| Abdomen 1 View (74018) |
$91.94 |
$178 |
1.1× |
| Abdomen 2 views (74019) |
$129.12 |
$259 |
1.3× |
| Ankle 2 views (73600) |
$91.94 |
$178 |
1.1× |
| Arthrogram hip (73525) |
$439.91 |
$450 |
1.3× |
| Arthrogram Wrist (73115) |
$439.91 |
$300 |
1.3× |
| Chest 1 view (71045) |
$91.94 |
$133 |
1.1× |
| Chest 2 views (71046) |
$91.94 |
$133 |
1.1× |
| Clavicle complete (73000) |
$91.94 |
$178 |
1.1× |
| Contrast X-Ray Of Knee Joint (73580) |
$439.91 |
$450 |
1.3× |
| CT abdomen and pelvis without and with contrast (74178) |
$439.91 |
$1,002 |
1.3× |
| CT abdomen and pelvis without contrast (74176) |
$268.48 |
$582 |
1.2× |
| CT abdomen w wo contrast (74170) |
$209.93 |
$1,266 |
1.3× |
| CT abdomen w/o contrast (74150) |
$129.12 |
$1,046 |
1.3× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) |
$209.93 |
$1,532 |
1.3× |
| CT cervical spine w/ contrast (72126) |
$439.91 |
$1,046 |
1.3× |
| CT cervical spine w/o contrast (72125) |
$129.12 |
$798 |
1.3× |
| CT cervical spine w/wo cont (72127) |
$209.93 |
$1,246 |
1.3× |
| CT chest w contrast (71260) |
$209.93 |
$1,046 |
1.3× |
| CT chest w/wo contrast (71270) |
$209.93 |
$1,246 |
1.3× |
| CT head/brain without and with contrast (70470) |
$209.93 |
$1,246 |
1.3× |
| CT l-spine w&w/o contrast (72133) |
$209.93 |
$1,246 |
1.3× |
| CT lower ext w/o (73700) |
$129.12 |
$798 |
1.3× |
| CT lower extremity w/contrast material (73701) |
$209.93 |
$1,046 |
1.3× |
| CT lumbar spine w contrast (72132) |
$439.91 |
$1,046 |
1.3× |
| CT lumbar spine w/o contrast (72131) |
$129.12 |
$798 |
1.3× |
| CT maxillofacial w contrast (70487) |
$209.93 |
$1,046 |
1.3× |
| CT maxillofacial wo contrast (70486) |
$129.12 |
$785 |
1.3× |
| CT neck tissue combo (70492) |
$209.93 |
$1,246 |
1.3× |
| CT pelvis w&w/o contrast (72194) |
$209.93 |
$1,246 |
1.3× |
| CT pelvis w/o contrast (72192) |
$129.12 |
$798 |
1.3× |
| CT soft tissue neck w contrast (70491) |
$209.93 |
$1,046 |
1.3× |
| CT soft tissue neck w/o contrast (70490) |
$129.12 |
$798 |
1.3× |
| CT thoracic spine w contrast (72129) |
$209.93 |
$1,046 |
1.3× |
| CT thoracic spine w/o contrast (72128) |
$129.12 |
$798 |
1.3× |
| CT thoracic spine w/wo cont (72130) |
$209.93 |
$1,246 |
1.3× |
| CT thorax w/o contrast (71250) |
$129.12 |
$798 |
1.3× |
| CT upper ext wo (73200) |
$129.12 |
$1,246 |
1.3× |
| CT upper extremity with contrast (73201) |
$439.91 |
$1,046 |
1.3× |
| Diskography lumbar (72295) |
$1,980.76 |
$1,020 |
1.1× |
| Fluoroscopy up to 1 hr (76000) |
$268.48 |
$250 |
1.2× |
| Foot 2 views (73620) |
$91.94 |
$178 |
1.1× |
| Forearm 2 views (73090) |
$91.94 |
$178 |
1.1× |
| Hand 2 views (73120) |
$129.12 |
$178 |
1.3× |
| Knee 3 Views (73562) |
$91.94 |
$213 |
1.1× |
| MRA head w/o contrast (70544) |
$268.48 |
$1,650 |
1.2× |
| Mra Neck W/O &W/Contrast Material (70549) |
$439.91 |
$2,050 |
1.3× |
| MRA neck w/o contrast (70547) |
$268.48 |
$1,650 |
1.2× |
| MRI any jt lower extrem w/contrast material (73722) |
$784.33 |
$1,850 |
1.1× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$439.91 |
$2,050 |
1.3× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$784.33 |
$1,850 |
1.1× |
| MRI cervical spine w/o cont (72141) |
$268.48 |
$1,650 |
1.2× |
| MRI chest w/o contrast (71550) |
$268.48 |
$1,650 |
1.2× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$439.91 |
$1,850 |
1.3× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$439.91 |
$2,050 |
1.3× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$268.48 |
$1,650 |
1.2× |
| Mri Neck Spine W/O & W/Dye (72156) |
$439.91 |
$2,050 |
1.3× |
| MRI orbit face &/neck w/o contrast (70540) |
$268.48 |
$1,650 |
1.2× |
| Mri Orbt/Fac/Nck W/O &W/Dye (70543) |
$439.91 |
$2,050 |
1.3× |
| MRI pelvis w/o & w contrast (72197) |
$439.91 |
$2,050 |
1.3× |
| MRI pelvis w/o contrast (72195) |
