| Abdomen 1 View (74018) |
$163.80 |
$273 |
1.8× |
| Abdomen 2 views (74019) |
$299.40 |
$499 |
2.7× |
| Ankle 2 views (73600) |
$163.80 |
$273 |
1.8× |
| Chest 1 view (71045) |
$163.80 |
$273 |
1.8× |
| Chest 2 views (71046) |
$198 |
$330 |
2.2× |
| Chest 3 views (71047) |
$236.40 |
$394 |
2.6× |
| Clavicle complete (73000) |
$163.80 |
$273 |
1.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$163.80 |
$273 |
1.5× |
CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$123–$1,225.80 |
$205–$2,043 |
varies |
CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$610.20–$611.40 |
$1,017–$1,019 |
varies |
| CT abdomen w contrast (74160) |
$536.40 |
$894 |
2.9× |
| CT abdomen w wo contrast (74170) |
$747 |
$1,245 |
4.0× |
| CT abdomen w/o contrast (74150) |
$299.40 |
$499 |
2.7× |
| CT Angio Abdomen and Pelvis (74174) |
$1,021.20 |
$1,702 |
2.8× |
| CT Angio Chest (71275) |
$536.40 |
$894 |
2.9× |
| CT Angio Head (70496) |
$536.40 |
$894 |
2.9× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$536.40 |
$894 |
2.9× |
CT Angio Neck (70498) range across 2 matching MRF lines |
$534–$536.40 |
$890–$894 |
varies |
| CT cervical spine w/ contrast (72126) |
$536.40 |
$894 |
1.5× |
| CT cervical spine w/o contrast (72125) |
$299.40 |
$499 |
2.7× |
| CT cervical spine w/wo cont (72127) |
$750.60 |
$1,251 |
4.1× |
| CT chest w contrast (71260) |
$536.40 |
$894 |
2.9× |
| CT chest w/wo contrast (71270) |
$750.60 |
$1,251 |
4.1× |
| CT head/brain with contrast (70460) |
$536.40 |
$894 |
2.9× |
| CT head/brain without and with contrast (70470) |
$750.60 |
$1,251 |
4.1× |
| CT iac w contrast (70481) |
$536.40 |
$894 |
2.9× |
| CT l-spine w&w/o contrast (72133) |
$750.60 |
$1,251 |
4.1× |
| CT lower ext w/o (73700) |
$299.40 |
$499 |
2.7× |
| CT lower extremity w/contrast material (73701) |
$536.40 |
$894 |
2.9× |
| CT lumbar spine w contrast (72132) |
$536.40 |
$894 |
1.5× |
| CT lumbar spine w/o contrast (72131) |
$299.40 |
$499 |
2.7× |
| CT maxillofacial w contrast (70487) |
$536.40 |
$894 |
2.9× |
| CT maxillofacial wo contrast (70486) |
$299.40 |
$499 |
2.7× |
| CT neck tissue combo (70492) |
$750.60 |
$1,251 |
4.1× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$750.60 |
$1,251 |
4.1× |
| CT orbits w/o contrast (70480) |
$299.40 |
$499 |
2.7× |
| CT pelvis w&w/o contrast (72194) |
$750.60 |
$1,251 |
4.1× |
| CT pelvis w/o contrast (72192) |
$299.40 |
$499 |
2.7× |
| CT scan of leg combo (73702) |
$750.60 |
$1,251 |
4.1× |
| CT scans face/jaw combo (70488) |
$750.60 |
$1,251 |
4.1× |
| CT soft tissue neck w contrast (70491) |
$536.40 |
$894 |
2.9× |
| CT soft tissue neck w/o contrast (70490) |
$299.40 |
$499 |
2.7× |
| CT thoracic spine w contrast (72129) |
$536.40 |
$894 |
2.9× |
| CT thoracic spine w/o contrast (72128) |
$299.40 |
$499 |
2.7× |
| CT thoracic spine w/wo cont (72130) |
$750.60 |
$1,251 |
4.1× |
| CT thorax w/o contrast (71250) |
$299.40 |
$499 |
2.7× |
| CT upper ext wo (73200) |
$299.40 |
$499 |
2.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$750.60 |
$1,251 |
4.1× |
| CT upper extremity with contrast (73201) |
$536.40 |
$894 |
1.5× |
| Cta Abdomen (74175) |
$536.40 |
$894 |
2.9× |
| Foot 2 views (73620) |
$163.80 |
$273 |
1.8× |
| Forearm 2 views (73090) |
$163.80 |
$273 |
1.8× |
| Hand 2 views (73120) |
$163.80 |
$273 |
1.5× |
| Knee 3 Views (73562) |
$198 |
$330 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$1,530 |
$2,550 |
6.1× |
| Neck soft tissue (70360) |
$163.80 |
$273 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$299.40 |
$499 |
2.7× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$357.60 |
$596 |
3.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$198 |
$330 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$163.80 |
$273 |
1.8× |
| Radex elbow complete minimum 3 views (73080) |
$198 |
$330 |
2.2× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$299.40 |
$499 |
2.7× |
| Radex fingr minimum 2 views (73140) |
$163.80 |
$273 |
1.8× |
| Radex foot complete minimum 3 views (73630) |
$198 |
