| Abdomen 2 views (74019) |
$153 |
$180 |
1.6× |
| Ankle 2 views (73600) |
$76.50 |
$90 |
0.9× |
| Bone age studies (77072) |
$72.25 |
$85 |
0.7× |
| Bone survey complete (77075) |
$282.62 |
$332.50 |
2.9× |
| Cervical spine 2 or 3 views (72040) |
$110.50 |
$130 |
1.4× |
| Chest 1 view (71045) |
$76.50 |
$90 |
0.9× |
| Chest 3 views (71047) |
$79.90 |
$94 |
1.0× |
| Clavicle complete (73000) |
$97.75 |
$115 |
1.2× |
| Contrast Xray Throat/Cerv Esopha - Fl Esophagus Pharynx (74210) |
$89.25 |
$105 |
0.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,062.50 |
$1,250 |
3.3× |
| CT abdomen and pelvis without contrast (74176) |
$765 |
$900 |
3.4× |
| CT abdomen w contrast (74160) |
$393.12 |
$462.50 |
2.4× |
| CT abdomen w wo contrast (74170) |
$552.50 |
$650 |
3.4× |
| CT abdomen w/o contrast (74150) |
$382.50 |
$450 |
3.9× |
| CT c-spine w/o contrast (72125) |
$382.50 |
$450 |
3.9× |
| CT chest w/wo contrast (71270) |
$552.50 |
$650 |
3.4× |
| CT chest with contrast (71260) |
$393.12 |
$462.50 |
2.4× |
| CT head/brain with contrast (70460) |
$393.12 |
$462.50 |
2.4× |
| CT head/brain without and with contrast (70470) |
$541.88 |
$637.50 |
3.3× |
| CT iac w contrast (70481) |
$393.12 |
$462.50 |
2.4× |
| CT lower ext w/o (73700) |
$637.50 |
$750 |
6.6× |
| CT lower extremity with contrast (73701) |
$658.75 |
$775 |
4.0× |
| CT lumbar spine w & w/o contrast (72133) |
$765 |
$900 |
4.7× |
| CT lumbar spine w/o contrast (72131) |
$382.50 |
$450 |
3.9× |
| CT maxillofacial w contrast (70487) |
$637.50 |
$750 |
3.9× |
| CT maxillofacial w/o contrast (70486) |
$382.50 |
$450 |
3.9× |
| CT maxillofacial w/wo contrast (70488) |
$467.50 |
$550 |
2.9× |
| CT neck soft tissue w contrast (70491) |
$393.12 |
$462.50 |
2.4× |
| CT orbits w/o contrast (70480) |
$297.50 |
$350 |
3.1× |
| CT pelvis w & w/o contrast (72194) |
$552.50 |
$650 |
3.4× |
| CT pelvis w/o contrast (72192) |
$382.50 |
$450 |
3.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$541.88 |
$637.50 |
3.3× |
| CT soft tissue neck w/o contrast (70490) |
$382.50 |
$450 |
3.9× |
| CT thoracic spine w/o contrast (72128) |
$382.50 |
$450 |
3.9× |
| CT thorax w/o contrast (71250) |
$382.50 |
$450 |
3.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$658.75 |
$775 |
4.0× |
| CT upper extremity w/o contrast rt (73200) |
$637.50 |
$750 |
6.6× |
| CT upper extremity with contrast (73201) |
$658.75 |
$775 |
2.0× |
| Cta Head (70496) |
$917.89 |
$1,079.88 |
5.6× |
| CTA lwr ext w&w/o contrast (73706) |
$1,275 |
$1,500 |
7.8× |
| Cta Neck (70498) |
$948.71 |
$1,116.12 |
5.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$175.10 |
$206 |
1.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$127.50 |
$150 |
1.3× |
| Foot 2 views (73620) |
$80.75 |
$95 |
1.0× |
| Forearm 2 views (73090) |
$86.70 |
$102 |
1.1× |
| Hand 2 views (73120) |
$89.25 |
$105 |
0.9× |
| Hand 3 views (73130) |
$89.25 |
$105 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$93.50 |
$110 |
1.2× |
| Knee 3 views (73562) |
$112.62 |
$132.50 |
1.4× |
| MRA head w/o contrast (70544) |
$1,045.50 |
$1,230 |
4.7× |
| MRA head with contrast (70545) |
$1,062.50 |
$1,250 |
3.3× |
| Neck soft tissue (70360) |
$55.25 |
$65 |
0.7× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$157.25 |
$185 |
1.6× |
| Osseous survey limited (77074) |
$178.50 |
$210 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$76.50 |
$90 |
0.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,296.25 |
$1,525 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$190.40 |
$224 |
2.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$119 |
$140 |
1.2× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$89.25 |
$105 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$102 |
$120 |
1.0× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$83.30 |
$98 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$127.50 |
$150 |
1.6× |
| Radiologic exam colon single contrast study (74270) |
$233.75 |
$275 |
1.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$97.75 |
$115 |
1.2× |
| Scanogram (77073) |
$127.50 |
$150 |
1.3× |
| Scapula complete (73010) |
$97.75 |
$115 |
1.0× |
| Screening digital breast tomosynthesis (77063) |
$63.75 |
$75 |
2.7× |
| Spine thoracic 3 views (72072) |
