| Abdomen 1 View (74018) |
$110.50 |
$170 |
1.3× |
| Abdomen 2 views (74019) |
$146.25 |
$225 |
1.5× |
| Ankle 2 views (73600) |
$110.50 |
$170 |
1.3× |
| Chest 1 view (71045) |
$110.50 |
$170 |
1.3× |
| Chest 2 views (71046) |
$146.25 |
$225 |
1.7× |
| Clavicle complete (73000) |
$110.50 |
$170 |
1.3× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$375.70 |
$578 |
3.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,036.75 |
$1,595 |
3.1× |
| CT abdomen and pelvis without contrast (74176) |
$659.75 |
$1,015 |
2.9× |
| CT abdomen w contrast (74160) |
$643.50 |
$990 |
3.8× |
| CT abdomen w/o contrast (74150) |
$375.70 |
$578 |
3.7× |
| CT Angio Abdomen and Pelvis (74174) |
$1,743.16 |
$2,681.79 |
5.2× |
| CT Angio Chest (71275) |
$734.50 |
$1,130 |
4.4× |
| CT Angio Head (70496) |
$734.50 |
$1,130 |
4.4× |
| CT Angio Neck (70498) |
$734.50 |
$1,130 |
4.4× |
| CT cervical spine w/o contrast (72125) |
$375.70 |
$578 |
3.7× |
| CT chest w contrast (71260) |
$643.50 |
$990 |
3.8× |
| CT chest w/wo contrast (71270) |
$708.50 |
$1,090 |
4.2× |
| CT head/brain with contrast (70460) |
$643.50 |
$990 |
3.8× |
| CT head/brain without and with contrast (70470) |
$708.50 |
$1,090 |
4.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$65 |
$100 |
0.8× |
| CT lower ext w/o (73700) |
$375.70 |
$578 |
3.7× |
| CT lower extremity w/contrast material (73701) |
$1,287 |
$1,980 |
7.6× |
| CT lumbar spine w/o contrast (72131) |
$375.70 |
$578 |
3.7× |
| CT maxillofacial wo contrast (70486) |
$375.70 |
$578 |
3.7× |
| CT neck tissue combo (70492) |
$708.50 |
$1,090 |
4.2× |
| CT pelvis w/o contrast (72192) |
$375.70 |
$578 |
3.7× |
| CT scan of leg combo (73702) |
$708.50 |
$1,090 |
4.2× |
| CT soft tissue neck w contrast (70491) |
$643.50 |
$990 |
3.8× |
| CT soft tissue neck w/o contrast (70490) |
$375.70 |
$578 |
3.7× |
| CT thoracic spine w/o contrast (72128) |
$375.70 |
$578 |
3.7× |
| CT thorax w/o contrast (71250) |
$375.70 |
$578 |
3.7× |
| CT upper ext wo (73200) |
$375.70 |
$578 |
3.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$845 |
$1,300 |
5.0× |
| Cta Abdomen (74175) |
$734.50 |
$1,130 |
4.4× |
| Foot 2 views (73620) |
$110.50 |
$170 |
1.3× |
| Forearm 2 views (73090) |
$110.50 |
$170 |
1.3× |
| Hand 2 views (73120) |
$110.50 |
$170 |
1.1× |
| Knee 3 Views (73562) |
$146.25 |
$225 |
1.7× |
| Neck soft tissue (70360) |
$110.50 |
$170 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$146.25 |
$225 |
1.5× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$325 |
$500 |
3.2× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$126.75 |
$195 |
1.5× |
| Radex elbow complete minimum 3 views (73080) |
$126.75 |
$195 |
1.5× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$146.25 |
$225 |
1.5× |
| Radex fingr minimum 2 views (73140) |
$126.75 |
$195 |
1.5× |
| Radex foot complete minimum 3 views (73630) |
$126.75 |
$195 |
1.5× |
| Radex Hand Minimum 3 Views (73130) |
$126.75 |
$195 |
1.5× |
| Radex Ribs Unilateral 2 Views (71100) |
$146.25 |
$225 |
1.7× |
| Radex shoulder complete minimum 2 views (73030) |
$146.25 |
$225 |
1.7× |
| Radex Sternum Minimum 2 Views (71120) |
$146.25 |
$225 |
1.7× |
| Radex Toe Minimum 2 Views (73660) |
$126.75 |
$195 |
1.5× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$126.75 |
$195 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$146.25 |
$225 |
1.5× |
| Radiologic exam knee complete 4/more views (73564) |
$146.25 |
$225 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$146.25 |
$225 |
1.7× |
| Radiologic examination knee 1/2 views (73560) |
$133.25 |
$205 |
1.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$146.25 |
$225 |
1.7× |
| Skull less than 4 views (70250) |
$146.25 |
$225 |
1.5× |
| Thoracic spine 2 views (72070) |
$146.25 |
$225 |
1.5× |
| Thoracic spine 3 views (72072) |
$182 |
$280 |
1.8× |
| Ultrasound Exam Aaa Screen (76706) |
$143 |
$220 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$201.50 |
$310 |
2.0× |
| Us complete joint (76881) |
$214.50 |
$330 |
2.1× |
| Us exam, pelvic, limited (76857) |
$178.75 |
$275 |
1.8× |
| Us pelvic non ob complete (76856) |
$191.75 |
$295 |
1.9× |
| Us retroperitoneal complete (76770) |
$269.75 |
$415 |
2.7× |
| Us scrotum and contents (76870) |
$240.50 |
$370 |
2.4× |
| Us thyroid (76536) |
$188.50 |
$290 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$182 |
$280 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$110.50 |
$170 |
1.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$110.50 |
$170 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$146.25 |
$225 |
1.7× |
| X-Ray Exam Hip Uni 4/> Views (73503) |
$146.25 |
$225 |
1.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$217.75 |
$335 |
2.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$360.75 |
$555 |
3.6× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$146.25 |
$225 |
1.7× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$182 |
$280 |
1.8× |
| X-ray humerus (73060) |
$133.25 |
$205 |
1.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$146.25 |
$225 |
1.5× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$146.25 |
$225 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$182 |
$280 |
1.8× |
| Xr c-spine 4 or 5 views (72050) |
$217.75 |
$335 |
2.2× |