$330 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$198 |
$330 |
2.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$299.40 |
$499 |
2.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$163.80 |
$273 |
1.8× |
| Radex shoulder complete minimum 2 views (73030) |
$198 |
$330 |
2.2× |
| Radex Sinuses Paransl < 3 Views (70210) |
$163.80 |
$273 |
1.8× |
| Radex Spine 1 View Specify Level (72020) |
$163.80 |
$273 |
1.8× |
| Radex Sternum Minimum 2 Views (71120) |
$163.80 |
$273 |
1.8× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$163.80 |
$273 |
1.8× |
| Radex Toe Minimum 2 Views (73660) |
$163.80 |
$273 |
1.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$198 |
$330 |
2.2× |
| Radiologic exam knee complete 4/more views (73564) |
$236.40 |
$394 |
2.1× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$356.40 |
$594 |
3.2× |
| Radiologic examination femur minimum 2 views (73552) |
$163.80 |
$273 |
1.8× |
| Radiologic examination knee 1/2 views (73560) |
$163.80 |
$273 |
1.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$163.80 |
$273 |
1.8× |
| Scapula (73010) |
$299.40 |
$499 |
2.7× |
| Shoulder 1 view (73020) |
$163.80 |
$273 |
1.8× |
| Skull less than 4 views (70250) |
$299.40 |
$499 |
2.7× |
| Thoracic spine 2 views (72070) |
$299.40 |
$499 |
2.7× |
| Thoracic spine 3 views (72072) |
$356.40 |
$594 |
3.2× |
| Thoracolumbar 2 views (72080) |
$163.80 |
$273 |
1.8× |
| Ultrasound Exam Aaa Screen (76706) |
$299.40 |
$499 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$239.40 |
$399 |
2.2× |
| Umbilical-artery Doppler (OB) (76820) |
$283.80 |
$473 |
2.6× |
| Us breast unilateral complete (76641) |
$249 |
$415 |
2.3× |
| Us chest (76604) |
$299.40 |
$499 |
2.7× |
| Us complete joint (76881) |
$299.40 |
$499 |
2.7× |
| Us exam, pelvic, limited (76857) |
$239.40 |
$399 |
2.2× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$299.40 |
$499 |
2.7× |
| Us ob limited 1 or more fetuses (76815) |
$283.80 |
$473 |
2.6× |
| Us pelvic non ob complete (76856) |
$299.40 |
$499 |
2.7× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$299.40 |
$499 |
2.7× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$283.80 |
$473 |
2.6× |
| Us retroperitoneal complete (76770) |
$299.40 |
$499 |
2.7× |
| Us retroperitoneal limited (76775) |
$239.40 |
$399 |
2.2× |
| Us scrotum and contents (76870) |
$299.40 |
$499 |
2.7× |
| Us thyroid (76536) |
$299.40 |
$499 |
2.7× |
| Wrist 2 views (73100) |
$163.80 |
$273 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$163.80 |
$273 |
1.8× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$299.40 |
$499 |
2.7× |
| X-Ray Exam Hip Uni 1 View (73501) |
$163.80 |
$273 |
1.8× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$198 |
$330 |
2.2× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$236.40 |
$394 |
2.1× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$283.80 |
$473 |
2.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$428.40 |
$714 |
3.9× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$163.80 |
$273 |
1.8× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$230.40 |
$384 |
2.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$299.40 |
$499 |
2.7× |
| X-ray eye for foreign body (70030) |
$163.80 |
$273 |
1.8× |
| X-ray humerus (73060) |
$163.80 |
$273 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$163.80 |
$273 |
1.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$283.80 |
$473 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$299.40 |
$499 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$356.40 |
$594 |
3.2× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$299.40 |
$499 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$163.80 |
$273 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$198 |
$330 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$356.40 |
$594 |
3.2× |
| Xr c-spine 4 or 5 views (72050) |
$230.40 |
$384 |
2.1× |
| Xr facial bones less than 3 views (70140) |
$163.80 |
$273 |
1.8× |
| Xr orbits complete 4 views (70200) |
$299.40 |
$499 |
2.7× |