contrast (70460) |
— |
$1,559.45 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,898.40 |
— |
| CT iac w contrast (70481) |
— |
$1,651.63 |
— |
| CT l-spine w&w/o contrast (72133) |
$1,120.96 |
$2,241.92 |
6.6× |
| CT lower ext w/o (73700) |
$594.83 |
$1,189.65 |
5.9× |
| CT lower extremity w/contrast material (73701) |
$654.05 |
$1,308.10 |
3.9× |
| CT lumbar spine w contrast (72132) |
— |
$1,565.60 |
— |
CT lumbar spine w/o contrast (72131)
range across 2 matching MRF lines |
— |
$1,645.28–$1,966.59 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,613.22 |
— |
| CT maxillofacial wo contrast (70486) |
— |
$1,127.85 |
— |
| CT neck tissue combo (70492) |
$870.35 |
$1,740.70 |
5.2× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$989.06 |
$1,978.12 |
5.9× |
| CT orbits w/o contrast (70480) |
— |
$1,497.99 |
— |
| CT pelvis w&w/o contrast (72194) |
$1,079.50 |
$2,159 |
6.4× |
| CT pelvis w/o contrast (72192) |
— |
$1,959 |
— |
| CT scan of leg combo (73702) |
$909.06 |
$1,818.12 |
5.4× |
| CT scans face/jaw combo (70488) |
— |
$1,947.39 |
— |
| CT soft tissue neck w contrast (70491) |
— |
$1,934.56 |
— |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,199.95 |
— |
| CT thoracic spine w contrast (72129) |
— |
$1,565.60 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,652.51 |
— |
| CT thoracic spine w/wo cont (72130) |
$1,157.12 |
$2,314.24 |
6.9× |
| CT thorax w/o contrast (71250) |
— |
$1,648.25 |
— |
| CT upper ext wo (73200) |
$648.20 |
$1,296.40 |
6.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$865.20 |
$1,730.40 |
5.1× |
| CT upper extremity with contrast (73201) |
— |
$1,458.45 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,740.20 |
$3,480.40 |
10.3× |
| Foot 2 views (73620) |
$103 |
$206 |
1.2× |
| Forearm 2 views (73090) |
$128.75 |
$257.50 |
1.5× |
| Hand 2 views (73120) |
$72.10 |
$144.20 |
0.7× |
| Joint Survey Single View (77077) |
$169.50 |
$339 |
1.7× |
| Knee 3 Views (73562) |
$141.63 |
$283.25 |
1.7× |
| MRA head w/o contrast (70544) |
$2,080.25 |
$4,160.49 |
9.1× |
| Neck soft tissue (70360) |
$221.45 |
$442.90 |
2.6× |
| Optic foramina (70190) |
$105.58 |
$211.15 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$169.50 |
$339 |
1.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$175.10 |
$350.20 |
1.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$128.75 |
$257.50 |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$128.75 |
$257.50 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$128.75 |
$257.50 |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$175.10 |
$350.20 |
1.7× |
| Radex fingr minimum 2 views (73140) |
$128.75 |
$257.50 |
1.5× |
| Radex foot complete minimum 3 views (73630) |
$128.75 |
$257.50 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$128.75 |
$257.50 |
1.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$90 |
$180 |
1.1× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$169.50 |
$339 |
1.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$128.75 |
$257.50 |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$103 |
$206 |
1.2× |
| Radex shoulder complete minimum 2 views (73030) |
$133.90 |
$267.80 |
1.6× |
| Radex Spine 1 View Specify Level (72020) |
$100.43 |
$200.85 |
1.2× |
| Radex Sternum Minimum 2 Views (71120) |
— |
$379 |
— |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$164.80 |
$329.60 |
2.0× |
| Radex Toe Minimum 2 Views (73660) |
$84.98 |
$169.95 |
1.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$84.98 |
$169.95 |
0.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$113.30 |
$226.60 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$169.50 |
$339 |
1.7× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$169.50 |
$339 |
1.7× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$169.50 |
$339 |
1.0× |
| Radiologic examination femur minimum 2 views (73552) |
$128.75 |
$257.50 |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$128.75 |
$257.50 |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$90 |
$180 |
1.1× |
| Scapula (73010) |
$128.75 |
$257.50 |
1.3× |
| Sella turcica (70240) |
$105.58 |
$211.15 |
1.3× |
| Shoulder 1 view (73020) |
$118.45 |
$236.90 |
1.4× |
| Skull less than 4 views (70250) |
$169.50 |
$339 |
1.7× |
| Thoracic spine 2 views (72070) |
$169.50 |
$339 |
1.7× |
| Ultrasound Breast Limited (76642) |
$149 |
$298 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$202 |
$404 |
2.0× |
| Us chest (76604) |
— |
$504 |
— |
| Us complete joint (76881) |
$400 |
$800 |
4.0× |
| Us ob limited 1 or more fetuses (76815) |
— |
$474.85 |
— |
| Us pelvic non ob complete (76856) |
— |
$473.80 |
— |
| Us retroperitoneal complete (76770) |
— |
$579.49 |
— |
| Us scrotum and contents (76870) |
— |
$616 |
— |
| Us thyroid (76536) |
— |
$461 |
— |
| Wrist 2 views (73100) |
$103 |
$206 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$128.75 |
$257.50 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$103 |
$206 |
1.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$72.05 |
$144.09 |
0.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$90.13 |
$180.25 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$164.80 |
$329.60 |
2.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$678 |
— |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$221.45 |
$442.90 |
2.6× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
— |
$540.75 |
— |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$118.45 |
$236.90 |
1.2× |
| X-ray humerus (73060) |
$103 |
$206 |
1.2× |
| X-ray IV pyelogram (ivp) (74400) |
— |
$941.42 |
— |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$108.50 |
$217 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$360.50 |
— |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$386.25 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$169.50 |
$339 |
1.7× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$169.50 |
$339 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$169.50 |
$339 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$175.10 |
$350.20 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$175.10 |
$350.20 |
1.7× |
| X-ray thoracic spine 4 vw (72074) |
— |
$355.35 |
— |
| X-Rays Bone Survey Complete (77075) |
— |
$624 |
— |
| Xr c-spine 4 or 5 views (72050) |
— |
$489.25 |
— |
| Xr facial bones less than 3 views (70140) |
$113.30 |
$226.60 |
1.4× |
| Xr orbits complete 4 views (70200) |
$169.50 |
$339 |
1.7× |