| Abdomen 2 views (74019) |
$77 |
$110 |
0.8× |
| Ankle 2 views (73600) |
$73.50 |
$105 |
0.9× |
| Bone age studies (77072) |
$61.25 |
$87.50 |
0.6× |
| Bone survey complete (77075) |
$218.75 |
$312.50 |
2.3× |
| Cervical spine 2 or 3 views (72040) |
$61.25 |
$87.50 |
0.8× |
| Chest 1 view (71045) |
$61.25 |
$87.50 |
0.8× |
| Clavicle complete (73000) |
$61.25 |
$87.50 |
0.8× |
| CT abdomen and pelvis without and with contrast (74178) |
$875 |
$1,250 |
2.8× |
| CT abdomen and pelvis without contrast (74176) |
$700 |
$1,000 |
3.2× |
| CT abdomen w contrast (74160) |
$472.50 |
$675 |
3.0× |
| CT abdomen w wo contrast (74170) |
$577.50 |
$825 |
3.6× |
| CT abdomen w/o contrast (74150) |
$472.50 |
$675 |
5.0× |
| CT c-spine w/o contrast (72125) |
$490 |
$700 |
5.2× |
| CT chest w/wo contrast (71270) |
$577.50 |
$825 |
3.6× |
| CT chest with contrast (71260) |
$472.50 |
$675 |
3.0× |
| CT head/brain with contrast (70460) |
$420 |
$600 |
2.7× |
| CT head/brain without and with contrast (70470) |
$525 |
$750 |
3.3× |
| CT iac w contrast (70481) |
$525 |
$750 |
3.3× |
| CT lower ext w/o (73700) |
$700 |
$1,000 |
7.4× |
| CT lower extremity w wo contrast (73702) |
$840 |
$1,200 |
5.3× |
| CT lower extremity with contrast (73701) |
$700 |
$1,000 |
4.4× |
| CT lumbar spine w/o contrast (72131) |
$472.50 |
$675 |
5.0× |
| CT maxillofacial w contrast (70487) |
$455 |
$650 |
2.9× |
| CT maxillofacial w/o contrast (70486) |
$455 |
$650 |
4.8× |
| CT maxillofacial w/wo contrast (70488) |
$525 |
$750 |
3.3× |
| CT neck soft tissue w contrast (70491) |
$490 |
$700 |
3.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$560 |
$800 |
3.5× |
| CT orbits w/o contrast (70480) |
$525 |
$750 |
5.6× |
| CT pelvis w & w/o contrast (72194) |
$560 |
$800 |
3.5× |
| CT pelvis w/o contrast (72192) |
$472.50 |
$675 |
5.0× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$560 |
$800 |
3.5× |
| CT soft tissue neck w/o contrast (70490) |
$490 |
$700 |
5.2× |
| CT thoracic spine w/o contrast (72128) |
$472.50 |
$675 |
5.0× |
| CT thorax w/o contrast (71250) |
$472.50 |
$675 |
5.0× |
| CT upper extremity w/o & w/contrast material (73202) |
$875 |
$1,250 |
5.5× |
| CT upper extremity w/o contrast rt (73200) |
$735 |
$1,050 |
7.8× |
| CT upper extremity with contrast (73201) |
$735 |
$1,050 |
2.3× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$1,085 |
$1,550 |
6.9× |
| Cta Abdomen (74175) |
$1,006.25 |
$1,437.50 |
6.4× |
| CTA abdomen pelvis (74174) |
$2,283.75 |
$3,262.50 |
7.3× |
| CTA chest (71275) |
$577.50 |
$825 |
3.6× |
| Cta Head (70496) |
$1,221.50 |
$1,745 |
7.7× |
| Cta Neck (70498) |
$1,270.50 |
$1,815 |
8.0× |
| Cta Pelvis (72191) |
$992.25 |
$1,417.50 |
6.3× |
| Foot 2 views (73620) |
$70 |
$100 |
0.9× |
| Forearm 2 views (73090) |
$94.50 |
$135 |
1.2× |
| Hand 2 views (73120) |
$70 |
$100 |
0.7× |
| Hand 3 views (73130) |
$77 |
$110 |
1.0× |
| Humerus Min 2 Views Left (73060) |
$80.50 |
$115 |
1.0× |
| Knee 3 views (73562) |
$80.50 |
$115 |
1.0× |
| MRA head with contrast (70545) |
$140 |
$200 |
0.4× |
| MRI c-spine with contrast (72142) |
$140 |
$200 |
0.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$140 |
$200 |
0.6× |
| MRI spinal canal lumbar w/contrast material (72149) |
$140 |
$200 |
0.4× |
| MRI upper ext joint w/o contrast (73221) |
$140 |
$200 |
0.6× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$140 |
$200 |
0.4× |
| Neck soft tissue (70360) |
$61.25 |
$87.50 |
0.8× |
| Ob Us Follow-Up Per Fetus - Us Ob Follow Up Transabdominal Approach (76816) |
$140 |
$200 |
1.5× |
| Osseous survey infant (77076) |
$110.25 |
$157.50 |
1.2× |
| Osseous survey limited (77074) |
$110.25 |
$157.50 |
1.2× |
| Pelvis 1 or 2 views (72170) |
$61.25 |
$87.50 |
0.6× |
| Radex hips bilateral with pelvis 2 views (73521) |
$87.50 |
$125 |
0.9× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$78.75 |
$112.50 |
0.8× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$57.75 |
$82.50 |
0.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$77 |
$110 |
0.8× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$66.50 |
$95 |
0.8× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$63 |
$90 |
0.8× |
| Ribs bilateral 3 views (71110) |
$80.50 |
