| Abdomen 2 views (74019) |
$120 |
$120 |
1.3× |
| Ankle 2 views (73600) |
$101 |
$101 |
1.3× |
| Bone age studies (77072) |
$70 |
$70 |
0.7× |
| Bone survey complete (77075) |
$540 |
$540 |
5.7× |
| Cervical spine 2 or 3 views (72040) |
$174 |
$174 |
2.2× |
| Chest 1 view (71045) |
$101 |
$101 |
1.3× |
| Chest 3 views (71047) |
$144 |
$144 |
1.8× |
| Clavicle complete (73000) |
$114 |
$114 |
1.4× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$1,155 |
$1,155 |
12.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$3,360 |
$3,360 |
10.6× |
| CT abdomen and pelvis without contrast (74176) |
$2,240 |
$2,240 |
10.4× |
| CT abdomen w contrast (74160) |
$1,400 |
$1,400 |
8.8× |
| CT abdomen w wo contrast (74170) |
$1,680 |
$1,680 |
10.6× |
| CT abdomen w/o contrast (74150) |
$1,120 |
$1,120 |
11.8× |
| CT c-spine w/o contrast (72125) |
$1,120 |
$1,120 |
11.8× |
| CT cervical spine w&w/o contrast (72127) |
$1,680 |
$1,680 |
10.6× |
| CT cervical spine with contrast (72126) |
$1,400 |
$1,400 |
4.4× |
| CT chest w/wo contrast (71270) |
$1,400 |
$1,400 |
8.8× |
| CT chest with contrast (71260) |
$1,400 |
$1,400 |
8.8× |
| CT head/brain with contrast (70460) |
$1,225 |
$1,225 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,400 |
$1,400 |
8.8× |
| CT iac w contrast (70481) |
$1,120 |
$1,120 |
7.1× |
| CT limited/localized follow up study (76380) |
$385 |
$385 |
4.9× |
| CT lower ext w/o (73700) |
$980 |
$980 |
10.4× |
| CT lower extremity w wo contrast (73702) |
$980 |
$980 |
6.2× |
| CT lower extremity with contrast (73701) |
$980 |
$980 |
6.2× |
| CT lumbar spine w & w/o contrast (72133) |
$1,680 |
$1,680 |
10.6× |
| CT lumbar spine w/o contrast (72131) |
$1,120 |
$1,120 |
11.8× |
| CT lumbar spine with contrast (72132) |
$1,400 |
$1,400 |
4.4× |
| CT maxillofacial w contrast (70487) |
$1,120 |
$1,120 |
7.1× |
| CT maxillofacial w/o contrast (70486) |
$980 |
$980 |
10.4× |
| CT maxillofacial w/wo contrast (70488) |
$1,400 |
$1,400 |
8.8× |
| CT neck soft tissue w contrast (70491) |
$1,120 |
$1,120 |
7.1× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,400 |
$1,400 |
8.8× |
| CT orbits w/o contrast (70480) |
$980 |
$980 |
10.4× |
| CT pelvis w & w/o contrast (72194) |
$1,680 |
$1,680 |
10.6× |
| CT pelvis w/o contrast (72192) |
$1,120 |
$1,120 |
11.8× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,400 |
$1,400 |
8.8× |
| CT soft tissue neck w/o contrast (70490) |
$980 |
$980 |
10.4× |
| CT thoracic spine w/contrast (72129) |
$1,400 |
$1,400 |
8.8× |
| CT thoracic spine w/o contrast (72128) |
$1,120 |
$1,120 |
11.8× |
| CT thoracic spine w/wo contrast (72130) |
$1,680 |
$1,680 |
10.6× |
| CT thorax w/o contrast (71250) |
$1,277.50 |
$1,277.50 |
13.5× |
| CT upper extremity w/o & w/contrast material (73202) |
$980 |
$980 |
6.2× |
| CT upper extremity w/o contrast rt (73200) |
$980 |
$980 |
10.4× |
| CT upper extremity with contrast (73201) |
$980 |
$980 |
3.1× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,000 |
$2,000 |
12.6× |
| Cta Abdomen (74175) |
$2,000 |
$2,000 |
12.6× |
| CTA abdomen pelvis (74174) |
$2,000 |
$2,000 |
6.3× |
| CTA chest (71275) |
$2,000 |
$2,000 |
12.6× |
| Cta Head (70496) |
$2,000 |
$2,000 |
12.6× |
| Cta Neck (70498) |
$2,000 |
$2,000 |
12.6× |
| Esophagus (74220) |
$385 |
$385 |
2.4× |
| Fluoroscopy up to 1 hr (76000) |
$252 |
$252 |
1.2× |
| Foot 2 views (73620) |
$101 |
$101 |
1.3× |
| Forearm 2 views (73090) |
$101 |
$101 |
1.3× |
| Hand 2 views (73120) |
$101 |
$101 |
1.1× |
| Hand 3 views (73130) |
$101 |
$101 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$101 |
$101 |
1.3× |
| Knee 3 views (73562) |
$75 |
$75 |
1.0× |
| Neck soft tissue (70360) |
$67 |
$67 |
0.9× |
| Pelvis 1 or 2 views (72170) |
$88 |
$88 |
0.9× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$217 |
$217 |
2.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$164 |
$164 |
1.7× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$101 |
$101 |
1.1× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$88 |
$88 |
1.1× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$126 |
$126 |
1.6× |
| Radiologic exam upr gi trc single contrast study (74240) |
$273 |
$273 |
1.7× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$101 |
$101 |
1.3× |
| Ribs bilateral 3 views (71110) |
$236 |
$236 |
2.5× |
| Sacroiliac Joints < 3 Views (72200) |
$96 |
$96 |
1.0× |
| Scapula complete (73010) |
$101 |
$101 |
1.1× |
| Sella turcica (70240) |
$132 |
$132 |
1.7× |
| Small bowel series (74250) |
$252 |
$252 |
1.6× |
| Spine thoracic 3 views (72072) |
