| Abdomen 1 View (74018) |
$158.40 |
$176 |
2.0× |
| Bone age studies (77072) |
$163.80 |
$182 |
1.7× |
| Clavicle complete (73000) |
$142.20 |
$158 |
1.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$783 |
$870 |
2.4× |
| CT abdomen and pelvis without contrast (74176) |
$688.50 |
$765 |
3.1× |
| CT abdomen w wo contrast (74170) |
$783 |
$870 |
4.9× |
| CT abdomen w/o contrast (74150) |
$688.50 |
$765 |
7.2× |
| CT Angio Abdomen and Pelvis (74174) |
$2,034 |
$2,260 |
6.3× |
| CT Angio Chest (71275) |
$1,417.50 |
$1,575 |
8.8× |
| CT angio hrt w/3d image (75574) |
$661.50 |
$735 |
2.1× |
| CT cervical spine w/ contrast (72126) |
$733.50 |
$815 |
2.3× |
| CT cervical spine w/o contrast (72125) |
$688.50 |
$765 |
7.2× |
| CT cervical spine w/wo cont (72127) |
$783 |
$870 |
4.9× |
| CT chest w contrast (71260) |
$733.50 |
$815 |
4.5× |
| CT chest w/wo contrast (71270) |
$783 |
$870 |
4.9× |
| CT head/brain with contrast (70460) |
$733.50 |
$815 |
4.5× |
| CT head/brain without and with contrast (70470) |
$783 |
$870 |
4.9× |
| CT iac w contrast (70481) |
$733.50 |
$815 |
4.5× |
| CT lower ext w/o (73700) |
$688.50 |
$765 |
7.2× |
| CT lower extremity w/contrast material (73701) |
$733.50 |
$815 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$688.50 |
$765 |
7.2× |
| CT maxillofacial w contrast (70487) |
$733.50 |
$815 |
4.5× |
| CT maxillofacial wo contrast (70486) |
$688.50 |
$765 |
7.2× |
| CT neck tissue combo (70492) |
$783 |
$870 |
4.9× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$783 |
$870 |
4.9× |
| CT orbits w/o contrast (70480) |
$688.50 |
$765 |
7.2× |
| CT soft tissue neck w contrast (70491) |
$733.50 |
$815 |
4.5× |
| CT soft tissue neck w/o contrast (70490) |
$688.50 |
$765 |
7.2× |
| CT thoracic spine w contrast (72129) |
$733.50 |
$815 |
4.5× |
| CT thoracic spine w/o contrast (72128) |
$688.50 |
$765 |
7.2× |
| CT thorax w/o contrast (71250) |
$688.50 |
$765 |
7.2× |
| CT upper ext wo (73200) |
$688.50 |
$765 |
7.2× |
| CT upper extremity with contrast (73201) |
$733.50 |
$815 |
2.3× |
| CTA pelvis (72191) |
$688.50 |
$765 |
4.3× |
| Dxa Bone Density Axial (77080) |
$283.50 |
$315 |
2.9× |
| Forearm 2 views (73090) |
$145.80 |
$162 |
1.8× |
| Knee 3 Views (73562) |
$175.50 |
$195 |
2.2× |
| Magnetic Image Jaw Joint (70336) |
$733.50 |
$815 |
3.3× |
| Mra Head W/O & W/Contrast Material (70546) |
$972 |
$1,080 |
3.0× |
| MRA head w/o contrast (70544) |
$972 |
$1,080 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$972 |
$1,080 |
3.0× |
| MRA neck w/o contrast (70547) |
$972 |
$1,080 |
4.4× |
| MRI abdomen w/o contrast (74181) |
$733.50 |
$815 |
3.3× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$922.50 |
$1,025 |
2.9× |
| MRI cervical spine w/o cont (72141) |
$733.50 |
$815 |
3.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$922.50 |
$1,025 |
2.9× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$733.50 |
$815 |
3.3× |
| Mri Neck Spine W/O & W/Dye (72156) |
$922.50 |
$1,025 |
2.9× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$922.50 |
$1,025 |
2.9× |
| MRI pelvis w/o & w contrast (72197) |
$922.50 |
$1,025 |
2.9× |
| MRI pelvis w/o contrast (72195) |
$733.50 |
$815 |
3.3× |
| MRI thoracic spine w/o contrast (72146) |
$733.50 |
$815 |
3.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$733.50 |
$815 |
3.3× |
Mri Uppr Extremity W/O&W/Dye (73220)
range across 2 matching MRF lines |
$877.50–$922.50 |
$975–$1,025 |
varies |
| MRI, dorsal spine combo (72157) |
$922.50 |
$1,025 |
2.9× |
| MRI, joint upper extrem (73221) |
$733.50 |
$815 |
3.3× |
| MRI, joint upper extrem combo (73223) |
$922.50 |
$1,025 |
2.9× |
| MRI, lumbar spine combo (72158) |
$922.50 |
$1,025 |
2.9× |
| Neck soft tissue (70360) |
$151.20 |
$168 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$148.50 |
$165 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$308.70 |
$343 |
3.2× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$335.70 |
