| Abdomen 2 views (74019) |
$332.80 |
$416 |
3.5× |
| Ankle 2 views (73600) |
$192 |
$240 |
2.4× |
| Bone age studies (77072) |
$256 |
$320 |
2.7× |
| Bone survey complete (77075) |
$576 |
$720 |
6.0× |
| Cervical spine 2 or 3 views (72040) |
$375.20 |
$469 |
4.7× |
| Chest 1 view (71045) |
$192 |
$240 |
2.4× |
| Chest 3 views (71047) |
$256 |
$320 |
3.2× |
| Clavicle complete (73000) |
$249.60 |
$312 |
3.1× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$620 |
$775 |
6.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,806.40 |
$3,508 |
8.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,770.40 |
$2,213 |
8.1× |
| CT c-spine w/o contrast (72125) |
$1,140 |
$1,425 |
11.9× |
| CT chest w/wo contrast (71270) |
$2,240 |
$2,800 |
13.9× |
| CT chest with contrast (71260) |
$1,840 |
$2,300 |
11.4× |
| CT head/brain without and with contrast (70470) |
$1,840 |
$2,300 |
11.4× |
| CT iac w contrast (70481) |
$1,560 |
$1,950 |
9.7× |
| CT lower ext w/o (73700) |
$1,200 |
$1,500 |
12.5× |
| CT lumbar spine w/o contrast (72131) |
$1,160 |
$1,450 |
12.1× |
| CT maxillofacial w contrast (70487) |
$1,560 |
$1,950 |
9.7× |
| CT maxillofacial w/o contrast (70486) |
$1,078.80 |
$1,348.50 |
11.2× |
| CT neck soft tissue w contrast (70491) |
$1,560 |
$1,950 |
9.7× |
| CT orbits w/o contrast (70480) |
$1,140 |
$1,425 |
11.9× |
| CT pelvis w & w/o contrast (72194) |
$2,240 |
$2,800 |
13.9× |
| CT pelvis w/o contrast (72192) |
$1,140 |
$1,425 |
11.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,840 |
$2,300 |
11.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,140 |
$1,425 |
11.9× |
| CT thoracic spine w/o contrast (72128) |
$1,140 |
$1,425 |
11.9× |
| CT thorax w/o contrast (71250) |
$1,140 |
$1,425 |
11.9× |
| CT upper extremity w/o contrast rt (73200) |
$1,200 |
$1,500 |
12.5× |
| Cta Abdomen (74175) |
$3,600 |
$4,500 |
22.3× |
| CTA abdomen pelvis (74174) |
$3,840 |
$4,800 |
12.0× |
| CTA chest (71275) |
$3,280 |
$4,100 |
20.3× |
| Cta Head (70496) |
$3,280 |
$4,100 |
20.3× |
| Cta Neck (70498) |
$3,280 |
$4,100 |
20.3× |
| Foot 2 views (73620) |
$239.20 |
$299 |
3.0× |
| Forearm 2 views (73090) |
$251.20 |
$314 |
3.1× |
| Hand 2 views (73120) |
$281.60 |
$352 |
2.9× |
| Hand 3 views (73130) |
$264 |
$330 |
3.3× |
| Humerus Min 2 Views Left (73060) |
$251.20 |
$314 |
3.1× |
| Knee 3 views (73562) |
$254.80 |
$318.50 |
3.2× |
| MRA head w/o contrast (70544) |
$2,560 |
$3,200 |
11.7× |
| MRA neck w/o contrast (70547) |
$2,560 |
$3,200 |
11.7× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,240 |
$2,800 |
7.0× |
| MRI abdomen w/o contrast (74181) |
$1,760 |
$2,200 |
8.0× |
| MRI cervical spine w/o contrast (72141) |
$2,080 |
$2,600 |
9.5× |
| MRI chest w/o & w/contrast material (71552) |
$2,240 |
$2,800 |
7.0× |
| MRI chest w/o contrast (71550) |
$2,080 |
$2,600 |
9.5× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,440 |
$1,800 |
4.5× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,280 |
$1,600 |
5.8× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,280 |
$1,600 |
5.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,100.80 |
$2,626 |
6.5× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,520 |
$1,900 |
4.7× |
| MRI pelvis w/o contrast (72195) |
$1,280 |
$1,600 |
5.8× |
| MRI scan of arm joint before and after contrast (73223) |
$1,440 |
$1,800 |
4.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,240 |
$2,800 |
7.0× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,240 |
$2,800 |
7.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,240 |
$2,800 |
7.0× |
| MRI thoracic spine w/o contrast (72146) |
$2,080 |
$2,600 |
9.5× |
| MRI tmj (70336) |
$1,440 |
$1,800 |
6.6× |
| MRI upper ext joint w/o contrast (73221) |
$1,356 |
$1,695 |
6.2× |
| Neck soft tissue (70360) |
$239.20 |
$299 |
3.0× |
| Pelvis 1 or 2 views (72170) |
$306.40 |
$383 |
3.2× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,440 |
$1,800 |
4.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$431.20 |
$539 |
4.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$224 |
$280 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$233.60 |
$292 |
2.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$260.80 |
