| Abdomen 2 views (74019) |
$206.70 |
$318 |
2.2× |
| Ankle 2 views (73600) |
$237.25 |
$365 |
3.0× |
| Bone age studies (77072) |
$213.20 |
$328 |
2.2× |
| Bone survey complete (77075) |
$555.75 |
$855 |
5.8× |
| Cervical spine 2 or 3 views (72040) |
$206.70 |
$318 |
2.6× |
| Chest 1 view (71045) |
$135.85 |
$209 |
1.7× |
| Chest 3 views (71047) |
$260.65 |
$401 |
3.3× |
| Clavicle complete (73000) |
$257.40 |
$396 |
3.2× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$258.05 |
$397 |
2.7× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,636.10 |
$5,594 |
11.4× |
| CT abdomen and pelvis without contrast (74176) |
$2,262.65 |
$3,481 |
10.4× |
| CT abdomen w contrast (74160) |
$1,761.50 |
$2,710 |
11.0× |
| CT abdomen w wo contrast (74170) |
$2,215.20 |
$3,408 |
13.9× |
| CT abdomen w/o contrast (74150) |
$1,237.60 |
$1,904 |
13.0× |
| CT angiography upper extremity lt (73206) |
$871.65 |
$1,341 |
5.5× |
| CT c-spine w/o contrast (72125) |
$1,235.65 |
$1,901 |
13.0× |
| CT cervical spine w&w/o contrast (72127) |
$1,418.30 |
$2,182 |
8.9× |
| CT cervical spine with contrast (72126) |
$1,337.70 |
$2,058 |
4.2× |
| CT chest w/wo contrast (71270) |
$1,713.40 |
$2,636 |
10.7× |
| CT chest with contrast (71260) |
$1,290.90 |
$1,986 |
8.1× |
| CT head/brain with contrast (70460) |
$1,314.30 |
$2,022 |
8.2× |
| CT head/brain without and with contrast (70470) |
$1,580.15 |
$2,431 |
9.9× |
| CT iac w contrast (70481) |
$813.80 |
$1,252 |
5.1× |
| CT limited/localized follow up study (76380) |
$576.55 |
$887 |
7.3× |
| CT lower ext w/o (73700) |
$787.80 |
$1,212 |
8.3× |
| CT lower extremity w wo contrast (73702) |
$920.40 |
$1,416 |
5.8× |
| CT lower extremity with contrast (73701) |
$841.75 |
$1,295 |
5.3× |
| CT lumbar spine w & w/o contrast (72133) |
$1,754.35 |
$2,699 |
11.0× |
| CT lumbar spine w/o contrast (72131) |
$1,450.15 |
$2,231 |
15.2× |
| CT lumbar spine with contrast (72132) |
$1,673.75 |
$2,575 |
5.3× |
| CT maxillofacial w contrast (70487) |
$1,279.85 |
$1,969 |
8.0× |
| CT maxillofacial w/o contrast (70486) |
$1,017.90 |
$1,566 |
10.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,485.90 |
$2,286 |
9.3× |
| CT neck soft tissue w contrast (70491) |
$1,383.20 |
$2,128 |
8.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$831.35 |
$1,279 |
5.2× |
| CT orbits w/o contrast (70480) |
$770.90 |
$1,186 |
8.1× |
| CT pelvis w & w/o contrast (72194) |
$1,704.95 |
$2,623 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,369.55 |
$2,107 |
14.4× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,600.30 |
$2,462 |
10.0× |
| CT soft tissue neck w/o contrast (70490) |
$982.15 |
$1,511 |
10.3× |
| CT thoracic spine w/contrast (72129) |
$1,572.35 |
$2,419 |
9.8× |
| CT thoracic spine w/o contrast (72128) |
$1,398.80 |
$2,152 |
14.7× |
| CT thoracic spine w/wo contrast (72130) |
$1,708.85 |
$2,629 |
10.7× |
| CT thorax w/o contrast (71250) |
$939.90 |
$1,446 |
9.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,019.20 |
$1,568 |
6.4× |
| CT upper extremity w/o contrast rt (73200) |
$842.40 |
$1,296 |
8.8× |
| CT upper extremity with contrast (73201) |
$889.20 |
$1,368 |
2.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,120.30 |
$3,262 |
13.3× |
| Cta Abdomen (74175) |
$2,001.35 |
$3,079 |
12.5× |
| CTA abdomen pelvis (74174) |
$3,225.95 |
$4,963 |
10.2× |
| CTA chest (71275) |
$1,428.05 |
$2,197 |
8.9× |
| Cta Head (70496) |
$1,047.15 |
$1,611 |
6.6× |
| CTA head&neck c+ w/noncontrast img&post-pxessing (70471) |