$373 |
0.7× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$165.60 |
$184 |
2.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$142.20 |
$158 |
1.8× |
| Radex elbow complete minimum 3 views (73080) |
$177.30 |
$197 |
2.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$222.30 |
$247 |
2.3× |
| Radex fingr minimum 2 views (73140) |
$142.20 |
$158 |
1.8× |
| Radex foot complete minimum 3 views (73630) |
$165.60 |
$184 |
2.1× |
| Radex Hand Minimum 3 Views (73130) |
$165.60 |
$184 |
2.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$172.80 |
$192 |
2.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$156.60 |
$174 |
2.0× |
| Radex shoulder complete minimum 2 views (73030) |
$165.60 |
$184 |
2.1× |
| Radex Sternum Minimum 2 Views (71120) |
$170.10 |
$189 |
2.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$236.70 |
$263 |
3.0× |
| Radex Toe Minimum 2 Views (73660) |
$142.20 |
$158 |
1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$167.40 |
$186 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$247.50 |
$275 |
2.6× |
| Radiologic exam knee complete 4/more views (73564) |
$253.80 |
$282 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$148.50 |
$165 |
1.9× |
| Radiologic examination tibia & fibula 2 views (73590) |
$166.50 |
$185 |
2.1× |
| Scapula (73010) |
$142.20 |
$158 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$213.30 |
$237 |
9.1× |
| Skull less than 4 views (70250) |
$167.40 |
$186 |
1.7× |
| Sternoclavicular joints (71130) |
$170.10 |
$189 |
2.1× |
| Thoracic spine 3 views (72072) |
$236.70 |
$263 |
2.5× |
| Ultrasound Exam Aaa Screen (76706) |
$144 |
$160 |
1.5× |
| Ultrasound, abdomen limited (76705) |
$153 |
$170 |
1.6× |
| Us breast unilateral complete (76641) |
$121.50 |
$135 |
1.3× |
| Us chest (76604) |
$144 |
$160 |
1.5× |
| Us complete joint (76881) |
$144 |
$160 |
1.5× |
| Us exam, pelvic, limited (76857) |
$144 |
$160 |
1.5× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$144 |
$160 |
1.5× |
| Us pelvic non ob complete (76856) |
$189 |
$210 |
2.0× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$94.50 |
$105 |
1.0× |
| Us retroperitoneal complete (76770) |
$189 |
$210 |
2.0× |
| Us retroperitoneal limited (76775) |
$153 |
$170 |
1.6× |
| Us scrotum and contents (76870) |
$162 |
$180 |
1.7× |
| Us thyroid (76536) |
$562.50 |
$625 |
5.9× |
| Us transrectal (76872) |
$144 |
$160 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$171.90 |
$191 |
2.1× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$165.60 |
$184 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$148.50 |
$165 |
1.9× |
X-Ray Exam Hips Bi 5/> Views (73523)
range across 2 matching MRF lines |
$142.20–$236.70 |
$158–$263 |
varies |
| X-Ray Exam L-S Spine Bending (72114) |
$350.10 |
$389 |
3.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$187.20 |
$208 |
2.3× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$317.70 |
$353 |
3.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$234 |
$260 |
2.4× |
| X-ray humerus (73060) |
$165.60 |
$184 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$142.20 |
$158 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$205.20 |
$228 |
2.1× |
X-ray nose-rectum child f.b. (76010)
range across 2 matching MRF lines |
$142.20–$495 |
$158–$550 |
varies |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$287.10 |
$319 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$170.10 |
$189 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$167.40 |
$186 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$227.70 |
$253 |
2.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$247.50 |
$275 |
2.6× |
| X-ray thoracic spine 4 vw (72074) |
$198 |
$220 |
2.1× |
| X-Ray Tmj Unilat (70328) |
$227.70 |
$253 |
2.8× |
| X-Rays Bone Survey Complete (77075) |
$593.10 |
$659 |
6.2× |
| Xr c-spine 4 or 5 views (72050) |
$270 |
$300 |
2.8× |
| Xr orbits complete 4 views (70200) |
$213.30 |
$237 |
2.2× |