| Abdomen 1 View (74018) |
$352 |
$352 |
4.0× |
| Abdomen 2 views (74019) |
$519 |
$519 |
4.9× |
| Ankle 2 views (73600) |
$173 |
$173 |
1.9× |
| Bone age studies (77072) |
$278 |
$278 |
2.6× |
| Bone survey infant (77076) |
$289 |
$289 |
2.7× |
| Cat Scan Follow-Up Study (76380) |
$785 |
$785 |
8.8× |
| Chest 1 view (71045) |
$327 |
$327 |
3.7× |
| Chest 2 views (71046) |
$420 |
$420 |
4.7× |
| Chest 3 views (71047) |
$293 |
$293 |
3.3× |
| Clavicle complete (73000) |
$362 |
$362 |
4.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$389 |
$389 |
3.6× |
| CT abdomen and pelvis without and with contrast (74178) |
$5,001 |
$5,001 |
14.0× |
| CT abdomen and pelvis without contrast (74176) |
$3,453 |
$3,453 |
14.2× |
| CT abdomen w contrast (74160) |
$2,680 |
$2,680 |
15.0× |
| CT abdomen w wo contrast (74170) |
$2,620 |
$2,620 |
14.6× |
| CT abdomen w/o contrast (74150) |
$1,638 |
$1,638 |
15.3× |
| CT Angio Abdomen and Pelvis (74174) |
$4,519 |
$4,519 |
12.7× |
| CT Angio Chest (71275) |
$2,816 |
$2,816 |
15.7× |
| CT Angio Head (70496) |
$3,078 |
$3,078 |
17.2× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$2,816 |
$2,816 |
15.7× |
| CT Angio Neck (70498) |
$3,078 |
$3,078 |
17.2× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,620 |
$2,620 |
14.6× |
| CT cervical spine w/ contrast (72126) |
$2,381 |
$2,381 |
6.7× |
| CT cervical spine w/o contrast (72125) |
$1,905 |
$1,905 |
17.8× |
| CT cervical spine w/wo cont (72127) |
$2,490 |
$2,490 |
13.9× |
| CT chest w contrast (71260) |
$2,680 |
$2,680 |
15.0× |
| CT chest w/wo contrast (71270) |
$2,620 |
$2,620 |
14.6× |
| CT head/brain with contrast (70460) |
$2,292 |
$2,292 |
12.8× |
| CT head/brain without and with contrast (70470) |
$2,620 |
$2,620 |
14.6× |
| CT iac w contrast (70481) |
$2,292 |
$2,292 |
12.8× |
| CT lower ext w/o (73700) |
$1,638 |
$1,638 |
15.3× |
| CT lower extremity w/contrast material (73701) |
$2,292 |
$2,292 |
12.8× |
| CT lumbar spine w contrast (72132) |
$2,084 |
$2,084 |
5.8× |
| CT lumbar spine w/o contrast (72131) |
$1,786 |
$1,786 |
16.7× |
| CT maxillofacial w contrast (70487) |
$2,292 |
$2,292 |
12.8× |
| CT maxillofacial wo contrast (70486) |
$1,638 |
$1,638 |
15.3× |
| CT neck tissue combo (70492) |
$2,620 |
$2,620 |
14.6× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$2,292 |
$2,292 |
12.8× |
| CT orbits w/o contrast (70480) |
$1,638 |
$1,638 |
15.3× |
| CT pelvis w&w/o contrast (72194) |
$2,620 |
$2,620 |
14.6× |
| CT pelvis w/o contrast (72192) |
$1,786 |
$1,786 |
16.7× |
| CT scans face/jaw combo (70488) |
$2,620 |
$2,620 |
14.6× |
| CT soft tissue neck w contrast (70491) |
$2,292 |
$2,292 |
12.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,638 |
$1,638 |
15.3× |
| CT thoracic spine w contrast (72129) |
$166 |
$166 |
0.9× |
| CT thoracic spine w/o contrast (72128) |
$1,786 |
$1,786 |
16.7× |
| CT thorax w/o contrast (71250) |
$1,786 |
$1,786 |
16.7× |
| CT upper ext wo (73200) |
$1,638 |
$1,638 |
15.3× |
| CT upper extremity with contrast (73201) |
$2,292 |
$2,292 |
6.4× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$4,339 |
$4,339 |
24.2× |
| Cta Abdomen (74175) |
$2,816 |
$2,816 |
15.7× |
| CTA pelvis (72191) |
$2,816 |
$2,816 |
15.7× |
| Dxa Bone Density Axial (77080) |
$694 |
$694 |
6.5× |
| Fetal Biophys Profile W/Nst (76818) |
$748 |
$748 |
7.0× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$725 |
$725 |
6.8× |
| Foot 2 views (73620) |
$182 |
$182 |
2.0× |
| Forearm 2 views (73090) |
$188 |
$188 |
2.1× |
| Hand 2 views (73120) |
$172 |
$172 |
1.6× |
| Knee 3 Views (73562) |
$357 |
$357 |
4.0× |
| Mra Head W/O & W/Contrast Material (70546) |
$4,323 |
$4,323 |
12.1× |
| MRA head w/o contrast (70544) |
$3,014 |
$3,014 |
12.4× |
