| Abdomen 1 View (74018) |
$168 |
— |
1.5× |
| Abdomen 2 views (74019) |
$202 |
— |
1.5× |
| Ankle 2 views (73600) |
$168 |
— |
1.5× |
| Arthrogram ankle (73615) |
$679 |
— |
1.6× |
| Arthrogram hip (73525) |
$679 |
— |
1.6× |
| Arthrogram Wrist (73115) |
$679 |
— |
1.6× |
| Bone age studies (77072) |
$202 |
— |
1.5× |
| Bone survey infant (77076) |
$202 |
— |
1.5× |
| Chest 1 view (71045) |
$168 |
— |
1.5× |
| Chest 2 views (71046) |
$168 |
— |
1.5× |
| Chest 3 views (71047) |
$168 |
— |
1.5× |
| Chest 4 or more views (71048) |
$202 |
— |
1.5× |
| Clavicle complete (73000) |
$168 |
— |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$202 |
— |
1.5× |
| Contrast X-Ray Bladder (74430) |
$679 |
— |
1.6× |
| Contrast X-Ray Of Elbow (73085) |
$679 |
— |
1.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$679 |
— |
1.6× |
| CT abdomen and pelvis without contrast (74176) |
$460 |
— |
1.5× |
| CT abdomen w contrast (74160) |
$338 |
— |
1.5× |
| CT abdomen w wo contrast (74170) |
$338 |
— |
1.5× |
| CT abdomen w/o contrast (74150) |
$202 |
— |
1.5× |
| CT Angio Abdomen and Pelvis (74174) |
$679 |
— |
1.6× |
| CT Angio Chest (71275) |
$338 |
— |
1.5× |
| CT Angio Head (70496) |
$338 |
— |
1.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$338 |
— |
1.5× |
| CT Angio Neck (70498) |
$338 |
— |
1.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$338 |
— |
1.5× |
| CT cervical spine w/ contrast (72126) |
$679 |
— |
1.6× |
| CT cervical spine w/o contrast (72125) |
$202 |
— |
1.5× |
| CT cervical spine w/wo cont (72127) |
$338 |
— |
1.5× |
| CT chest w contrast (71260) |
$338 |
— |
1.5× |
| CT chest w/wo contrast (71270) |
$338 |
— |
1.5× |
| CT head/brain with contrast (70460) |
$338 |
— |
1.5× |
| CT head/brain without and with contrast (70470) |
$338 |
— |
1.5× |
| CT iac w contrast (70481) |
$338 |
— |
1.5× |
| CT l-spine w&w/o contrast (72133) |
$338 |
— |
1.5× |
| CT lower ext w/o (73700) |
$202 |
— |
1.5× |
| CT lower extremity w/contrast material (73701) |
$338 |
— |
1.5× |
| CT lumbar spine w contrast (72132) |
$679 |
— |
1.6× |
| CT lumbar spine w/o contrast (72131) |
$202 |
— |
1.5× |
| CT maxillofacial w contrast (70487) |
$338 |
— |
1.5× |
| CT maxillofacial wo contrast (70486) |
$202 |
— |
1.5× |
| CT neck tissue combo (70492) |
$338 |
— |
1.5× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$338 |
— |
1.5× |
| CT orbits w/o contrast (70480) |
$202 |
— |
1.5× |
| CT pelvis w&w/o contrast (72194) |
$338 |
— |
1.5× |
| CT pelvis w/o contrast (72192) |
$202 |
— |
1.5× |
| CT scan of leg combo (73702) |
$338 |
— |
1.5× |
| CT scans face/jaw combo (70488) |
$338 |
— |
1.5× |
| CT soft tissue neck w contrast (70491) |
$338 |
— |
1.5× |
| CT soft tissue neck w/o contrast (70490) |
$202 |
— |
1.5× |
| CT thoracic spine w contrast (72129) |
$338 |
— |
1.5× |
| CT thoracic spine w/o contrast (72128) |
$202 |
— |
1.5× |
| CT thoracic spine w/wo cont (72130) |
$338 |
— |
1.5× |
| CT thorax w/o contrast (71250) |
$202 |
— |
1.5× |
| CT upper ext wo (73200) |
$202 |
— |
1.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$338 |
— |
1.5× |
| CT upper extremity with contrast (73201) |
$679 |
— |
1.6× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$338 |
— |
1.5× |
| Cta Abdomen (74175) |
$338 |
— |
1.5× |
| CTA pelvis (72191) |
$338 |
— |
1.5× |
| Dilation ureters/urethra rs&i (74485) |
$130.59 |
$219 |
0.1× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$202 |
— |
1.5× |
| Dxa Bone Density Axial (77080) |
$202 |
— |
1.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$168 |
— |
1.5× |
| Esophagram (74220) |
$338 |
— |
1.5× |
| Fetal Biophys Profile W/Nst (76818) |
$202 |
— |
1.5× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$202 |
— |
1.5× |
| Fluoroscopy up to 1 hr (76000) |
$460 |
— |
1.5× |
| Foot 2 views (73620) |
$168 |
— |
1.5× |
| Forearm 2 views (73090) |
$168 |
— |
1.5× |
| Hand 2 views (73120) |
$202 |
— |
1.5× |
| Infant hip ultrasound, limited static exam (76886) |
$168 |
— |
1.5× |
| Joint Survey Single View (77077) |
$202 |
— |
1.5× |
| Knee 3 Views (73562) |
$168 |
— |
1.5× |
| Magnetic Image Jaw Joint (70336) |
$460 |
— |
1.5× |
| Mra Head W/O & W/Contrast Material (70546) |
$679 |
— |
1.6× |
| MRA head w/o contrast (70544) |
$460 |
— |
1.5× |
| MRA head with contrast (70545) |
$679 |
— |
1.6× |
| MRA neck w contrast (70548) |
$679 |
— |
1.6× |
| Mra Neck W/O &W/Contrast Material (70549) |
$679 |
— |
1.6× |
| MRA neck w/o contrast (70547) |
$460 |
— |
1.5× |
