| Abdomen 2 views (74019) |
$102.90 |
$147 |
1.1× |
| Ankle 2 views (73600) |
$130.20 |
$186 |
1.7× |
| Bone age studies (77072) |
$130.20 |
$186 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$182.35 |
$260.50 |
2.4× |
| Chest 1 view (71045) |
$182.35 |
$260.50 |
2.4× |
| Chest 3 views (71047) |
$130.20 |
$186 |
1.7× |
| Clavicle complete (73000) |
$130.20 |
$186 |
1.7× |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) |
$476.35 |
$680.50 |
5.2× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,393 |
$1,990 |
4.6× |
| CT abdomen and pelvis without contrast (74176) |
$1,208.20 |
$1,726 |
5.8× |
| CT abdomen w contrast (74160) |
$889 |
$1,270 |
5.8× |
| CT abdomen w wo contrast (74170) |
$1,001 |
$1,430 |
6.5× |
| CT abdomen w/o contrast (74150) |
$452.20 |
$646 |
4.9× |
| CT c-spine w/o contrast (72125) |
$633.15 |
$904.50 |
6.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,001 |
$1,430 |
6.5× |
| CT cervical spine with contrast (72126) |
$889 |
$1,270 |
2.9× |
| CT chest w/wo contrast (71270) |
$1,001 |
$1,430 |
6.5× |
| CT chest with contrast (71260) |
$1,244.60 |
$1,778 |
8.1× |
| CT head/brain with contrast (70460) |
$889 |
$1,270 |
5.8× |
| CT head/brain without and with contrast (70470) |
$1,001 |
$1,430 |
6.5× |
| CT iac w contrast (70481) |
$889 |
$1,270 |
5.8× |
| CT limited/localized follow up study (76380) |
$284.20 |
$406 |
3.7× |
| CT lower ext w/o (73700) |
$452.20 |
$646 |
4.9× |
| CT lower extremity w wo contrast (73702) |
$1,001 |
$1,430 |
6.5× |
| CT lower extremity with contrast (73701) |
$889 |
$1,270 |
5.8× |
| CT lumbar spine w & w/o contrast (72133) |
$1,001 |
$1,430 |
6.5× |
| CT lumbar spine w/o contrast (72131) |
$633.15 |
$904.50 |
6.9× |
| CT lumbar spine with contrast (72132) |
$889 |
$1,270 |
2.9× |
| CT maxillofacial w contrast (70487) |
$889 |
$1,270 |
5.8× |
| CT maxillofacial w/o contrast (70486) |
$633.15 |
$904.50 |
6.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,001 |
$1,430 |
6.5× |
| CT neck soft tissue w contrast (70491) |
$889 |
$1,270 |
5.8× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,001 |
$1,430 |
6.5× |
| CT orbits w/o contrast (70480) |
$452.20 |
$646 |
4.9× |
| CT pelvis w & w/o contrast (72194) |
$1,001 |
$1,430 |
6.5× |
| CT pelvis w/o contrast (72192) |
$633.15 |
$904.50 |
6.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,001 |
$1,430 |
6.5× |
| CT soft tissue neck w/o contrast (70490) |
$452.20 |
$646 |
4.9× |
| CT thoracic spine w/contrast (72129) |
$889 |
$1,270 |
5.8× |
| CT thoracic spine w/o contrast (72128) |
$452.20 |
$646 |
4.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,001 |
$1,430 |
6.5× |
| CT thorax w/o contrast (71250) |
$357.35 |
$510.50 |
3.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,001 |
$1,430 |
6.5× |
| CT upper extremity w/o contrast rt (73200) |
$452.20 |
$646 |
4.9× |
| CT upper extremity with contrast (73201) |
$889 |
$1,270 |
2.9× |
| Cta Abdl Aorta&Bi Iliofem W/Contrast&Postp (75635) |
$885.50 |
$1,265 |
5.8× |
| Cta Abdomen (74175) |
$885.50 |
$1,265 |
5.8× |
| CTA abdomen pelvis (74174) |
$1,288.70 |
$1,841 |
4.2× |
| CTA chest (71275) |
$823.55 |
$1,176.50 |
5.4× |
| Cta Head (70496) |
$1,229.20 |
$1,756 |
8.0× |
| CTA lwr ext w&w/o contrast (73706) |
$885.50 |
$1,265 |
5.8× |
| Cta Neck (70498) |
$699.65 |
$999.50 |
4.6× |
| Cta Pelvis (72191) |
$1,042.30 |
$1,489 |
6.8× |
| Dxa bone density study 1/> sites axial skel (77080) |
$410.55 |
$586.50 |
4.5× |
| Dxa bone density study 1/>sites appendiclr skel (77081) |
$226.80 |
$324 |
3.0× |
| Foot 2 views (73620) |
$130.20 |
$186 |
1.7× |
| Forearm 2 views (73090) |
$130.20 |
$186 |
1.7× |
| Hand 2 views (73120) |
$130.20 |
$186 |
1.4× |
| Hand 3 views (73130) |
$102.90 |
$147 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$130.20 |
$186 |
1.7× |
| Knee 3 views (73562) |
$182.35 |
$260.50 |
2.4× |
| Neck soft tissue (70360) |
$130.20 |
$186 |
1.7× |
| Pelvis 1 or 2 views (72170) |
$130.20 |
$186 |
1.4× |
| Radex hips bilateral with pelvis 2 views (73521) |
$194.60 |
$278 |
2.1× |
| Radiolog exam mandible compl minimum 4 views (70110) |
$240.10 |
$343 |
2.6× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$102.90 |
$147 |
1.3× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$182.35 |
