| Ankle 2 views (73600) |
$160.80 |
$268 |
1.8× |
| Clavicle complete (73000) |
$160.80 |
$268 |
1.8× |
| Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if… (74174) |
$1,001.40 |
$1,669 |
2.7× |
| Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and… (74175) |
$525.60 |
$876 |
2.8× |
| Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if… (71275) |
$525.60 |
$876 |
2.8× |
| Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if… (73706) |
$525.60 |
$876 |
2.8× |
| Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and… (70498) |
$524.70 |
$874.50 |
2.8× |
| Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections… (72127) |
$735.60 |
$1,226 |
4.0× |
| Computed tomography, lower extremity; without contrast material Age Under 21 (73700) |
$293.40 |
$489 |
2.7× |
| Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections… (73702) |
$735.60 |
$1,226 |
4.0× |
| Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Age… (72133) |
$735.60 |
$1,226 |
4.0× |
| Computed tomography, maxillofacial area; with contrast material(s) Age Under 21 (70487) |
$525.60 |
$876 |
2.8× |
| Computed tomography, maxillofacial area; without contrast material Age Under 21 (70486) |
$293.40 |
$489 |
2.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Age… (70481) |
$525.60 |
$876 |
2.8× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Age… (70480) |
$293.40 |
$489 |
2.7× |
| Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material,… (70482) |
$735.60 |
$1,226 |
4.0× |
| Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections… (70492) |
$735.60 |
$1,226 |
4.0× |
| Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections… (72130) |
$735.60 |
$1,226 |
4.0× |
| Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further… (71270) |
$735.60 |
$1,226 |
4.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$661.20 |
$1,102 |
1.8× |
| CT abdomen and pelvis without contrast (74176) |
$598.80 |
$998 |
2.4× |
| CT abdomen w & w/o contrast (74170) |
$732.60 |
$1,221 |
4.0× |
| CT abdomen w/contrast (74160) |
$525.60 |
$876 |
2.8× |
| CT abdomen w/o contrast (74150) |
$293.40 |
$489 |
2.7× |
| CT cervical spine w/contrast (72126) |
$525.60 |
$876 |
1.4× |
| CT cervical spine w/o contrast (72125) |
$293.40 |
$489 |
2.7× |
| CT chest w/contrast (71260) |
$525.60 |
$876 |
2.8× |
| CT extremity upper w & w/o contrast (73202) |
$735.60 |
$1,226 |
4.0× |
| CT extremity upper w/o contrast (73200) |
$293.40 |
$489 |
2.7× |
| CT head/brain with contrast (70460) |
$525.60 |
$876 |
2.8× |
| CT head/brain without and with contrast (70470) |
$735.60 |
$1,226 |
4.0× |
| CT l-spine w/contrast (72132) |
$525.60 |
$876 |
1.4× |
| CT lower extremity w/dye (73701) |
$525.60 |
$876 |
2.8× |
| CT lumbar spine w/o contrast (72131) |
$293.40 |
$489 |
2.7× |
| CT maxillofacial w/wo contrast (70488) |
$735.60 |
$1,226 |
4.0× |
| CT neck w/contrast (70491) |
$525.60 |
$876 |
2.8× |
| CT neck w/o contrast (70490) |
$293.40 |
$489 |
2.7× |
| CT pelvis w & w/o contrast (72194) |
$735.60 |
$1,226 |
4.0× |
| CT pelvis w/o contrast (72192) |
$293.40 |
$489 |
2.7× |
| CT thoracic spine w/contrast (72129) |
$525.60 |
$876 |
2.8× |
| CT thoracic spine w/o contrast (72128) |
$293.40 |
$489 |
2.7× |
