| Abdomen 1 View (74018) |
$186 |
$248 |
2.2× |
| Abdomen 2 views (74019) |
$252 |
$336 |
2.5× |
| Ankle 2 views (73600) |
$186 |
$248 |
2.2× |
| Chest 1 view (71045) |
$186 |
$248 |
2.2× |
| Chest 2 views (71046) |
$186 |
$248 |
2.2× |
| Clavicle complete (73000) |
$187.50 |
$250 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$525 |
$700 |
5.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,197.50 |
$2,930 |
6.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,200 |
$1,600 |
5.2× |
| CT abdomen w contrast (74160) |
$1,125 |
$1,500 |
6.7× |
| CT abdomen w wo contrast (74170) |
$1,417.50 |
$1,890 |
8.4× |
| CT abdomen w/o contrast (74150) |
$873.75 |
$1,165 |
8.7× |
| CT Angio Chest (71275) |
$1,387.50 |
$1,850 |
8.2× |
| CT Angio Neck (70498) |
$1,350 |
$1,800 |
8.0× |
| CT cervical spine w/o contrast (72125) |
$1,012.50 |
$1,350 |
10.1× |
| CT chest w contrast (71260) |
$1,196.25 |
$1,595 |
7.1× |
| CT chest w/wo contrast (71270) |
$1,387.50 |
$1,850 |
8.2× |
| CT head/brain with contrast (70460) |
$952.50 |
$1,270 |
5.6× |
| CT head/brain without and with contrast (70470) |
$1,331.25 |
$1,775 |
7.9× |
| CT iac w contrast (70481) |
$1,020 |
$1,360 |
6.0× |
| CT lower ext w/o (73700) |
$866.25 |
$1,155 |
8.6× |
| CT lower extremity w/contrast material (73701) |
$952.50 |
$1,270 |
5.6× |
| CT lumbar spine w/o contrast (72131) |
$937.50 |
$1,250 |
9.3× |
| CT maxillofacial w contrast (70487) |
$847.50 |
$1,130 |
5.0× |
| CT maxillofacial wo contrast (70486) |
$821.25 |
$1,095 |
8.2× |
| CT neck tissue combo (70492) |
$1,267.50 |
$1,690 |
7.5× |
| CT orbits w/o contrast (70480) |
$821.25 |
$1,095 |
8.2× |
| CT pelvis w&w/o contrast (72194) |
$1,387.50 |
$1,850 |
8.2× |
| CT pelvis w/o contrast (72192) |
$866.25 |
$1,155 |
8.6× |
| CT scan of leg combo (73702) |
$1,252.50 |
$1,670 |
7.4× |
| CT soft tissue neck w contrast (70491) |
$1,125 |
$1,500 |
6.7× |
| CT soft tissue neck w/o contrast (70490) |
$873.75 |
$1,165 |
8.7× |
| CT thoracic spine w/o contrast (72128) |
$945 |
$1,260 |
9.4× |
| CT thorax w/o contrast (71250) |
$922.50 |
$1,230 |
9.2× |
| CT upper ext wo (73200) |
$866.25 |
$1,155 |
8.6× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,260 |
$1,680 |
7.5× |
| CT upper extremity with contrast (73201) |
$952.50 |
$1,270 |
2.8× |
| Cta Abdomen (74175) |
$1,387.50 |
$1,850 |
8.2× |
| Foot 2 views (73620) |
$186 |
$248 |
2.2× |
| Forearm 2 views (73090) |
$187.50 |
$250 |
2.2× |
| Hand 2 views (73120) |
$150 |
$200 |
1.5× |
| Knee 3 Views (73562) |
$225 |
$300 |
2.7× |
| Neck soft tissue (70360) |
$247.50 |
$330 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$187.50 |
$250 |
1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$187.50 |
$250 |
2.2× |
| Radex Calcaneus Minimum 2 Views (73650) |
$187.50 |
$250 |
2.2× |
| Radex elbow complete minimum 3 views (73080) |
$225 |
$300 |
2.7× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$262.50 |
$350 |
2.6× |
| Radex fingr minimum 2 views (73140) |
$187.50 |
$250 |
2.2× |
| Radex foot complete minimum 3 views (73630) |
$187.50 |
$250 |
2.2× |
| Radex Hand Minimum 3 Views (73130) |
$187.50 |
$250 |
2.2× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$187.50 |
$250 |
2.2× |
| Radex Ribs Unilateral 2 Views (71100) |
$187.50 |
$250 |
2.2× |
| Radex shoulder complete minimum 2 views (73030) |
$225 |
$300 |
2.7× |
| Radex Spine 1 View Specify Level (72020) |
$186 |
$248 |
2.2× |
| Radex Sternum Minimum 2 Views (71120) |
$187.50 |
$250 |
2.2× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$318.75 |
$425 |
3.8× |
| Radex Toe Minimum 2 Views (73660) |
$186 |
$248 |
2.2× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$187.50 |
$250 |
2.2× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$269.25 |
$359 |
2.7× |
| Radiologic exam knee complete 4/more views (73564) |
$262.50 |
$350 |
2.6× |
| Radiologic examination femur minimum 2 views (73552) |
$243.75 |
$325 |
2.9× |
| Radiologic examination knee 1/2 views (73560) |
$187.50 |
$250 |
2.2× |
| Radiologic examination tibia & fibula 2 views (73590) |
$187.50 |
$250 |
2.2× |
| Ribs bilateral 3 views (71110) |
$318.75 |
$425 |
3.2× |
| Scapula (73010) |
$240 |
$320 |
2.4× |
| Shoulder 1 view (73020) |
$186 |
$248 |
2.2× |
| Skull less than 4 views (70250) |
$187.50 |
$250 |
1.9× |
| Thoracic spine 2 views (72070) |
$262.50 |
$350 |
2.6× |
| Ultrasound, abdomen limited (76705) |
$281.25 |
$375 |
2.8× |
| Unlisted us procedure (76999) |
$198.75 |
$265 |
2.4× |
| Us chest (76604) |
$307.50 |
$410 |
3.1× |
| Us exam, pelvic, limited (76857) |
$269.25 |
$359 |
2.7× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$198.75 |
$265 |
2.0× |
| Us ob limited 1 or more fetuses (76815) |
$268.50 |
$358 |
2.7× |
| Us pelvic non ob complete (76856) |
$345 |
$460 |
3.4× |
| Us retroperitoneal complete (76770) |
$300 |
$400 |
3.0× |
| Us thyroid (76536) |
$258.75 |
$345 |
2.6× |
| Wrist 2 views (73100) |
$186 |
$248 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$187.50 |
$250 |
2.2× |
| X-Ray Exam Hip Uni 1 View (73501) |
$186 |
$248 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$240 |
$320 |
2.9× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$337.50 |
$450 |
3.4× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$262.50 |
$350 |
3.1× |
| X-ray humerus (73060) |
$187.50 |
$250 |
2.2× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$225 |
$300 |
2.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$262.50 |
$350 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$262.50 |
$350 |
2.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$269.25 |
$359 |
2.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$240 |
$320 |
2.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$262.50 |
$350 |
3.1× |
| Xr c-spine 4 or 5 views (72050) |
$281.25 |
$375 |
2.8× |
| Xr facial bones less than 3 views (70140) |
$225 |
$300 |
2.7× |