$268.48 |
$1,650 |
1.2× |
| MRI thoracic spine w/o contrast (72146) |
$268.48 |
$1,650 |
1.2× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$268.48 |
$1,650 |
1.2× |
| Mri Uppr Extremity W/O&W/Dye (73220) |
$439.91 |
$1,650 |
1.3× |
| MRI, abdomen, combo (74183) |
$439.91 |
$2,050 |
1.3× |
| MRI, dorsal spine combo (72157) |
$439.91 |
$2,050 |
1.3× |
| MRI, joint upper extrem (73221) |
$268.48 |
$1,850 |
1.2× |
| MRI, joint upper extrem combo (73223) |
$439.91 |
$1,650 |
1.3× |
| MRI, lumbar spine combo (72158) |
$439.91 |
$2,050 |
1.3× |
| Myelogram cervical (72240) |
$784.33 |
$451.45 |
1.1× |
| Myelogram Lumbar (72265) |
$784.33 |
$311 |
1.1× |
| Myelograpy 2/more regions rs&i (72270) |
$784.33 |
$500 |
1.1× |
| Nonvascular Shunt X-Ray (75809) |
$129.12 |
$2,006 |
1.3× |
| Pelvis 1 or 2 views (72170) |
$129.12 |
$178 |
1.3× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) |
$129.12 |
$178 |
1.3× |
| Radex Ankle Complete Minimum 3 Views (73610) |
$91.94 |
$178 |
1.1× |
| Radex Calcaneus Minimum 2 Views (73650) |
$91.94 |
$178 |
1.1× |
| Radex elbow complete minimum 3 views (73080) |
$91.94 |
$200 |
1.1× |
| Radex Facial Bones Complete Minimum 3 Views (70150) |
$129.12 |
$178 |
1.3× |
| Radex fingr minimum 2 views (73140) |
$91.94 |
$178 |
1.1× |
| Radex foot complete minimum 3 views (73630) |
$91.94 |
$213 |
1.1× |
| Radex Hand Minimum 3 Views (73130) |
$91.94 |
$178 |
1.1× |
| Radex Ribs Unilateral 2 Views (71100) |
$91.94 |
$133 |
1.1× |
| Radex shoulder complete minimum 2 views (73030) |
$91.94 |
$225 |
1.1× |
| Radex Spine 1 View Specify Level (72020) |
$91.94 |
$178 |
1.1× |
| Radex Wrist Complete Minimum 3 Views (73110) |
$91.94 |
$200 |
1.1× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$129.12 |
$169 |
1.3× |
| Radiologic exam knee complete 4/more views (73564) |
$129.12 |
$250 |
1.3× |
| Radiologic exam pelvis compl minimum 3 views (72190) |
$129.12 |
$311 |
1.3× |
| Radiologic examination femur minimum 2 views (73552) |
$91.94 |
$178 |
1.1× |
| Radiologic examination knee 1/2 views (73560) |
$91.94 |
$213 |
1.1× |
| Radiologic examination tibia & fibula 2 views (73590) |
$91.94 |
$178 |
1.1× |
| Shoulder 1 view (73020) |
$91.94 |
$178 |
1.1× |
| Shoulder Arthrography (73040) |
$439.91 |
$300 |
1.3× |
| Skull less than 4 views (70250) |
$129.12 |
$178 |
1.3× |
| Thoracic spine 2 views (72070) |
$129.12 |
$178 |
1.3× |
| Thoracolumbar 2 views (72080) |
$91.94 |
$178 |
1.1× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$129.12 |
$375 |
1.3× |
| Wrist 2 views (73100) |
$91.94 |
$178 |
1.1× |
| X-Ray Bend Only L-S Spine (72120) |
$129.12 |
$311 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$91.94 |
$178 |
1.1× |
| X-Ray Exam Hip Uni 1 View (73501) |
$91.94 |
$178 |
1.1× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$91.94 |
$178 |
1.1× |
| X-Ray Exam Hips Bi 2 Views (73521) |
$129.12 |
$300 |
1.3× |
| X-Ray Exam L-S Spine Bending (72114) |
$129.12 |
$178 |
1.3× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) |
$91.94 |
$178 |
1.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) |
$129.12 |
$311 |
1.3× |
| X-Ray Exam Unilat Ribs/Chest (71101) |
$129.12 |
$178 |
1.3× |
| X-ray eye for foreign body (70030) |
$91.94 |
$178 |
1.1× |
| X-ray humerus (73060) |
$91.94 |
$178 |
1.1× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$91.94 |
$178 |
1.1× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$129.12 |
$178 |
1.3× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$129.12 |
$178 |
1.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$91.94 |
$178 |
1.1× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$129.12 |
$178 |
1.3× |
| X-ray thoracic spine 4 vw (72074) |
$129.12 |
$311 |
1.3× |
| Xr c-spine 4 or 5 views (72050) |
$129.12 |
$178 |
1.3× |