| Ankle 2 views (73600) |
$77.88 |
$155.75 |
1.0× |
| Bone age studies (77072) |
$204.50 |
$409 |
2.3× |
| Bone survey complete (77075) |
$239.50 |
$479 |
2.7× |
| Cervical spine 2 or 3 views (72040) |
$89.50 |
$179 |
1.2× |
| Chest 1 view (71045) |
$89.50 |
$179 |
1.2× |
| Chest 3 views (71047) |
$77.88 |
$155.75 |
1.0× |
| Clavicle complete (73000) |
$77.88 |
$155.75 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$800 |
$1,600 |
8.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,030 |
$4,060 |
6.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,630 |
$3,260 |
7.9× |
| CT abdomen w contrast (74160) |
$1,130 |
$2,260 |
7.5× |
| CT abdomen w wo contrast (74170) |
$784.88 |
$1,569.76 |
5.2× |
| CT abdomen w/o contrast (74150) |
$930 |
$1,860 |
10.3× |
| CT c-spine w/o contrast (72125) |
$600 |
$1,200 |
6.7× |
| CT cervical spine w&w/o contrast (72127) |
$467.43 |
$934.85 |
3.1× |
| CT cervical spine with contrast (72126) |
$800 |
$1,600 |
2.7× |
| CT chest w/wo contrast (71270) |
$1,140 |
$2,280 |
7.5× |
| CT chest with contrast (71260) |
$800 |
$1,600 |
5.3× |
| CT head/brain with contrast (70460) |
$800 |
$1,600 |
5.3× |
| CT head/brain without and with contrast (70470) |
$1,140 |
$2,280 |
7.5× |
| CT heart no contrast quant eval coronry calcium (75571) |
$129.87 |
$259.74 |
1.7× |
| CT iac w contrast (70481) |
$622.56 |
$1,245.12 |
4.1× |
| CT lower ext w/o (73700) |
$530 |
$1,060 |
5.9× |
| CT lower extremity w wo contrast (73702) |
$930 |
$1,860 |
6.2× |
| CT lower extremity with contrast (73701) |
$630 |
$1,260 |
4.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,140 |
$2,280 |
7.5× |
| CT lumbar spine w/o contrast (72131) |
$600 |
$1,200 |
6.7× |
| CT lumbar spine with contrast (72132) |
$800 |
$1,600 |
2.7× |
| CT maxillofacial w contrast (70487) |
$676.12 |
$1,352.25 |
4.5× |
| CT maxillofacial w/o contrast (70486) |
$700 |
$1,400 |
7.8× |
| CT maxillofacial w/wo contrast (70488) |
$900 |
$1,800 |
6.0× |
| CT neck soft tissue w contrast (70491) |
$900 |
$1,800 |
6.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$815 |
$1,630 |
5.4× |
| CT orbits w/o contrast (70480) |
$498.32 |
$996.62 |
5.5× |
| CT pelvis w & w/o contrast (72194) |
$1,140 |
$2,280 |
7.5× |
| CT pelvis w/o contrast (72192) |
$600 |
$1,200 |
6.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,140 |
$2,280 |
7.5× |
| CT soft tissue neck w/o contrast (70490) |
$680 |
$1,360 |
7.5× |
| CT thoracic spine w/contrast (72129) |
$800 |
$1,600 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$600 |
$1,200 |
6.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,140 |
$2,280 |
7.5× |
| CT thorax w/o contrast (71250) |
$600 |
$1,200 |
6.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$930 |
$1,860 |
6.2× |
| CT upper extremity w/o contrast rt (73200) |
$530 |
$1,060 |
5.9× |
| CT upper extremity with contrast (73201) |
$630 |
$1,260 |
2.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,300 |
$2,600 |
8.6× |
| Cta Abdomen (74175) |
$1,130 |
$2,260 |
7.5× |
| CTA chest (71275) |
$1,140 |
$2,280 |
7.5× |
| Cta Head (70496) |
$800 |
$1,600 |
5.3× |
| Cta Neck (70498) |
$1,030 |
$2,060 |
6.8× |
| Cta Pelvis (72191) |
$1,030 |
$2,060 |
6.8× |
| Esophagus (74220) |
$252.18 |
$504.35 |
1.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$359.50 |
$719 |
4.0× |
| Fluoroscopy up to 1 hr (76000) |
$140.64 |
$281.28 |
0.7× |
| Foot 2 views (73620) |
$77.88 |
$155.75 |
1.0× |
| Forearm 2 views (73090) |
$77.88 |
$155.75 |
1.0× |
| Hand 2 views (73120) |
$140.64 |
$281.28 |
1.6× |
| Hand 3 views (73130) |
$89.50 |
$179 |
1.2× |
| Humerus Min 2 Views Left (73060) |
$84.50 |
$169 |
1.1× |
| Neck soft tissue (70360) |
$77.88 |
$155.75 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$140.64 |
$281.28 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$77.88 |
$155.75 |
1.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$140.64 |
$281.28 |
1.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$140.64 |
$281.28 |
1.6× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$140.64 |
