| Bone age studies (77072) |
$177.80 |
$254 |
1.6× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,183 |
$1,690 |
6.5× |
| CT - st neck w&wo contr (70492) |
$1,180.90 |
$1,687 |
6.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,233.70 |
$3,191 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$1,372 |
$1,960 |
5.5× |
| CT abdomen w wo contrast (74170) |
$2,220.40 |
$3,172 |
12.1× |
| CT abdomen w/contrast (74160) |
$2,020.90 |
$2,887 |
11.0× |
| CT abdomen w/o contrast (74150) |
$1,372 |
$1,960 |
12.6× |
| CT cervical spine w/contrast (72126) |
$1,382.50 |
$1,975 |
3.8× |
| CT cervical spine w/o contrast (72125) |
$1,297.80 |
$1,854 |
11.9× |
| CT chest w/contrast (71260) |
$1,647.80 |
$2,354 |
9.0× |
| CT head/brain with contrast (70460) |
$936.60 |
$1,338 |
5.1× |
| CT head/brain without and with contrast (70470) |
$2,020.90 |
$2,887 |
11.0× |
| CT lumbar spine w/contrast (72132) |
$1,248.10 |
$1,783 |
3.4× |
| CT lumbar spine w/o contrast (72131) |
$1,099 |
$1,570 |
10.1× |
| CT lumbar spine w/o then w/ con (72133) |
$1,382.50 |
$1,975 |
7.5× |
| CT maxillofacial area w/o contrast (70486) |
$974.40 |
$1,392 |
8.9× |
| CT maxillofacial w/contrast (70487) |
$1,073.10 |
$1,533 |
5.9× |
| CT maxillofacial w/o then w/ con (70488) |
$1,248.10 |
$1,783 |
6.8× |
| CT orbit sella ear w/o con (70480) |
$987 |
$1,410 |
9.0× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$1,397.20 |
$1,996 |
7.6× |
| CT pelvis w & w/o contrast (72194) |
$1,796.90 |
$2,567 |
9.8× |
| CT pelvis w/o contrast (72192) |
$998.20 |
$1,426 |
9.1× |
| CT soft tissue neck w/contrast (70491) |
$998.20 |
$1,426 |
5.4× |
| CT soft tissue neck w/o contrast (70490) |
$842.80 |
$1,204 |
7.7× |
| CT spine cervical w/wo contrast (72127) |
$1,696.80 |
$2,424 |
9.3× |
| CT thoracic spine w/contrast (72129) |
$1,136.10 |
$1,623 |
6.2× |
| CT thoracic spine w/o contrast (72128) |
$981.40 |
$1,402 |
9.0× |
| CT thoracic spine w/o then w/ con (72130) |
$1,376.20 |
$1,966 |
7.5× |
| CT thorax w/o contrast (71250) |
$1,397.20 |
$1,996 |
12.8× |
| CT thorax w/o then w/ contrast (71270) |
$1,845.90 |
$2,637 |
10.1× |
| Doppler echo fetal spectral display complete (76827) |
$98 |
$140 |
0.9× |
| Fetal biophysical profile non-stress testing (76818) |
$142.11 |
$203.02 |
1.3× |
| Fetal biophysical profile w/o nst (76819) |
$142.11 |
$203.02 |
1.3× |
| Nose to rectum for fb child (76010) |
$117.60 |
$168 |
1.3× |
| Ob us < 14 wks single fetus (76801) |
$142.11 |
$203.01 |
1.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$147.70 |
$211 |
1.6× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$137.63 |
$196.62 |
1.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$224 |
$320 |
2.1× |
| Radex spine cervical 2 or 3 views (72040) |
$154 |
$220 |
1.7× |
| Radex spine cervical 4 or 5 views (72050) |
$350 |
$500 |
3.2× |
| Radex spine cervical 6 or more views (72052) |
$499.10 |
$713 |
4.6× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$424.90 |
$607 |
3.9× |
| Ultrasound, abdomen limited (76705) |
$106.05 |
$151.50 |
1.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$142.11 |
$203.01 |
1.3× |
| Us compl joint r-t w/image documentation (76881) |
$142.11 |
$203.01 |
1.3× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$142.11 |
$203.01 |
1.3× |
| Us obstetric transvaginal (76817) |
$142.11 |
$203.01 |
1.3× |
| Us pelvic limited or f/u non-ob (76857) |
$142.11 |
$203.01 |
1.3× |
| Us pelvis complete (76856) |
$142.11 |
$203.01 |
1.3× |
| Us retroperitoneal complete (76770) |
$142.11 |
$203.01 |
1.3× |
| Us retroperitoneal limited (76775) |
$142.11 |
$203.01 |
1.3× |
| Us scrotum (76870) |
$142.11 |
$203.01 |
1.3× |
| Us soft tissue head/neck (76536) |
$142.11 |
$203.01 |
1.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$117.60 |
$168 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$256.90 |
$367 |
2.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$117.60 |
$168 |
1.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$270.20 |
$386 |
2.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$231.70 |
$331 |
2.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$338.80 |
$484 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$196 |
$280 |
1.8× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) |
$163.80 |
$234 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$299.60 |
$428 |
3.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$368.90 |
$527 |
4.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$154 |
$220 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$109.90 |
$157 |
1.0× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$119 |
$170 |
1.3× |
| Xr abdomen 1 view (74018) |
$243.60 |
$348 |
2.7× |
| Xr abdomen 2 views (74019) |
$258.30 |
$369 |
2.4× |
| Xr abdomen 3 views (74021) |
$280 |
$400 |
2.6× |
| Xr chest 1 view (71045) |
$145.60 |
$208 |
1.6× |
| Xr chest 2 views (71046) |
$200.20 |
$286 |
2.2× |
| Xr facial bones 3 views (70150) |
$156.10 |
$223 |
1.4× |
| Xr lower extremity 2 views infant (73592) |
$283.50 |
$405 |
3.1× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$233.80 |
$334 |
2.1× |
| Xr mandible 4 views (70110) |
$154 |
$220 |
1.4× |
| Xr nasal bones (70160) |
$419.30 |
$599 |
4.6× |
| Xr pelvis 3 views (72190) |
$231.70 |
$331 |
2.1× |
| Xr spine 1 view (72020) |
$201.60 |
$288 |
2.2× |
| Xr upper extremity 2 views infant (73092) |
$272.30 |
$389 |
2.5× |
| Xray neck soft tissue (70360) |
$99.40 |
$142 |
1.1× |
| Xray orbits complete min 4 views (70200) |
$143.50 |
$205 |
1.3× |
| Xray pelvis 1 or 2 views (72170) |
$249.90 |
$357 |
2.3× |
| Xray ribs bilateral 3 views (71110) |
$338.80 |
$484 |
3.1× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$177.10 |
$253 |
1.6× |
| Xray sinuses paranasal <3 views (70210) |
$143.50 |
$205 |
1.6× |
| Xray spine thoracic 2 views (72070) |
$303.80 |
$434 |
2.8× |
| Xray spine thoracic 3 views (72072) |
$325.50 |
$465 |
3.0× |
| Xray tmj's bilateral open-clsc (70330) |
$123.20 |
$176 |
1.4× |