| Abdomen 2 views (74019) |
$148.50 |
$297 |
1.5× |
| Ankle 2 views (73600) |
$51 |
$102 |
0.6× |
| Bone age studies (77072) |
$45.50 |
$91 |
0.5× |
| Bone survey complete (77075) |
$309.50 |
$619 |
3.1× |
| Bone survey infant (77076) |
$209.50 |
$419 |
2.1× |
| Cervical spine 2 or 3 views (72040) |
$51 |
$102 |
0.6× |
| Chest 1 view (71045) |
$75 |
$150 |
0.9× |
| Chest xray 3 views (71047) |
$150 |
$300 |
1.8× |
| Cholecystography, oral contrast Non-Facility (74290) |
$93 |
$186 |
0.6× |
| Clavicle complete (73000) |
$55.50 |
$111 |
0.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$725 |
$1,450 |
7.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$66.50 |
$133 |
0.4× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,465 |
$2,930 |
4.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,056.50 |
$2,113 |
4.6× |
| CT abdomen w contrast (74160) |
$857 |
$1,714 |
5.1× |
| CT abdomen w wo contrast (74170) |
$1,089 |
$2,178 |
6.5× |
| CT abdomen w/o contrast (74150) |
$718.50 |
$1,437 |
7.2× |
| CT angio lwr extr w/o&w/dye (73706) |
$941.50 |
$1,883 |
5.6× |
| CT angiography upper extremity lt (73206) |
$900 |
$1,800 |
5.3× |
| CT c-spine w/contrast (72126) |
$900 |
$1,800 |
2.7× |
| CT c-spine w/o contrast (72125) |
$744.50 |
$1,489 |
7.4× |
| CT cervical spine w&w/o contrast (72127) |
$350.12 |
$700.24 |
2.1× |
| CT chest w contrast (71260) |
$824.50 |
$1,649 |
4.9× |
| CT chest w/wo contrast (71270) |
$984 |
$1,968 |
5.8× |
| CT head/brain with contrast (70460) |
$803 |
$1,606 |
4.8× |
| CT head/brain without and with contrast (70470) |
$934.50 |
$1,869 |
5.6× |
| CT iac w contrast (70481) |
$765.50 |
$1,531 |
4.5× |
| CT limited/localized follow up study (76380) |
$173.16 |
$346.32 |
2.1× |
| CT lower ext w/o (73700) |
$603 |
$1,206 |
6.0× |
| CT lower extremity w wo contrast (73702) |
$808.50 |
$1,617 |
4.8× |
| CT lower extremity w/contrast material (73701) |
$647.50 |
$1,295 |
3.8× |
| CT lumbar spine w & w/o contrast (72133) |
$350.12 |
$700.24 |
2.1× |
| CT lumbar spine w/contrast (72132) |
$875 |
$1,750 |
2.6× |
| CT lumbar spine w/o contrast (72131) |
$740 |
$1,480 |
7.4× |
| CT maxillofacial w contrast (70487) |
$758.50 |
$1,517 |
4.5× |
| CT maxillofacial w/wo contrast (70488) |
$885 |
$1,770 |
5.3× |
| CT maxillofacial wo contrast (70486) |
$651 |
$1,302 |
6.5× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$900 |
$1,800 |
5.3× |
| CT orbits w/o contrast (70480) |
$677 |
$1,354 |
6.8× |
| CT pelvis w/o contrast (72192) |
$722.50 |
$1,445 |
7.2× |
| CT pelvis w/wo contrast (72194) |
$975 |
$1,950 |
5.8× |
| CT scan of arm combo (73202) |
$350.12 |
$700.24 |
2.1× |
| CT soft tissue neck w contrast (70491) |
$729 |
$1,458 |
4.3× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$896 |
$1,792 |
5.3× |
| CT soft tissue neck w/o contrast (70490) |
$640.50 |
$1,281 |
6.4× |
| CT thoracic spine w/contrast (72129) |
$900 |
$1,800 |
5.3× |
| CT thoracic spine w/o contrast (72128) |
$729 |
$1,458 |
7.3× |
| CT thoracic spine w/wo contrast (72130) |
$350.12 |
$700.24 |
2.1× |
| CT thorax w/o contrast (71250) |
$456.50 |
$913 |
4.6× |
| CT upper ext wo (73200) |
$633.50 |
$1,267 |
6.3× |
| CT upper extremity with contrast (73201) |
$838 |
$1,676 |
2.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$915 |
$1,830 |
5.4× |
| Cta Abdomen (74175) |
$975 |
$1,950 |
5.8× |
| CTA abdomen pelvis (74174) |
$1,195 |
$2,390 |
3.6× |
| CTA chest (71275) |
$942 |
$1,884 |
5.6× |
| Cta Head (70496) |
$946 |
$1,892 |
5.6× |
| Cta Neck (70498) |
$978 |
$1,956 |
5.8× |
| Cta Pelvis (72191) |
