| Abdomen 1 View (74018) |
$174.80 |
$437 |
1.6× |
| Abdomen 2 views (74019) |
$226.80 |
$567 |
1.7× |
| Ankle 2 views (73600) |
$161.60 |
$404 |
1.4× |
| Bone age studies (77072) |
$86.40 |
$216 |
0.6× |
| Bone survey infant (77076) |
$183.60 |
$459 |
1.4× |
| Chest 1 view (71045) |
$129.60 |
$324 |
1.2× |
| Chest 2 views (71046) |
$168.40 |
$421 |
1.5× |
| Clavicle complete (73000) |
$168.40 |
$421 |
1.5× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,504.40 |
$3,761 |
11.2× |
| Contrast X-Ray Bladder (74430) |
$358 |
$895 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,387.20 |
$5,968 |
5.3× |
| CT abdomen and pelvis without contrast (74176) |
$1,935.20 |
$4,838 |
6.3× |
| CT abdomen w contrast (74160) |
$1,696.80 |
$4,242 |
7.5× |
| CT abdomen w wo contrast (74170) |
$1,754.80 |
$4,387 |
7.8× |
| CT abdomen w/o contrast (74150) |
$1,484 |
$3,710 |
11.0× |
| CT Angio Abdomen and Pelvis (74174) |
$3,001.60 |
$7,504 |
6.7× |
| CT Angio Chest (71275) |
$1,806 |
$4,515 |
8.0× |
| CT Angio Head (70496) |
$1,690.40 |
$4,226 |
7.5× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$936.80 |
$2,342 |
4.2× |
| CT Angio Neck (70498) |
$1,600 |
$4,000 |
7.1× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) |
$2,064.80 |
$5,162 |
9.2× |
| CT cervical spine w/ contrast (72126) |
$1,548.40 |
$3,871 |
3.5× |
| CT cervical spine w/o contrast (72125) |
$1,478 |
$3,695 |
11.0× |
| CT cervical spine w/wo cont (72127) |
$1,760.40 |
$4,401 |
7.8× |
| CT chest w contrast (71260) |
$1,594 |
$3,985 |
7.1× |
| CT chest w/wo contrast (71270) |
$1,800 |
$4,500 |
8.0× |
| CT head/brain with contrast (70460) |
$1,245.20 |
$3,113 |
5.5× |
| CT head/brain without and with contrast (70470) |
$1,600 |
$4,000 |
7.1× |
| CT iac w contrast (70481) |
$942 |
$2,355 |
4.2× |
| CT l-spine w&w/o contrast (72133) |
$1,760.40 |
$4,401 |
7.8× |
| CT lower ext w/o (73700) |
$1,052.40 |
$2,631 |
7.8× |
| CT lower extremity w/contrast material (73701) |
$1,226.40 |
$3,066 |
5.4× |
| CT lumbar spine w contrast (72132) |
$1,329.20 |
$3,323 |
3.0× |
| CT lumbar spine w/o contrast (72131) |
$1,303.60 |
$3,259 |
9.7× |
| CT maxillofacial w contrast (70487) |
$1,097.20 |
$2,743 |
4.9× |
| CT maxillofacial wo contrast (70486) |
$742 |
$1,855 |
5.5× |
| CT neck tissue combo (70492) |
$1,361.20 |
$3,403 |
6.0× |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) |
$1,149.20 |
$2,873 |
5.1× |
| CT orbits w/o contrast (70480) |
$786.80 |
$1,967 |
5.9× |
| CT pelvis w&w/o contrast (72194) |
$1,614 |
$4,035 |
7.2× |
| CT pelvis w/o contrast (72192) |
$1,315.60 |
$3,289 |
9.8× |
| CT scan of leg combo (73702) |
$1,614 |
$4,035 |
7.2× |
| CT scans face/jaw combo (70488) |
$1,470.80 |
$3,677 |
6.5× |
| CT soft tissue neck w contrast (70491) |
$1,324 |
$3,310 |
5.9× |
| CT soft tissue neck w/o contrast (70490) |
$1,072 |
$2,680 |
8.0× |
| CT thoracic spine w contrast (72129) |
$1,466 |
$3,665 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$1,284.80 |
$3,212 |
9.6× |
| CT thoracic spine w/wo cont (72130) |
$1,760.40 |
$4,401 |
7.8× |
| CT thorax w/o contrast (71250) |
$1,504.40 |
$3,761 |
11.2× |
| CT upper ext wo (73200) |
$1,129.20 |
$2,823 |
8.4× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,614 |
$4,035 |
7.2× |
| CT upper extremity with contrast (73201) |
$1,319.60 |
