| Abdomen 1 View (74018) |
$219.75 |
$293 |
2.6× |
| Abdomen 2 views (74019) |
$327 |
$436 |
3.2× |
| Ankle 2 views (73600) |
$203.25 |
$271 |
2.4× |
| Cat Scan Follow-Up Study (76380) |
$370.50 |
$494 |
4.3× |
| Chest 1 view (71045) |
$223.50 |
$298 |
2.6× |
| Chest 2 views (71046) |
$259.50 |
$346 |
3.0× |
| Chest 3 views (71047) |
$237 |
$316 |
2.8× |
| Chest 4 or more views (71048) |
$338.25 |
$451 |
3.3× |
| Clavicle complete (73000) |
$244.50 |
$326 |
2.8× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$330.75 |
$441 |
3.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,907.25 |
$2,543 |
5.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,847.25 |
$2,463 |
7.8× |
| CT abdomen w contrast (74160) |
$1,168.50 |
$1,558 |
6.7× |
| CT abdomen w wo contrast (74170) |
$1,311.75 |
$1,749 |
7.6× |
| CT abdomen w/o contrast (74150) |
$822 |
$1,096 |
8.0× |
| CT Angio Abdomen and Pelvis (74174) |
$1,578.75 |
$2,105 |
4.6× |
| CT Angio Chest (71275) |
$1,821 |
$2,428 |
10.5× |
| CT Angio Head (70496) |
$1,514.25 |
$2,019 |
8.7× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$1,233.75 |
$1,645 |
7.1× |
| CT Angio Neck (70498) |
$1,626.75 |
$2,169 |
9.4× |
| CT cervical spine w/ contrast (72126) |
$1,463.25 |
$1,951 |
4.2× |
| CT cervical spine w/o contrast (72125) |
$1,312.50 |
$1,750 |
12.7× |
| CT chest w contrast (71260) |
$1,507.50 |
$2,010 |
8.7× |
| CT chest w/wo contrast (71270) |
$1,350 |
$1,800 |
7.8× |
| CT head/brain with contrast (70460) |
$1,051.50 |
$1,402 |
6.1× |
| CT head/brain without and with contrast (70470) |
$1,193.25 |
$1,591 |
6.9× |
| CT iac w contrast (70481) |
$939.75 |
$1,253 |
5.4× |
| CT lower ext w/o (73700) |
$1,122.75 |
$1,497 |
10.9× |
| CT lower extremity w/contrast material (73701) |
$813.75 |
$1,085 |
4.7× |
| CT lumbar spine w contrast (72132) |
$1,463.25 |
$1,951 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$1,306.50 |
$1,742 |
12.6× |
| CT maxillofacial w contrast (70487) |
$940.50 |
$1,254 |
5.4× |
| CT maxillofacial wo contrast (70486) |
$1,086 |
$1,448 |
10.5× |
| CT neck tissue combo (70492) |
$1,099.50 |
$1,466 |
6.3× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,028.25 |
$1,371 |
5.9× |
| CT orbits w/o contrast (70480) |
$728.25 |
$971 |
7.1× |
| CT pelvis w&w/o contrast (72194) |
$1,345.50 |
$1,794 |
7.8× |
| CT pelvis w/o contrast (72192) |
$1,179.75 |
$1,573 |
11.4× |
| CT scans face/jaw combo (70488) |
$1,041.75 |
$1,389 |
6.0× |
| CT soft tissue neck w contrast (70491) |
$1,464.75 |
$1,953 |
8.5× |
| CT soft tissue neck w/o contrast (70490) |
$766.50 |
$1,022 |
7.4× |
| CT thoracic spine w contrast (72129) |
$1,080.75 |
$1,441 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$905.25 |
$1,207 |
8.8× |
| CT thoracic spine w/wo cont (72130) |
$875.25 |
$1,167 |
5.1× |
| CT thorax w/o contrast (71250) |
$1,194 |
$1,592 |
11.6× |
| CT upper ext wo (73200) |
$759.75 |
$1,013 |
7.4× |
| CT upper extremity with contrast (73201) |
$1,345.50 |
$1,794 |
3.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,041.75 |
$1,389 |
6.0× |
| Cta Abdomen (74175) |
$1,278.75 |
$1,705 |
7.4× |
| CTA pelvis (72191) |
$1,254 |
$1,672 |
7.2× |
| Foot 2 views (73620) |
$231.75 |
$309 |
2.7× |
| Forearm 2 views (73090) |
$252.75 |
$337 |
2.9× |
| Hand 2 views (73120) |
$232.50 |
$310 |
2.3× |
| Joint Survey Single View (77077) |
$342 |
$456 |
3.3× |
| Knee 3 Views (73562) |
$378 |
$504 |
4.4× |
| Mra Head W/O & W/Contrast Material (70546) |
$1,833 |
$2,444 |
5.3× |
| MRA head w/o contrast (70544) |
$1,028.25 |
$1,371 |
4.4× |
| Mra Neck W/O &W/Contrast Material (70549) |
$1,905 |
$2,540 |
5.5× |
| MRA neck w/o contrast (70547) |
$1,025.25 |
$1,367 |
4.3× |
| Neck soft tissue (70360) |
$205.50 |
$274 |
2.4× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) |
$310.50 |
$414 |
3.0× |
| Ophthalmic us dx quantitative a-scan only (76511) |
$366.75 |
$489 |
3.6× |
| Pelvis 1 or 2 views (72170) |
$288.75 |
$385 |
2.8× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$407.25 |
$543 |
3.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$282.75 |
$377 |
3.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$204 |
$272 |
2.4× |
| Radex elbow complete minimum 3 views (73080) |
$269.25 |
$359 |
3.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$356.25 |
$475 |
3.4× |
| Radex fingr minimum 2 views (73140) |
$219 |
$292 |
2.5× |
| Radex foot complete minimum 3 views (73630) |
$276.75 |
$369 |