$115 |
0.9× |
| Sacroiliac Joints < 3 Views (72200) |
$61.25 |
$87.50 |
0.6× |
| Scapula complete (73010) |
$61.25 |
$87.50 |
0.6× |
| Spine thoracic 3 views (72072) |
$64.75 |
$92.50 |
0.7× |
| Thoracolumbar 2 views (72080) |
$61.25 |
$87.50 |
0.8× |
| Ultrasound, abdomen limited (76705) |
$148.75 |
$212.50 |
1.6× |
| Upper Extremity Infant (73092) |
$57.75 |
$82.50 |
0.6× |
| Us abdl aorta screen aaa (76706) |
$192.50 |
$275 |
2.0× |
| Us chest (76604) |
$140 |
$200 |
1.5× |
| Us ob transvaginal (76817) |
$157.50 |
$225 |
1.7× |
| Us pelvic non ob complete (76856) |
$148.75 |
$212.50 |
1.6× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$140 |
$200 |
1.5× |
| Us pregnancy ltd (76815) |
$140 |
$200 |
1.5× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$148.75 |
$212.50 |
1.6× |
| Us retroperitoneal complete (76770) |
$166.25 |
$237.50 |
1.8× |
| Us retroperitoneal limited (76775) |
$148.75 |
$212.50 |
1.6× |
| Us scrotum and contents (76870) |
$166.25 |
$237.50 |
1.8× |
| Us soft tissue head/neck (76536) |
$148.75 |
$212.50 |
1.6× |
| Us xtr non-vasc lmtd (76882) |
$115.50 |
$165 |
1.2× |
| Wrist 2 views (73100) |
$70 |
$100 |
0.9× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$80.50 |
$115 |
0.9× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$61.25 |
$87.50 |
0.8× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$59.50 |
$85 |
0.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$63 |
$90 |
0.8× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$70 |
$100 |
0.9× |
| X-ray exam hip uni 1 view (73501) |
$52.50 |
$75 |
0.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$61.25 |
$87.50 |
0.8× |
| X-ray exam of femur 1 (73551) |
$70 |
$100 |
0.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$70 |
$100 |
0.7× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$61.25 |
$87.50 |
0.8× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$70 |
$100 |
0.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$70 |
$100 |
0.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$61.25 |
$87.50 |
0.8× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$105 |
$150 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$59.50 |
$85 |
0.8× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$66.50 |
$95 |
0.8× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$77 |
$110 |
0.8× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$84 |
$120 |
0.9× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$70 |
$100 |
0.9× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$77 |
$110 |
1.0× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$80.50 |
$115 |
0.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$64.75 |
$92.50 |
0.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$73.50 |
$105 |
0.9× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$70 |
$100 |
0.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$80.50 |
$115 |
0.9× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$78.75 |
$112.50 |
0.8× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$64.75 |
$92.50 |
0.8× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$80.50 |
$115 |
1.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$70 |
$100 |
0.9× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$52.50 |
$75 |
0.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$70 |
$100 |
0.7× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$64.75 |
$92.50 |
0.7× |
| X-Ray Spine One View - Xr Spine (72020) |
$52.50 |
$75 |
0.7× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$61.25 |
$87.50 |
0.8× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$61.25 |
$87.50 |
0.8× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$61.25 |
$87.50 |
0.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$26.25 |
$37.50 |
0.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$80.50 |
$115 |
1.0× |
| Xr c-spine 6 or more views (72052) |
$101.50 |
$145 |
1.1× |
| Xr finger(s) 2+ views (73140) |
$26.25 |
$37.50 |
0.3× |
| Xr shoulder 1 view (73020) |
$57.75 |
$82.50 |
0.7× |
| Xr spine cervical 4 or 5 views (72050) |
$66.50 |
$95 |
0.7× |
| Xr tibia/fibula 2 views (73590) |
$80.50 |
$115 |
1.0× |
| Xray knee 1 or 2 views rt (73560) |
$63 |
$90 |
0.8× |