| Abdomen 1 View (74018) |
$174.40 |
$218 |
2.0× |
| Abdomen 2 views (74019) |
$216.80 |
$271 |
2.0× |
| Ankle 2 views (73600) |
$212 |
$265 |
2.4× |
| Bone age studies (77072) |
$315.20 |
$394 |
3.0× |
| Bone Imaging Limited Area (78300) |
$1,303.20 |
$1,629 |
3.2× |
| Bone Imaging Multiple Areas (78305) |
$1,389.60 |
$1,737 |
3.4× |
| Bone Imaging Whole Body (78306) |
$1,846.40 |
$2,308 |
4.5× |
| Bone survey infant (77076) |
$242.40 |
$303 |
2.3× |
| Cat Scan Follow-Up Study (76380) |
$808.80 |
$1,011 |
9.1× |
| Chest 1 view (71045) |
$183.20 |
$229 |
2.1× |
| Chest 2 views (71046) |
$219.20 |
$274 |
2.5× |
| Clavicle complete (73000) |
$220 |
$275 |
2.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$500 |
$625 |
4.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,004 |
$3,755 |
8.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,080.80 |
$2,601 |
8.5× |
| CT abdomen w contrast (74160) |
$2,397.60 |
$2,997 |
13.4× |
| CT abdomen w wo contrast (74170) |
$2,938.40 |
$3,673 |
16.4× |
| CT abdomen w/o contrast (74150) |
$1,749.60 |
$2,187 |
16.4× |
| CT Angio Abdomen and Pelvis (74174) |
$4,526.40 |
$5,658 |
12.7× |
| CT Angio Chest (71275) |
$2,441.60 |
$3,052 |
13.6× |
| CT Angio Head (70496) |
$2,516 |
$3,145 |
14.0× |
| CT Angio Neck (70498) |
$2,516 |
$3,145 |
14.0× |
| CT cervical spine w/ contrast (72126) |
$2,366.40 |
$2,958 |
6.6× |
| CT cervical spine w/o contrast (72125) |
$1,472 |
$1,840 |
13.8× |
| CT chest w contrast (71260) |
$1,701.60 |
$2,127 |
9.5× |
| CT chest w/wo contrast (71270) |
$2,607.20 |
$3,259 |
14.5× |
| CT head/brain with contrast (70460) |
$1,760.80 |
$2,201 |
9.8× |
| CT head/brain without and with contrast (70470) |
$2,292 |
$2,865 |
12.8× |
| CT iac w contrast (70481) |
$2,100 |
$2,625 |
11.7× |
| CT lower ext w/o (73700) |
$1,235.20 |
$1,544 |
11.6× |
| CT lower extremity w/contrast material (73701) |
$1,984.80 |
$2,481 |
11.1× |
| CT lumbar spine w/o contrast (72131) |
$1,468.80 |
$1,836 |
13.8× |
| CT maxillofacial w contrast (70487) |
$1,566.40 |
$1,958 |
8.7× |
| CT maxillofacial wo contrast (70486) |
$1,153.60 |
$1,442 |
10.8× |
| CT neck tissue combo (70492) |
$2,562.40 |
$3,203 |
14.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,324 |
$2,905 |
13.0× |
| CT orbits w/o contrast (70480) |
$1,929.60 |
$2,412 |
18.1× |
| CT pelvis w&w/o contrast (72194) |
$2,460 |
$3,075 |
13.7× |
| CT pelvis w/o contrast (72192) |
$1,480 |
$1,850 |
13.9× |
| CT scans face/jaw combo (70488) |
$2,582.40 |
$3,228 |
14.4× |
| CT soft tissue neck w contrast (70491) |
$1,790.40 |
$2,238 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$1,468.80 |
$1,836 |
13.8× |
| CT thoracic spine w contrast (72129) |
$2,258.40 |
$2,823 |
12.6× |
| CT thoracic spine w/o contrast (72128) |
$1,468.80 |
$1,836 |
13.8× |
| CT thorax w/o contrast (71250) |
$1,423.20 |
$1,779 |
13.3× |
| CT upper ext wo (73200) |
$1,575.20 |
$1,969 |
14.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$2,277.60 |
$2,847 |
12.7× |
| CT upper extremity with contrast (73201) |
$2,022.40 |
$2,528 |
5.7× |
| Cta Abdomen (74175) |
$2,568.80 |
$3,211 |
14.3× |
| Dxa Bone Density Axial (77080) |
$474.40 |
$593 |
4.4× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$291.20 |
$364 |
3.3× |
| Esophagram (74220) |
$616.80 |
$771 |
3.4× |
| Fetal Biophys Profile W/Nst (76818) |
$376 |
$470 |
3.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$576 |
$720 |
5.4× |
| Foot 2 views (73620) |
$207.20 |
$259 |
2.3× |
| Forearm 2 views (73090) |
$220 |
$275 |
2.5× |
| Hand 2 views (73120) |
$193.60 |
$242 |
1.8× |
| Hepatobil Syst Image W/Drug (78227) |
$1,983.20 |
$2,479 |
3.6× |
| Knee 3 Views (73562) |
$233.60 |
$292 |
2.6× |
| Magnetic Image Jaw Joint (70336) |
$2,450.40 |
$3,063 |
10.1× |
| Mra Head W/O & W/Contrast Material (70546) |
$3,603.20 |
$4,504 |
10.1× |
| MRA head w/o contrast (70544) |
$2,276.80 |
$2,846 |
9.3× |
| MRA head with contrast (70545) |
$2,732 |
$3,415 |
7.7× |
| MRA neck w contrast (70548) |
$2,444.80 |
$3,056 |
6.9× |