| CT thorax lung cancer scr c- (71271) |
$160.80 |
$268 |
1.5× |
| CT thorax w/o contrast (71250) |
$293.40 |
$489 |
2.7× |
| CT upper extremity w/dye (73201) |
$525.60 |
$876 |
1.4× |
| CTA head w contrast (70496) |
$525.60 |
$876 |
2.8× |
| MRI pelvis w/o contrast (72195) |
$1,500 |
$2,500 |
6.0× |
| Ob us limited fetus(s) (76815) |
$278.40 |
$464 |
2.5× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$293.40 |
$489 |
2.7× |
| Radex hip unilateral with pelvis 1 view (73501) |
$160.80 |
$268 |
1.8× |
| Radex hip unilateral with pelvis 2-3 views (73502) |
$194.40 |
$324 |
2.1× |
| Radex hip unilateral with pelvis minimum 4 views (73503) |
$231.60 |
$386 |
2.1× |
| Radex hips bilateral with pelvis minimum 5 views (73523) |
$278.40 |
$464 |
2.5× |
| Radex spine cervical 2 or 3 views (72040) |
$160.80 |
$268 |
1.8× |
| Radex spine cervical 4 or 5 views (72050) |
$225.60 |
$376 |
2.0× |
| Radex spine cervical 6 or more views (72052) |
$225.60 |
$376 |
2.0× |
| Radex spine thoracolumbar junction min 2 views (72080) |
$160.80 |
$268 |
1.8× |
| Radiologic exam chest 3 views (71047) |
$231.60 |
$386 |
2.5× |
| Radiologic examination femur minimum 2 views (73552) |
$160.80 |
$268 |
1.8× |
| Radiologic examination, ankle; complete, minimum of 3 views Age Under 21 (73610) |
$194.40 |
$324 |
2.1× |
| Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect,… (74022) |
$350.40 |
$584 |
3.2× |
| Radiologic examination, elbow; 2 views Age Under 21 (73070) |
$160.80 |
$268 |
1.8× |
| Radiologic examination, elbow; complete, minimum of 3 views Age Under 21 (73080) |
$194.40 |
$324 |
2.1× |
| Radiologic examination, facial bones; less than 3 views Age Under 21 (70140) |
$160.80 |
$268 |
1.8× |
| Radiologic examination, foot; complete, minimum of 3 views Age Under 21 (73630) |
$194.40 |
$324 |
2.1× |
| Radiologic examination, hand; minimum of 3 views Age Under 21 (73130) |
$194.40 |
$324 |
2.1× |
| Radiologic examination, knee; both knees, standing, anteroposterior Age Under 21 (73565) |
$278.40 |
$464 |
3.0× |
| Radiologic examination, knee; complete, 4 or more views Age Under 21 (73564) |
$231.60 |
$386 |
2.1× |
| Radiologic examination, mandible; partial, less than 4 views Age Under 21 (70100) |
$160.80 |
$268 |
1.8× |
| Radiologic examination, mastoids; complete, minimum of 3 views per side Age Under 21 (70130) |
$293.40 |
$489 |
2.7× |
| Radiologic examination, nasal bones, complete, minimum of 3 views Age Under 21 (70160) |
$160.80 |
$268 |
1.8× |
| Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views Age Under 21 (71111) |
$349.20 |
$582 |
3.2× |
| Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views Age Under 21 (71101) |
$293.40 |
$489 |
2.7× |
| Radiologic examination, sacroiliac joints; less than 3 views Age Under 21 (72200) |
$293.40 |
$489 |
2.7× |
| Radiologic examination, shoulder; complete, minimum of 2 views Age Under 21 (73030) |
$194.40 |
$324 |
2.1× |
| Radiologic examination, sinuses, paranasal, less than 3 views Age Under 21 (70210) |
$160.80 |
$268 |
1.8× |
| Radiologic examination, skull; less than 4 views Age Under 21 (70250) |
$293.40 |
$489 |
2.7× |
| Radiologic examination, spine, lumbosacral; 2 or 3 views Age Under 21 (72100) |
$293.40 |
