| Abdomen 2 views (74019) |
$97.60 |
$122 |
1.0× |
| Ankle 2 views (73600) |
$79.60 |
$99.50 |
1.0× |
| Bone survey complete (77075) |
$90.07 |
$112.59 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$91.60 |
$114.50 |
1.1× |
| Chest 1 view (71045) |
$154.40 |
$193 |
1.9× |
| Chest 3 views (71047) |
$131.18 |
$163.98 |
1.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$86.64 |
$108.30 |
0.5× |
| Clavicle complete (73000) |
$157.60 |
$197 |
1.9× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$216.42 |
$270.52 |
2.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$410.24 |
$512.80 |
1.3× |
| CT abdomen and pelvis without contrast (74176) |
$261.45 |
$326.81 |
1.2× |
| CT abdomen w contrast (74160) |
$471.45 |
$661 |
2.9× |
| CT abdomen w wo contrast (74170) |
$504.90 |
$707.50 |
3.1× |
| CT abdomen w/o contrast (74150) |
$439.20 |
$549 |
4.5× |
| CT angiography upper extremity lt (73206) |
$358.20 |
$447.75 |
2.2× |
| CT c-spine w/o contrast (72125) |
$437.60 |
$547 |
4.5× |
| CT cervical spine with contrast (72126) |
$390.40 |
$488 |
1.2× |
| CT chest w/wo contrast (71270) |
$485.20 |
$679.50 |
2.9× |
| CT chest with contrast (71260) |
$427.20 |
$534 |
2.6× |
| CT head/brain with contrast (70460) |
$427.10 |
$599 |
2.6× |
| CT head/brain without and with contrast (70470) |
$485.10 |
$680.50 |
2.9× |
| CT iac w contrast (70481) |
$364 |
$455 |
2.2× |
| CT lower ext w/o (73700) |
$580.25 |
$807.50 |
5.9× |
| CT lower extremity w wo contrast (73702) |
$755.30 |
$1,055 |
4.6× |
| CT lower extremity with contrast (73701) |
$688.70 |
$961 |
4.2× |
| CT lumbar spine w & w/o contrast (72133) |
$481.05 |
$678.50 |
2.9× |
| CT lumbar spine w/o contrast (72131) |
$437.60 |
$547 |
4.5× |
| CT lumbar spine with contrast (72132) |
$398 |
$497.50 |
1.2× |
| CT maxillofacial w contrast (70487) |
$513 |
$720 |
3.1× |
| CT maxillofacial w/o contrast (70486) |
$427.80 |
$600 |
4.4× |
| CT maxillofacial w/wo contrast (70488) |
$582.40 |
$818 |
3.5× |
| CT neck soft tissue w contrast (70491) |
$399.60 |
$499.50 |
2.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$208 |
$260 |
1.3× |
| CT orbits w/o contrast (70480) |
$286 |
$357.50 |
2.9× |
| CT pelvis w & w/o contrast (72194) |
$476 |
$668 |
2.9× |
| CT pelvis w/o contrast (72192) |
$433.60 |
$542 |
4.4× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$110 |
$137.50 |
1.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$488.80 |
$684 |
3.0× |
| CT soft tissue neck w/o contrast (70490) |
$444 |
$555 |
4.5× |
| CT thoracic spine w/contrast (72129) |
$440.80 |
$551 |
2.7× |
| CT thoracic spine w/o contrast (72128) |
$437.60 |
$547 |
4.5× |
| CT thoracic spine w/wo contrast (72130) |
$503.77 |
$629.72 |
3.1× |
| CT thorax w/o contrast (71250) |
$437.60 |
$547 |
4.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$719.60 |
$1,004 |
4.4× |
| CT upper extremity w/o contrast rt (73200) |
$560.30 |
$779 |
5.7× |
| CT upper extremity with contrast (73201) |
$640.40 |
$892 |
2.0× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$510.10 |
$709.29 |
3.1× |
| Cta Abdomen (74175) |
$401.60 |
$502 |
2.4× |
| CTA chest (71275) |
$402.10 |
$502.62 |
2.4× |
| Cta Head (70496) |
$396.77 |
$495.96 |
2.4× |
| CTA lwr ext w&w/o contrast (73706) |
$401.60 |
$502 |
2.4× |
| Cta Neck (70498) |
$271.60 |
$339.50 |
1.7× |
| Echoencephalography real time imaging (76506) |
$100.80 |
$126 |
1.0× |
| Esophagus (74220) |
$141.60 |
$177 |
0.9× |
| Foot 2 views (73620) |
$79.20 |
$99 |
1.0× |
| Forearm 2 views (73090) |
$120 |
$150 |
1.5× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$68 |
$85 |
0.3× |
| Hand 2 views (73120) |
$79.60 |
$99.50 |
0.8× |
| Hand 3 views (73130) |
$154.40 |
$193 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$150.40 |
$188 |
1.8× |
| Knee 3 views (73562) |
$208 |
$260 |
2.5× |
| Neck soft tissue (70360) |
$107.20 |
$134 |
1.3× |
| Osseous survey infant (77076) |
$97.88 |
$122.36 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$70 |
$87.50 |
0.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$53.27 |
$66.59 |
0.1× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$95.60 |
$119.50 |
1.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$235.20 |
$294 |
2.4× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$116.40 |
$145.50 |
1.2× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$111.60 |
$139.50 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$120.80 |
$151 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$124 |
$155 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$101.20 |
$126.50 |
1.2× |
| Radiologic exam colon single contrast study (74270) |
$187.20 |
$234 |
1.1× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$105.49 |
$131.86 |
0.6× |
| Radiologic exam upr gi trc double contrast study (74246) |
$274.40 |
$343 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$255.60 |