3.2× |
| Radex Hand Minimum 3 Views (73130) |
$302.25 |
$403 |
3.5× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$210 |
$280 |
2.4× |
| Radex Ribs Unilateral 2 Views (71100) |
$248.25 |
$331 |
2.9× |
| Radex shoulder complete minimum 2 views (73030) |
$284.25 |
$379 |
3.3× |
| Radex Spine 1 View Specify Level (72020) |
$186 |
$248 |
2.2× |
| Radex Sternum Minimum 2 Views (71120) |
$223.50 |
$298 |
2.6× |
| Radex Toe Minimum 2 Views (73660) |
$204 |
$272 |
2.4× |
| Radex upper extremity infant minimum 2 views (73092) |
$292.50 |
$390 |
2.8× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$270.75 |
$361 |
3.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$326.25 |
$435 |
3.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$342 |
$456 |
3.3× |
| Radiologic exam knee complete 4/more views (73564) |
$347.25 |
$463 |
3.4× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$293.25 |
$391 |
2.8× |
| Radiologic examination femur 1 view (73551) |
$189 |
$252 |
2.2× |
| Radiologic examination femur minimum 2 views (73552) |
$227.25 |
$303 |
2.6× |
| Radiologic examination knee 1/2 views (73560) |
$196.50 |
$262 |
2.3× |
| Radiologic Examination Osseous Survey Limited (77074) |
$342 |
$456 |
3.3× |
| Radiologic examination tibia & fibula 2 views (73590) |
$264 |
$352 |
3.1× |
| Scapula (73010) |
$325.50 |
$434 |
3.2× |
| Shoulder 1 view (73020) |
$183 |
$244 |
2.1× |
| Skull less than 4 views (70250) |
$330.75 |
$441 |
3.2× |
| Sternoclavicular joints (71130) |
$231 |
$308 |
2.7× |
| Thoracic spine 2 views (72070) |
$324.75 |
$433 |
3.1× |
| Thoracic spine 3 views (72072) |
$369 |
$492 |
3.6× |
| Thoracolumbar 2 views (72080) |
$236.25 |
$315 |
2.7× |
| Ultrasound Breast Limited (76642) |
$191.25 |
$255 |
2.2× |
| Ultrasound Exam Aaa Screen (76706) |
$343.50 |
$458 |
3.3× |
| Ultrasound, abdomen limited (76705) |
$505.50 |
$674 |
4.9× |
| Us breast unilateral complete (76641) |
$342 |
$456 |
3.3× |
| Us chest (76604) |
$325.50 |
$434 |
3.2× |
| Us complete joint (76881) |
$333.75 |
$445 |
3.2× |
| Us exam, pelvic, limited (76857) |
$324.75 |
$433 |
3.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$351.75 |
$469 |
3.4× |
| Us ob transvaginal (76817) |
$300 |
$400 |
2.9× |
| Us pelvic non ob complete (76856) |
$549 |
$732 |
5.3× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$290.25 |
$387 |
2.8× |
| Us retroperitoneal complete (76770) |
$448.50 |
$598 |
4.3× |
| Us retroperitoneal limited (76775) |
$330 |
$440 |
3.2× |
| Us scrotum and contents (76870) |
$375 |
$500 |
3.6× |
| Us spinal canal and contents (76800) |
$325.50 |
$434 |
3.2× |
| Us thyroid (76536) |
$495.75 |
$661 |
4.8× |
| Wrist 2 views (73100) |
$233.25 |
$311 |
2.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$2,401.50 |
$3,202 |
27.9× |
| X-Ray Bend Only L-S Spine (72120) |
$342 |
$456 |
3.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$195 |
$260 |
2.3× |
| X-Ray Exam Hip Uni 1 View (73501) |
$183 |
$244 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$212.25 |
$283 |
2.5× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$375 |
$500 |
3.6× |
| X-Ray Exam L-S Spine Bending (72114) |
$411 |
$548 |
4.0× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$279 |
$372 |
3.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$408 |
$544 |
4.0× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$534.75 |
$713 |
5.2× |
| X-ray eye for foreign body (70030) |
$147 |
$196 |
1.7× |
| X-ray humerus (73060) |
$254.25 |
$339 |
3.0× |
| X-ray IV pyelogram (ivp) (74400) |
$555.75 |
$741 |
3.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$184.50 |
$246 |
2.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$213 |
$284 |
2.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$336.75 |
$449 |
3.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$411.75 |
$549 |
4.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$303 |
$404 |
2.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$227.25 |
$303 |
2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$219 |
$292 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$386.25 |
$515 |
3.7× |
| X-Rays Bone Length Studies (77073) |
$345.75 |
$461 |
3.3× |
| X-Rays Bone Survey Complete (77075) |
$456.75 |
$609 |
4.4× |
| Xr c-spine 4 or 5 views (72050) |
$422.25 |
$563 |
4.1× |
| Xr facial bones less than 3 views (70140) |
$156 |
$208 |
1.8× |
| Xr orbits complete 4 views (70200) |
$296.25 |
$395 |
2.9× |