| Ankle 2 views (73600) |
$161.15 |
$293 |
1.8× |
| Clavicle complete (73000) |
$161.15 |
$293 |
1.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$2,230.80 |
$4,056 |
6.1× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$2,230.80 |
$4,056 |
12.1× |
| Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast… (75635) |
$1,728.65 |
$3,143 |
9.3× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$2,341.90 |
$4,258 |
12.7× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$2,230.80 |
$4,056 |
12.1× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$2,341.90 |
$4,258 |
12.7× |
| Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and… (72191) |
$1,045 |
$1,900 |
5.6× |
| Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if… (73206) |
$2,230.80 |
$4,056 |
12.1× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$665.50 |
$1,210 |
6.0× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$1,221 |
$2,220 |
6.6× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$1,112.10 |
$2,022 |
6.0× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$810.15 |
$1,473 |
7.3× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$1,147.30 |
$2,086 |
6.2× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$730.95 |
$1,329 |
6.6× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$1,255.65 |
$2,283 |
6.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,387 |
$4,340 |
6.5× |
| CT abdomen and pelvis without contrast (74176) |
$1,758.35 |
$3,197 |
7.0× |
| CT abdomen w & w/o contrast (74170) |
$1,249.60 |
$2,272 |
6.8× |
| CT abdomen w/o contrast (74150) |
$618.75 |
$1,125 |
5.6× |
| CT cervical spine w/o contrast (72125) |
$818.95 |
$1,489 |
7.4× |
| CT chest w/contrast (71260) |
$1,197.90 |
$2,178 |
6.5× |
| CT extremity upper w/o contrast (73200) |
$693 |
$1,260 |
6.3× |
| CT head/brain with contrast (70460) |
$1,333.75 |
$2,425 |
7.2× |
| CT head/brain without and with contrast (70470) |
$1,249.60 |
$2,272 |
6.8× |
| CT l-spine w/contrast (72132) |
$1,073.60 |
$1,952 |
2.9× |
| CT lower extremity w/dye (73701) |
$944.90 |
$1,718 |
5.1× |
| CT lumbar spine w/o contrast (72131) |
$818.95 |
$1,489 |
7.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,169.85 |
$2,127 |
6.3× |
| CT neck w/contrast (70491) |
$917.95 |
$1,669 |
5.0× |
| CT neck w/o contrast (70490) |
$618.75 |
$1,125 |
5.6× |
| CT pelvis w & w/o contrast (72194) |
$1,249.60 |
$2,272 |
6.8× |
| CT pelvis w/o contrast (72192) |
$730.95 |
$1,329 |
6.6× |
| CT thoracic spine w/contrast (72129) |
$871.20 |
$1,584 |
4.7× |
| CT thoracic spine w/o contrast (72128) |
$647.90 |
$1,178 |
5.9× |
| CT thorax w/o contrast (71250) |
$772.75 |
$1,405 |
7.0× |
| CT upper extremity w/dye (73201) |
$983.95 |
$1,789 |
2.7× |
| CTA head w contrast (70496) |
$2,339.70 |
$4,254 |
12.6× |
| Fetal biophys profile w/o nst (76819) |
$300.30 |
$546 |
2.7× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$435.05 |
$791 |
3.9× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$312.95 |
$569 |
3.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$469.15 |
$853 |
4.3× |
| Radex spine cervical 2 or 3 views (72040) |
$199.10 |
$362 |
2.2× |
| Radex spine cervical 4 or 5 views (72050) |
$336.60 |
$612 |
3.1× |
| Radex spine cervical 6 or more views (72052) |
$394.35 |
$717 |
3.6× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$161.15 |
$293 |
1.8× |
| Radiologic exam abdomen 3+ views (74021) |
$336.60 |
$612 |
3.1× |
| Radiologic examination femur 1 view (73551) |
$141.35 |
$257 |
1.5× |
| Radiologic examination femur minimum 2 views (73552) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$201.85 |
$367 |
2.2× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$336.60 |
$612 |
3.1× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$201.85 |
$367 |
2.2× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$196.35 |
$357 |
2.1× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$201.85 |
$367 |
2.2× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$201.85 |
$367 |
1.8× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$254.10 |
$462 |
2.3× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$240.90 |
$438 |
2.2× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$226.05 |
$411 |
2.5× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$161.15 |
$293 |
1.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$161.15 |
$293 |
1.5× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$201.85 |
$367 |
1.8× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$269.50 |
$490 |
2.4× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$215.60 |
$392 |
2.3× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$161.15 |
$293 |
1.8× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$161.15 |
$293 |
1.8× |
| Ultrasound, abdomen limited (76705) |
$233.20 |
$424 |
2.1× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$198 |
$360 |
1.8× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$315.70 |
$574 |
2.9× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$253 |
$460 |
2.3× |
| Umbilical-artery Doppler (OB) (76820) |
$202.40 |
$368 |
1.8× |
| Us exam, pelvic, limited (76857) |
$109.45 |
$199 |
1.0× |
| Us ob transvaginal (76817) |
$202.40 |
$368 |
1.8× |
| Us retroperitoneal complete (76770) |
$272.25 |
$495 |
2.5× |
| Us scrotum (76870) |
$217.80 |
$396 |
2.0× |
| Us soft tissue head/neck (76536) |
$251.35 |
$457 |
2.3× |
| X-ray exam of finger(s) (73140) |
$161.15 |
$293 |
1.8× |
| X-ray exam of knee 1 or 2 (73560) |
$201.85 |
$367 |
2.2× |
| X-ray heel (73650) |
$161.15 |
$293 |
1.8× |
| X-ray of joint between lower spine and hip bone 3 or more views|PROFESSIONAL COMPONENT (72202) |
$161.15 |
$293 |
1.5× |
| Xr abdomen 1 view (74018) |
$199.65 |
$363 |
2.2× |
| Xr abdomen 2 views (74019) |
$250.80 |
$456 |
2.3× |
| Xr bone age studies (77072) |
$161.15 |
$293 |
1.5× |
| Xr chest 1 view (71045) |
$161.15 |
$293 |
1.8× |
| Xr chest 2 views (71046) |
$184.80 |
$336 |
2.0× |
| Xr facial bones 3+ views (70150) |
$161.15 |
$293 |
1.5× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$161.15 |
$293 |
1.8× |
| Xr forearm 2 views (73090) |
$161.15 |
$293 |
1.8× |
| Xr hand 2v (73120) |
$161.15 |
$293 |
1.5× |
| Xr neck soft tissue (70360) |
$161.15 |
$293 |
1.8× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$193.05 |
$351 |
2.1× |
| Xr pelvis 1-2 views (72170) |
$201.85 |
$367 |
1.8× |
| Xr pelvis min 3 view (72190) |
$242 |
$440 |
2.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$161.15 |
$293 |
1.8× |
| Xr shoulder 1 view (73020) |
$161.15 |
$293 |
1.8× |
| Xr spine thoracic 3v (72072) |
$161.15 |
$293 |
1.5× |
| Xr t-spine 2 views (72070) |
$161.15 |
$293 |
1.5× |
| Xr tibia/fibula 2 views (73590) |
$201.85 |
$367 |
2.2× |
| Xr wrist 2 views (73100) |
$201.85 |
$367 |
2.2× |