| Mra Neck W/O &W/Contrast Material (70549) |
$3,476.80 |
$4,346 |
9.8× |
| MRA neck w/o contrast (70547) |
$2,468.80 |
$3,086 |
10.1× |
| MRI abdomen w/o contrast (74181) |
$2,392 |
$2,990 |
9.8× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,511.20 |
$4,389 |
9.9× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$3,084 |
$3,855 |
3.9× |
| MRI cervical spine w contrast (72142) |
$3,160.80 |
$3,951 |
8.9× |
| MRI cervical spine w/o cont (72141) |
$2,066.40 |
$2,583 |
8.5× |
| MRI chest w/o contrast (71550) |
$2,649.60 |
$3,312 |
10.9× |
| MRI chest wo w contrast (71552) |
$3,668 |
$4,585 |
10.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$3,304.80 |
$4,131 |
9.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,477.60 |
$3,097 |
10.2× |
| MRI lumbar spine w contrast (72149) |
$3,162.40 |
$3,953 |
8.9× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,798.40 |
$4,748 |
10.7× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,616 |
$3,270 |
10.7× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$3,656 |
$4,570 |
10.3× |
| MRI pelvis w/o & w contrast (72197) |
$3,784 |
$4,730 |
10.6× |
| MRI pelvis w/o contrast (72195) |
$2,567.20 |
$3,209 |
10.5× |
| MRI thoracic spine w/o contrast (72146) |
$2,102.40 |
$2,628 |
8.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$2,463.20 |
$3,079 |
10.1× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$3,399.20 |
$4,249 |
9.5× |
| MRI, abdomen, combo (74183) |
$3,634.40 |
$4,543 |
10.2× |
| MRI, dorsal spine combo (72157) |
$3,856 |
$4,820 |
10.8× |
| MRI, dorsal spine contrast (72147) |
$3,183.20 |
$3,979 |
8.9× |
| MRI, joint upper extrem (73221) |
$2,516.80 |
$3,146 |
10.3× |
| MRI, joint upper extrem combo (73223) |
$3,566.40 |
$4,458 |
10.0× |
| MRI, lumbar spine combo (72158) |
$3,924 |
$4,905 |
11.0× |
| Neck soft tissue (70360) |
$317.60 |
$397 |
3.6× |
| Ob us nuchal meas 1 gest (76813) |
$285.60 |
$357 |
2.7× |
| Pelvis 1 or 2 views (72170) |
$220 |
$275 |
2.1× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$532.80 |
$666 |
5.0× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$220 |
$275 |
2.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$168 |
$210 |
1.9× |
| Radex elbow complete minimum 3 views (73080) |
$241.60 |
$302 |
2.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$412.80 |
$516 |
3.9× |
| Radex fingr minimum 2 views (73140) |
$176 |
$220 |
2.0× |
| Radex foot complete minimum 3 views (73630) |
$211.20 |
$264 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$216.80 |
$271 |
2.4× |
| Radex lower extremity infant minimum 2 views (73592) |
$256.80 |
$321 |
2.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$204.80 |
$256 |
2.3× |
| Radex Ribs Unilateral 2 Views (71100) |
$238.40 |
$298 |
2.7× |
| Radex shoulder complete minimum 2 views (73030) |
$240 |
$300 |
2.7× |
| Radex Sinuses Paransl < 3 Views (70210) |
$263.20 |
$329 |
3.0× |
| Radex Spine 1 View Specify Level (72020) |
$336.80 |
$421 |
3.8× |
| Radex Sternum Minimum 2 Views (71120) |
$363.20 |
$454 |
4.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$448 |
$560 |
5.0× |
| Radex Toe Minimum 2 Views (73660) |
$178.40 |
$223 |
2.0× |
| Radex upper extremity infant minimum 2 views (73092) |
$161.60 |
$202 |
1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$241.60 |
$302 |
2.7× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$416 |
$520 |
3.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$439.20 |
$549 |
4.1× |
| Radiologic exam colon double contrast study (74280) |
$1,140.80 |
$1,426 |
6.4× |
| Radiologic exam colon single contrast study (74270) |
$872.80 |
$1,091 |
4.9× |
| Radiologic exam knee complete 4/more views (73564) |
$460 |
$575 |
4.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$400.80 |
$501 |
3.8× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$752 |
$940 |
4.2× |
| Radiologic exam upr gi trc double contrast study (74246) |
$868 |
$1,085 |
4.8× |
| Radiologic examination femur 1 view (73551) |
$271.20 |
$339 |
3.1× |
| Radiologic examination femur minimum 2 views (73552) |
