| Ankle 2 views (73600) |
$342.50 |
$342.50 |
3.9× |
| Cervical spine 2 or 3 views (72040) |
$273 |
$273 |
3.1× |
| Chest 1 view (71045) |
$273 |
$273 |
3.1× |
| Clavicle complete (73000) |
$342.50 |
$342.50 |
3.9× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,023 |
$2,023 |
5.8× |
| CT abdomen and pelvis without contrast (74176) |
$1,173 |
$1,173 |
4.9× |
| CT abdomen w contrast (74160) |
$1,814 |
$1,814 |
10.3× |
| CT abdomen w wo contrast (74170) |
$2,023 |
$2,023 |
11.5× |
| CT abdomen w/o contrast (74150) |
$1,173 |
$1,173 |
11.2× |
| CT angiography upper extremity lt (73206) |
$2,050 |
$2,050 |
11.6× |
| CT c-spine w/o contrast (72125) |
$1,173 |
$1,173 |
11.2× |
| CT cervical spine w&w/o contrast (72127) |
$2,023 |
$2,023 |
11.5× |
| CT chest w/wo contrast (71270) |
$2,023 |
$2,023 |
11.5× |
| CT chest with contrast (71260) |
$1,814 |
$1,814 |
10.3× |
| CT head/brain with contrast (70460) |
$1,814 |
$1,814 |
10.3× |
| CT head/brain without and with contrast (70470) |
$2,023 |
$2,023 |
11.5× |
| CT lower extremity w wo contrast (73702) |
$2,530.50 |
$2,530.50 |
14.4× |
| CT lumbar spine w/o contrast (72131) |
$1,173 |
$1,173 |
11.2× |
| CT lumbar spine with contrast (72132) |
$1,814 |
$1,814 |
5.2× |
| CT maxillofacial w contrast (70487) |
$1,814 |
$1,814 |
10.3× |
| CT maxillofacial w/o contrast (70486) |
$1,173 |
$1,173 |
11.2× |
| CT maxillofacial w/wo contrast (70488) |
$2,023 |
$2,023 |
11.5× |
| CT neck soft tissue w contrast (70491) |
$1,814 |
$1,814 |
10.3× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$2,023 |
$2,023 |
11.5× |
| CT orbits w/o contrast (70480) |
$1,173 |
$1,173 |
11.2× |
| CT pelvis w & w/o contrast (72194) |
$2,023 |
$2,023 |
11.5× |
| CT pelvis w/o contrast (72192) |
$1,173 |
$1,173 |
11.2× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$2,023 |
$2,023 |
11.5× |
| CT soft tissue neck w/o contrast (70490) |
$1,173 |
$1,173 |
11.2× |
| CT thoracic spine w/o contrast (72128) |
$1,173 |
$1,173 |
11.2× |
| CT thoracic spine w/wo contrast (72130) |
$2,023 |
$2,023 |
11.5× |
| CT thorax w/o contrast (71250) |
$616 |
$616 |
5.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$2,050 |
$2,050 |
11.6× |
| CTA chest (71275) |
$2,050 |
$2,050 |
11.6× |
| Cta Head (70496) |
$1,007 |
$1,007 |
5.7× |
| CTA lwr ext w&w/o contrast (73706) |
$2,050 |
$2,050 |
11.6× |
| Cta Neck (70498) |
$2,050 |
$2,050 |
11.6× |
| Cta Pelvis (72191) |
$2,050 |
$2,050 |
11.6× |
| Dxa bone density study 1/> sites axial skel (77080) |
$545 |
$545 |
5.2× |
| Echoencephalography real time imaging (76506) |
$709 |
$709 |
6.8× |
| Esophagus (74220) |
$526 |
$526 |
3.0× |
| Foot 2 views (73620) |
$342.50 |
$342.50 |
3.9× |
| Forearm 2 views (73090) |
$342.50 |
$342.50 |
3.9× |
| Hand 2 views (73120) |
$342.50 |
$342.50 |
3.3× |
| Hand 3 views (73130) |
$273 |
$273 |
3.1× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,605 |
$1,605 |
4.0× |
| Humerus Min 2 Views Left (73060) |
$342.50 |
$342.50 |
3.9× |
| Knee 3 views (73562) |
$342.50 |
$342.50 |
3.9× |
| Neck soft tissue (70360) |
$273 |
$273 |
3.1× |
| Pelvis 1 or 2 views (72170) |
$273 |
$273 |
2.6× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$552 |
$552 |
5.3× |
| Radex hips bilateral with pelvis 2 views (73521) |
$273 |
$273 |
2.6× |
| Radex mastoids compl minimum 3 views pr side (70130) |
$273 |
$273 |
2.6× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$273 |
$273 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$273 |
$273 |
3.1× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$273 |
$273 |