$326 |
3.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$226.40 |
$283 |
2.8× |
| Sacroiliac Joints < 3 Views (72200) |
$272 |
$340 |
2.8× |
| Scapula complete (73010) |
$224.80 |
$281 |
2.3× |
| Spine thoracic 3 views (72072) |
$202.40 |
$253 |
2.1× |
| Thoracolumbar 2 views (72080) |
$336 |
$420 |
4.2× |
| Tmj unilateral (70328) |
$224 |
$280 |
2.8× |
| Ultrasound, abdomen limited (76705) |
$465.60 |
$582 |
4.8× |
| Unlisted Ultrasound Procedure (76999) |
$273.60 |
$342 |
3.4× |
| Upper Extremity Infant (73092) |
$192 |
$240 |
2.0× |
| Us abdl aorta screen aaa (76706) |
$460.80 |
$576 |
4.8× |
| Us breast unilateral complete (76641) |
$544 |
$680 |
5.7× |
| Us breast unilateral limited (76642) |
$304 |
$380 |
3.8× |
| Us chest (76604) |
$440 |
$550 |
4.6× |
| Us compl joint r-t w/image documentation (76881) |
$480.80 |
$601 |
5.0× |
| Us ob transvaginal (76817) |
$580 |
$725 |
6.0× |
| Us pelvic non ob complete (76856) |
$544.80 |
$681 |
5.7× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$464 |
$580 |
4.8× |
| Us pregnancy ltd (76815) |
$460 |
$575 |
4.8× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$523.20 |
$654 |
5.4× |
| Us retroperitoneal complete (76770) |
$620 |
$775 |
6.4× |
| Us retroperitoneal limited (76775) |
$544 |
$680 |
5.7× |
| Us scrotum and contents (76870) |
$528 |
$660 |
5.5× |
| Us soft tissue head/neck (76536) |
$480.80 |
$601 |
5.0× |
| Us xtr non-vasc lmtd (76882) |
$420 |
$525 |
4.4× |
| Wrist 2 views (73100) |
$192 |
$240 |
2.4× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$398.40 |
$498 |
4.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$192 |
$240 |
2.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$256.80 |
$321 |
3.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$219.20 |
$274 |
2.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$280 |
$350 |
3.5× |
| X-ray exam hip uni 1 view (73501) |
$192 |
$240 |
2.4× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$262.40 |
$328 |
3.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$352.80 |
$441 |
3.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$291.20 |
$364 |
3.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$229.20 |
$286.50 |
2.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$224 |
$280 |
2.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$297.60 |
$372 |
3.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$316.80 |
$396 |
4.0× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$192 |
$240 |
2.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$393.60 |
$492 |
4.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$304 |
$380 |
3.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$280.80 |
$351 |
3.5× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$224 |
$280 |
2.8× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$272 |
$340 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$233.60 |
$292 |
2.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$324 |
$405 |
3.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$455.20 |
$569 |
4.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$316 |
$395 |
3.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$330.40 |
$413 |
4.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$192 |
$240 |
2.4× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$192 |
$240 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$256 |
$320 |
2.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$350.40 |
$438 |
3.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$224 |
$280 |
2.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$256 |
$320 |
3.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$315.20 |
$394 |
3.3× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$199.60 |
$249.50 |
2.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$274.40 |
$343 |
3.4× |
| Xr c-spine 6 or more views (72052) |
$192 |
$240 |
2.0× |
| Xr finger(s) 2+ views (73140) |
$203.60 |
$254.50 |
2.5× |
| Xr spine cervical 4 or 5 views (72050) |
$449.60 |
$562 |
4.7× |
| Xr tibia/fibula 2 views (73590) |
$288.80 |
$361 |
3.6× |
| Xr tmj bilateral (70330) |
$272 |
$340 |
3.4× |
| Xray knee 1 or 2 views rt (73560) |
$219.20 |
$274 |
2.7× |