| Abdomen 2 views (74019) |
$189 |
$270 |
1.8× |
| Ankle 2 views (73600) |
$189 |
$270 |
2.2× |
| Bone age studies (77072) |
$189 |
$270 |
1.8× |
| Bone survey complete (77075) |
$1,142 |
$1,631 |
10.9× |
| Cervical spine 2 or 3 views (72040) |
$189 |
$270 |
2.2× |
| Chest 1 view (71045) |
$189 |
$270 |
2.2× |
| Chest 3 views (71047) |
$189 |
$270 |
2.2× |
| Clavicle complete (73000) |
$189 |
$270 |
2.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,061 |
$1,515 |
10.1× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,552 |
$3,646 |
7.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,954 |
$2,792 |
8.2× |
| CT abdomen w contrast (74160) |
$1,517 |
$2,167 |
8.6× |
| CT abdomen w wo contrast (74170) |
$1,656 |
$2,366 |
9.4× |
| CT abdomen w/o contrast (74150) |
$1,061 |
$1,515 |
10.1× |
| CT c-spine w/o contrast (72125) |
$1,061 |
$1,515 |
10.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,656 |
$2,366 |
9.4× |
| CT cervical spine with contrast (72126) |
$1,445 |
$2,064 |
4.1× |
| CT chest w/wo contrast (71270) |
$1,656 |
$2,366 |
9.4× |
| CT chest with contrast (71260) |
$1,517 |
$2,167 |
8.6× |
| CT head/brain with contrast (70460) |
$1,517 |
$2,167 |
8.6× |
| CT head/brain without and with contrast (70470) |
$1,656 |
$2,366 |
9.4× |
| CT heart no contrast quant eval coronry calcium (75571) |
$182 |
$260 |
2.1× |
| CT lower ext w/o (73700) |
$1,061 |
$1,515 |
10.1× |
| CT lower extremity w wo contrast (73702) |
$1,656 |
$2,366 |
9.4× |
| CT lower extremity with contrast (73701) |
$1,517 |
$2,167 |
8.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,517 |
$2,167 |
8.6× |
| CT lumbar spine w/o contrast (72131) |
$1,061 |
$1,515 |
10.1× |
| CT lumbar spine with contrast (72132) |
$1,517 |
$2,167 |
4.3× |
| CT maxillofacial w contrast (70487) |
$1,517 |
$2,167 |
8.6× |
| CT maxillofacial w/o contrast (70486) |
$1,061 |
$1,515 |
10.1× |
| CT maxillofacial w/wo contrast (70488) |
$1,656 |
$2,366 |
9.4× |
| CT neck soft tissue w contrast (70491) |
$1,517 |
$2,167 |
8.6× |
| CT orbits w/o contrast (70480) |
$1,061 |
$1,515 |
10.1× |
| CT pelvis w & w/o contrast (72194) |
$1,656 |
$2,366 |
9.4× |
| CT pelvis w/o contrast (72192) |
$1,061 |
$1,515 |
10.1× |
| CT scan for measuring calcium and other minerals in bone (77078) |
$414 |
$592 |
4.7× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,656 |
$2,366 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,061 |
$1,515 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,517 |
$2,167 |
8.6× |
| CT thoracic spine w/o contrast (72128) |
$1,061 |
$1,515 |
10.1× |
| CT thoracic spine w/wo contrast (72130) |
$1,656 |
$2,366 |
9.4× |
| CT thorax w/o contrast (71250) |
$1,061 |
$1,515 |
10.1× |
| CT unlisted procedure (76497) |
$962 |
$1,375 |
11.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,577 |
$2,253 |
9.0× |
| CT upper extremity w/o contrast rt (73200) |
$1,061 |
$1,515 |
10.1× |
| CT upper extremity with contrast (73201) |
$1,517 |
$2,167 |
4.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,303 |
$1,861 |
7.4× |
| Cta Abdomen (74175) |
$1,464 |
$2,091 |
8.3× |
| CTA abdomen pelvis (74174) |
$1,670 |
$2,385 |
4.8× |
| CTA chest (71275) |
$1,248 |
$1,783 |
7.1× |
| Cta Head (70496) |
$1,348 |
$1,926 |
7.7× |
| Cta Neck (70498) |
$1,348 |
$1,926 |
7.7× |
| Fetal biophysical profile non-stress testing (76818) |
$389 |
$555 |
3.7× |
| Fluoroscopy up to 1 hr (76000) |
$515 |
$735 |
2.1× |
| Foot 2 views (73620) |
$192 |
$274 |
2.2× |
| Forearm 2 views (73090) |
$189 |
$270 |
2.2× |
| Hand 2 views (73120) |
$224 |
$320 |
2.1× |
| Hand 3 views (73130) |
$189 |
$270 |
2.2× |
| Humerus Min 2 Views Left (73060) |
$189 |
$270 |
2.2× |
| Knee 3 views (73562) |
$189 |
$270 |
2.2× |
| MRA head w & w/o contrast (70546) |
$770 |
$1,100 |
2.2× |
| MRA head w/o contrast (70544) |
$490 |
$700 |
2.0× |
| Mra Neck W/O &W/Contrast Material (70549) |
$770 |
$1,100 |
2.2× |
| MRA neck w/o contrast (70547) |
$490 |
$700 |
2.0× |
| MRI abdomen w/o & w/contrast material (74183) |
$770 |
$1,100 |
2.2× |
| MRI abdomen w/o contrast (74181) |
$490 |
$700 |
2.0× |
| MRI cervical spine w/o contrast (72141) |
$490 |
$700 |
2.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$490 |
$700 |
2.0× |
| MRI orbit face &/neck w/o contrast (70540) |
$490 |
$700 |
2.0× |
| MRI orbit/face/neck w&w/o cont (70543) |
$770 |
$1,100 |
2.2× |
| MRI pelvis w/o & w/contrast material (72197) |
$770 |
$1,100 |
2.2× |
| MRI pelvis w/o contrast (72195) |
$490 |
$700 |
2.0× |
| MRI scan of arm joint before and after contrast (73223) |
$770 |
$1,100 |
2.2× |
| MRI scan of leg joint before and after contrast (73723) |