2.6× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$273 |
$273 |
3.1× |
| Radiologic exam colon single contrast study (74270) |
$896 |
$896 |
5.1× |
| Radiologic exam upr gi trc single contrast study (74240) |
$526 |
$526 |
3.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$342.50 |
$342.50 |
3.9× |
| Ribs bilateral 3 views (71110) |
$273 |
$273 |
2.6× |
| Scapula complete (73010) |
$273 |
$273 |
2.6× |
| Sella turcica (70240) |
$273 |
$273 |
3.1× |
| Small bowel series (74250) |
$526 |
$526 |
3.0× |
| Tmj unilateral (70328) |
$273 |
$273 |
3.1× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$1,067 |
$1,067 |
6.1× |
| Us compl joint r-t w/image documentation (76881) |
$583 |
$583 |
5.6× |
| Us ob transvaginal (76817) |
$583 |
$583 |
5.6× |
| Us pelvic non ob complete (76856) |
$652 |
$652 |
6.2× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$569 |
$569 |
5.4× |
| Us pregnancy ltd (76815) |
$378 |
$378 |
3.6× |
| Us scrotum and contents (76870) |
$714 |
$714 |
6.8× |
| Us soft tissue head/neck (76536) |
$583 |
$583 |
5.6× |
| Us spinal canal and contents (76800) |
$685 |
$685 |
6.5× |
| Us xtr non-vasc lmtd (76882) |
$440 |
$440 |
4.2× |
| Wrist 2 views (73100) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$860 |
$860 |
4.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$342.50 |
$342.50 |
3.9× |
| X-ray exam hip uni 1 view (73501) |
$273 |
$273 |
3.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$273 |
$273 |
3.1× |
| X-ray eye for foreign body (70030) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$273 |
$273 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$273 |
$273 |
3.1× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$273 |
$273 |
3.1× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$1,655.50 |
$1,655.50 |
15.8× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$273 |
$273 |
3.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$273 |
$273 |
2.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$273 |
$273 |
3.1× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$273 |
$273 |
3.1× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$459 |
$459 |
4.4× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$273 |
$273 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$273 |
$273 |
3.1× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$342.50 |
$342.50 |
3.9× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$273 |
$273 |
3.1× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$273 |
$273 |
3.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$459 |
$459 |
4.4× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$273 |
$273 |
2.6× |
| X-Ray Spine One View - Xr Spine (72020) |
$273 |
$273 |
3.1× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$273 |
$273 |
3.1× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$273 |
$273 |
2.6× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$273 |
$273 |
2.6× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$273 |
$273 |
3.1× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$342.50 |
$342.50 |
3.9× |
| Xr Cholecystography Oral Contrast (74290) |
$526 |
$526 |
3.0× |
| Xr finger(s) 2+ views (73140) |
$273 |
$273 |
3.1× |
| XR Mastoids < 3 Views Bilateral (70120) |
$273 |
$273 |
2.6× |
| Xr optic foramina (70190) |
$273 |
$273 |
3.1× |
| Xr shoulder 1 view (73020) |
$342.50 |
$342.50 |
3.9× |
| Xr spine cervical 4 or 5 views (72050) |
$459 |
$459 |
4.4× |
| Xr tibia/fibula 2 views (73590) |
$342.50 |
$342.50 |
3.9× |
| Xray knee 1 or 2 views rt (73560) |
$342.50 |
$342.50 |
3.9× |