$350.12 |
$700.24 |
2.1× |
| Cystography minimum 3 views rs&i (74430) |
$153.50 |
$307 |
0.5× |
| Dxa bone density study 1/> sites axial skel (77080) |
$200.50 |
$401 |
2.0× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$173.16 |
$346.32 |
2.1× |
| Dxa bone density study axial skeleton (77085) |
$209.50 |
$419 |
2.1× |
| Esophagus (74220) |
$66.50 |
$133 |
0.4× |
| Facial bones min 3 views (70150) |
$70.50 |
$141 |
0.7× |
| Fluoroscopy up to 1 hr (76000) |
$350 |
$700 |
1.5× |
| Foot 2 views (73620) |
$40 |
$80 |
0.5× |
| Forearm 2 views (73090) |
$159.50 |
$319 |
1.9× |
| Hand 2 views (73120) |
$40 |
$80 |
0.4× |
| Knee 3 views (73562) |
$55.50 |
$111 |
0.7× |
| Manual Appl Stress Pfrmd Phys/Qhp Joint Films (77071) |
$173.16 |
$346.32 |
2.1× |
| Neck soft tissue (70360) |
$51 |
$102 |
0.6× |
| Osseous survey limited (77074) |
$209.50 |
$419 |
2.1× |
| Pelvis 1 or 2 views (72170) |
$168 |
$336 |
1.7× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$159.50 |
$319 |
1.9× |
| Radex Calcaneus Minimum 2 Views (73650) |
$48.50 |
$97 |
0.6× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$159.50 |
$319 |
1.9× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$34 |
$68 |
0.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$55.50 |
$111 |
0.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$67.50 |
$135 |
0.7× |
| Radex fingr minimum 2 views (73140) |
$159.50 |
$319 |
1.9× |
| Radex Foot Compl Minimum 3 Views (73630) |
$159.50 |
$319 |
1.9× |
| Radex Hand Minimum 3 Views (73130) |
$159.50 |
$319 |
1.9× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$55.50 |
$111 |
0.7× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$224 |
$448 |
2.2× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$57.50 |
$115 |
0.6× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$57.50 |
$115 |
0.6× |
| Radex Humerus Minimum 2 Views (73060) |
$159.50 |
$319 |
1.9× |
| Radex Kne 1/2 Views (73560) |
$51 |
$102 |
0.6× |
| Radex Kne Compl 4/More Views (73564) |
$224 |
$448 |
2.2× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$70.50 |
$141 |
0.7× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$48.50 |
$97 |
0.6× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$224 |
$448 |
2.2× |
| Radex Sho Compl Minimum 2 Views (73030) |
$159.50 |
$319 |
1.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$55.50 |
$111 |
0.7× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$72 |
$144 |
0.7× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$70.50 |
$141 |
0.8× |
| Radex Toe Minimum 2 Views (73660) |
$159.50 |
$319 |
1.9× |
| Radex upper extremity infant minimum 2 views (73092) |
$48.50 |
$97 |
0.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$159.50 |
$319 |
1.9× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$67.50 |
$135 |
0.7× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$42 |
$84 |
0.5× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$60 |
$120 |
0.6× |
| Radiologic exam chest 2 views (71046) |
$82 |
$164 |
1.0× |
| Radiologic exam colon single contrast study (74270) |
$116.50 |
$233 |
0.7× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$350.12 |
$700.24 |
2.1× |
| Radiologic exam upr gi trc double contrast study (74246) |
$139 |
$278 |
0.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$121.50 |
$243 |
0.7× |
| Radiologic examination femur 1 view (73551) |
$159.50 |
$319 |
1.9× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$51 |
$102 |
0.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$159.50 |
$319 |
1.9× |