$770 |
$1,100 |
2.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$770 |
$1,100 |
2.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$770 |
$1,100 |
2.2× |
| MRI thoracic spine w/o contrast (72146) |
$490 |
$700 |
2.0× |
| MRI upper ext joint w/o contrast (73221) |
$490 |
$700 |
2.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$770 |
$1,100 |
2.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$490 |
$700 |
2.0× |
| Neck soft tissue (70360) |
$182 |
$260 |
2.1× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$265 |
$379 |
2.5× |
| Osseous survey infant (77076) |
$1,184 |
$1,691 |
11.3× |
| Osseous survey limited (77074) |
$574 |
$820 |
5.5× |
| Pelvis 1 or 2 views (72170) |
$189 |
$270 |
1.8× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$770 |
$1,100 |
2.2× |
| Pr red cell survival study (78130) |
$27 |
$39 |
0.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$378 |
$540 |
3.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$291 |
$416 |
2.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$189 |
$270 |
2.2× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$189 |
$270 |
2.2× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$189 |
$270 |
2.2× |
| Red Cell Volume Determination Spx Mult Samplings (78121) |
$4 |
$6 |
0.0× |
| Ribs bilateral 3 views (71110) |
$189 |
$270 |
1.8× |
| Sacroiliac Joints < 3 Views (72200) |
$189 |
$270 |
1.8× |
| Scapula complete (73010) |
$189 |
$270 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$408 |
$583 |
3.9× |
| Unlisted Ultrasound Procedure (76999) |
$259 |
$370 |
3.0× |
| Upper Extremity Infant (73092) |
$224 |
$320 |
2.1× |
| Us abdl aorta screen aaa (76706) |
$408 |
$583 |
3.9× |
| Us breast unilateral complete (76641) |
$298 |
$425 |
2.8× |
| Us chest (76604) |
$253 |
$361 |
2.4× |
| Us fetal nuchal translucency 1st gestation (76813) |
$408 |
$583 |
3.9× |
| Us kidney transplant (76776) |
$449 |
$642 |
4.3× |
| Us pelvic non ob complete (76856) |
$398.50 |
$569 |
3.8× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$236 |
$337 |
2.2× |
| Us pregnancy ltd (76815) |
$265 |
$379 |
2.5× |
| Us scrotum and contents (76870) |
$398.50 |
$569 |
3.8× |
| Us soft tissue head/neck (76536) |
$389 |
$555 |
3.7× |
| Us transrectal (76872) |
$408 |
$583 |
3.9× |
| Us xtr non-vasc lmtd (76882) |
$236 |
$337 |
2.2× |
| Wrist 2 views (73100) |
$189 |
$270 |
2.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$316 |
$452 |
3.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$189 |
$270 |
2.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$189 |
$270 |
2.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$189 |
$270 |
2.2× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$189 |
$270 |
2.2× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$291 |
$416 |
2.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$189 |
$270 |
2.2× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$189 |
$270 |
2.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$291 |
$416 |
2.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$185 |
$264 |
2.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$189 |
$270 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$189 |
$270 |
2.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$291 |
$416 |
2.8× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$189 |
$270 |
2.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$23 |
$33 |
0.2× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$189 |
$270 |
1.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$189 |
$270 |
2.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$189 |
$270 |
2.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$291 |
$416 |
3.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$316 |
$452 |
3.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$189 |
$270 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$189 |
$270 |
2.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$189 |
$270 |
1.8× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$189 |
$270 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$192 |
$274 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$189 |
$270 |
2.2× |
| Xr c-spine 6 or more views (72052) |
$316 |
$452 |
3.0× |
| Xr finger(s) 2+ views (73140) |
$189 |
$270 |
2.2× |
| Xr optic foramina (70190) |
$189 |
$270 |
2.2× |
| Xr shoulder 1 view (73020) |
$189 |
$270 |
2.2× |
| Xr spine cervical 4 or 5 views (72050) |
$316 |
$452 |
3.0× |
| Xr tibia/fibula 2 views (73590) |
$189 |
$270 |
2.2× |
| Xr tmj bilateral (70330) |
$189 |
$270 |
2.2× |
| Xray knee 1 or 2 views rt (73560) |
$189 |
$270 |
2.2× |