| Abdomen 2 views (74019) |
$154.50 |
$309 |
1.5× |
| Ankle 2 views (73600) |
$103 |
$206 |
1.2× |
| Bone survey complete (77075) |
— |
$624 |
— |
| Cervical spine 2 or 3 views (72040) |
$221.45 |
$442.90 |
2.6× |
| Chest 1 view (71045) |
$90 |
$180 |
1.1× |
| Chest 3 views (71047) |
$175.10 |
$350.20 |
2.1× |
| Clavicle complete (73000) |
$128.75 |
$257.50 |
1.5× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,576 |
$3,152 |
4.7× |
| CT abdomen and pelvis without contrast (74176) |
$1,321 |
$2,642 |
5.8× |
| CT abdomen w contrast (74160) |
$1,162.09 |
$2,324.18 |
6.9× |
| CT abdomen w wo contrast (74170) |
$1,545 |
$3,090 |
9.2× |
| CT abdomen w/o contrast (74150) |
$1,029.50 |
$2,059 |
10.2× |
| CT c-spine w/o contrast (72125) |
— |
$1,656.13 |
— |
| CT cervical spine w&w/o contrast (72127) |
$1,175.20 |
$2,350.40 |
7.0× |
| CT cervical spine with contrast (72126) |
— |
$1,952.64 |
— |
| CT chest w/wo contrast (71270) |
$1,175.20 |
$2,350.40 |
7.0× |
| CT chest with contrast (71260) |
— |
$1,952.64 |
— |
| CT head/brain with contrast (70460) |
— |
$1,559.45 |
— |
| CT head/brain without and with contrast (70470) |
— |
$1,898.40 |
— |
| CT iac w contrast (70481) |
— |
$1,651.63 |
— |
| CT lower ext w/o (73700) |
$594.83 |
$1,189.65 |
5.9× |
| CT lower extremity w wo contrast (73702) |
$909.06 |
$1,818.12 |
5.4× |
| CT lower extremity with contrast (73701) |
$654.05 |
$1,308.10 |
3.9× |
| CT lumbar spine w & w/o contrast (72133) |
$1,120.96 |
$2,241.92 |
6.6× |
| CT lumbar spine w/o contrast (72131) |
— |
$1,805.94 |
— |
| CT lumbar spine with contrast (72132) |
— |
$1,565.60 |
— |
| CT maxillofacial w contrast (70487) |
— |
$1,613.22 |
— |
| CT maxillofacial w/o contrast (70486) |
— |
$1,127.85 |
— |
| CT maxillofacial w/wo contrast (70488) |
— |
$1,947.39 |
— |
| CT neck soft tissue w contrast (70491) |
— |
$1,934.56 |
— |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$989.06 |
$1,978.12 |
5.9× |
| CT orbits w/o contrast (70480) |
— |
$1,497.99 |
— |
| CT pelvis w & w/o contrast (72194) |
$1,079.50 |
$2,159 |
6.4× |
| CT pelvis w/o contrast (72192) |
— |
$1,959 |
— |
| CT soft tissue neck w/o & w/contrast material (70492) |
$870.35 |
$1,740.70 |
5.2× |
| CT soft tissue neck w/o contrast (70490) |
— |
$1,199.95 |
— |
| CT thoracic spine w/contrast (72129) |
— |
$1,565.60 |
— |
| CT thoracic spine w/o contrast (72128) |
— |
$1,652.51 |
— |
| CT thoracic spine w/wo contrast (72130) |
$1,157.12 |
$2,314.24 |
6.9× |
| CT thorax w/o contrast (71250) |
— |
$1,648.25 |
— |
| CT upper extremity w/o & w/contrast material (73202) |
$865.20 |
$1,730.40 |
5.1× |
| CT upper extremity w/o contrast rt (73200) |
$648.20 |
$1,296.40 |
6.4× |
| CT upper extremity with contrast (73201) |
— |
$1,458.45 |
— |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,740.20 |
$3,480.40 |
10.3× |
| CTA chest (71275) |
$1,388 |
$2,776 |
8.2× |
| Cta Head (70496) |
$1,267.53 |
$2,535.06 |
7.5× |
| CTA lwr ext w&w/o contrast (73706) |
$1,150.92 |
$2,301.84 |
6.8× |
| Cta Neck (70498) |
$690.50 |
$1,381 |
4.1× |
| Foot 2 views (73620) |
$103 |
$206 |
1.2× |
| Forearm 2 views (73090) |
$128.75 |
$257.50 |
1.5× |
| Hand 2 views (73120) |
$72.10 |
$144.20 |
0.7× |
| Hand 3 views (73130) |
$128.75 |
$257.50 |
1.5× |
| Humerus Min 2 Views Left (73060) |
$103 |
$206 |
1.2× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$169.50 |
$339 |
1.7× |
| Knee 3 views (73562) |
$141.63 |
$283.25 |
1.7× |
| MRA head w/o contrast (70544) |
$2,080.25 |
$4,160.49 |
9.1× |
| Neck soft tissue (70360) |
$221.45 |
$442.90 |
2.6× |
| Osseous survey infant (77076) |
— |
$566.50 |
— |
| Pelvis 1 or 2 views (72170) |
$169.50 |
$339 |
1.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$72.05 |
$144.09 |
0.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$169.50 |
$339 |
1.7× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$169.50 |
$339 |
1.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$92.70 |
