| Abdomen 2 views (74019) |
$98.65 |
$197.30 |
0.9× |
| Bone age studies (77072) |
$105.15 |
$210.30 |
1.0× |
| Bone survey complete (77075) |
$195.80 |
$391.60 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$78.85 |
$157.70 |
0.9× |
| Chest 1 view (71045) |
$64.40 |
$128.80 |
0.7× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$157.15 |
$314.30 |
0.9× |
| Clavicle complete (73000) |
$91.25 |
$182.50 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$705.70 |
$1,411.40 |
6.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,842.80 |
$3,685.60 |
5.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,332.55 |
$2,665.10 |
5.6× |
| CT abdomen w contrast (74160) |
$849.85 |
$1,699.70 |
4.8× |
| CT abdomen w wo contrast (74170) |
$1,002 |
$2,004 |
5.7× |
| CT abdomen w/o contrast (74150) |
$726.35 |
$1,452.70 |
6.9× |
| CT c-spine w/o contrast (72125) |
$728.10 |
$1,456.20 |
6.9× |
| CT cervical spine w&w/o contrast (72127) |
$797.25 |
$1,594.50 |
4.5× |
| CT cervical spine with contrast (72126) |
$663.15 |
$1,326.30 |
1.9× |
| CT chest w/wo contrast (71270) |
$1,009.65 |
$2,019.30 |
5.7× |
| CT chest with contrast (71260) |
$844.40 |
$1,688.80 |
4.8× |
| CT head/brain with contrast (70460) |
$689 |
$1,378 |
3.9× |
| CT head/brain without and with contrast (70470) |
$1,013.30 |
$2,026.60 |
5.8× |
| CT iac w contrast (70481) |
$705.50 |
$1,411 |
4.0× |
| CT limited/localized follow up study (76380) |
$533.40 |
$1,066.80 |
6.1× |
| CT lower ext w/o (73700) |
$518.50 |
$1,037 |
4.9× |
| CT lower extremity w wo contrast (73702) |
$663.15 |
$1,326.30 |
3.8× |
| CT lower extremity with contrast (73701) |
$581.40 |
$1,162.80 |
3.3× |
| CT lumbar spine w & w/o contrast (72133) |
$797.25 |
$1,594.50 |
4.5× |
| CT lumbar spine w/o contrast (72131) |
$651.90 |
$1,303.80 |
6.2× |
| CT lumbar spine with contrast (72132) |
$663.15 |
$1,326.30 |
1.9× |
| CT maxillofacial w contrast (70487) |
$675.35 |
$1,350.70 |
3.8× |
| CT maxillofacial w/o contrast (70486) |
$673.35 |
$1,346.70 |
6.4× |
| CT maxillofacial w/wo contrast (70488) |
$880.82 |
$1,761.65 |
5.0× |
| CT neck soft tissue w contrast (70491) |
$773.40 |
$1,546.80 |
4.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$831.05 |
$1,662.10 |
4.7× |
| CT orbits w/o contrast (70480) |
$676.25 |
$1,352.50 |
6.4× |
| CT pelvis w & w/o contrast (72194) |
$841 |
$1,682 |
4.8× |
| CT pelvis w/o contrast (72192) |
$606.20 |
$1,212.40 |
5.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$853.65 |
$1,707.30 |
4.9× |
| CT soft tissue neck w/o contrast (70490) |
$670.20 |
$1,340.40 |
6.4× |
| CT thoracic spine w/contrast (72129) |
$664 |
$1,328 |
3.8× |
| CT thoracic spine w/o contrast (72128) |
$728.10 |
$1,456.20 |
6.9× |
| CT thoracic spine w/wo contrast (72130) |
$797.25 |
$1,594.50 |
4.5× |
| CT thorax w/o contrast (71250) |
$705.70 |
$1,411.40 |
6.7× |
| CT upper extremity w/o & w/contrast material (73202) |
$670.20 |
$1,340.40 |
3.8× |
| CT upper extremity w/o contrast rt (73200) |
$570.70 |
$1,141.40 |
5.4× |
| CT upper extremity with contrast (73201) |
$562.35 |
$1,124.70 |
1.6× |
| CTA chest (71275) |
$1,373.25 |
$2,746.50 |
7.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$119.50 |
$239 |
1.1× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$65.65 |
$131.30 |
0.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$237.35 |
$474.70 |
2.3× |
| Fluoroscopy up to 1 hr (76000) |
$165.55 |
$331.10 |
0.7× |
| Forearm 2 views (73090) |
$80.05 |
$160.10 |
0.9× |
| Hand 3 views (73130) |
$67.60 |
$135.20 |
0.8× |
| Humerus Min 2 Views Left (73060) |
$87.30 |
$174.60 |
1.0× |
| Knee 3 views (73562) |
$92.40 |
$184.80 |
1.1× |
| MRI tmj (70336) |
$888.95 |
$1,777.90 |
3.7× |
| Neck soft tissue (70360) |
$85 |
$170 |
1.0× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$144.55 |
$289.10 |
1.4× |
| Osseous survey infant (77076) |
$74.10 |
$148.20 |
0.7× |
| Osseous survey limited (77074) |
$151.75 |
$303.50 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$104.55 |
$209.10 |
1.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$92.25 |
$184.50 |
1.1× |
| Radex hips bilateral with pelvis 2 views (73521) |
$107.40 |
$214.80 |
1.0× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$79.05 |
$158.10 |
0.8× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$124.40 |
$248.80 |
1.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$81 |
$162 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$127.95 |
$255.90 |
1.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$91.35 |
$182.70 |
1.0× |
| Ribs bilateral 3 views (71110) |
$115.60 |
$231.20 |
1.1× |
| Scanogram (77073) |
$81.35 |
$162.70 |
0.8× |
| Scapula complete (73010) |
$98.10 |
$196.20 |
0.9× |
| Screening digital breast tomosynthesis (77063) |
