| Abdomen 2 views (74019) |
$190 |
$272 |
1.8× |
| Ankle 2 views (73600) |
$129.50 |
$184.50 |
1.5× |
| Cervical spine 2 or 3 views (72040) |
$162.50 |
$232 |
1.9× |
| Chest 1 view (71045) |
$144 |
$205 |
1.6× |
| Clavicle complete (73000) |
$181.50 |
$259 |
2.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,987 |
$4,267 |
8.5× |
| CT abdomen and pelvis without contrast (74176) |
$2,253 |
$3,219 |
9.4× |
| CT abdomen w contrast (74160) |
$1,296 |
$1,852 |
7.4× |
| CT abdomen w wo contrast (74170) |
$1,713 |
$2,447 |
9.7× |
| CT abdomen w/o contrast (74150) |
$1,101 |
$1,573 |
10.5× |
| CT c-spine w/o contrast (72125) |
$1,370 |
$1,957 |
13.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,761 |
$2,516 |
10.0× |
| CT cervical spine with contrast (72126) |
$1,408 |
$2,012 |
4.0× |
| CT chest w/wo contrast (71270) |
$1,856 |
$2,651 |
10.5× |
| CT chest with contrast (71260) |
$1,532 |
$2,188 |
8.7× |
| CT head/brain with contrast (70460) |
$1,289 |
$1,842 |
7.3× |
| CT head/brain without and with contrast (70470) |
$1,614 |
$2,305 |
9.2× |
| CT heart no contrast quant eval coronry calcium (75571) |
$122 |
$174 |
1.4× |
| CT lower ext w/o (73700) |
$1,041 |
$1,487 |
9.9× |
| CT lower extremity w wo contrast (73702) |
$1,499 |
$2,142 |
8.5× |
| CT lower extremity with contrast (73701) |
$1,193 |
$1,704 |
6.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,702 |
$2,431 |
9.7× |
| CT lumbar spine w/o contrast (72131) |
$1,216 |
$1,737 |
11.6× |
| CT lumbar spine with contrast (72132) |
$1,407 |
$2,010 |
4.0× |
| CT maxillofacial w contrast (70487) |
$1,197.50 |
$1,710.50 |
6.8× |
| CT maxillofacial w/o contrast (70486) |
$1,159 |
$1,655.50 |
11.0× |
| CT maxillofacial w/wo contrast (70488) |
$1,459 |
$2,084 |
8.3× |
| CT neck soft tissue w contrast (70491) |
$1,408 |
$2,012 |
8.0× |
| CT pelvis w & w/o contrast (72194) |
$1,682 |
$2,403 |
9.5× |
| CT pelvis w/o contrast (72192) |
$1,135 |
$1,621 |
10.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,447 |
$2,067 |
8.2× |
| CT soft tissue neck w/o contrast (70490) |
$1,216 |
$1,737 |
11.6× |
| CT thoracic spine w/contrast (72129) |
$1,407 |
$2,010 |
8.0× |
| CT thoracic spine w/o contrast (72128) |
$1,175 |
$1,679 |
11.2× |
| CT thoracic spine w/wo contrast (72130) |
$1,761 |
$2,516 |
10.0× |
| CT thorax w/o contrast (71250) |
$1,187 |
$1,695 |
11.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,499 |
$2,142 |
8.5× |
| CT upper extremity w/o contrast rt (73200) |
$1,040 |
$1,485 |
9.9× |
| CT upper extremity with contrast (73201) |
$972 |
$1,389 |
2.8× |
| Cta Abdomen (74175) |
$390 |
$557 |
2.2× |
| CTA abdomen pelvis (74174) |
$496 |
$709 |
1.4× |
| CTA chest (71275) |
$1,106 |
$1,579.50 |
6.3× |
| Cta Head (70496) |
$351 |
$501 |
2.0× |
| Cta Neck (70498) |
$350 |
$500 |
2.0× |
| Esophagus (74220) |
$312 |
$445 |
1.8× |
| Foot 2 views (73620) |
$130 |
$185 |
1.5× |
| Forearm 2 views (73090) |
$195 |
$278 |
2.2× |
| Hand 2 views (73120) |
$142 |
$203 |
1.4× |
| Hand 3 views (73130) |
$150 |
$214 |
1.7× |
| Humerus Min 2 Views Left (73060) |
$179 |
$255 |
2.0× |
| Knee 3 views (73562) |
$239 |
$342 |
2.7× |
| Neck soft tissue (70360) |
$171 |
$244 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$187 |
$267 |
1.8× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$130 |
$185 |
1.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$305 |
$435 |
2.9× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$211 |
$301 |
2.0× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$199 |
$284 |
1.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$138 |
$197 |
1.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$146 |
$208 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$219 |
$313 |
2.5× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$4 |