$185.40 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$108.15 |
$132.65 |
1.3× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$128.75 |
$257.50 |
1.5× |
| Sacroiliac Joints < 3 Views (72200) |
$169.50 |
$339 |
1.7× |
| Scapula complete (73010) |
$128.75 |
$257.50 |
1.3× |
| Sella turcica (70240) |
$105.58 |
$211.15 |
1.3× |
| Small bowel series (74250) |
$169.50 |
$339 |
1.0× |
| Ultrasound, abdomen limited (76705) |
$202 |
$404 |
2.0× |
| Upper Extremity Infant (73092) |
$84.98 |
$169.95 |
0.8× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
— |
$941.42 |
— |
| Us breast unilateral limited (76642) |
$149 |
$298 |
1.8× |
| Us chest (76604) |
— |
$504 |
— |
| Us compl joint r-t w/image documentation (76881) |
$400 |
$800 |
4.0× |
| Us pelvic non ob complete (76856) |
— |
$473.80 |
— |
| Us pregnancy ltd (76815) |
— |
$474.85 |
— |
| Us retroperitoneal complete (76770) |
— |
$579.49 |
— |
| Us scrotum and contents (76870) |
— |
$616 |
— |
| Us soft tissue head/neck (76536) |
— |
$461 |
— |
| Wrist 2 views (73100) |
$103 |
$206 |
1.2× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$175.10 |
$350.20 |
1.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$128.75 |
$257.50 |
1.5× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$128.75 |
$257.50 |
1.5× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$103 |
$206 |
1.2× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$128.75 |
$257.50 |
1.5× |
| X-ray exam hip uni 1 view (73501) |
$90.13 |
$180.25 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$164.80 |
$329.60 |
2.0× |
| X-Ray Exam Hips Bi 5/> Views (73523) |
— |
$678 |
— |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$175.10 |
$350.20 |
1.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$113.30 |
$226.60 |
1.4× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$128.75 |
$257.50 |
1.5× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$128.75 |
$257.50 |
1.5× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$108.50 |
$217 |
1.3× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$90 |
$180 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
— |
$360.50 |
— |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$128.75 |
$257.50 |
1.5× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$169.50 |
$339 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$169.50 |
$339 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$103 |
$206 |
1.2× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$118.45 |
$236.90 |
1.2× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
— |
$386.25 |
— |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$169.50 |
$339 |
1.7× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$169.50 |
$339 |
2.0× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$133.90 |
$267.80 |
1.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$175.10 |
$350.20 |
2.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$175.10 |
$350.20 |
1.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$169.50 |
$339 |
1.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$100.43 |
$200.85 |
1.2× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
— |
$379 |
— |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$169.50 |
$339 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
— |
$355.35 |
— |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$84.98 |
$169.95 |
1.0× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$113.30 |
$226.60 |
1.4× |
| Xr c-spine 6 or more views (72052) |
— |
$540.75 |
— |
| Xr chest 4+ views (71048) |
$175.10 |
$350.20 |
1.7× |
| Xr finger(s) 2+ views (73140) |
$128.75 |
$257.50 |
1.5× |
| Xr optic foramina (70190) |
$105.58 |
$211.15 |
1.3× |
| Xr shoulder 1 view (73020) |
$118.45 |
$236.90 |
1.4× |
| Xr spine cervical 4 or 5 views (72050) |
— |
$489.25 |
— |
| Xr tibia/fibula 2 views (73590) |
$90 |
$180 |
1.1× |
| Xr tmj bilateral (70330) |
$164.80 |
$329.60 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$128.75 |
$257.50 |
1.5× |