| Abdomen 2 views (74019) |
$199.75 |
$235 |
1.9× |
| Cervical spine 2 or 3 views (72040) |
$199.75 |
$235 |
2.3× |
| Chest 1 view (71045) |
$157.25 |
$185 |
1.8× |
| Clavicle complete (73000) |
$127.50 |
$150 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,720 |
$3,200 |
7.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,657.50 |
$1,950 |
6.9× |
| CT abdomen w contrast (74160) |
$1,657.50 |
$1,950 |
9.4× |
| CT abdomen w wo contrast (74170) |
$2,125 |
$2,500 |
12.1× |
| CT abdomen w/o contrast (74150) |
$1,317.50 |
$1,550 |
12.5× |
| CT c-spine w/o contrast (72125) |
$1,062.50 |
$1,250 |
10.1× |
| CT cervical spine with contrast (72126) |
$1,147.50 |
$1,350 |
3.3× |
| CT chest w/wo contrast (71270) |
$2,125 |
$2,500 |
12.1× |
| CT chest with contrast (71260) |
$1,657.50 |
$1,950 |
9.4× |
| CT head/brain with contrast (70460) |
$1,147.50 |
$1,350 |
6.5× |
| CT head/brain without and with contrast (70470) |
$1,657.50 |
$1,950 |
9.4× |
| CT lower ext w/o (73700) |
$1,062.50 |
$1,250 |
10.1× |
| CT lumbar spine w/o contrast (72131) |
$1,062.50 |
$1,250 |
10.1× |
| CT lumbar spine with contrast (72132) |
$1,147.50 |
$1,350 |
3.3× |
| CT maxillofacial w contrast (70487) |
$1,105 |
$1,300 |
6.3× |
| CT maxillofacial w/o contrast (70486) |
$1,062.50 |
$1,250 |
10.1× |
| CT neck soft tissue w contrast (70491) |
$1,147.50 |
$1,350 |
6.5× |
| CT orbits w/o contrast (70480) |
$1,062.50 |
$1,250 |
10.1× |
| CT pelvis w & w/o contrast (72194) |
$1,657.50 |
$1,950 |
9.4× |
| CT pelvis w/o contrast (72192) |
$1,062.50 |
$1,250 |
10.1× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,657.50 |
$1,950 |
9.4× |
| CT soft tissue neck w/o contrast (70490) |
$1,062.50 |
$1,250 |
10.1× |
| CT thoracic spine w/contrast (72129) |
$1,147.50 |
$1,350 |
6.5× |
| CT thoracic spine w/o contrast (72128) |
$1,062.50 |
$1,250 |
10.1× |
| CT thorax w/o contrast (71250) |
$1,190 |
$1,400 |
11.3× |
| CT upper extremity w/o contrast rt (73200) |
$1,062.50 |
$1,250 |
10.1× |
| CTA chest (71275) |
$2,422.50 |
$2,850 |
13.7× |
| Cta Head (70496) |
$2,125 |
$2,500 |
12.1× |
| Cta Neck (70498) |
$1,742.50 |
$2,050 |
9.9× |
| Foot 2 views (73620) |
$114.75 |
$135 |
1.3× |
| Forearm 2 views (73090) |
$114.75 |
$135 |
1.3× |
| Hand 3 views (73130) |
$140.25 |
$165 |
1.6× |
| Humerus Min 2 Views Left (73060) |
$131.75 |
$155 |
1.5× |
| Knee 3 views (73562) |
$157.25 |
$185 |
1.8× |
| Pelvis 1 or 2 views (72170) |
$157.25 |
$185 |
1.5× |
| Radex hips bilateral with pelvis 2 views (73521) |
$163.62 |
$192.50 |
1.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$157.25 |
$185 |
1.5× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$157.25 |
$185 |
1.5× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$157.25 |
$185 |
1.8× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$93.50 |
$110 |
0.9× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$199.75 |
$235 |
2.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$157.25 |
$185 |
1.8× |
| Ribs bilateral 3 views (71110) |
$242.25 |
$285 |
2.3× |
| Scanogram (77073) |
$127.50 |
$150 |
1.2× |
| Scapula complete (73010) |
$157.25 |
$185 |
1.5× |
| Tmj unilateral (70328) |
$157.25 |
$185 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$297.50 |
$350 |
2.8× |
| Us breast unilateral complete (76641) |
$212.50 |
$250 |
2.0× |
| Us compl joint r-t w/image documentation (76881) |
$297.50 |
$350 |
2.8× |
| Us pelvic non ob complete (76856) |
$297.50 |
$350 |
2.8× |
| Us retroperitoneal complete (76770) |
$340 |
$400 |
3.2× |
| Us retroperitoneal limited (76775) |
$248.62 |
$292.50 |
2.4× |
| Us scrotum and contents (76870) |
$297.50 |
$350 |
2.8× |
| Us soft tissue head/neck (76536) |
$255 |
$300 |
2.4× |
| Us xtr non-vasc lmtd (76882) |
$297.50 |
$350 |
2.8× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$212.50 |
$250 |
2.0× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$157.25 |
$185 |
1.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$97.75 |
$115 |
1.1× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$140.25 |
$165 |
1.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$157.25 |
$185 |
1.8× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$199.75 |
$235 |
1.9× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$157.25 |
$185 |
1.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$157.25 |
$185 |
1.8× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$114.75 |
$135 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$199.75 |
$235 |
1.9× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$263.50 |
$310 |
3.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$199.75 |
$235 |
1.9× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$327.25 |
$385 |
3.1× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$114.75 |
$135 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$157.25 |
$185 |
1.5× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$199.75 |
$235 |
1.9× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$199.75 |
$235 |
2.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$133.88 |
$157.50 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$114.75 |
$135 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$199.75 |
$235 |
2.3× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$199.75 |
$235 |
2.3× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$157.25 |
$185 |
1.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$199.75 |
$235 |
1.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$157.25 |
$185 |
1.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$157.25 |
$185 |
1.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$140.25 |
$165 |
1.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$199.75 |
$235 |
1.9× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$114.75 |
$135 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$140.25 |
$165 |
1.6× |
| Xr c-spine 6 or more views (72052) |
$140.25 |
$165 |
1.3× |
| Xr chest 4+ views (71048) |
$242.25 |
$285 |
2.3× |
| Xr Cholecystography Oral Contrast (74290) |
$136 |
$160 |
0.8× |
| Xr finger(s) 2+ views (73140) |
$97.75 |
$115 |
1.1× |
| Xr shoulder 1 view (73020) |
$157.25 |
$185 |
1.8× |
| Xr spine cervical 4 or 5 views (72050) |
$263.50 |
$310 |
2.5× |
| Xr tibia/fibula 2 views (73590) |
$131.75 |
$155 |
1.5× |
| Xray knee 1 or 2 views rt (73560) |
$114.75 |
$135 |
1.3× |