$240 |
$300 |
2.7× |
| Radiologic examination knee 1/2 views (73560) |
$188 |
$235 |
2.1× |
| Radiologic Examination Osseous Survey Limited (77074) |
$538.40 |
$673 |
5.0× |
| Radiologic examination tibia & fibula 2 views (73590) |
$193.60 |
$242 |
2.2× |
| Ribs bilateral 3 views (71110) |
$524.80 |
$656 |
4.9× |
| Scapula (73010) |
$264.80 |
$331 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$91.20 |
$114 |
3.9× |
| Shoulder 1 view (73020) |
$212 |
$265 |
2.4× |
| Skull less than 4 views (70250) |
$383.20 |
$479 |
3.6× |
| Sternoclavicular joints (71130) |
$320 |
$400 |
3.6× |
| Thoracic spine 2 views (72070) |
$253.60 |
$317 |
2.4× |
| Thoracic spine 3 views (72072) |
$428 |
$535 |
4.0× |
| Thoracolumbar 2 views (72080) |
$240 |
$300 |
2.7× |
| Ultrasound Exam Aaa Screen (76706) |
$461.60 |
$577 |
4.3× |
| Ultrasound, abdomen limited (76705) |
$489.60 |
$612 |
4.6× |
| Umbilical-artery Doppler (OB) (76820) |
$408 |
$510 |
3.8× |
| Upper gi w/o kub (74240) |
$808.80 |
$1,011 |
4.5× |
| Us chest (76604) |
$517.60 |
$647 |
4.8× |
| Us complete joint (76881) |
$624.80 |
$781 |
5.8× |
| Us exam, pelvic, limited (76857) |
$512.80 |
$641 |
4.8× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$424 |
$530 |
4.0× |
| Us ob limited 1 or more fetuses (76815) |
$505.60 |
$632 |
4.7× |
| Us ob transvaginal (76817) |
$364.80 |
$456 |
3.4× |
| Us pelvic non ob complete (76856) |
$548.80 |
$686 |
5.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$482.40 |
$603 |
4.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$420.80 |
$526 |
3.9× |
| Us retroperitoneal complete (76770) |
$615.20 |
$769 |
5.8× |
| Us retroperitoneal limited (76775) |
$476.80 |
$596 |
4.5× |
| Us scrotum and contents (76870) |
$554.40 |
$693 |
5.2× |
| Us thyroid (76536) |
$480 |
$600 |
4.5× |
| Us transrectal (76872) |
$628 |
$785 |
5.9× |
| Wrist 2 views (73100) |
$192.80 |
$241 |
2.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$330.40 |
$413 |
3.7× |
| X-Ray Bend Only L-S Spine (72120) |
$417.60 |
$522 |
3.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$177.60 |
$222 |
2.0× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$263.20 |
$329 |
2.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$185.60 |
$232 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$248 |
$310 |
2.8× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$448.80 |
$561 |
4.2× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$423.20 |
$529 |
4.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$331.20 |
$414 |
3.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$588.80 |
$736 |
5.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$657.60 |
$822 |
6.2× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$256 |
$320 |
2.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$734.40 |
$918 |
6.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$260.80 |
$326 |
2.4× |
| X-ray eye for foreign body (70030) |
$276.80 |
$346 |
3.1× |
| X-ray humerus (73060) |
$196 |
$245 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$181.60 |
$227 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$212 |
$265 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$277.60 |
$347 |
2.6× |
| X-ray nose-rectum child f.b. (76010) |
$296.80 |
$371 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$549.60 |
$687 |
5.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$363.20 |
$454 |
3.4× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$80.80 |
$101 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$236 |
$295 |
2.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$296.80 |
$371 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$545.60 |
$682 |
5.1× |
| X-ray thoracic spine 4 vw (72074) |
$457.60 |
$572 |
4.3× |
| X-Rays Bone Survey Complete (77075) |
$856.80 |
$1,071 |
8.0× |
| Xr c-spine 4 or 5 views (72050) |
$502.40 |
$628 |
4.7× |
| Xr facial bones less than 3 views (70140) |
$328 |
$410 |
3.7× |
| Xr orbits complete 4 views (70200) |
$500 |
$625 |
4.7× |