| Ankle 2 views (73600) |
$74.78 |
$498.50 |
0.8× |
| Bone age studies (77072) |
$64.65 |
$431 |
0.6× |
| Clavicle complete (73000) |
$77.70 |
$518 |
0.9× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$226.35 |
$1,509 |
1.2× |
| CT - st neck w&wo contr (70492) |
$230.85 |
$1,539 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$255 |
$1,700 |
0.7× |
| CT abdomen and pelvis without contrast (74176) |
$255 |
$1,700 |
1.0× |
| CT abdomen w wo contrast (74170) |
$230.85 |
$1,539 |
1.3× |
| CT abdomen w/contrast (74160) |
$230.85 |
$1,539 |
1.3× |
| CT abdomen w/o contrast (74150) |
$230.85 |
$1,539 |
2.1× |
| CT angio abd&plvis cntrst mtrl w/wo cntrst imges (74174) |
$230.85 |
$1,539 |
0.6× |
| CT angio abdom w/o & w/dye (74175) |
$230.85 |
$1,539 |
1.3× |
| CT angio abdominal arteries (75635) |
$230.85 |
$1,539 |
1.3× |
| CT cervical spine w/o contrast (72125) |
$230.85 |
$1,539 |
2.1× |
| CT chest w/contrast (71260) |
$230.85 |
$1,539 |
1.3× |
| CT head/brain with contrast (70460) |
$230.85 |
$1,539 |
1.3× |
| CT head/brain without and with contrast (70470) |
$230.85 |
$1,539 |
1.3× |
| CT limited/localized follow up study (76380) |
$78.45 |
$523 |
0.9× |
| CT lower ext w/wo contrast (73702) |
$230.85 |
$1,539 |
1.3× |
| CT lower extremity w contrast (73701) |
$230.85 |
$1,539 |
1.3× |
| CT lower extremity w/o contrast unilateral (73700) |
$230.85 |
$1,539 |
2.1× |
| CT lumbar spine w/contrast (72132) |
$230.85 |
$1,539 |
0.6× |
| CT lumbar spine w/o contrast (72131) |
$230.85 |
$1,539 |
2.1× |
| CT maxillofacial area w/o contrast (70486) |
$230.85 |
$1,539 |
2.1× |
| CT maxillofacial w/contrast (70487) |
$230.85 |
$1,539 |
1.3× |
| CT maxillofacial w/o then w/ con (70488) |
$226.35 |
$1,509 |
1.2× |
| CT orbit sella ear w/o con (70480) |
$230.85 |
$1,539 |
2.1× |
| CT orbit/ear/fossa w/o then w/ con (70482) |
$230.85 |
$1,539 |
1.3× |
| CT pelvis w & w/o contrast (72194) |
$230.85 |
$1,539 |
1.3× |
| CT pelvis w/o contrast (72192) |
$230.85 |
$1,539 |
2.1× |
| CT soft tissue neck w/contrast (70491) |
$230.85 |
$1,539 |
1.3× |
| CT soft tissue neck w/o contrast (70490) |
$230.85 |
$1,539 |
2.1× |
| CT thoracic spine w/contrast (72129) |
$230.85 |
$1,539 |
1.3× |
| CT thoracic spine w/o contrast (72128) |
$230.85 |
$1,539 |
2.1× |
| CT thorax lung cancer scr c- (71271) |
$32.85 |
$219 |
0.3× |
| CT thorax w/o contrast (71250) |
$230.85 |
$1,539 |
2.1× |
| CT thorax w/o then w/ contrast (71270) |
$230.85 |
$1,539 |
1.3× |
| CT upper extremity w/dye (73201) |
$230.85 |
$1,539 |
0.6× |
| CT upper extremity w/o contrast rt (73200) |
$230.85 |
$1,539 |
2.1× |
| CTA chest w/wo contrast (71275) |
$230.85 |
$1,539 |
1.3× |
| CTA head w contrast (70496) |
$230.85 |
$1,539 |
1.3× |
| CTA lower extremity w/wo contrast unilateral (73706) |
$230.85 |
$1,539 |
1.3× |
| Cta Neck (70498) |
$230.85 |
$1,539 |
1.3× |
| Humerus min 2 views (73060) |
$77.70 |
$518 |
0.9× |
| Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by… (73723) |
$319.65 |
$2,131 |
