| Abdomen 2 views (74019) |
$239.85 |
$369 |
1.9× |
| Ankle 2 views (73600) |
$24.70 |
$38 |
0.2× |
| Bone age studies (77072) |
$239.85 |
$369 |
1.9× |
| Bone survey infant (77076) |
$438.75 |
$675 |
3.6× |
| Cervical spine 2 or 3 views (72040) |
$239.85 |
$369 |
2.3× |
| Chest 1 view (71045) |
$239.85 |
$369 |
2.3× |
| Chest xray 3 views (71047) |
$257.08 |
$395.50 |
2.5× |
| Clavicle complete (73000) |
$239.85 |
$369 |
2.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$280.15 |
$431 |
0.7× |
| CT abdomen and pelvis without contrast (74176) |
$242.45 |
$373 |
0.9× |
| CT abdomen w contrast (74160) |
$177.45 |
$273 |
0.9× |
| CT abdomen w wo contrast (74170) |
$195.65 |
$301 |
0.9× |
| CT abdomen w/o contrast (74150) |
$165.75 |
$255 |
1.3× |
| CT c-spine w/contrast (72126) |
$1,745.90 |
$2,686 |
4.2× |
| CT c-spine w/o contrast (72125) |
$791.70 |
$1,218 |
6.4× |
| CT cervical spine w&w/o contrast (72127) |
$1,277.90 |
$1,966 |
6.2× |
| CT chest w contrast (71260) |
$846.30 |
$1,302 |
4.1× |
| CT chest w/wo contrast (71270) |
$1,381.90 |
$2,126 |
6.7× |
| CT head/brain with contrast (70460) |
$1,067.30 |
$1,642 |
5.2× |
| CT head/brain without and with contrast (70470) |
$1,917.50 |
$2,950 |
9.3× |
| CT iac w contrast (70481) |
$1,073.80 |
$1,652 |
5.2× |
| CT limited/localized follow up study (76380) |
$136.50 |
$210 |
1.3× |
| CT lower ext w/o (73700) |
$139.75 |
$215 |
1.1× |
| CT lower extremity w wo contrast (73702) |
$169 |
$260 |
0.8× |
| CT lower extremity w/contrast material (73701) |
$161.85 |
$249 |
0.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,277.90 |
$1,966 |
6.2× |
| CT lumbar spine w/contrast (72132) |
$1,745.90 |
$2,686 |
4.2× |
| CT lumbar spine w/o contrast (72131) |
$791.70 |
$1,218 |
6.4× |
| CT maxillofacial w contrast (70487) |
$1,073.80 |
$1,652 |
5.2× |
| CT maxillofacial w/wo contrast (70488) |
$1,277.90 |
$1,966 |
6.2× |
| CT maxillofacial wo contrast (70486) |
$791.70 |
$1,218 |
6.4× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,277.90 |
$1,966 |
6.2× |
| CT orbits w/o contrast (70480) |
$516.75 |
$795 |
4.2× |
| CT pelvis w/o contrast (72192) |
$516.75 |
$795 |
4.2× |
| CT pelvis w/wo contrast (72194) |
$1,277.90 |
$1,966 |
6.2× |
| CT scan of arm combo (73202) |
$1,277.90 |
$1,966 |
6.2× |
| CT soft tissue neck w contrast (70491) |
$1,073.80 |
$1,652 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
$791.70 |
$1,218 |
6.4× |
| CT thoracic spine w/contrast (72129) |
$1,073.80 |
$1,652 |
5.2× |
| CT thoracic spine w/o contrast (72128) |
$791.70 |
$1,218 |
6.4× |
| CT thoracic spine w/wo contrast (72130) |
$1,277.90 |
$1,966 |
6.2× |
| CT thorax w/o contrast (71250) |
$989.62 |
$1,522.50 |
8.0× |
| CT unlisted procedure (76497) |
$78 |
$120 |
0.8× |
| CT upper ext wo (73200) |
$791.70 |
$1,218 |
6.4× |
| CT upper extremity with contrast (73201) |
$1,745.90 |
$2,686 |
4.2× |
| CTA abdomen pelvis (74174) |
$1,745.90 |
$2,686 |
4.2× |
| CTA chest (71275) |
$846.30 |
$1,302 |
4.1× |
| Cta Head (70496) |
$846.30 |
$1,302 |
4.1× |
| Cta Pelvis (72191) |
$846.30 |
$1,302 |
4.1× |
| Doppler Echo Fetal Puls Spectral F/U/Repeat (76828) |
$77.02 |
$118.50 |
0.6× |
| Doppler Echo Fetal Spectral Display Complete (76827) |
$78.65 |
$121 |
0.6× |
| Doppler Fetal Mid Cerebral Artery (76821) |
$97.50 |
$150 |
0.8× |
| Echo exam of eye (76529) |
$202.15 |
$311 |
2.0× |
| Facial bones min 3 views (70150) |