$2,544.75 |
$3,915 |
8.0× |
| CTA lwr ext w&w/o contrast (73706) |
$939.25 |
$1,445 |
5.9× |
| Cta Neck (70498) |
$1,890.85 |
$2,909 |
11.8× |
| Foot 2 views (73620) |
$204.10 |
$314 |
2.6× |
| Forearm 2 views (73090) |
$215.80 |
$332 |
2.7× |
| Full Mouth X-Ray Of Teeth - Xr Teeth Full Mouth (70320) |
$156 |
$240 |
0.7× |
| Hand 2 views (73120) |
$211.90 |
$326 |
2.2× |
| Hand 3 views (73130) |
$267.80 |
$412 |
3.4× |
| Humerus Min 2 Views Left (73060) |
$228.80 |
$352 |
2.9× |
| Knee 3 views (73562) |
$272.35 |
$419 |
3.4× |
| Neck soft tissue (70360) |
$217.10 |
$334 |
2.7× |
| Osseous survey infant (77076) |
$247.65 |
$381 |
2.6× |
| Pelvis 1 or 2 views (72170) |
$225.55 |
$347 |
2.4× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$154.70 |
$238 |
2.0× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$336.70 |
$518 |
3.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$216.45 |
$333 |
2.3× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$218.40 |
$336 |
2.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$562.90 |
$866 |
5.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$273 |
$420 |
2.9× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$182 |
$280 |
2.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$339.30 |
$522 |
3.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$221.65 |
$341 |
2.8× |
| Radiologic exam teeth prtl exam < full mouth (70310) |
$98.15 |
$151 |
0.5× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$265.20 |
$408 |
3.3× |
| Ribs bilateral 3 views (71110) |
$302.25 |
$465 |
3.2× |
| Sacroiliac Joints < 3 Views (72200) |
$141.70 |
$218 |
1.5× |
| Scapula complete (73010) |
$196.95 |
$303 |
2.1× |
| Sella turcica (70240) |
$115.70 |
$178 |
1.5× |
| Spine thoracic 3 views (72072) |
$248.30 |
$382 |
2.6× |
| Thoracolumbar 2 views (72080) |
$175.50 |
$270 |
2.2× |
| Tmj unilateral (70328) |
$112.45 |
$173 |
1.4× |
| Ultrasound, abdomen limited (76705) |
$411.45 |
$633 |
4.3× |
| Unlisted Ultrasound Procedure (76999) |
$209.30 |
$322 |
2.6× |
| Upper Extremity Infant (73092) |
$83.85 |
$129 |
0.9× |
| Us abdl aorta screen aaa (76706) |
$325 |
$500 |
3.4× |
| Us chest (76604) |
$401.05 |
$617 |
4.2× |
| Us compl joint r-t w/image documentation (76881) |
$464.10 |
$714 |
4.9× |
| Us ob transvaginal (76817) |
$449.15 |
$691 |
4.7× |
| Us pelvic non ob complete (76856) |
$507.65 |
$781 |
5.3× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$346.45 |
$533 |
3.6× |
| Us pregnancy ltd (76815) |
$391.30 |
$602 |
4.1× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$486.20 |
$748 |
5.1× |
| Us retroperitoneal complete (76770) |
$474.50 |
$730 |
5.0× |
| Us retroperitoneal limited (76775) |
$211.90 |
$326 |
2.2× |
| Us scrotum and contents (76870) |
$508.30 |
$782 |
5.3× |
| Us soft tissue head/neck (76536) |
$454.35 |
$699 |
4.8× |
| Us transrectal (76872) |
$351 |
$540 |
3.7× |
| Us xtr non-vasc lmtd (76882) |
$378.95 |
$583 |
4.0× |
| Wrist 2 views (73100) |
$235.95 |
$363 |
3.0× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$315.25 |
$485 |
3.3× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$219.05 |
$337 |
2.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$332.80 |
$512 |
4.2× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$234.65 |
$361 |
3.0× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$274.95 |
$423 |
3.5× |
| X-ray exam entire spi 4/5 vw (72083) |
$464.75 |
$715 |
4.9× |
| X-ray exam hip uni 1 view (73501) |
$167.05 |