$281.28 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$140.64 |
$281.28 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$89.50 |
$179 |
1.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$109.50 |
$219 |
1.5× |
| Radiologic exam colon single contrast study (74270) |
$252.18 |
$504.35 |
1.7× |
| Radiologic exam upr gi trc double contrast study (74246) |
$252.18 |
$504.35 |
1.7× |
| Radiologic exam upr gi trc single contrast study (74240) |
$252.18 |
$504.35 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$77.88 |
$155.75 |
1.0× |
| Ribs bilateral 3 views (71110) |
$140.64 |
$281.28 |
1.6× |
| Sacroiliac Joints < 3 Views (72200) |
$140.64 |
$281.28 |
1.6× |
| Scapula complete (73010) |
$140.64 |
$281.28 |
1.6× |
| Small bowel series (74250) |
$164.50 |
$329 |
1.1× |
| Spine thoracic 3 views (72072) |
$140.64 |
$281.28 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$289.50 |
$579 |
3.2× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$482.35 |
$964.70 |
3.2× |
| Us abdl aorta screen aaa (76706) |
$424.50 |
$849 |
4.7× |
| Us breast unilateral complete (76641) |
$140.64 |
$281.28 |
1.6× |
| Us breast unilateral limited (76642) |
$77.88 |
$155.75 |
1.0× |
| Us chest (76604) |
$140.64 |
$281.28 |
1.6× |
| Us compl joint r-t w/image documentation (76881) |
$239.50 |
$479 |
2.7× |
| Us kidney transplant (76776) |
$277.50 |
$555 |
3.1× |
| Us ob transvaginal (76817) |
$309.50 |
$619 |
3.4× |
| Us pelvic non ob complete (76856) |
$234.50 |
$469 |
2.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$140.64 |
$281.28 |
1.6× |
| Us pregnancy ltd (76815) |
$254.50 |
$509 |
2.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$239.50 |
$479 |
2.7× |
| Us retroperitoneal complete (76770) |
$289.50 |
$579 |
3.2× |
| Us retroperitoneal limited (76775) |
$274.50 |
$549 |
3.0× |
| Us scrotum and contents (76870) |
$285 |
$570 |
3.2× |
| Us soft tissue head/neck (76536) |
$204.50 |
$409 |
2.3× |
| Wrist 2 views (73100) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$159.50 |
$319 |
1.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$204.50 |
$409 |
2.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$89.50 |
$179 |
1.2× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$252.18 |
$504.35 |
1.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$77.88 |
$155.75 |
1.0× |
| X-ray exam entire spi 4/5 vw (72083) |
$140.64 |
$281.28 |
1.6× |
| X-ray exam hip uni 1 view (73501) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$77.88 |
$155.75 |
1.0× |
| X-ray exam hip uni 4/> views (73503) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$140.64 |
$281.28 |
1.6× |
| X-ray exam of femur 1 (73551) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$89.50 |
$179 |
1.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$89.50 |
$179 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$104.50 |
$209 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$168.77 |
$337.53 |
1.9× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$168.77 |
$337.53 |
1.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Retrograde Pyelogram - Fl Pyelogram Retrograde (74420) |
$288.20 |
$576.40 |
1.0× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$94.50 |
$189 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$104.50 |
$209 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$104.50 |
$209 |
1.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$140.64 |
$281.28 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$49.18 |
$98.35 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$77.88 |
$155.75 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$77.88 |
$155.75 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$140.64 |
$281.28 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$77.88 |
$155.75 |
1.0× |
| Xr shoulder 1 view (73020) |
$89.50 |
$179 |
1.2× |
| Xr spine cervical 4 or 5 views (72050) |
$140.64 |
$281.28 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$89.50 |
$179 |
1.2× |
| Xray knee 1 or 2 views rt (73560) |
$76.19 |
$152.38 |
1.0× |