$377.65 |
$581 |
3.1× |
| Fetal biophysical profile non-stress testing (76818) |
$145.60 |
$224 |
1.2× |
| Fetal Echo (76825) |
$227.82 |
$350.50 |
0.4× |
| Foot 2 views (73620) |
$23.40 |
$36 |
0.2× |
| Forearm 2 views (73090) |
$239.85 |
$369 |
2.3× |
| Gastrointestinal endoscopic ultrasound, supervision and interpretation Non-Facility (76975) |
$117.32 |
$180.50 |
0.4× |
| Hand 2 views (73120) |
$239.85 |
$369 |
1.9× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$239.85 |
$369 |
1.9× |
| Knee 3 views (73562) |
$139.10 |
$214 |
1.4× |
| Neck soft tissue (70360) |
$239.85 |
$369 |
2.3× |
| Pelvis 1 or 2 views (72170) |
$239.85 |
$369 |
1.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$26.65 |
$41 |
0.3× |
| Radex Calcaneus Minimum 2 Views (73650) |
$24.05 |
$37 |
0.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$239.85 |
$369 |
2.3× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$239.85 |
$369 |
2.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$377.65 |
$581 |
3.1× |
| Radex fingr minimum 2 views (73140) |
$239.85 |
$369 |
2.3× |
| Radex Foot Compl Minimum 3 Views (73630) |
$24.70 |
$38 |
0.2× |
| Radex Hand Minimum 3 Views (73130) |
$239.85 |
$369 |
2.3× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$239.85 |
$369 |
2.3× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$239.85 |
$369 |
1.9× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$312.65 |
$481 |
2.5× |
| Radex Humerus Minimum 2 Views (73060) |
$239.85 |
$369 |
2.3× |
| Radex Kne 1/2 Views (73560) |
$239.85 |
$369 |
2.3× |
| Radex Kne Compl 4/More Views (73564) |
$33.15 |
$51 |
0.3× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$377.65 |
$581 |
3.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$239.85 |
$369 |
2.3× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$239.85 |
$369 |
1.9× |
| Radex Sho Compl Minimum 2 Views (73030) |
$239.85 |
$369 |
2.3× |
| Radex Sinuses Paransl < 3 Views (70210) |
$239.85 |
$369 |
2.3× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$377.65 |
$581 |
3.1× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$384.80 |
$592 |
3.7× |
| Radex Toe Minimum 2 Views (73660) |
$19.50 |
$30 |
0.2× |
| Radex upper extremity infant minimum 2 views (73092) |
$377.65 |
$581 |
3.1× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$239.85 |
$369 |
2.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$239.85 |
$369 |
2.3× |
| Radiologic exam chest 2 views (71046) |
$285.35 |
$439 |
2.8× |
| Radiologic examination tibia & fibula 2 views (73590) |
$117.32 |
$180.50 |
1.1× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Non-Facility (70130) |
$356.20 |
$548 |
2.9× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$239.85 |
$369 |
1.9× |
| Ribs bilateral 3 views (71110) |
$377.65 |
$581 |
3.1× |
| Sacroiliac Joints < 3 Views (72200) |
$239.85 |
$369 |
1.9× |
| Scapula (73010) |
$239.85 |
$369 |
1.9× |
| Shoulder 1 view (73020) |
$239.85 |
$369 |
2.3× |
| Thoracolumbar 2 views (72080) |
$219.70 |
$338 |
2.1× |
| Tmj unilateral (70328) |
$239.85 |
$369 |
2.3× |
| Ultrasound breast complete (76641) |
$196.30 |
$302 |
1.6× |
| Ultrasound Exam Aaa Screen (76706) |
$299 |
$460 |
2.4× |
| Ultrasound, abdomen limited (76705) |
$83.85 |
$129 |
0.7× |
| Umbilical-artery Doppler (OB) (76820) |
$70.20 |
$108 |
0.6× |
| Unlisted ultrasound procedure (76999) |
$300.30 |
$462 |
2.9× |
| Us breast unilateral limited (76642) |