$257 |
2.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$176.80 |
$272 |
2.2× |
| X-ray exam hip uni 4/> views (73503) |
$243.10 |
$374 |
2.6× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$260 |
$400 |
2.7× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$310.70 |
$478 |
3.3× |
| X-ray exam of femur 1 (73551) |
$193.70 |
$298 |
2.4× |
| X-ray eye for foreign body (70030) |
$154.70 |
$238 |
2.0× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$260 |
$400 |
2.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$203.45 |
$313 |
2.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$287.30 |
$442 |
3.6× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$209.30 |
$322 |
2.6× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$200.85 |
$309 |
2.5× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$312.65 |
$481 |
3.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$213.20 |
$328 |
2.7× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$181.35 |
$279 |
2.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$232.70 |
$358 |
2.4× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$496.60 |
$764 |
5.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$148.20 |
$228 |
1.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$266.50 |
$410 |
3.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$152.10 |
$234 |
1.9× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$321.10 |
$494 |
3.4× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$236.60 |
$364 |
2.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$239.85 |
$369 |
3.0× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$270.40 |
$416 |
2.8× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$335.40 |
$516 |
3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$210.60 |
$324 |
2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$258.05 |
$397 |
3.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$291.85 |
$449 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$239.20 |
$368 |
3.0× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$190.45 |
$293 |
2.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$404.95 |
$623 |
4.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$224.25 |
$345 |
2.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$183.95 |
$283 |
2.3× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$190.45 |
$293 |
2.4× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$165.75 |
$255 |
2.1× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$48.75 |
$75 |
0.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$218.40 |
$336 |
2.3× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$305.50 |
$470 |
3.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$174.20 |
$268 |
2.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$288.60 |
$444 |
3.6× |
| Xr c-spine 6 or more views (72052) |
$433.55 |
$667 |
4.6× |
| Xr chest 4+ views (71048) |
$304.20 |
$468 |
3.2× |
| Xr finger(s) 2+ views (73140) |
$191.10 |
$294 |
2.4× |
| Xr internal auditory meati complete (70134) |
$302.25 |
$465 |
0.6× |
| XR Mastoids < 3 Views Bilateral (70120) |
$155.35 |
$239 |
1.6× |
| Xr optic foramina (70190) |
$118.95 |
$183 |
1.5× |
| Xr shoulder 1 view (73020) |
$257.40 |
$396 |
3.2× |
| Xr spine cervical 4 or 5 views (72050) |
$365.30 |
$562 |
3.8× |
| Xr tibia/fibula 2 views (73590) |
$250.90 |
$386 |
3.2× |
| Xr tmj bilateral (70330) |
$212.55 |
$327 |
2.7× |
| Xray knee 1 or 2 views rt (73560) |
$226.20 |
$348 |
2.9× |