$6 |
0.0× |
| Ribs bilateral 3 views (71110) |
$203 |
$290 |
1.9× |
| Sacroiliac Joints < 3 Views (72200) |
$203 |
$290 |
1.9× |
| Scapula complete (73010) |
$182 |
$260 |
1.7× |
| Tmj unilateral (70328) |
$151 |
$215 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$643 |
$919 |
6.1× |
| Upper Extremity Infant (73092) |
$265 |
$379 |
2.5× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,013 |
$1,447 |
5.7× |
| Us breast unilateral limited (76642) |
$237 |
$338 |
2.7× |
| Us chest (76604) |
$495 |
$707 |
4.7× |
| Us compl joint r-t w/image documentation (76881) |
$306 |
$437 |
2.9× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$306 |
$437 |
2.9× |
| Us ob transvaginal (76817) |
$363 |
$518 |
3.5× |
| Us pelvic non ob complete (76856) |
$643 |
$919 |
6.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$532 |
$760 |
5.1× |
| Us retroperitoneal complete (76770) |
$412 |
$588 |
3.9× |
| Us scrotum and contents (76870) |
$504 |
$720 |
4.8× |
| Us soft tissue head/neck (76536) |
$430 |
$614 |
4.1× |
| Us xtr non-vasc lmtd (76882) |
$306 |
$437 |
2.9× |
| Wrist 2 views (73100) |
$187 |
$267 |
2.1× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$316 |
$452 |
3.0× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$235 |
$336 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$142 |
$203 |
1.6× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$187 |
$267 |
2.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$207 |
$295 |
2.4× |
| X-ray exam hip uni 1 view (73501) |
$130 |
$185 |
1.5× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$128 |
$183 |
1.5× |
| X-ray exam of femur 1 (73551) |
$95 |
$135 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$292 |
$417 |
2.8× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$235 |
$336 |
2.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$182 |
$260 |
2.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$155 |
$221 |
1.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$137 |
$195 |
1.6× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$290 |
$414 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$150 |
$214 |
1.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$139.50 |
$199.50 |
1.3× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$454 |
$648 |
4.3× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$158.50 |
$226 |
1.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$234.50 |
$334.50 |
2.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$203 |
$290 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$195 |
$278 |
1.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$251 |
$359 |
2.4× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$175.50 |
$250 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$203 |
$290 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$292 |
$417 |
3.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$203 |
$290 |
2.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$340 |
$486 |
3.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$207 |
$295 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$151 |
$215.50 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$105 |
$150 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$138 |
$197 |
1.6× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$195 |
$278 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$433 |
$618 |
4.1× |
| Xr finger(s) 2+ views (73140) |
$166 |
$237 |
1.9× |
| XR Mastoids < 3 Views Bilateral (70120) |
$147 |
$210 |
1.4× |
| Xr shoulder 1 view (73020) |
$166 |
$237 |
1.9× |
| Xr spine cervical 4 or 5 views (72050) |
$239 |
$342 |
2.3× |
| Xr tibia/fibula 2 views (73590) |
$179 |
$255 |
2.0× |
| Xr tmj bilateral (70330) |
$227 |
$324 |
2.6× |
| Xray knee 1 or 2 views rt (73560) |
$195 |
$278 |
2.2× |