| MRA head with contrast (70545) |
$4,323 |
$4,323 |
12.1× |
| MRA neck w contrast (70548) |
$3,014 |
$3,014 |
8.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$4,323 |
$4,323 |
12.1× |
| MRA neck w/o contrast (70547) |
$3,014 |
$3,014 |
12.4× |
| MRI abdomen w contrast (74182) |
$3,275 |
$3,275 |
9.2× |
| MRI abdomen w/o contrast (74181) |
$2,620 |
$2,620 |
10.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$3,929 |
$3,929 |
11.0× |
| MRI cervical spine w contrast (72142) |
$3,275 |
$3,275 |
9.2× |
| MRI cervical spine w/o cont (72141) |
$2,858 |
$2,858 |
11.7× |
| MRI chest w/o contrast (71550) |
$3,000 |
$3,000 |
12.3× |
| MRI chest wo w contrast (71552) |
$4,584 |
$4,584 |
12.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$4,125 |
$4,125 |
11.6× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$2,685 |
$2,685 |
11.0× |
| MRI lumbar spine w contrast (72149) |
$3,014 |
$3,014 |
8.5× |
| Mri Neck Spine W/O & W/Dye (72156) |
$3,929 |
$3,929 |
11.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,751 |
$2,751 |
11.3× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$4,060 |
$4,060 |
11.4× |
| MRI pelvis w contrast (72196) |
$3,275 |
$3,275 |
9.2× |
| MRI pelvis w/o & w contrast (72197) |
$4,192 |
$4,192 |
11.8× |
| MRI pelvis w/o contrast (72195) |
$2,751 |
$2,751 |
11.3× |
| MRI thoracic spine w/o contrast (72146) |
$2,620 |
$2,620 |
10.7× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$4,125 |
$4,125 |
11.6× |
| MRI, abdomen, combo (74183) |
$4,286 |
$4,286 |
12.0× |
| MRI, dorsal spine combo (72157) |
$4,049 |
$4,049 |
11.4× |
| MRI, dorsal spine contrast (72147) |
$3,275 |
$3,275 |
9.2× |
| MRI, joint upper extrem (73221) |
$2,620 |
$2,620 |
10.7× |
| MRI, lumbar spine combo (72158) |
$4,167 |
$4,167 |
11.7× |
| Neck soft tissue (70360) |
$197 |
$197 |
2.2× |
| Optic foramina (70190) |
$167 |
$167 |
1.9× |
| Pelvis 1 or 2 views (72170) |
$366 |
$366 |
3.4× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,547 |
$1,547 |
3.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$653 |
$653 |
6.1× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$406 |
$406 |
4.6× |
| Radex Calcaneus Minimum 2 Views (73650) |
$167 |
$167 |
1.9× |
| Radex elbow complete minimum 3 views (73080) |
$213 |
$213 |
2.4× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$542 |
$542 |
5.1× |
| Radex fingr minimum 2 views (73140) |
$147 |
$147 |
1.7× |
| Radex foot complete minimum 3 views (73630) |
$435 |
$435 |
4.9× |
| Radex Hand Minimum 3 Views (73130) |
$198 |
$198 |
2.2× |
| Radex lower extremity infant minimum 2 views (73592) |
$193 |
$193 |
2.2× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$326 |
$326 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$174 |
$174 |
2.0× |
| Radex Ribs Unilateral 2 Views (71100) |
$237 |
$237 |
2.7× |
| Radex shoulder complete minimum 2 views (73030) |
$468 |
$468 |
5.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$197 |
$197 |
2.2× |
| Radex Spine 1 View Specify Level (72020) |
$166 |
$166 |
1.9× |
| Radex Sternum Minimum 2 Views (71120) |
$244 |
$244 |
2.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$356 |
$356 |
4.0× |
| Radex Toe Minimum 2 Views (73660) |
$158 |
$158 |
1.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$182 |
$182 |
1.7× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$419 |
$419 |
4.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$502 |
$502 |
4.7× |
| Radiologic exam knee complete 4/more views (73564) |
$417 |
$417 |
3.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$301 |
$301 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$203 |
$203 |
2.3× |
| Radiologic examination femur minimum 2 views (73552) |
$238 |
$238 |
2.7× |
| Radiologic examination knee 1/2 views (73560) |