$489 |
2.7× |
| Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views Age Under 21 (72114) |
$420 |
$700 |
3.8× |
| Radiologic examination, wrist; complete, minimum of 3 views Age Under 21 (73110) |
$194.40 |
$324 |
2.1× |
| Radiologic examination; humerus, minimum of 2 views Age Under 21 (73060) |
$160.80 |
$268 |
1.8× |
| Radiologic examination; orbits, complete, minimum of 4 views Age Under 21 (70200) |
$293.40 |
$489 |
2.7× |
| Radiologic examination; toe(s), minimum of 2 views Age Under 21 (73660) |
$160.80 |
$268 |
1.8× |
| Scapula complete (73010) |
$293.40 |
$489 |
2.7× |
| Ultrasound, abdomen limited (76705) |
$234.60 |
$391 |
2.1× |
| Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space,… (76882) |
$293.40 |
$489 |
2.7× |
| Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Age Under 21 (76856) |
$293.40 |
$489 |
2.7× |
| Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14… (76801) |
$293.40 |
$489 |
2.7× |
| Umbilical-artery Doppler (OB) (76820) |
$278.40 |
$464 |
2.5× |
| Us abdominal aorta real time screen study aaa (76706) |
$293.40 |
$489 |
2.7× |
| Us breast uni real time with image complete (76641) |
$244.20 |
$407 |
2.2× |
| Us chest (76604) |
$293.40 |
$489 |
2.7× |
| Us compl joint r-t w/image documentation (76881) |
$293.40 |
$489 |
2.7× |
| Us exam, pelvic, limited (76857) |
$234.60 |
$391 |
2.1× |
| US OB Follow-Up/Repeat (76816) |
$278.40 |
$464 |
2.5× |
| Us retroperitoneal complete (76770) |
$293.40 |
$489 |
2.7× |
| Us retroperitoneal ltd (76775) |
$234.60 |
$391 |
2.1× |
| Us scrotum (76870) |
$293.40 |
$489 |
2.7× |
| Us soft tissue head/neck (76536) |
$293.40 |
$489 |
2.7× |
| X-ray exam of finger(s) (73140) |
$160.80 |
$268 |
1.8× |
| X-ray exam of knee 1 or 2 (73560) |
$160.80 |
$268 |
1.8× |
| X-ray heel (73650) |
$160.80 |
$268 |
1.8× |
| Xr abdomen 1 view (74018) |
$160.80 |
$268 |
1.8× |
| Xr abdomen 2 views (74019) |
$293.40 |
$489 |
2.7× |
| Xr chest 1 view (71045) |
$160.80 |
$268 |
1.8× |
| Xr chest 2 views (71046) |
$194.40 |
$324 |
2.1× |
| Xr eye foreign body (70030) |
$160.80 |
$268 |
1.8× |
| Xr facial bones 3+ views (70150) |
$293.40 |
$489 |
2.7× |
| Xr foot arthritis pa only bilateral - report(ortho pro) (73620) |
$160.80 |
$268 |
1.8× |
| Xr forearm 2 views (73090) |
$160.80 |
$268 |
1.8× |
| Xr hand 2v (73120) |
$160.80 |
$268 |
1.5× |
| Xr neck soft tissue (70360) |
$160.80 |
$268 |
1.8× |
| Xr o knee w/ merchant view bilat - report(ortho pro) (73562) |
$194.40 |
$324 |
2.1× |
| Xr pelvis 1-2 views (72170) |
$293.40 |
$489 |
2.7× |
| Xr pelvis min 3 view (72190) |
$349.20 |
$582 |
3.2× |
| Xr sacrum/coccyx 2+ views (72220) |
$160.80 |
$268 |
1.8× |
| Xr shoulder 1 view (73020) |
$160.80 |
$268 |
1.8× |
| Xr sinuses 3+ views (70220) |
$194.40 |
$324 |
2.1× |
| Xr skull min 4 view (70260) |
$349.20 |
$582 |
3.2× |
| Xr spine 1 view (72020) |
$160.80 |
$268 |
1.8× |
| Xr spine thoracic 3v (72072) |
$349.20 |
$582 |
3.2× |
| Xr sternum 2+ views (71120) |
$160.80 |
$268 |
1.8× |
| Xr t-spine 2 views (72070) |
$293.40 |
$489 |
2.7× |
| Xr tibia/fibula 2 views (73590) |
$160.80 |
$268 |
1.8× |
| Xr tmj bilateral (70330) |
$160.80 |
$268 |
1.8× |
| Xr wrist 2 views (73100) |
$160.80 |
$268 |
1.8× |