$3,299 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,741.60 |
$4,354 |
7.7× |
| Cta Abdomen (74175) |
$1,999.60 |
$4,999 |
8.9× |
| CTA pelvis (72191) |
$2,064.80 |
$5,162 |
9.2× |
| Dxa Bone Density Axial (77080) |
$161.60 |
$404 |
1.2× |
| Echo Guide For Artery Repair (76936) |
$710.40 |
$1,776 |
2.6× |
| Esophagram (74220) |
$342 |
$855 |
1.5× |
| Fetal Biophys Profile W/Nst (76818) |
$381.20 |
$953 |
2.8× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$381.20 |
$953 |
2.8× |
| Fluoroscopy up to 1 hr (76000) |
$129.60 |
$324 |
0.4× |
| Foot 2 views (73620) |
$155.20 |
$388 |
1.4× |
| Forearm 2 views (73090) |
$181.20 |
$453 |
1.6× |
| Hand 2 views (73120) |
$155.20 |
$388 |
1.2× |
| Infant hip ultrasound with hip movement (dynamic) (76885) |
$283.20 |
$708 |
2.5× |
| Infant hip ultrasound, limited static exam (76886) |
$194 |
$485 |
1.7× |
| Knee 3 Views (73562) |
$252.80 |
$632 |
2.3× |
| Neck soft tissue (70360) |
$91.20 |
$228 |
0.8× |
| Optic foramina (70190) |
$108.40 |
$271 |
1.0× |
| Pelvis 1 or 2 views (72170) |
$188 |
$470 |
1.4× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$252.80 |
$632 |
1.9× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$188 |
$470 |
1.7× |
| Radex Calcaneus Minimum 2 Views (73650) |
$116.80 |
$292 |
1.0× |
| Radex elbow complete minimum 3 views (73080) |
$200.40 |
$501 |
1.8× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$324.40 |
$811 |
2.4× |
| Radex fingr minimum 2 views (73140) |
$142.40 |
$356 |
1.3× |
| Radex foot complete minimum 3 views (73630) |
$188 |
$470 |
1.7× |
| Radex Hand Minimum 3 Views (73130) |
$188 |
$470 |
1.7× |
| Radex lower extremity infant minimum 2 views (73592) |
$174.80 |
$437 |
1.6× |
| Radex Mastoids Compl Minimum 3 Views PR Side (70130) |
$118.80 |
$297 |
0.9× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$200.40 |
$501 |
1.8× |
| Radex Ribs Unilateral 2 Views (71100) |
$122.80 |
$307 |
1.1× |
| Radex shoulder complete minimum 2 views (73030) |
$200.40 |
$501 |
1.8× |
| Radex Sinuses Paransl < 3 Views (70210) |
$122.80 |
$307 |
1.1× |
| Radex Spine 1 View Specify Level (72020) |
$96 |
$240 |
0.9× |
| Radex Sternum Minimum 2 Views (71120) |
$213.60 |
$534 |
1.9× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$142.40 |
$356 |
1.3× |
| Radex Toe Minimum 2 Views (73660) |
$142.40 |
$356 |
1.3× |
| Radex upper extremity infant minimum 2 views (73092) |
$174.80 |
$437 |
1.3× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$181.20 |
$453 |
1.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$207.60 |
$519 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$252.80 |
$632 |
1.9× |
| Radiologic exam colon double contrast study (74280) |
$496.80 |
$1,242 |
2.2× |
| Radiologic exam colon single contrast study (74270) |
$394 |
$985 |
1.7× |
| Radiologic exam knee complete 4/more views (73564) |
$252.80 |
$632 |
1.9× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$220 |
$550 |
1.6× |
| Radiologic Exam Small Int Single Contrast Study (74250) |
$368 |
$920 |
1.6× |
| Radiologic examination femur minimum 2 views (73552) |
$213.60 |
$534 |
1.9× |
| Radiologic examination knee 1/2 views (73560) |
$155.20 |
$388 |
1.4× |
| Radiologic examination tibia & fibula 2 views (73590) |
$200.40 |
$501 |
1.8× |
| Ribs bilateral 3 views (71110) |