$319.50 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$120 |
$150 |
1.5× |
| Ribs bilateral 3 views (71110) |
$166 |
$207.50 |
1.7× |
| Scapula complete (73010) |
$112 |
$140 |
1.1× |
| Screening digital breast tomosynthesis (77063) |
$50.90 |
$63.62 |
2.2× |
| Sella turcica (70240) |
$62.80 |
$78.50 |
0.8× |
| Shuntogram indwelling nonvascular shunt rs&i (75809) |
$75.06 |
$93.82 |
0.8× |
| Small bowel series (74250) |
$113.53 |
$141.91 |
0.7× |
| Spine thoracic 3 views (72072) |
$101.20 |
$126.50 |
1.0× |
| Tmj unilateral (70328) |
$16 |
$20 |
0.2× |
| Ultrasound, abdomen limited (76705) |
$89.20 |
$111.50 |
0.9× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$217.60 |
$272 |
1.3× |
| Us abdl aorta screen aaa (76706) |
$85.98 |
$107.48 |
0.9× |
| Us breast unilateral complete (76641) |
$160 |
$200 |
1.6× |
| Us chest (76604) |
$202.80 |
$253.50 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$244.80 |
$306 |
2.5× |
| Us pelvic non ob complete (76856) |
$315.20 |
$394 |
3.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$237.60 |
$297 |
2.4× |
| Us pregnancy ltd (76815) |
$77.64 |
$97.05 |
0.8× |
| Us retroperitoneal complete (76770) |
$276.80 |
$346 |
2.8× |
| Us retroperitoneal limited (76775) |
$406.90 |
$574 |
4.1× |
| Us scrotum and contents (76870) |
$248.40 |
$310.50 |
2.5× |
| Us soft tissue head/neck (76536) |
$308.40 |
$385.50 |
3.1× |
| Us transrectal (76872) |
$199.20 |
$249 |
2.0× |
| Us xtr non-vasc lmtd (76882) |
$43.20 |
$54 |
0.4× |
| Wrist 2 views (73100) |
$79.60 |
$99.50 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$127.60 |
$159.50 |
1.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$88.80 |
$111 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$139.20 |
$174 |
1.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$254 |
$317.50 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$76.40 |
$95.50 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$154.40 |
$193 |
1.9× |
| X-ray exam hip uni 1 view (73501) |
$117.60 |
$147 |
1.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$188.80 |
$236 |
2.3× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$377.60 |
$472 |
3.8× |
| X-ray eye for foreign body (70030) |
$64.24 |
$80.30 |
0.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$112 |
$140 |
1.1× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$34.80 |
$43.50 |
0.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$171.20 |
$214 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$79.60 |
$99.50 |
1.0× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$56 |
$70 |
0.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$147.60 |
$184.50 |
1.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$107.60 |
$134.50 |
1.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$146.40 |
$183 |
1.5× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$87.60 |
$109.50 |
0.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$107.20 |
$134 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$112.80 |
$141 |
1.1× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$112 |
$140 |
1.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$65.20 |
$81.50 |
0.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$118.40 |
$148 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$228 |
$285 |
2.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$108 |
$135 |
1.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$107.20 |
$134 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$202.40 |
$253 |
2.5× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$111.60 |
$139.50 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$98.40 |
$123 |
1.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$58.80 |
$73.50 |
0.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$68.40 |
$85.50 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$82 |
$102.50 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$114.80 |
$143.50 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$78 |
$97.50 |
0.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$122 |
$152.50 |
1.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$120 |
$150 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$136 |
$170 |
1.7× |
| Xr c-spine 6 or more views (72052) |
$109.60 |
$137 |
1.1× |
| Xr chest 4+ views (71048) |
$134.38 |
$167.98 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$120 |
$150 |
1.5× |
| Xr internal auditory meati complete (70134) |
$68.40 |
$85.50 |
0.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$140 |
$175 |
1.4× |
| Xr optic foramina (70190) |
$117.60 |
$147 |
1.4× |
| Xr shoulder 1 view (73020) |
$76 |
$95 |
0.9× |
| Xr spine cervical 4 or 5 views (72050) |
$106.40 |
$133 |
1.1× |
| Xr tibia/fibula 2 views (73590) |
$120 |
$150 |
1.5× |
| Xr tmj bilateral (70330) |
$111.20 |
$139 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$80 |
$100 |
1.0× |