| Abdomen 2 views (74019) |
$120.50 |
$241 |
1.3× |
| Ankle 2 views (73600) |
$128.50 |
$257 |
1.6× |
| Bone age studies (77072) |
$81 |
$162 |
0.9× |
| Cervical spine 2 or 3 views (72040) |
$109.50 |
$219 |
1.4× |
| Chest 1 view (71045) |
$59 |
$118 |
0.7× |
| Chest 3 views (71047) |
$87.25 |
$174.50 |
1.1× |
| Clavicle complete (73000) |
$78 |
$156 |
1.0× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$226 |
$452 |
2.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,793 |
$5,586 |
8.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,877.50 |
$3,755 |
8.7× |
| CT abdomen w contrast (74160) |
$1,409 |
$2,818 |
8.9× |
| CT abdomen w wo contrast (74170) |
$1,644.50 |
$3,289 |
10.4× |
| CT abdomen w/o contrast (74150) |
$1,644.50 |
$3,289 |
17.4× |
| CT angio hrt w/3d image (75574) |
$1,115.50 |
$2,231 |
3.5× |
| CT angiography upper extremity lt (73206) |
$1,294 |
$2,588 |
8.1× |
| CT c-spine w/o contrast (72125) |
$1,242.50 |
$2,485 |
13.1× |
| CT cervical spine w&w/o contrast (72127) |
$1,646 |
$3,292 |
10.4× |
| CT cervical spine with contrast (72126) |
$1,387.50 |
$2,775 |
4.4× |
| CT chest w/wo contrast (71270) |
$1,596 |
$3,192 |
10.0× |
| CT chest with contrast (71260) |
$1,339.50 |
$2,679 |
8.4× |
| CT colonography screening (74263) |
$701 |
$1,402 |
3.2× |
| CT colonography w/dye (74262) |
$781 |
$1,562 |
4.9× |
| CT colonography w/o cntrst (74261) |
$742 |
$1,484 |
7.8× |
| CT head/brain with contrast (70460) |
$1,221.50 |
$2,443 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,455.50 |
$2,911 |
9.2× |
| CT heart contrast eval cardiac structure&morph (75572) |
$939 |
$1,878 |
3.0× |
| CT heart no contrast quant eval coronry calcium (75571) |
$136 |
$272 |
1.7× |
| CT hrt w/3d image congen (75573) |
$947 |
$1,894 |
3.0× |
| CT iac w contrast (70481) |
$1,221 |
$2,442 |
7.7× |
| CT limited/localized follow up study (76380) |
$516.50 |
$1,033 |
6.6× |
| CT lower ext w/o (73700) |
$1,018 |
$2,036 |
10.8× |
| CT lower extremity w wo contrast (73702) |
$1,346.50 |
$2,693 |
8.5× |
| CT lower extremity with contrast (73701) |
$1,212.50 |
$2,425 |
7.6× |
| CT lumbar spine w & w/o contrast (72133) |
$1,544.50 |
$3,089 |
9.7× |
| CT lumbar spine w/o contrast (72131) |
$1,182 |
$2,364 |
12.5× |
| CT lumbar spine with contrast (72132) |
$1,383 |
$2,766 |
4.4× |
| CT maxillofacial w contrast (70487) |
$1,248 |
$2,496 |
7.9× |
| CT maxillofacial w/o contrast (70486) |
$1,013.50 |
$2,027 |
10.7× |
| CT maxillofacial w/wo contrast (70488) |
$1,451 |
$2,902 |
9.1× |
| CT neck soft tissue w contrast (70491) |
$1,282 |
$2,564 |
8.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,499 |
$2,998 |
9.4× |
| CT orbits w/o contrast (70480) |
$1,070.50 |
$2,141 |
11.3× |
| CT pelvis w & w/o contrast (72194) |
$1,596.50 |
$3,193 |
10.1× |
| CT pelvis w/o contrast (72192) |
$1,091.50 |
$2,183 |
11.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,497 |
$2,994 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,009 |
$2,018 |
10.7× |
| CT thoracic spine w/contrast (72129) |
$1,312.50 |
$2,625 |
8.3× |
| CT thoracic spine w/o contrast (72128) |
$1,097.50 |
$2,195 |
11.6× |
| CT thoracic spine w/wo contrast (72130) |
$1,525 |
$3,050 |
9.6× |
| CT thorax w/o contrast (71250) |
$1,052 |
$2,104 |
11.1× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,454 |
$2,908 |
9.2× |
| CT upper extremity w/o contrast rt (73200) |
$1,028 |
$2,056 |
10.9× |
| CT upper extremity with contrast (73201) |
$1,201 |
$2,402 |
3.8× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,629.50 |
$3,259 |
10.3× |
| Cta Abdomen (74175) |
$1,544.50 |
$3,089 |
9.7× |
| CTA abdomen pelvis (74174) |
$2,357.50 |
$4,715 |
7.5× |
| CTA chest (71275) |
$1,514 |
$3,028 |
9.5× |
| Cta Head (70496) |
$1,471.50 |
$2,943 |
9.3× |
| CTA lwr ext w&w/o contrast (73706) |
$1,340.50 |
$2,681 |
8.4× |
| Cta Neck (70498) |
$1,486 |
$2,972 |
9.4× |
| Cta Pelvis (72191) |
$1,514.50 |
$3,029 |
9.5× |
| Foot 2 views (73620) |
$59.50 |
$119 |
0.8× |
| Forearm 2 views (73090) |
$78 |
$156 |
1.0× |
| Hand 2 views (73120) |
$68.50 |
$137 |
0.7× |
| Hand 3 views (73130) |
$83.50 |
$167 |
1.1× |
| Humerus Min 2 Views Left (73060) |
$70 |
$140 |
0.9× |
| Knee 3 views (73562) |
$75 |
$150 |
1.0× |
| Neck soft tissue (70360) |
$83.50 |