| Radiologic examination, teeth; single view Non-Facility (70300) |
$40 |
$80 |
0.5× |
| Ribs bilateral 3 views (71110) |
$110 |
$220 |
1.1× |
| Sacroiliac Joints < 3 Views (72200) |
$40 |
$80 |
0.4× |
| Scapula (73010) |
$53.50 |
$107 |
0.5× |
| Sella turcica (70240) |
$55.50 |
$111 |
0.7× |
| Shoulder 1 view (73020) |
$51 |
$102 |
0.6× |
| Small bowel series (74250) |
$86 |
$172 |
0.5× |
| Spine thoracic 3 views (72072) |
$45.50 |
$91 |
0.5× |
| Thoracolumbar 2 views (72080) |
$55.50 |
$111 |
0.7× |
| Tmj unilateral (70328) |
$55.50 |
$111 |
0.7× |
| Unlisted Diagnostic Radiographic Procedure (76499) |
$180 |
$360 |
2.2× |
| Urethrocystogram voiding (74455) |
$153.50 |
$307 |
0.7× |
| Urethrocystography retrograde rs&i (74450) |
$135 |
$270 |
0.6× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$123 |
$246 |
0.7× |
| Venogram Extremity Unilateral (75820) |
$175 |
$350 |
0.1× |
| Venography caval superior serialography rs&i (75827) |
$3,051.86 |
$6,103.72 |
2.0× |
| Vertebral fracture assessment via dxa (77086) |
$90.50 |
$181 |
1.1× |
| Wrist 2 views (73100) |
$48.50 |
$97 |
0.6× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$55.50 |
$111 |
0.6× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$55 |
$110 |
0.7× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$143.50 |
$287 |
0.9× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$48.50 |
$97 |
0.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$57.50 |
$115 |
0.7× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$57.50 |
$115 |
0.6× |
| X-ray exam of femur 2/> (73552) |
$159.50 |
$319 |
1.9× |
| X-ray eye for foreign body (70030) |
$51 |
$102 |
0.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$55.50 |
$111 |
0.7× |
| X-ray IV pyelogram (ivp) (74400) |
$123 |
$246 |
0.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$55.50 |
$111 |
0.7× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$51 |
$102 |
0.6× |
| X-ray leg, infant (73592) |
$51 |
$102 |
0.6× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$72 |
$144 |
0.7× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$113 |
$226 |
1.1× |
| X-ray nose-rectum child f.b. (76010) |
$34 |
$68 |
0.4× |
| X-ray optic foramen (70190) |
$51 |
$102 |
0.6× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$70.50 |
$141 |
0.7× |
| X-ray retrograde pyelogram (74420) |
$112 |
$224 |
0.3× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$55.50 |
$111 |
0.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$167 |
$334 |
1.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$130 |
$260 |
1.3× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$51 |
$102 |
0.5× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$51 |
$102 |
0.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$70.50 |
$141 |
0.8× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$89 |
$178 |
0.9× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$55.50 |
$111 |
0.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$86 |
$172 |
0.5× |
| X-Ray Spine One View - Xr Spine (72020) |
$34 |
$68 |
0.4× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$55.50 |
$111 |
0.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$55.50 |
$111 |
0.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$51 |
$102 |
0.5× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$89 |
$178 |
0.9× |
| Xr bone length studies (77073) |
$209.50 |
$419 |
2.1× |
| Xr c-spine 4 or 5 views (72050) |
$88 |
$176 |
0.9× |
| Xr c-spine 6 or more views (72052) |
$88 |
$176 |
0.9× |
| Xr chest 4+ views (71048) |
$150 |
$300 |
1.5× |