$226.80 |
$567 |
1.7× |
| Scapula (73010) |
$207.60 |
$519 |
1.5× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$76 |
$190 |
3.3× |
| Sella turcica (70240) |
$84.80 |
$212 |
0.8× |
| Shoulder 1 view (73020) |
$149.20 |
$373 |
1.3× |
| Skull less than 4 views (70250) |
$149.20 |
$373 |
1.1× |
| Sternoclavicular joints (71130) |
$74 |
$185 |
0.7× |
| Thoracic spine 2 views (72070) |
$252.80 |
$632 |
1.9× |
| Thoracic spine 3 views (72072) |
$258 |
$645 |
1.9× |
| Thoracolumbar 2 views (72080) |
$239.20 |
$598 |
2.1× |
| Ultrasound Breast Limited (76642) |
$220 |
$550 |
2.0× |
| Ultrasound Exam Aaa Screen (76706) |
$216.40 |
$541 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$387.60 |
$969 |
2.9× |
| Upper gi w/o kub (74240) |
$394 |
$985 |
1.7× |
| Urethrocystogram voiding (74455) |
$178 |
$445 |
0.6× |
| Us breast unilateral complete (76641) |
$220 |
$550 |
1.6× |
| Us chest (76604) |
$258 |
$645 |
1.9× |
| Us complete joint (76881) |
$277.60 |
$694 |
2.1× |
| Us exam, pelvic, limited (76857) |
$355.20 |
$888 |
2.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$207.60 |
$519 |
1.5× |
| Us ob transvaginal (76817) |
$407.60 |
$1,019 |
3.0× |
| Us pelvic non ob complete (76856) |
$387.60 |
$969 |
2.9× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$329.60 |
$824 |
2.5× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) |
$131.60 |
$329 |
1.0× |
| Us retroperitoneal complete (76770) |
$432.80 |
$1,082 |
3.2× |
| Us scrotum and contents (76870) |
$452.40 |
$1,131 |
3.4× |
| Us thyroid (76536) |
$337.20 |
$843 |
2.5× |
| Venography extremity bilateral rs&i (75822) |
$242.80 |
$607 |
0.1× |
| Venography extremity unilateral rs&i (75820) |
$183.60 |
$459 |
0.1× |
| Wrist 2 views (73100) |
$181.20 |
$453 |
1.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$220 |
$550 |
2.0× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$168.40 |
$421 |
1.5× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) |
$220 |
$550 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$174.80 |
$437 |
1.6× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$245.60 |
$614 |
1.8× |
| X-Ray Exam L-S Spine Bending (72114) |
$374.40 |
$936 |
2.8× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$136.80 |
$342 |
1.2× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$311.20 |
$778 |
2.3× |
| X-ray humerus (73060) |
$174.80 |
$437 |
1.6× |
| X-ray IV pyelogram (ivp) (74400) |
$438.80 |
$1,097 |
1.9× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$207.60 |
$519 |
1.5× |
| X-ray nose-rectum child f.b. (76010) |
$176.40 |
$441 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$200.40 |
$501 |
1.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$232.80 |
$582 |
2.1× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$277.60 |
$694 |
2.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$297.20 |
$743 |
2.2× |
| X-ray thoracic spine 4 vw (72074) |
$290.40 |
$726 |
2.2× |
| X-Ray Tmj Unilat (70328) |
$122.80 |
$307 |
1.1× |
| X-Rays Bone Length Studies (77073) |
$324.40 |
$811 |
2.4× |
| X-Rays Bone Survey Complete (77075) |
$324.40 |
$811 |
2.4× |
| Xr c-spine 4 or 5 views (72050) |
$277.60 |
$694 |
2.1× |
| Xr facial bones less than 3 views (70140) |
$207.60 |
$519 |
1.9× |
| Xr orbits complete 4 views (70200) |
$220 |
$550 |
1.6× |