$298 |
$298 |
3.4× |
| Radiologic Examination Osseous Survey Limited (77074) |
$456 |
$456 |
4.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$384 |
$384 |
4.3× |
| Ribs bilateral 3 views (71110) |
$311 |
$311 |
2.9× |
| Scapula (73010) |
$480 |
$480 |
4.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$238 |
$238 |
10.2× |
| Sella turcica (70240) |
$170 |
$170 |
1.9× |
| Shoulder 1 view (73020) |
$186 |
$186 |
2.1× |
| Skull less than 4 views (70250) |
$238 |
$238 |
2.2× |
| Sternoclavicular joints (71130) |
$270 |
$270 |
3.0× |
| Thoracic spine 2 views (72070) |
$455 |
$455 |
4.3× |
| Thoracic spine 3 views (72072) |
$553 |
$553 |
5.2× |
| Thoracolumbar 2 views (72080) |
$253 |
$253 |
2.8× |
| Ultrasound Exam Aaa Screen (76706) |
$413 |
$413 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$714 |
$714 |
6.7× |
| Urethrocystogram voiding (74455) |
$878 |
$878 |
3.6× |
| Us chest (76604) |
$533 |
$533 |
5.0× |
| Us complete joint (76881) |
$477 |
$477 |
4.5× |
| Us exam, pelvic, limited (76857) |
$542 |
$542 |
5.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$417 |
$417 |
3.9× |
| Us ob limited 1 or more fetuses (76815) |
$551 |
$551 |
5.2× |
| Us ob transvaginal (76817) |
$641 |
$641 |
6.0× |
| Us pelvic non ob complete (76856) |
$1,092 |
$1,092 |
10.2× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$755 |
$755 |
7.1× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$494 |
$494 |
4.6× |
| Us retroperitoneal complete (76770) |
$595 |
$595 |
5.6× |
| Us retroperitoneal limited (76775) |
$551 |
$551 |
5.2× |
| Us scrotum and contents (76870) |
$827 |
$827 |
7.7× |
| Us thyroid (76536) |
$548 |
$548 |
5.1× |
| Wrist 2 views (73100) |
$284 |
$284 |
3.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$249 |
$249 |
2.8× |
| X-Ray Bend Only L-S Spine (72120) |
$310 |
$310 |
2.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$185 |
$185 |
2.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) |
$282 |
$282 |
3.2× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$450 |
$450 |
4.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$183 |
$183 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$251 |
$251 |
2.8× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$251 |
$251 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$295 |
$295 |
2.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$422 |
$422 |
4.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$434 |
$434 |
4.9× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$860 |
$860 |
8.1× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$494 |
$494 |
4.6× |
| X-ray humerus (73060) |
$221 |
$221 |
2.5× |
| X-ray IV pyelogram (ivp) (74400) |
$950 |
$950 |
5.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$181 |
$181 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$278 |
$278 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$567 |
$567 |
5.3× |
| X-ray nose-rectum child f.b. (76010) |
$166 |
$166 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$356 |
$356 |
3.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$298 |
$298 |
2.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$161 |
$161 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$256 |
$256 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$338 |
$338 |
3.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$338 |
$338 |
3.2× |
| X-Ray Tmj Unilat (70328) |
$247 |
$247 |
2.8× |
| X-Rays Bone Length Studies (77073) |
$278 |
$278 |
2.6× |
| X-Rays Bone Survey Complete (77075) |
$457 |
$457 |
4.3× |
| Xr c-spine 4 or 5 views (72050) |
$614 |
$614 |
5.7× |
| Xr facial bones less than 3 views (70140) |
$238 |
$238 |
2.7× |
| Xr orbits complete 4 views (70200) |
$270 |
$270 |
2.5× |