$159.90 |
$246 |
1.6× |
| Us chest (76604) |
$76.05 |
$117 |
0.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$261.95 |
$403 |
1.0× |
| Us compl joint r-t w/image documentation (76881) |
$268.45 |
$413 |
2.2× |
| Us encephalogram (76506) |
$87.42 |
$134.50 |
0.7× |
| Us hips infant static (76886) |
$85.80 |
$132 |
0.8× |
| Us infant hips w manipulation (76885) |
$100.42 |
$154.50 |
1.0× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$300.30 |
$462 |
2.4× |
| Us ob detailed single fetus (76811) |
$265.20 |
$408 |
0.9× |
| Us ob limited (76815) |
$89.05 |
$137 |
0.7× |
| Us ob transvaginal (76817) |
$104.32 |
$160.50 |
0.8× |
| Us pelvic non ob complete (76856) |
$229.78 |
$353.50 |
1.9× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$66.95 |
$103 |
0.5× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$137.15 |
$211 |
1.1× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$118.95 |
$183 |
1.0× |
| Us retroperitoneal complete (76770) |
$275.28 |
$423.50 |
2.2× |
| Us retroperitoneal limited (76775) |
$79.30 |
$122 |
0.6× |
| Us scrotum and contents (76870) |
$88.40 |
$136 |
0.7× |
| Us soft tissue head/neck (76536) |
$77.35 |
$119 |
0.6× |
| Us, eye b-scan (76512) |
$202.15 |
$311 |
1.6× |
| Us,transplanted kidney, real time/ doppler (76776) |
$447.85 |
$689 |
3.6× |
| Wrist 2 views (73100) |
$239.85 |
$369 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$377.65 |
$581 |
3.1× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$247.65 |
$381 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$239.85 |
$369 |
2.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$139.42 |
$214.50 |
1.4× |
| X-ray exam of femur 2/> (73552) |
$239.85 |
$369 |
2.3× |
| X-ray eye for foreign body (70030) |
$239.85 |
$369 |
2.3× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$239.85 |
$369 |
2.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$239.85 |
$369 |
2.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$208.65 |
$321 |
2.0× |
| X-ray leg, infant (73592) |
$24.05 |
$37 |
0.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$258.05 |
$397 |
2.1× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$438.75 |
$675 |
3.6× |
| X-ray optic foramen (70190) |
$221 |
$340 |
2.1× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$239.85 |
$369 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$281.45 |
$433 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$377.65 |
$581 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$377.65 |
$581 |
3.1× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$239.85 |
$369 |
1.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$239.85 |
$369 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$311.35 |
$479 |
3.0× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$377.65 |
$581 |
3.1× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$265.85 |
$409 |
2.2× |
| X-Ray Spine One View - Xr Spine (72020) |
$239.85 |
$369 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$280.15 |
$431 |
2.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$245.05 |
$377 |
2.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$280.15 |
$431 |
2.3× |
| Xr bone length studies (77073) |
$42.25 |
$65 |
0.3× |
| Xr c-spine 4 or 5 views (72050) |
$377.65 |
$581 |
3.1× |
| Xr c-spine 6 or more views (72052) |
$377.65 |
$581 |
3.1× |
| Xr chest 4+ views (71048) |
$377.65 |
$581 |
3.1× |