| Abdomen 2 views (74019) |
$139 |
$278 |
1.4× |
| Ankle 2 views (73600) |
$90 |
$180 |
1.1× |
| Bone survey complete (77075) |
$312 |
$624 |
3.1× |
| Cervical spine 2 or 3 views (72040) |
$136.50 |
$273 |
1.6× |
| Chest 1 view (71045) |
$90 |
$180 |
1.1× |
| Chest 3 views (71047) |
$122 |
$244 |
1.5× |
| Clavicle complete (73000) |
$90 |
$180 |
1.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,603.75 |
$3,207.50 |
4.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,321 |
$2,642 |
5.8× |
| CT abdomen w contrast (74160) |
$1,029.50 |
$2,059 |
6.1× |
| CT abdomen w wo contrast (74170) |
$1,029.50 |
$2,059 |
6.1× |
| CT abdomen w/o contrast (74150) |
$1,029.50 |
$2,059 |
10.2× |
| CT angiography upper extremity lt (73206) |
$885.75 |
$1,771.50 |
5.3× |
| CT c-spine w/o contrast (72125) |
$664.50 |
$1,329 |
6.6× |
| CT cervical spine w&w/o contrast (72127) |
$938 |
$1,876 |
5.6× |
| CT cervical spine with contrast (72126) |
$681 |
$1,362 |
2.0× |
| CT chest w/wo contrast (71270) |
$877.50 |
$1,755 |
5.2× |
| CT chest with contrast (71260) |
$715 |
$1,430 |
4.2× |
| CT head/brain with contrast (70460) |
$790 |
$1,580 |
4.7× |
| CT head/brain without and with contrast (70470) |
$790 |
$1,580 |
4.7× |
| CT heart no contrast quant eval coronry calcium (75571) |
$90 |
$180 |
1.1× |
| CT iac w contrast (70481) |
$620 |
$1,240 |
3.7× |
| CT lower ext w/o (73700) |
$527 |
$1,054 |
5.2× |
| CT lower extremity w wo contrast (73702) |
$657.50 |
$1,315 |
3.9× |
| CT lower extremity with contrast (73701) |
$604.50 |
$1,209 |
3.6× |
| CT lumbar spine w & w/o contrast (72133) |
$822.50 |
$1,645 |
4.9× |
| CT lumbar spine w/o contrast (72131) |
$829 |
$1,658 |
8.2× |
| CT lumbar spine with contrast (72132) |
$840 |
$1,680 |
2.5× |
| CT maxillofacial w contrast (70487) |
$620 |
$1,240 |
3.7× |
| CT maxillofacial w/o contrast (70486) |
$610 |
$1,220 |
6.1× |
| CT maxillofacial w/wo contrast (70488) |
$733 |
$1,466 |
4.3× |
| CT neck soft tissue w contrast (70491) |
$620 |
$1,240 |
3.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$741 |
$1,482 |
4.4× |
| CT orbits w/o contrast (70480) |
$530.50 |
$1,061 |
5.3× |
| CT pelvis w & w/o contrast (72194) |
$1,079.50 |
$2,159 |
6.4× |
| CT pelvis w/o contrast (72192) |
$979.50 |
$1,959 |
9.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$850 |
$1,700 |
5.0× |
| CT soft tissue neck w/o contrast (70490) |
$530.50 |
$1,061 |
5.3× |
| CT thoracic spine w/contrast (72129) |
$740 |
$1,480 |
4.4× |
| CT thoracic spine w/o contrast (72128) |
$738 |
$1,476 |
7.3× |
| CT thoracic spine w/wo contrast (72130) |
$822.50 |
$1,645 |
4.9× |
| CT thorax w/o contrast (71250) |
$699.50 |
$1,399 |
7.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$662 |
$1,324 |
3.9× |
| CT upper extremity w/o contrast rt (73200) |
$527 |
$1,054 |
5.2× |
| CT upper extremity with contrast (73201) |
$583 |
$1,166 |
1.7× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,023.75 |
$2,047.50 |
6.1× |
| Cta Abdomen (74175) |
$765.50 |
$1,531 |
4.5× |
| CTA abdomen pelvis (74174) |
$925 |
$1,850 |
2.8× |
| CTA chest (71275) |
$785 |
$1,570 |
4.7× |
| Cta Head (70496) |
$690.50 |
$1,381 |
4.1× |
| CTA lwr ext w&w/o contrast (73706) |
$705.50 |
$1,411 |
4.2× |
| Cta Neck (70498) |
$690.50 |
$1,381 |
4.1× |
| Cta Pelvis (72191) |
$765.50 |
$1,531 |
4.5× |
| Foot 2 views (73620) |
$90 |
$180 |
1.1× |
| Forearm 2 views (73090) |
$90 |
$180 |
1.1× |
| Hand 2 views (73120) |
$169.50 |
$339 |
1.7× |
| Hand 3 views (73130) |
$182.50 |
$365 |
2.2× |
| Humerus Min 2 Views Left (73060) |
$90 |
$180 |
1.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$169.50 |
$339 |
1.7× |
| Knee 3 views (73562) |
$107.50 |
$215 |
1.3× |
| Neck soft tissue (70360) |
$90 |
$180 |
1.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$169.50 |
$339 |
1.7× |
| Osseous survey limited (77074) |
$169.50 |
$339 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$169.50 |
$339 |
1.7× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$90 |
$180 |
1.1× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$169.50 |
$339 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$169.50 |
$339 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$90 |
$180 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$105.50 |
$211 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$90 |
$180 |
1.1× |
| Ribs bilateral 3 views (71110) |
$285 |