| MRI abdomen w contrast (74182) |
$679 |
— |
1.6× |
| MRI abdomen w/o contrast (74181) |
$460 |
— |
1.5× |
| MRI any jt lower extrem w/contrast material (73722) |
$1,502 |
— |
1.5× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$679 |
— |
1.6× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$1,502 |
— |
1.5× |
| MRI Breast W/O Contrast Bilateral (77047) |
$460 |
— |
1.5× |
| MRI cervical spine w contrast (72142) |
$679 |
— |
1.6× |
| MRI cervical spine w/o cont (72141) |
$460 |
— |
1.5× |
| MRI chest w/o contrast (71550) |
$460 |
— |
1.5× |
| MRI chest with contrast (71551) |
$1,502 |
— |
1.5× |
| MRI chest wo w contrast (71552) |
$679 |
— |
1.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$679 |
— |
1.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$679 |
— |
1.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$460 |
— |
1.5× |
| MRI lumbar spine w contrast (72149) |
$679 |
— |
1.6× |
| Mri Neck Spine W/O & W/Dye (72156) |
$679 |
— |
1.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$460 |
— |
1.5× |
| MRI orbit face neck w contrast (70542) |
$679 |
— |
1.6× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$679 |
— |
1.6× |
| MRI pelvis w contrast (72196) |
$679 |
— |
1.6× |
| MRI pelvis w/o & w contrast (72197) |
$679 |
— |
1.6× |
| MRI pelvis w/o contrast (72195) |
$460 |
— |
1.5× |
| MRI thoracic spine w/o contrast (72146) |
$460 |
— |
1.5× |
| MRI upper extremity oth than jt w/contr matrl (73219) |
$679 |
— |
1.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$460 |
— |
1.5× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$679 |
— |
1.6× |
| MRI, abdomen, combo (74183) |
$679 |
— |
1.6× |
| MRI, dorsal spine combo (72157) |
$679 |
— |
1.6× |
| MRI, dorsal spine contrast (72147) |
$679 |
— |
1.6× |
| MRI, joint upper extrem (73221) |
$460 |
— |
1.5× |
| MRI, joint upper extrem combo (73223) |
$679 |
— |
1.6× |
| MRI, lumbar spine combo (72158) |
$679 |
— |
1.6× |
| Neck soft tissue (70360) |
$168 |
— |
1.5× |
| Ob us nuchal meas 1 gest (76813) |
$202 |
— |
1.5× |
| Ophthalmic Ultrasonic Foreign Body Localization (76529) |
$168 |
— |
1.5× |
Ophthalmic ultrasound dx b-scan w/wo a-scan (76512)
range across 2 matching MRF lines |
$26–$202 |
— |
varies |
| Pelvis 1 or 2 views (72170) |
$202 |
— |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$202 |
— |
1.5× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$168 |
— |
1.5× |
| Radex Calcaneus Minimum 2 Views (73650) |
$168 |
— |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$168 |
— |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$202 |
— |
1.5× |
| Radex fingr minimum 2 views (73140) |
$168 |
— |
1.5× |
| Radex foot complete minimum 3 views (73630) |
$168 |
— |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$168 |
— |
1.5× |
| Radex lower extremity infant minimum 2 views (73592) |
$168 |
— |
1.5× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$202 |
— |
1.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$168 |
— |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$168 |
— |
1.5× |
| Radex shoulder complete minimum 2 views (73030) |
$168 |
— |
1.5× |
| Radex Spine 1 View Specify Level (72020) |
$168 |
— |
1.5× |
| Radex Sternum Minimum 2 Views (71120) |
$168 |
— |
1.5× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$168 |
— |
1.5× |
| Radex Toe Minimum 2 Views (73660) |
$168 |
— |
1.5× |
| Radex upper extremity infant minimum 2 views (73092) |
$202 |
— |
1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$168 |
— |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$202 |
— |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$202 |
— |
1.5× |
| Radiologic exam colon double contrast study (74280) |
$338 |
— |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$338 |
— |
1.5× |
| Radiologic exam knee complete 4/more views (73564) |
$202 |
— |
1.5× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$202 |
— |
1.5× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$338 |
— |
1.5× |
| Radiologic exam swallow function contrast study (74230) |
$338 |
— |
1.5× |
| Radiologic exam upr gi trc double contrast study (74246) |
$338 |
— |
1.5× |
| Radiologic examination femur 1 view (73551) |
$168 |
— |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$168 |
— |
1.5× |
| Radiologic examination knee 1/2 views (73560) |
$168 |
— |
1.5× |
| Radiologic Examination Osseous Survey Limited (77074) |
$202 |
— |
1.5× |
| Radiologic examination tibia & fibula 2 views (73590) |
$168 |
— |
1.5× |
