| Abdomen 2 views (74019) |
$142.50 |
$285 |
1.6× |
| Ankle 2 views (73600) |
$105 |
$210 |
1.4× |
| Bone age studies (77072) |
$142.50 |
$285 |
1.6× |
| Bone survey complete (77075) |
$142.50 |
$285 |
1.6× |
| Cervical spine 2 or 3 views (72040) |
$105 |
$210 |
1.4× |
| Chest 1 view (71045) |
$80.85 |
$161.70 |
1.1× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$232.50 |
$465 |
1.5× |
| Clavicle complete (73000) |
$105 |
$210 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,414.50 |
$2,829 |
4.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,144 |
$2,288 |
5.5× |
| CT abdomen w contrast (74160) |
$898 |
$1,796 |
5.8× |
| CT abdomen w wo contrast (74170) |
$943 |
$1,886 |
6.1× |
| CT abdomen w/o contrast (74150) |
$497.50 |
$995 |
5.4× |
| CT c-spine w/o contrast (72125) |
$689 |
$1,378 |
7.5× |
| CT cervical spine w&w/o contrast (72127) |
$628.50 |
$1,257 |
4.1× |
| CT chest w/wo contrast (71270) |
$902 |
$1,804 |
5.9× |
| CT chest with contrast (71260) |
$800 |
$1,600 |
5.2× |
| CT head/brain with contrast (70460) |
$572.50 |
$1,145 |
3.7× |
| CT head/brain without and with contrast (70470) |
$628.50 |
$1,257 |
4.1× |
| CT iac w contrast (70481) |
$515.37 |
$1,030.75 |
3.4× |
| CT lower ext w/o (73700) |
$301 |
$602 |
3.3× |
| CT lower extremity w wo contrast (73702) |
$422.50 |
$845 |
2.7× |
| CT lower extremity with contrast (73701) |
$387.50 |
$775 |
2.5× |
| CT lumbar spine w & w/o contrast (72133) |
$628.50 |
$1,257 |
4.1× |
| CT lumbar spine w/o contrast (72131) |
$640 |
$1,280 |
7.0× |
| CT maxillofacial w contrast (70487) |
$515.37 |
$1,030.75 |
3.4× |
| CT maxillofacial w/o contrast (70486) |
$520 |
$1,040 |
5.7× |
| CT maxillofacial w/wo contrast (70488) |
$578.50 |
$1,157 |
3.8× |
| CT neck soft tissue w contrast (70491) |
$623 |
$1,246 |
4.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$528.50 |
$1,057 |
3.4× |
| CT orbits w/o contrast (70480) |
$543 |
$1,086 |
5.9× |
| CT pelvis w & w/o contrast (72194) |
$623 |
$1,246 |
4.1× |
| CT pelvis w/o contrast (72192) |
$497.50 |
$995 |
5.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$683.50 |
$1,367 |
4.4× |
| CT soft tissue neck w/o contrast (70490) |
$497.50 |
$995 |
5.4× |
| CT thoracic spine w/o contrast (72128) |
$543 |
$1,086 |
5.9× |
| CT thoracic spine w/wo contrast (72130) |
$628.50 |
$1,257 |
4.1× |
| CT thorax w/o contrast (71250) |
$720 |
$1,440 |
7.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$422.50 |
$845 |
2.7× |
| CT upper extremity w/o contrast rt (73200) |
$311 |
$622 |
3.4× |
| CT upper extremity with contrast (73201) |
$387.50 |
$775 |
1.3× |
| CTA chest (71275) |
$810 |
$1,620 |
5.3× |
| Foot 2 views (73620) |
$105 |
$210 |
1.4× |
| Forearm 2 views (73090) |
$105 |
$210 |
1.4× |
| Hand 2 views (73120) |
$142.50 |
$285 |
1.6× |
| Hand 3 views (73130) |
$136.50 |
$273 |
1.8× |
| Humerus Min 2 Views Left (73060) |
$105 |
$210 |
1.4× |
| Neck soft tissue (70360) |
$105 |
$210 |
1.4× |
| Osseous survey infant (77076) |
$142.50 |
$285 |
1.6× |
| Pelvis 1 or 2 views (72170) |
$142.50 |
$285 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$142.50 |
$285 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$142.50 |
$285 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$142.50 |
$285 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$80.85 |
$161.70 |
1.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$94.54 |
$189.09 |
1.0× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$136.50 |
$273 |
1.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$105 |
$210 |
1.4× |
| Ribs bilateral 3 views (71110) |
$142.50 |
$285 |
1.6× |
| Scanogram (77073) |
$142.50 |
$285 |
1.6× |
| Scapula complete (73010) |
$142.50 |
$285 |
1.6× |
| Spine thoracic 3 views (72072) |
$142.50 |
$285 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$185.25 |
$370.50 |
2.0× |
| Upper Extremity Infant (73092) |
$142.50 |
$285 |
1.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$232.50 |
$465 |
1.5× |
| Us abdl aorta screen aaa (76706) |
$142.50 |
$285 |
1.6× |
| Us breast unilateral complete (76641) |
$142.50 |
$285 |
1.6× |
| Us breast unilateral limited (76642) |
$105 |
$210 |
1.4× |
| Us chest (76604) |
$142.50 |
$285 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$142.50 |
$285 |
1.6× |
| Us infant hips limited static (76886) |
$74.50 |
$149 |
1.0× |
| Us kidney transplant (76776) |
$142.50 |
$285 |
1.6× |
| Us ob detailed single fetus (76811) |
$300 |
$600 |
1.4× |
| Us ob transvaginal (76817) |
$142.50 |
$285 |
1.6× |
| Us pelvic non ob complete (76856) |
$142.50 |
$285 |
1.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$142.50 |
$285 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$142.50 |
$285 |
1.6× |
| Us retroperitoneal complete (76770) |
$142.50 |
$285 |
1.6× |
| Us retroperitoneal limited (76775) |
$142.50 |
$285 |
1.6× |
| Us scrotum and contents (76870) |
$142.50 |
$285 |
1.6× |
| Us soft tissue head/neck (76536) |
$142.50 |
$285 |
1.6× |
| Us xtr non-vasc lmtd (76882) |
$142.50 |
$285 |
1.6× |
| Wrist 2 views (73100) |
$105 |
$210 |
1.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$142.50 |
$285 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$105 |
$210 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$136.50 |
$273 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$105 |
$210 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$105 |
$210 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$105 |
$210 |
1.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$142.50 |
$285 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$136.50 |
$273 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$105 |
$210 |
1.4× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$185.25 |
$370.50 |
2.0× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$105 |
$210 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$105 |
$210 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$90.50 |
$181 |
1.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$142.50 |
$285 |
1.6× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$90.50 |
$181 |
1.0× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$105 |
$210 |
1.4× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$142.50 |
$285 |
1.6× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$105 |
$210 |
1.4× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$142.50 |
$285 |
1.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$142.50 |
$285 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$142.50 |
$285 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$105 |
$210 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$136.50 |
$273 |
1.8× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$105 |
$210 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$142.50 |
$285 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$142.50 |
$285 |
1.6× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$105 |
$210 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$105 |
$210 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$105 |
$210 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$142.50 |
$285 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$105 |
$210 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$142.50 |
$285 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$105 |
$210 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$105 |
$210 |
1.4× |