$138 |
$138 |
1.5× |
| Thoracolumbar 2 views (72080) |
$124 |
$124 |
1.6× |
| Tmj unilateral (70328) |
$93 |
$93 |
1.2× |
| Ultrasound, abdomen limited (76705) |
$280 |
$280 |
3.0× |
| Upper Extremity Infant (73092) |
$93 |
$93 |
1.0× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$315 |
$315 |
2.0× |
| Us abdl aorta screen aaa (76706) |
$266 |
$266 |
2.8× |
| Us breast unilateral complete (76641) |
$260 |
$260 |
2.7× |
| Us breast unilateral limited (76642) |
$260 |
$260 |
3.3× |
| Us chest (76604) |
$310 |
$310 |
3.3× |
| Us pelvic non ob complete (76856) |
$280 |
$280 |
3.0× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$280 |
$280 |
3.0× |
| Us pregnancy ltd (76815) |
$189 |
$189 |
2.0× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$280 |
$280 |
3.0× |
| Us retroperitoneal complete (76770) |
$364 |
$364 |
3.8× |
| Us retroperitoneal limited (76775) |
$266 |
$266 |
2.8× |
| Us scrotum and contents (76870) |
$203 |
$203 |
2.1× |
| Us soft tissue head/neck (76536) |
$412 |
$412 |
4.4× |
| Us spinal canal and contents (76800) |
$280 |
$280 |
3.0× |
| Us xtr non-vasc lmtd (76882) |
$227 |
$227 |
2.4× |
| Wrist 2 views (73100) |
$101 |
$101 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$138 |
$138 |
1.5× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$101 |
$101 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$112 |
$112 |
1.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$101 |
$101 |
1.3× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$112 |
$112 |
1.4× |
| X-ray exam entire spi 4/5 vw (72083) |
$124 |
$124 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$88 |
$88 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$145 |
$145 |
1.8× |
| X-ray eye for foreign body (70030) |
$132 |
$132 |
1.7× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$132 |
$132 |
1.4× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$132 |
$132 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$101 |
$101 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$101 |
$101 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$96 |
$96 |
1.2× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$119 |
$119 |
1.3× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$93 |
$93 |
1.2× |
| X-Ray Leg, Infant - Xr Lower Extremity 2+ Views Infant Left (73592) |
$93 |
$93 |
1.2× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$111 |
$111 |
1.2× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$221 |
$221 |
2.3× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$168 |
$168 |
1.8× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$111 |
$111 |
1.4× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$96 |
$96 |
1.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$184 |
$184 |
1.9× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$124 |
$124 |
1.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$217 |
$217 |
2.8× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$124 |
$124 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$168 |
$168 |
1.8× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$115 |
$115 |
1.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$111 |
$111 |
1.4× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$114 |
$114 |
1.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$132 |
$132 |
1.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$115 |
$115 |
1.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$174 |
$174 |
1.8× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$174 |
$174 |
1.8× |
| X-Ray Spine One View - Xr Spine (72020) |
$111 |
$111 |
1.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$131 |
$131 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$122 |
$122 |
1.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$154 |
$154 |
1.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$171 |
$171 |
1.8× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$91 |
$91 |
1.2× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$112 |
$112 |
1.4× |
| Xr c-spine 6 or more views (72052) |
$211 |
$211 |
2.2× |
| Xr chest 4+ views (71048) |
$147 |
$147 |
1.6× |
| Xr finger(s) 2+ views (73140) |
$98 |
$98 |
1.2× |
| XR Mastoids < 3 Views Bilateral (70120) |
$115 |
$115 |
1.2× |
| Xr shoulder 1 view (73020) |
$101 |
$101 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$184 |
$184 |
1.9× |
| Xr tibia/fibula 2 views (73590) |
$101 |
$101 |
1.3× |
| Xr tmj bilateral (70330) |
$157 |
$157 |
2.0× |
| Xray knee 1 or 2 views rt (73560) |
$101 |
$101 |
1.3× |