$167 |
1.1× |
| Pelvis 1 or 2 views (72170) |
$120 |
$240 |
1.3× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$454 |
$908 |
4.8× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$132.60 |
$265.20 |
1.4× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$127 |
$254 |
1.3× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$62 |
$124 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$83 |
$166 |
1.1× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$155 |
$310 |
2.0× |
| Scanogram (77073) |
$334.50 |
$669 |
3.5× |
| Scapula complete (73010) |
$106 |
$212 |
1.1× |
| Spine thoracic 3 views (72072) |
$113.50 |
$227 |
1.2× |
| Thoracolumbar 2 views (72080) |
$227 |
$454 |
2.9× |
| Ultrasound, abdomen limited (76705) |
$190.50 |
$381 |
2.0× |
| Upper Extremity Infant (73092) |
$130.50 |
$261 |
1.4× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$303 |
$606 |
1.9× |
| Us pelvic non ob complete (76856) |
$342.50 |
$685 |
3.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$184.50 |
$369 |
1.9× |
| Us retroperitoneal complete (76770) |
$220 |
$440 |
2.3× |
| Us retroperitoneal limited (76775) |
$187 |
$374 |
2.0× |
| Us scrotum and contents (76870) |
$353.50 |
$707 |
3.7× |
| Us soft tissue head/neck (76536) |
$325 |
$650 |
3.4× |
| Wrist 2 views (73100) |
$69.50 |
$139 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$182.50 |
$365 |
1.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$116.50 |
$233 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$69.50 |
$139 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$50.50 |
$101 |
0.6× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$69.50 |
$139 |
0.9× |
| X-ray exam hip uni 1 view (73501) |
$132 |
$264 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$158 |
$316 |
2.0× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$248.50 |
$497 |
2.6× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
$274.50 |
$549 |
2.9× |
| X-ray exam of femur 1 (73551) |
$56.50 |
$113 |
0.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$148 |
$296 |
1.6× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$87 |
$174 |
1.1× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$70.50 |
$141 |
0.9× |
| X-ray IV pyelogram+drip infusn (74410) |
$303 |
$606 |
1.9× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$205 |
$410 |
2.2× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$73 |
$146 |
0.9× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$141 |
$282 |
1.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$109.50 |
$219 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$324 |
$648 |
3.4× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$135.20 |
$270.40 |
1.7× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$118 |
$236 |
1.2× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$119.50 |
$239 |
1.5× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$119.50 |
$239 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$282 |
$564 |
3.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$86.50 |
$173 |
0.9× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$115.50 |
$231 |
1.5× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$106 |
$212 |
1.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$92 |
$184 |
1.2× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$55 |
$110 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$135 |
$270 |
1.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$78 |
$156 |
0.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$137.50 |
$275 |
1.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$158.50 |
$317 |
2.0× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$153 |
$306 |
1.9× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$249.50 |
$499 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$118 |
$236 |
1.5× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$74.50 |
$149 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$128.50 |
$257 |
1.4× |
| Xr finger(s) 2+ views (73140) |
$118 |
$236 |
1.5× |
| Xr shoulder 1 view (73020) |
$133 |
$266 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$241 |
$482 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$74.50 |
$149 |
0.9× |
| Xray knee 1 or 2 views rt (73560) |
$75 |
$150 |
1.0× |