$260.50 |
2.4× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$130.20 |
$186 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$130.20 |
$186 |
1.4× |
| Scapula complete (73010) |
$130.20 |
$186 |
1.4× |
| Spine thoracic 3 views (72072) |
$240.10 |
$343 |
2.6× |
| Tmj unilateral (70328) |
$130.20 |
$186 |
1.7× |
| Ultrasound, abdomen limited (76705) |
$403.90 |
$577 |
4.4× |
| Unlisted Ultrasound Procedure (76999) |
$182.70 |
$261 |
2.4× |
| Us abdl aorta screen aaa (76706) |
$241.50 |
$345 |
2.6× |
| Us breast unilateral complete (76641) |
$241.50 |
$345 |
2.6× |
| Us chest (76604) |
$288.40 |
$412 |
3.1× |
| Us compl joint r-t w/image documentation (76881) |
$288.40 |
$412 |
3.1× |
| Us kidney transplant (76776) |
$288.40 |
$412 |
3.1× |
| Us ob transvaginal (76817) |
$288.40 |
$412 |
3.1× |
| Us pelvic non ob complete (76856) |
$288.40 |
$412 |
3.1× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$241.50 |
$345 |
2.6× |
| Us pregnant uterus 14 wk transabdl 1/1st gestat (76801) |
$288.40 |
$412 |
3.1× |
| Us retroperitoneal complete (76770) |
$403.90 |
$577 |
4.4× |
| Us retroperitoneal limited (76775) |
$288.40 |
$412 |
3.1× |
| Us scrotum and contents (76870) |
$288.40 |
$412 |
3.1× |
| Us soft tissue head/neck (76536) |
$288.40 |
$412 |
3.1× |
| Us transrectal (76872) |
$288.40 |
$412 |
3.1× |
| Us xtr non-vasc lmtd (76882) |
$235.90 |
$337 |
2.6× |
| Wrist 2 views (73100) |
$130.20 |
$186 |
1.7× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$259 |
$370 |
2.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$130.20 |
$186 |
1.7× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$182.35 |
$260.50 |
2.4× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$130.20 |
$186 |
1.7× |
| X-Ray Elbow 3+ Vw - Xr Elbow 3+ Views Right (73080) |
$130.20 |
$186 |
1.7× |
| X-ray exam hip uni 1 view (73501) |
$130.20 |
$186 |
1.7× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$182.35 |
$260.50 |
2.4× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$240.10 |
$343 |
2.6× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$130.20 |
$186 |
1.7× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$182.35 |
$260.50 |
2.4× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$130.20 |
$186 |
1.7× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$130.20 |
$186 |
1.7× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$182.35 |
$260.50 |
2.0× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$182.35 |
$260.50 |
2.0× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$240.10 |
$343 |
2.6× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$130.20 |
$186 |
1.7× |
| X-Ray Nose-Rectum Child F.B. - Xr Nose to Rectum Foreign Body Peds (76010) |
$130.20 |
$186 |
1.7× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$130.20 |
$186 |
1.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$240.10 |
$343 |
2.6× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$240.10 |
$343 |
2.6× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$130.20 |
$186 |
1.7× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$182.35 |
$260.50 |
2.4× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$130.20 |
$186 |
1.7× |
| X-Ray Sinuses <3 Vw - Xr Paranasal Sinuses 1-2 Views (70210) |
$130.20 |
$186 |
1.7× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$240.10 |
$343 |
2.6× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$130.20 |
$186 |
1.4× |
| X-Ray Spine One View - Xr Spine (72020) |
$130.20 |
$186 |
1.7× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$130.20 |
$186 |
1.7× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$130.20 |
$186 |
1.4× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$130.20 |
$186 |
1.7× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$182.35 |
$260.50 |
2.4× |
| Xr c-spine 6 or more views (72052) |
$240.10 |
$343 |
2.6× |
| Xr finger(s) 2+ views (73140) |
$130.20 |
$186 |
1.7× |
| Xr shoulder 1 view (73020) |
$130.20 |
$186 |
1.7× |
| Xr spine cervical 4 or 5 views (72050) |
$240.10 |
$343 |
2.6× |
| Xr tibia/fibula 2 views (73590) |
$130.20 |
$186 |
1.7× |
| Xr tmj bilateral (70330) |
$130.20 |
$186 |
1.7× |
| Xray knee 1 or 2 views rt (73560) |
$130.20 |
$186 |
1.7× |