| Chest 1 view (71045) |
$105 |
$140 |
1.0× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$1,275 |
$1,700 |
6.1× |
| CT abdomen and pelvis without contrast (74176) |
$684 |
$912 |
2.4× |
| CT abdomen w contrast (74160) |
$1,205.25 |
$1,607 |
5.7× |
| CT angio lwr extr w/o&w/dye (73706) |
$993.75 |
$1,325 |
4.7× |
| CT chest w contrast (71260) |
$1,103.25 |
$1,471 |
5.2× |
| CT head/brain with contrast (70460) |
$912 |
$1,216 |
4.3× |
| CT head/brain without and with contrast (70470) |
$1,101 |
$1,468 |
5.2× |
| CT iac w contrast (70481) |
$1,351.50 |
$1,802 |
6.4× |
| CT maxillofacial w contrast (70487) |
$1,148.25 |
$1,531 |
5.5× |
| CT maxillofacial w/wo contrast (70488) |
$1,410 |
$1,880 |
6.7× |
| CT maxillofacial wo contrast (70486) |
$939 |
$1,252 |
7.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,538.25 |
$2,051 |
7.3× |
| CT orbits w/o contrast (70480) |
$1,158.75 |
$1,545 |
9.2× |
| CT soft tissue neck w contrast (70491) |
$1,118.25 |
$1,491 |
5.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,372.50 |
$1,830 |
6.5× |
| CT soft tissue neck w/o contrast (70490) |
$921.75 |
$1,229 |
7.4× |
| CT thorax w/o contrast (71250) |
$907.50 |
$1,210 |
7.2× |
| CTA abdomen pelvis (74174) |
$1,731.75 |
$2,309 |
4.1× |
| CTA chest (71275) |
$1,623.75 |
$2,165 |
7.7× |
| Cta Head (70496) |
$2,263.50 |
$3,018 |
10.8× |
| Cta Neck (70498) |
$2,276.25 |
$3,035 |
10.8× |
| Esophagus (74220) |
$1,275 |
$1,700 |
6.1× |
| MRA head w/o contrast (70544) |
$1,898.25 |
$2,531 |
6.6× |
| MRA neck w contrast (70548) |
$1,987.50 |
$2,650 |
4.8× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,860.50 |
$3,814 |
6.8× |
| MRA neck w/o contrast (70547) |
$1,896 |
$2,528 |
6.6× |
| MRI cervical spine w/o contrast (72141) |
$1,731 |
$2,308 |
6.1× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,899.75 |
$2,533 |
6.6× |
| MRI orbit face neck w contrast (70542) |
$2,058 |
$2,744 |
4.9× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,571 |
$3,428 |
6.1× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,529.75 |
$3,373 |
6.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,499 |
$3,332 |
6.0× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,332.50 |
$3,110 |
5.6× |
| MRI temporomandibular joint (70336) |
$1,687.50 |
$2,250 |
5.9× |
| MRI thoracic spine w/o contrast (72146) |
$1,735.50 |
$2,314 |
6.1× |
| Neck soft tissue (70360) |
$363 |
$484 |
3.5× |
| Ophthalmic biometry by ultrasound echography, A-scan; Non-Facility (76516) |
$417.75 |
$557 |
3.3× |
| Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution… (76513) |
$252.75 |
$337 |
2.0× |
| Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter… (76510) |
$321.75 |
$429 |
2.0× |
| Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)… (76514) |
$87 |
$116 |
2.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$105 |
$140 |
1.0× |
| Radiologic exam chest 2 views (71046) |
$105 |
$140 |
1.0× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$793.50 |
$1,058 |
3.8× |
| Radiologic examination, mastoids; less than 3 views per side Non-Facility (70120) |
$276.75 |
$369 |
2.2× |
| Sialogram (70390) |
$690.75 |
$921 |
2.4× |
| Us soft tissue head/neck (76536) |
$338.25 |
$451 |
2.7× |
| Us, eye b-scan (76512) |
$252.75 |
$337 |
2.0× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$438 |
$584 |
3.5× |