| Abdomen 2 views (74019) |
$368.40 |
$614 |
3.9× |
| Ankle 2 views (73600) |
$173.70 |
$289.50 |
2.2× |
| Bone age studies (77072) |
$327.30 |
$545.50 |
3.5× |
| Bone survey complete (77075) |
$725.40 |
$1,209 |
7.7× |
| Cervical spine 2 or 3 views (72040) |
$203.40 |
$339 |
2.6× |
| Chest 1 view (71045) |
$203.40 |
$339 |
2.6× |
| Chest 3 views (71047) |
$215.70 |
$359.50 |
2.7× |
| Clavicle complete (73000) |
$177 |
$295 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$390 |
$650 |
4.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,279.80 |
$2,133 |
4.1× |
| CT abdomen and pelvis without contrast (74176) |
$656.10 |
$1,093.50 |
3.0× |
| CT abdomen w contrast (74160) |
$922.80 |
$1,538 |
5.8× |
| CT abdomen w wo contrast (74170) |
$853.50 |
$1,422.50 |
5.4× |
| CT abdomen w/o contrast (74150) |
$639.60 |
$1,066 |
6.8× |
| CT c-spine w/o contrast (72125) |
$1,394.70 |
$2,324.50 |
14.7× |
| CT cervical spine w&w/o contrast (72127) |
$1,616.40 |
$2,694 |
10.2× |
| CT cervical spine with contrast (72126) |
$1,238.70 |
$2,064.50 |
3.9× |
| CT chest w/wo contrast (71270) |
$1,440 |
$2,400 |
9.1× |
| CT chest with contrast (71260) |
$1,440 |
$2,400 |
9.1× |
| CT head/brain with contrast (70460) |
$1,184.10 |
$1,973.50 |
7.5× |
| CT head/brain without and with contrast (70470) |
$1,560.90 |
$2,601.50 |
9.8× |
| CT iac w contrast (70481) |
$1,291.50 |
$2,152.50 |
8.1× |
| CT lower ext w/o (73700) |
$1,225.50 |
$2,042.50 |
12.9× |
| CT lower extremity w wo contrast (73702) |
$1,776.60 |
$2,961 |
11.2× |
| CT lower extremity with contrast (73701) |
$1,225.50 |
$2,042.50 |
7.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,693.50 |
$2,822.50 |
10.7× |
| CT lumbar spine w/o contrast (72131) |
$1,257.30 |
$2,095.50 |
13.3× |
| CT lumbar spine with contrast (72132) |
$1,441.50 |
$2,402.50 |
4.6× |
| CT maxillofacial w contrast (70487) |
$1,197.30 |
$1,995.50 |
7.5× |
| CT maxillofacial w/o contrast (70486) |
$995.40 |
$1,659 |
10.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,399.20 |
$2,332 |
8.8× |
| CT neck soft tissue w contrast (70491) |
$1,464 |
$2,440 |
9.2× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,472.40 |
$2,454 |
9.3× |
| CT orbits w/o contrast (70480) |
$1,270.50 |
$2,117.50 |
13.4× |
| CT pelvis w & w/o contrast (72194) |
$1,078.50 |
$1,797.50 |
6.8× |
| CT pelvis w/o contrast (72192) |
$644.10 |
$1,073.50 |
6.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,715.40 |
$2,859 |
10.8× |
| CT soft tissue neck w/o contrast (70490) |
$1,422.90 |
$2,371.50 |
15.0× |
| CT thoracic spine w/contrast (72129) |
$1,581.90 |
$2,636.50 |
10.0× |
| CT thoracic spine w/o contrast (72128) |
$1,231.50 |
$2,052.50 |
13.0× |
| CT thoracic spine w/wo contrast (72130) |
$1,406.40 |
$2,344 |
8.9× |
| CT thorax w/o contrast (71250) |
$1,257.30 |
$2,095.50 |
13.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,776.60 |
$2,961 |
11.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,152.30 |
$1,920.50 |
12.2× |
| CT upper extremity with contrast (73201) |
$1,224.30 |
$2,040.50 |
3.9× |
| CTA chest (71275) |
$1,289.10 |
$2,148.50 |
8.1× |
| Foot 2 views (73620) |
$173.70 |
$289.50 |
2.2× |
| Forearm 2 views (73090) |
$173.70 |
$289.50 |
2.2× |
| Hand 2 views (73120) |
$184.80 |
$308 |
2.0× |
| Hand 3 views (73130) |
$327.30 |
$545.50 |
4.2× |
| Humerus Min 2 Views Left (73060) |
$181.50 |
$302.50 |
2.3× |
| Knee 3 views (73562) |
$184.80 |
$308 |
2.3× |
| Neck soft tissue (70360) |
$294.90 |
$491.50 |
3.7× |
| Osseous survey infant (77076) |
$327.30 |
$545.50 |
3.5× |
| Pelvis 1 or 2 views (72170) |
$327.30 |
$545.50 |
3.5× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$333.30 |
$555.50 |
0.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$327.30 |
$545.50 |
3.5× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$327.30 |
$545.50 |
3.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$327.30 |
$545.50 |
3.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$201.30 |