| Ribs bilateral 3 views (71110) |
$202 |
— |
1.5× |
| Scapula (73010) |
$202 |
— |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$30 |
— |
1.3× |
| Shoulder 1 view (73020) |
$168 |
— |
1.5× |
| Shoulder Arthrography (73040) |
$679 |
— |
1.6× |
| Skull less than 4 views (70250) |
$202 |
— |
1.5× |
| Sternoclavicular joints (71130) |
$168 |
— |
1.5× |
| Tbs technical calculation only (77091) |
$168 |
— |
1.5× |
| Thoracic spine 2 views (72070) |
$202 |
— |
1.5× |
| Thoracic spine 3 views (72072) |
$202 |
— |
1.5× |
| Thoracolumbar 2 views (72080) |
$168 |
— |
1.5× |
| Ultrasound Breast Limited (76642) |
$168 |
— |
1.5× |
| Ultrasound Exam Aaa Screen (76706) |
$202 |
— |
1.5× |
Ultrasound, abdomen limited (76705)
range across 2 matching MRF lines |
$24–$202 |
— |
varies |
| Umbilical-artery Doppler (OB) (76820) |
$202 |
— |
1.5× |
| Unlisted us procedure (76999) |
$168 |
— |
1.5× |
| Upper gi w/o kub (74240) |
$338 |
— |
1.5× |
| Urethrocystogram voiding (74455) |
$460 |
— |
1.5× |
| Us breast unilateral complete (76641) |
$202 |
— |
1.5× |
Us chest (76604)
range across 2 matching MRF lines |
$25–$202 |
— |
varies |
| Us complete joint (76881) |
$202 |
— |
1.5× |
Us exam, pelvic, limited (76857)
range across 2 matching MRF lines |
$20–$202 |
— |
varies |
| Us kidney transplant (76776) |
$202 |
— |
1.5× |
Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882)
range across 2 matching MRF lines |
$28–$202 |
— |
varies |
| Us ob detailed single fetus (76811) |
$460 |
— |
1.5× |
Us ob limited 1 or more fetuses (76815)
range across 2 matching MRF lines |
$27–$202 |
— |
varies |
Us ob transvaginal (76817)
range across 2 matching MRF lines |
$30–$202 |
— |
varies |
| Us pelvic non ob complete (76856) |
$202 |
— |
1.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$202 |
— |
1.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$202 |
— |
1.5× |
| Us retroperitoneal complete (76770) |
$202 |
— |
1.5× |
Us retroperitoneal limited (76775)
range across 2 matching MRF lines |
$24–$202 |
— |
varies |
| Us scrotum and contents (76870) |
$202 |
— |
1.5× |
| Us spinal canal and contents (76800) |
$202 |
— |
1.5× |
Us thyroid (76536)
range across 2 matching MRF lines |
$23–$202 |
— |
varies |
| Us transrectal (76872) |
$36.37 |
$61 |
0.3× |
| Wrist 2 views (73100) |
$168 |
— |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$168 |
— |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168 |
— |
1.5× |
| X-Ray Exam Breast Specimen (76098) |
$1,042 |
— |
1.5× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$168 |
— |
1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$202 |
— |
1.5× |
| X-Ray Exam Hip Uni 1 View (73501) |
$168 |
— |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$168 |
— |
1.5× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$66.79 |
$112 |
0.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$202 |
— |
1.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$202 |
— |
1.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$202 |
— |
1.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$67.98 |
$114 |
0.5× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$168 |
— |
1.5× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$202 |
— |
1.5× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$202 |
— |
1.5× |
| X-ray eye for foreign body (70030) |
$168 |
— |
1.5× |
| X-ray humerus (73060) |
$168 |
— |
1.5× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$168 |
— |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$168 |
— |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$202 |
— |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$168 |
— |
1.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$202 |
— |
1.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$202 |
— |
1.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$36.97 |
$62 |
0.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$168 |
— |
1.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$168 |
— |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$202 |
— |
1.5× |
| X-ray thoracic spine 4 vw (72074) |
$49.49 |
$83 |
0.4× |
| X-Ray Urinary Tract Exam With Contrast Material (74420) |
$679 |
— |
1.6× |
| X-Rays Bone Length Studies (77073) |
$202 |
— |
1.5× |
| X-Rays Bone Survey Complete (77075) |
$202 |
— |
1.5× |
| Xr c-spine 4 or 5 views (72050) |
$202 |
— |
1.5× |
| Xr facial bones less than 3 views (70140) |
$168 |
— |
1.5× |
| Xr orbits complete 4 views (70200) |
$52.47 |
$88 |
0.4× |