| Abdomen 1 View (74018) |
$191.25 |
$225 |
2.4× |
| Abdomen 2 views (74019) |
$212.50 |
$250 |
2.2× |
| Ankle 2 views (73600) |
$148.75 |
$175 |
1.9× |
| Bone Imaging 3 Phase (78315) |
$510 |
$600 |
1.4× |
| Chest 1 view (71045) |
$174.25 |
$205 |
2.2× |
| Chest 2 views (71046) |
$191.25 |
$225 |
2.4× |
| Clavicle complete (73000) |
$161.50 |
$190 |
2.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$650.25 |
$765 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$714 |
$840 |
2.2× |
| CT abdomen and pelvis without contrast (74176) |
$658.75 |
$775 |
3.0× |
| CT Angio Abdomen and Pelvis (74174) |
$2,452.25 |
$2,885 |
7.6× |
| CT Angio Chest (71275) |
$1,649 |
$1,940 |
10.2× |
| CT Angio Neck (70498) |
$1,670.25 |
$1,965 |
10.4× |
| CT cervical spine w/o contrast (72125) |
$658.75 |
$775 |
6.9× |
| CT chest w contrast (71260) |
$684.25 |
$805 |
4.2× |
| CT chest w/wo contrast (71270) |
$714 |
$840 |
4.4× |
| CT head/brain without and with contrast (70470) |
$714 |
$840 |
4.4× |
| CT lower ext w/o (73700) |
$658.75 |
$775 |
6.9× |
| CT lower extremity w/contrast material (73701) |
$684.25 |
$805 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$658.75 |
$775 |
6.9× |
| CT maxillofacial wo contrast (70486) |
$658.75 |
$775 |
6.9× |
| CT neck tissue combo (70492) |
$714 |
$840 |
4.4× |
| CT pelvis w/o contrast (72192) |
$658.75 |
$775 |
6.9× |
| CT scans face/jaw combo (70488) |
$714 |
$840 |
4.4× |
| CT soft tissue neck w contrast (70491) |
$684.25 |
$805 |
4.2× |
| CT soft tissue neck w/o contrast (70490) |
$658.75 |
$775 |
6.9× |
| CT thoracic spine w/o contrast (72128) |
$658.75 |
$775 |
6.9× |
| CT thorax w/o contrast (71250) |
$658.75 |
$775 |
6.9× |
| CT upper ext wo (73200) |
$658.75 |
$775 |
6.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,755.25 |
$2,065 |
10.9× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$3,374.50 |
$3,970 |
10.5× |
Dxa Bone Density Axial (77080)
range across 2 matching MRF lines |
$42.50–$276.25 |
$50–$325 |
varies |
| Foot 2 views (73620) |
$136 |
$160 |
1.7× |
| Forearm 2 views (73090) |
$174.25 |
$205 |
2.2× |
| Hand 2 views (73120) |
$148.75 |
$175 |
1.5× |
| Hepatobil Syst Image W/Drug (78227) |
$765 |
$900 |
1.5× |
| Knee 3 Views (73562) |
$212.50 |
$250 |
2.7× |
| MRA head w/o contrast (70544) |
$867 |
$1,020 |
4.0× |
| MRI cervical spine w/o cont (72141) |
$786.25 |
$925 |
3.6× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$786.25 |
$925 |
2.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$786.25 |
$925 |
3.6× |
| MRI pelvis w/o & w contrast (72197) |
$786.25 |
$925 |
2.5× |
| MRI pelvis w/o contrast (72195) |
$786.25 |
$925 |
3.6× |
| MRI thoracic spine w/o contrast (72146) |
$786.25 |
$925 |
3.6× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$786.25 |
$925 |
3.6× |
| MRI, joint upper extrem (73221) |
$786.25 |
$925 |
3.6× |
| MRI, lumbar spine combo (72158) |
$786.25 |
$925 |
2.5× |
| Myocardial Spect Multiple Studies (78452) |
$1,848.75 |
$2,175 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$178.50 |
$210 |
1.9× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$369.75 |
$435 |
3.8× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$195.50 |
$230 |
2.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$161.50 |
$190 |
2.0× |
| Radex elbow complete minimum 3 views (73080) |
$212.50 |
$250 |
2.7× |
| Radex fingr minimum 2 views (73140) |
$148.75 |
$175 |
1.9× |
| Radex foot complete minimum 3 views (73630) |
$191.25 |
$225 |
2.4× |
| Radex Hand Minimum 3 Views (73130) |
$191.25 |
$225 |
2.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$187 |
$220 |
2.3× |
| Radex shoulder complete minimum 2 views (73030) |
$199.75 |
$235 |
2.5× |
| Radex Sinuses Paransl < 3 Views (70210) |
$144.50 |
$170 |
1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$199.75 |
$235 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$191.25 |
$225 |
2.4× |
| Radiologic examination knee 1/2 views (73560) |
$191.25 |
$225 |
2.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$199.75 |
$235 |
2.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$97.75 |
$115 |
4.2× |
| Shoulder 1 view (73020) |
$148.75 |
$175 |
1.9× |
| Thoracic spine 2 views (72070) |
$187 |
$220 |
1.9× |
| Thoracic spine 3 views (72072) |
$284.75 |
$335 |
3.0× |
| Ultrasound Breast Limited (76642) |
$140.25 |
$165 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$195.50 |
$230 |
2.0× |
| Us complete joint (76881) |
$195.50 |
$230 |
2.0× |
| Us exam, pelvic, limited (76857) |
$195.50 |
$230 |
2.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$195.50 |
$230 |
2.0× |
| Us ob limited 1 or more fetuses (76815) |
$229.50 |
$270 |
2.4× |
| Us ob transvaginal (76817) |
$195.50 |
$230 |
2.0× |
| Us pelvic non ob complete (76856) |
$216.75 |
$255 |
2.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$195.50 |
$230 |
2.0× |
| Us retroperitoneal limited (76775) |
$195.50 |
$230 |
2.0× |
| Us scrotum and contents (76870) |
$216.75 |
$255 |
2.3× |
| Us thyroid (76536) |
$531.25 |
$625 |
5.5× |
| Wrist 2 views (73100) |
$136 |
$160 |
1.7× |
| X-Ray Bend Only L-S Spine (72120) |
$327.25 |
$385 |
3.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$153 |
$180 |
1.9× |
| X-Ray Exam Hip Uni 1 View (73501) |
$195.50 |
$230 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$238 |
$280 |
3.0× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$238 |
$280 |
2.5× |
| X-Ray Exam L-S Spine Bending (72114) |
$420.75 |
$495 |
4.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$225.25 |
$265 |
2.8× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$280.50 |
$330 |
2.9× |
| X-ray humerus (73060) |
$161.50 |
$190 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$246.50 |
$290 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$199.75 |
$235 |
2.5× |
| Xr c-spine 4 or 5 views (72050) |
$361.25 |
$425 |
3.8× |