$570 |
2.8× |
| Sacroiliac Joints < 3 Views (72200) |
$169.50 |
$339 |
1.7× |
| Scanogram (77073) |
$247.50 |
$495 |
2.5× |
| Scapula complete (73010) |
$90 |
$180 |
0.9× |
| Small bowel series (74250) |
$169.50 |
$339 |
1.0× |
| Spine thoracic 3 views (72072) |
$169.50 |
$339 |
1.7× |
| Tmj unilateral (70328) |
$98 |
$196 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$202 |
$404 |
2.0× |
| Unlisted Ultrasound Procedure (76999) |
$135 |
$270 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$386.50 |
$773 |
2.3× |
| Us breast unilateral complete (76641) |
$169.50 |
$339 |
1.7× |
| Us breast unilateral limited (76642) |
$85.25 |
$170.50 |
1.0× |
| Us chest (76604) |
$202 |
$404 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$202 |
$404 |
2.0× |
| Us ob transvaginal (76817) |
$202 |
$404 |
2.0× |
| Us pelvic non ob complete (76856) |
$208.50 |
$417 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$92.50 |
$185 |
0.9× |
| Us pregnancy ltd (76815) |
$202 |
$404 |
2.0× |
| Us retroperitoneal complete (76770) |
$202 |
$404 |
2.0× |
| Us retroperitoneal limited (76775) |
$202 |
$404 |
2.0× |
| Us scrotum and contents (76870) |
$202 |
$404 |
2.0× |
| Us soft tissue head/neck (76536) |
$202 |
$404 |
2.0× |
| Wrist 2 views (73100) |
$90 |
$180 |
1.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$169.50 |
$339 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$90 |
$180 |
1.1× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$97.50 |
$195 |
1.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$90 |
$180 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$90 |
$180 |
1.1× |
| X-ray exam hip uni 1 view (73501) |
$90 |
$180 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$100 |
$200 |
1.2× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$339 |
$678 |
3.4× |
| X-ray exam of femur 1 (73551) |
$90 |
$180 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$169.50 |
$339 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$90 |
$180 |
1.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$97.50 |
$195 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$90 |
$180 |
1.1× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$90 |
$180 |
1.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$169.50 |
$339 |
1.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$108.50 |
$217 |
1.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$90 |
$180 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$169.50 |
$339 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$90 |
$180 |
1.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$169.50 |
$339 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$169.50 |
$339 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$136.50 |
$273 |
1.6× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$169.50 |
$339 |
1.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$169.50 |
$339 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$90 |
$180 |
1.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$140 |
$280 |
1.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$162.50 |
$325 |
1.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$90 |
$180 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$169.50 |
$339 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$169.50 |
$339 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$90 |
$180 |
1.1× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$240 |
$480 |
2.9× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$189.50 |
$379 |
2.3× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$169.50 |
$339 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$169.50 |
$339 |
1.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$90 |
$180 |
1.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$92.50 |
$185 |
1.1× |
| Xr c-spine 6 or more views (72052) |
$178 |
$356 |
1.8× |
| Xr chest 4+ views (71048) |
$132.50 |
$265 |
1.3× |
| Xr finger(s) 2+ views (73140) |
$90 |
$180 |
1.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$169.50 |
$339 |
1.7× |
| Xr optic foramina (70190) |
$90 |
$180 |
1.1× |
| Xr shoulder 1 view (73020) |
$90 |
$180 |
1.1× |
| Xr spine cervical 4 or 5 views (72050) |
$169.50 |
$339 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$90 |
$180 |
1.1× |
| Xr tmj bilateral (70330) |
$153 |
$306 |
1.8× |
| Xray knee 1 or 2 views rt (73560) |
$90 |
$180 |
1.1× |