$41.20 |
$82.40 |
1.8× |
| Sella turcica (70240) |
$59.75 |
$119.50 |
0.7× |
| Small bowel series (74250) |
$201.35 |
$402.70 |
1.1× |
| Spine thoracic 3 views (72072) |
$111.25 |
$222.50 |
1.1× |
| Thoracolumbar 2 views (72080) |
$79.25 |
$158.50 |
0.9× |
| Ultrasound, abdomen limited (76705) |
$222.35 |
$444.70 |
2.1× |
| Umbilical-artery Doppler (OB) (76820) |
$159.25 |
$318.50 |
1.5× |
| Unlisted Ultrasound Procedure (76999) |
$169.50 |
$339 |
1.9× |
| Upper Extremity Infant (73092) |
$86.75 |
$173.50 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$335.75 |
$671.50 |
1.9× |
| Us abdl aorta screen aaa (76706) |
$220.20 |
$440.40 |
2.1× |
| Us breast unilateral complete (76641) |
$203.75 |
$407.50 |
1.9× |
| Us breast unilateral limited (76642) |
$203.75 |
$407.50 |
2.3× |
| Us chest (76604) |
$221.25 |
$442.50 |
2.1× |
| Us compl joint r-t w/image documentation (76881) |
$116.90 |
$233.80 |
1.1× |
| Us ob transvaginal (76817) |
$193.30 |
$386.60 |
1.8× |
| Us pelvic non ob complete (76856) |
$223.15 |
$446.30 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$169.60 |
$339.20 |
1.6× |
| Us pregnancy ltd (76815) |
$166.35 |
$332.70 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$244.50 |
$489 |
2.3× |
| Us retroperitoneal limited (76775) |
$250.50 |
$501 |
2.4× |
| Us scrotum and contents (76870) |
$232.95 |
$465.90 |
2.2× |
| Us soft tissue head/neck (76536) |
$246.90 |
$493.80 |
2.4× |
| Us xtr non-vasc lmtd (76882) |
$92.25 |
$184.50 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$128.10 |
$256.20 |
1.2× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$74.10 |
$148.20 |
0.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$91.35 |
$182.70 |
1.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$82.85 |
$165.70 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$92.70 |
$185.40 |
1.1× |
| X-ray exam entire spi 4/5 vw (72083) |
$73.10 |
$146.20 |
0.7× |
| X-ray exam hip uni 1 view (73501) |
$92.25 |
$184.50 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$88.65 |
$177.30 |
1.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$271.90 |
$543.80 |
2.6× |
| X-ray exam of femur 1 (73551) |
$92.25 |
$184.50 |
1.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$128.75 |
$257.50 |
1.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$91.35 |
$182.70 |
1.0× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$69.35 |
$138.70 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$99.05 |
$198.10 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$86.75 |
$173.50 |
1.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$95.95 |
$191.90 |
0.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$173.15 |
$346.30 |
1.7× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$124.80 |
$249.60 |
1.2× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$104.50 |
$209 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$110.05 |
$220.10 |
1.0× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$125.80 |
$251.60 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$113.15 |
$226.30 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$134.45 |
$268.90 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$172 |
$344 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$120.70 |
$241.40 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$104.90 |
$209.80 |
1.2× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$104.90 |
$209.80 |
1.2× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$127.95 |
$255.90 |
1.5× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$61.80 |
$123.60 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$146.80 |
$293.60 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$73.35 |
$146.70 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$66.85 |
$133.70 |
0.8× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$88.25 |
$176.50 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$103.70 |
$207.40 |
1.2× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$94.55 |
$189.10 |
0.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$60.25 |
$120.50 |
0.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$78.25 |
$156.50 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$155.25 |
$310.50 |
1.5× |
| Xr chest 4+ views (71048) |
$98.35 |
$196.70 |
0.9× |
| Xr finger(s) 2+ views (73140) |
$70.65 |
$141.30 |
0.8× |
| Xr optic foramina (70190) |
$66 |
$132 |
0.8× |
| Xr shoulder 1 view (73020) |
$67.20 |
$134.40 |
0.8× |
| Xr spine cervical 4 or 5 views (72050) |
$135.50 |
$271 |
1.3× |
| Xr tibia/fibula 2 views (73590) |
$82.85 |
$165.70 |
0.9× |
| Xr tmj bilateral (70330) |
$112.15 |
$224.30 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$77.35 |
$154.70 |
0.9× |