$114.75 |
$135 |
1.2× |
| Thoracolumbar 2 views (72080) |
$114.75 |
$135 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$165.75 |
$195 |
1.7× |
| Unlisted Ultrasound Procedure (76999) |
$204 |
$240 |
2.5× |
| Upper Extremity Infant (73092) |
$68 |
$80 |
0.7× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$297.50 |
$350 |
1.8× |
| Us breast unilateral complete (76641) |
$255 |
$300 |
2.6× |
| Us breast unilateral limited (76642) |
$127.50 |
$150 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$165.75 |
$195 |
1.7× |
| Us kidney transplant (76776) |
$165.75 |
$195 |
1.7× |
| Us ob transvaginal (76817) |
$212.50 |
$250 |
2.2× |
| Us pelvic non ob complete (76856) |
$165.75 |
$195 |
1.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$165.75 |
$195 |
1.7× |
| Us pregnancy ltd (76815) |
$157.25 |
$185 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$157.25 |
$185 |
1.6× |
| Us retroperitoneal complete (76770) |
$165.75 |
$195 |
1.7× |
| Us scrotum and contents (76870) |
$165.75 |
$195 |
1.7× |
| Us soft tissue head/neck (76536) |
$165.75 |
$195 |
1.7× |
| Wrist 2 views (73100) |
$72.25 |
$85 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$187 |
$220 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$106.25 |
$125 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$89.25 |
$105 |
1.1× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$76.50 |
$90 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$85 |
$100 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$93.50 |
$110 |
1.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$93.50 |
$110 |
1.2× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$265.62 |
$312.50 |
2.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$123.25 |
$145 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$123.25 |
$145 |
1.5× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$89.25 |
$105 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$89.25 |
$105 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$89.25 |
$105 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$110.50 |
$130 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$212.50 |
$250 |
2.6× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$68 |
$80 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$112.62 |
$132.50 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$182.75 |
$215 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$80.75 |
$95 |
1.0× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$80.75 |
$95 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$110.50 |
$130 |
1.1× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$114.75 |
$135 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$131.75 |
$155 |
1.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$102 |
$120 |
1.0× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$97.75 |
$115 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$102 |
$120 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$119 |
$140 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$43.35 |
$51 |
0.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$144.50 |
$170 |
1.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$97.75 |
$115 |
1.0× |
| X-Ray Spine One View - Xr Spine (72020) |
$83.30 |
$98 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$97.75 |
$115 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$106.25 |
$125 |
1.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$97.75 |
$115 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$55.25 |
$65 |
0.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$80.75 |
$95 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$165.75 |
$195 |
1.7× |
| Xr chest 4+ views (71048) |
$191.25 |
$225 |
2.0× |
| Xr Cholecystography Oral Contrast (74290) |
$144.50 |
$170 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$63.75 |
$75 |
0.8× |
| Xr optic foramina (70190) |
$46.75 |
$55 |
0.6× |
| Xr shoulder 1 view (73020) |
$97.75 |
$115 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$127.50 |
$150 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$97.75 |
$115 |
1.2× |
| Xr tmj bilateral (70330) |
$89.25 |
$105 |
1.1× |
| Xray knee 1 or 2 views rt (73560) |
$97.75 |
$115 |
1.2× |