| Abdomen 2 views (74019) |
$263 |
$438 |
2.5× |
| Ankle 2 views (73600) |
$120 |
$200 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$119.50 |
$199 |
1.4× |
| Chest 1 view (71045) |
$139 |
$232 |
1.6× |
| Clavicle complete (73000) |
$120 |
$200 |
1.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,298 |
$2,163 |
3.7× |
| CT abdomen and pelvis without contrast (74176) |
$955 |
$1,591 |
4.0× |
| CT abdomen w contrast (74160) |
$757 |
$1,262 |
4.3× |
| CT abdomen w wo contrast (74170) |
$927 |
$1,545 |
5.3× |
| CT abdomen w/o contrast (74150) |
$496 |
$827 |
4.7× |
| CT c-spine w/o contrast (72125) |
$556 |
$927 |
5.3× |
| CT cervical spine w&w/o contrast (72127) |
$927 |
$1,545 |
5.3× |
| CT cervical spine with contrast (72126) |
$577 |
$961 |
1.6× |
| CT chest w/wo contrast (71270) |
$865 |
$1,442 |
4.9× |
| CT chest with contrast (71260) |
$757 |
$1,262 |
4.3× |
| CT head/brain with contrast (70460) |
$757 |
$1,262 |
4.3× |
| CT head/brain without and with contrast (70470) |
$865 |
$1,442 |
4.9× |
| CT lower ext w/o (73700) |
$478 |
$796 |
4.6× |
| CT lower extremity w wo contrast (73702) |
$865 |
$1,442 |
4.9× |
| CT lower extremity with contrast (73701) |
$773 |
$1,288 |
4.4× |
| CT lumbar spine w & w/o contrast (72133) |
$927 |
$1,545 |
5.3× |
| CT lumbar spine w/o contrast (72131) |
$541 |
$902 |
5.2× |
| CT lumbar spine with contrast (72132) |
$840 |
$1,400 |
2.4× |
| CT maxillofacial w contrast (70487) |
$757 |
$1,262 |
4.3× |
| CT maxillofacial w/o contrast (70486) |
$478 |
$796 |
4.6× |
| CT maxillofacial w/wo contrast (70488) |
$865 |
$1,442 |
4.9× |
| CT neck soft tissue w contrast (70491) |
$788 |
$1,313 |
4.5× |
| CT orbits w/o contrast (70480) |
$478 |
$796 |
4.6× |
| CT pelvis w & w/o contrast (72194) |
$927 |
$1,545 |
5.3× |
| CT pelvis w/o contrast (72192) |
$478 |
$796 |
4.6× |
| CT soft tissue neck w/o contrast (70490) |
$478 |
$796 |
4.6× |
| CT thoracic spine w/contrast (72129) |
$575 |
$958 |
3.3× |
| CT thoracic spine w/o contrast (72128) |
$510 |
$850 |
4.9× |
| CT thoracic spine w/wo contrast (72130) |
$697 |
$1,162 |
4.0× |
| CT thorax w/o contrast (71250) |
$556 |
$927 |
5.3× |
| CT upper extremity w/o & w/contrast material (73202) |
$850 |
$1,416 |
4.8× |
| CT upper extremity w/o contrast rt (73200) |
$478 |
$796 |
4.6× |
| CT upper extremity with contrast (73201) |
$840 |
$1,400 |
2.4× |
| CTA chest (71275) |
$1,128 |
$1,880 |
6.4× |
| Foot 2 views (73620) |
$120 |
$200 |
1.4× |
| Forearm 2 views (73090) |
$120 |
$200 |
1.4× |
| Hand 2 views (73120) |
$165 |
$275 |
1.6× |
| Hand 3 views (73130) |
$167 |
$279 |
1.9× |
| Humerus Min 2 Views Left (73060) |
$120 |
$200 |
1.4× |
| Knee 3 views (73562) |
$115 |
$191 |
1.3× |
| Neck soft tissue (70360) |
$120 |
$200 |
1.4× |
| Pelvis 1 or 2 views (72170) |
$165 |
$275 |
1.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$223 |
$371 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$167 |
$279 |
1.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$129.50 |
$216 |
1.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$263 |
$438 |
2.5× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$139 |
$232 |
1.6× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$136 |
$227 |
1.6× |
| Scapula complete (73010) |
$167 |
$279 |
1.6× |
| Ultrasound, abdomen limited (76705) |
$220 |
$366 |
2.1× |
| Upper Extremity Infant (73092) |
$165 |
$275 |
1.6× |
| Us pelvic non ob complete (76856) |
$220 |
$366 |
2.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$167 |
$279 |
1.6× |
| Us pregnancy ltd (76815) |
$167 |
$279 |
1.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$239 |
$398 |
2.3× |
| Us retroperitoneal complete (76770) |
$369 |
$615 |
3.5× |
| Us retroperitoneal limited (76775) |
$254 |
$424 |
2.4× |
| Us scrotum and contents (76870) |
$220 |
$366 |
2.1× |
| Us soft tissue head/neck (76536) |
$217 |
$361 |
2.1× |
| Us xtr non-vasc lmtd (76882) |
$187 |
$312 |
1.8× |
| Wrist 2 views (73100) |
$120 |
$200 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$120 |
$200 |
1.4× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$111 |
$185 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$120 |
$200 |
1.4× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$120 |
$200 |
1.4× |
| X-ray exam hip uni 1 view (73501) |
$112 |
$187 |
1.3× |
| X-ray exam hip uni 4/> views (73503) |
$223 |
$371 |
2.1× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$167 |
$279 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$134 |
$224 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$120 |
$200 |
1.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$120 |
$200 |
1.4× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$120 |
$200 |
1.4× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$120 |
$200 |
1.4× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$167 |
$279 |
1.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$191 |
$318 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$120 |
$200 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$112.50 |
$187.50 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$158 |
$263 |
1.5× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$120 |
$200 |
1.4× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$167 |
$279 |
1.6× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$167 |
$279 |
1.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$120 |
$200 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$120 |
$200 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$158 |
$263 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$167 |
$279 |
1.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$167 |
$279 |
1.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$120 |
$200 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$88 |
$147 |
1.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$120 |
$200 |
1.4× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$169 |
$282 |
1.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$120 |
$200 |
1.4× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$118 |
$196 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$191 |
$318 |
1.8× |
| Xr finger(s) 2+ views (73140) |
$134 |
$224 |
1.5× |
| XR Mastoids < 3 Views Bilateral (70120) |
$158 |
$263 |
1.5× |
| Xr shoulder 1 view (73020) |
$120 |
$200 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
$167 |
$279 |
1.6× |
| Xr tibia/fibula 2 views (73590) |
$120 |
$200 |
1.4× |
| Xr tmj bilateral (70330) |
$120 |
$200 |
1.4× |
| Xray knee 1 or 2 views rt (73560) |
$120 |
$200 |
1.4× |