$335.50 |
2.6× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$410.40 |
$684 |
4.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$215.70 |
$359.50 |
2.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$213.30 |
$355.50 |
2.7× |
| Sacroiliac Joints < 3 Views (72200) |
$327.30 |
$545.50 |
3.5× |
| Scanogram (77073) |
$327.30 |
$545.50 |
3.5× |
| Scapula complete (73010) |
$173.70 |
$289.50 |
1.8× |
| Sella turcica (70240) |
$293.10 |
$488.50 |
3.7× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$378.90 |
$631.50 |
4.0× |
| Spine thoracic 3 views (72072) |
$327.30 |
$545.50 |
3.5× |
| Ultrasound, abdomen limited (76705) |
$327.30 |
$545.50 |
3.5× |
| Upper Extremity Infant (73092) |
$327.30 |
$545.50 |
3.5× |
| Us abdl aorta screen aaa (76706) |
$253.50 |
$422.50 |
2.7× |
| Us breast unilateral complete (76641) |
$327.30 |
$545.50 |
3.5× |
| Us breast unilateral limited (76642) |
$241.50 |
$402.50 |
3.1× |
| Us chest (76604) |
$327.30 |
$545.50 |
3.5× |
| Us compl joint r-t w/image documentation (76881) |
$327.30 |
$545.50 |
3.5× |
| Us infant hips dynamic (76885) |
$327.30 |
$545.50 |
4.2× |
| Us ob transvaginal (76817) |
$327.30 |
$545.50 |
3.5× |
| Us pelvic non ob complete (76856) |
$327.30 |
$545.50 |
3.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$283.50 |
$472.50 |
3.0× |
| Us pregnancy ltd (76815) |
$327.30 |
$545.50 |
3.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$195.30 |
$325.50 |
2.1× |
| Us retroperitoneal complete (76770) |
$283.50 |
$472.50 |
3.0× |
| Us retroperitoneal limited (76775) |
$327.30 |
$545.50 |
3.5× |
| Us scrotum and contents (76870) |
$419.10 |
$698.50 |
4.4× |
| Us soft tissue head/neck (76536) |
$327.30 |
$545.50 |
3.5× |
| Us transrectal prostate volume (76873) |
$327.30 |
$545.50 |
3.5× |
| Us xtr non-vasc lmtd (76882) |
$327.30 |
$545.50 |
3.5× |
| Wrist 2 views (73100) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$382.20 |
$637 |
4.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$193.50 |
$322.50 |
2.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$174.30 |
$290.50 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$200.70 |
$334.50 |
2.5× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$213.30 |
$355.50 |
2.7× |
| X-ray exam hip uni 1 view (73501) |
$204.60 |
$341 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$264 |
$440 |
3.4× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$327.30 |
$545.50 |
3.5× |
| X-ray exam of femur 1 (73551) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$327.30 |
$545.50 |
4.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$327.30 |
$545.50 |
4.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$379.50 |
$632.50 |
4.0× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$200.10 |
$333.50 |
2.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$201.30 |
$335.50 |
2.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$224.40 |
$374 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$182.10 |
$303.50 |
2.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$293.10 |
$488.50 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$195.90 |
$326.50 |
2.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$203.40 |
$339 |
2.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$173.70 |
$289.50 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$327.30 |
$545.50 |
3.5× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$195.90 |
$326.50 |
2.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$176.10 |
$293.50 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$399.90 |
$666.50 |
4.2× |
| Xr finger(s) 2+ views (73140) |
$173.70 |
$289.50 |
2.2× |
| Xr shoulder 1 view (73020) |
$183.15 |
$305.25 |
2.3× |
| Xr spine cervical 4 or 5 views (72050) |
$327.30 |
$545.50 |
3.5× |
| Xr tibia/fibula 2 views (73590) |
$173.70 |
$289.50 |
2.2× |
| Xr tmj bilateral (70330) |
$154.50 |
$257.50 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$173.70 |
$289.50 |
2.2× |