0.9× |
| Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by… (73720) |
$319.65 |
$2,131 |
0.9× |
| MRA head w/o contrast (70544) |
$319.65 |
$2,131 |
1.3× |
| MRA neck w/o contrast (70547) |
$319.65 |
$2,131 |
1.3× |
| MRI abdomen w/o contrast (74181) |
$319.65 |
$2,131 |
1.3× |
| MRI cervical spine w/o contrast (72141) |
$319.65 |
$2,131 |
1.3× |
| MRI joint upr extr w/o&w/dye (73223) |
$319.65 |
$2,131 |
0.9× |
| MRI joint upr extrem w/o dye (73221) |
$319.65 |
$2,131 |
1.3× |
| Mri Lower Extremity W/O Dye (73718) |
$319.65 |
$2,131 |
1.3× |
| MRI lumbar w/wo contrast (72158) |
$319.65 |
$2,131 |
0.9× |
| MRI pelvis w/o contrast (72195) |
$319.65 |
$2,131 |
1.3× |
| MRI pelvis w/wo contrast (72197) |
$319.65 |
$2,131 |
0.9× |
| MRI spine cervical wo/w contrast (72156) |
$319.65 |
$2,131 |
0.9× |
| MRI thoracic spine w wo contrast (72157) |
$319.65 |
$2,131 |
0.9× |
| MRI thoracic spine w/o contrast (72146) |
$319.65 |
$2,131 |
1.3× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$476.32 |
$3,175.50 |
1.9× |
| MRI upr ext w/o jnts w/o-w/con rt (73220) |
$319.65 |
$2,131 |
0.9× |
| Nose to rectum for fb child (76010) |
$43.95 |
$293 |
0.5× |
| Ob us < 14 wks single fetus (76801) |
$105 |
$700 |
1.0× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$77.70 |
$518 |
0.9× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$77.70 |
$518 |
0.7× |
| Radex hips bilateral with pelvis 2 views (73521) |
$37.50 |
$250 |
0.3× |
| Radex spine cervical 2 or 3 views (72040) |
$77.70 |
$518 |
0.9× |
| Radex spine cervical 4 or 5 views (72050) |
$77.70 |
$518 |
0.7× |
| Radex spine cervical 6 or more views (72052) |
$77.70 |
$518 |
0.7× |
| Radex X-Ray Exam Thoracolmb 2+ Vw - Xr Thoracolumbar Spine 2 Views (72080) |
$77.70 |
$518 |
0.9× |
| Radiologic Exam Chest 4+ Views - Xr Chest 4+ Views (71048) |
$57.15 |
$381 |
0.5× |
| Radiologic Examination Femur 1 View - Xr Femur 1 Vw Right (73551) |
$77.70 |
$518 |
0.9× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$77.70 |
$518 |
0.9× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$77.70 |
$518 |
0.7× |
| Ultrasound, abdomen limited (76705) |
$105 |
$700 |
1.0× |
| Us abdominal aorta real time screen study aaa (76706) |
$74.70 |
$498 |
0.7× |
| Us chest (76604) |
$105 |
$700 |
1.0× |
| Us lmtd jt/fcl eval nonvasc xtr strux r-t w/img (76882) |
$105 |
$700 |
1.0× |
| Us ob limited 1 or more fetuses (76815) |
$105 |
$700 |
1.0× |
| Us obstetric transvaginal (76817) |
$46.05 |
$307 |
0.4× |
| Us pelvic limited or f/u non-ob (76857) |
$105 |
$700 |
1.0× |
| Us pelvis complete (76856) |
$105 |
$700 |
1.0× |
| Us retroperitoneal complete (76770) |
$105 |
$700 |
1.0× |
| Us retroperitoneal limited (76775) |
$105 |
$700 |
1.0× |
| Us scrotum (76870) |
$105 |
$700 |
1.0× |
| Us soft tissue head/neck (76536) |
$105 |
$700 |
1.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$77.70 |
$518 |
0.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$77.70 |
$518 |
0.9× |
| X-ray exam hips bi 3-4 views (73522) |
$77.70 |
$518 |
0.7× |
| X-ray exam of finger(s) (73140) |
$77.70 |
$518 |
0.9× |
| X-Ray Foot 2 Vw - Xr Foot 1-2 Views Right (73620) |
$77.70 |
$518 |
0.9× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$77.70 |
$518 |
0.9× |
| X-Ray Hand 2 Vw - Xr Hand 1-2 Views Right (73120) |
$77.70 |
$518 |
0.7× |
| X-Ray Hand 3+ Vw - Xr Hand 3+ Views Right (73130) |
$77.70 |
$518 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$77.70 |
$518 |
0.9× |
| X-Ray Knee 3 View - Xr Knee 3 Views Right (73562) |
$76.72 |
$511.50 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$77.70 |
$518 |
0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$46.65 |
$311 |
0.5× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$59.70 |
$398 |
0.5× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$77.70 |
$518 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$77.70 |
$518 |
0.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$77.70 |
$518 |
0.7× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$71.70 |
$478 |
0.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$77.70 |
$518 |
0.9× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$77.70 |
$518 |
0.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$77.70 |
$518 |
0.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$77.70 |
$518 |
0.7× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$77.70 |
$518 |
0.9× |
| X-Ray Wrist 2 Vw - Xr Wrist 1-2 Views Right (73100) |
$71.85 |
$479 |
0.8× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$77.70 |
$518 |
0.9× |
| Xr abdomen 1 view (74018) |
$74.40 |
$496 |
0.8× |
| Xr abdomen 2 views (74019) |
$77.70 |
$518 |
0.7× |
| Xr abdomen 3 views (74021) |
$77.70 |
$518 |
0.7× |
| Xr bone density axial (77080) |
$65.55 |
$437 |
0.6× |
| Xr chest 1 view (71045) |
$44.70 |
$298 |
0.5× |
| Xr chest 2 views (71046) |
$57.15 |
$381 |
0.6× |
| Xr eye foreign body (70030) |
$76.20 |
$508 |
0.8× |
| Xr facial bones 3 views (70150) |
$77.70 |
$518 |
0.7× |
| Xr lumbar spine 4 views w/ flex ext (72120) |
$77.70 |
$518 |
0.7× |
| Xr nasal bones (70160) |
$77.70 |
$518 |
0.9× |
| Xr pelvis 3 views (72190) |
$77.70 |
$518 |
0.7× |
| Xr spine 1 view (72020) |
$77.70 |
$518 |
0.9× |
| Xray elbow 2 views (73070) |
$77.70 |
$518 |
0.9× |
| Xray forearm 2 views (73090) |
$77.70 |
$518 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$77.70 |
$518 |
0.9× |
| Xray neck soft tissue (70360) |
$77.70 |
$518 |
0.9× |
| Xray pelvis 1 or 2 views (72170) |
$77.70 |
$518 |
0.7× |
| Xray ribs bilateral 3 views (71110) |
$77.70 |
$518 |
0.7× |
| Xray ribs unilat w/ pa chest 3v rt (71101) |
$77.70 |
$518 |
0.7× |
| Xray scapula complete (73010) |
$63 |
$420 |
0.6× |
| Xray shoulder 1 view (73020) |
$77.70 |
$518 |
0.9× |
| Xray sinuses paranasal <3 views (70210) |
$55.50 |
$370 |
0.6× |
| Xray spine thoracic 2 views (72070) |
$77.70 |
$518 |
0.7× |
| Xray spine thoracic 3 views (72072) |
$77.70 |
$518 |
0.7× |
| Xray tibia-fibula 2 views bil (73590) |
$77.70 |
$518 |
0.9× |