| Abdomen 2 views (74019) |
$168 |
$336 |
1.7× |
| Angiography pulmonary bilateral slctv rs&i (75743) |
$3,330 |
$6,659 |
1.1× |
| Ankle 2 views (73600) |
$168 |
$336 |
2.0× |
| Bone age studies (77072) |
$141 |
$281 |
1.4× |
| Cervical spine 2 or 3 views (72040) |
$112 |
$224 |
1.3× |
| Chest 1 view (71045) |
$112 |
$224 |
1.3× |
| Chest 3 views (71047) |
$196 |
$392 |
2.3× |
| Clavicle complete (73000) |
$168 |
$336 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$1,800 |
$3,600 |
5.4× |
| CT abdomen and pelvis without contrast (74176) |
$1,220 |
$2,440 |
5.3× |
| CT abdomen w contrast (74160) |
$1,300 |
$2,600 |
7.7× |
| CT abdomen w wo contrast (74170) |
$1,800 |
$3,600 |
10.7× |
| CT abdomen w/o contrast (74150) |
$1,200 |
$2,400 |
11.9× |
| CT c-spine w/o contrast (72125) |
$1,200 |
$2,400 |
11.9× |
| CT cervical spine w&w/o contrast (72127) |
$1,800 |
$3,600 |
10.7× |
| CT cervical spine with contrast (72126) |
$1,300 |
$2,600 |
3.9× |
| CT chest w/wo contrast (71270) |
$1,800 |
$3,600 |
10.7× |
| CT chest with contrast (71260) |
$1,300 |
$2,600 |
7.7× |
| CT head/brain with contrast (70460) |
$1,300 |
$2,600 |
7.7× |
| CT head/brain without and with contrast (70470) |
$1,800 |
$3,600 |
10.7× |
| CT iac w contrast (70481) |
$1,300 |
$2,600 |
7.7× |
| CT lower ext w/o (73700) |
$1,200 |
$2,400 |
11.9× |
| CT lower extremity w wo contrast (73702) |
$578 |
$1,155 |
3.4× |
| CT lower extremity with contrast (73701) |
$1,300 |
$2,600 |
7.7× |
| CT lumbar spine w & w/o contrast (72133) |
$1,800 |
$3,600 |
10.7× |
| CT lumbar spine w/o contrast (72131) |
$1,200 |
$2,400 |
11.9× |
| CT lumbar spine with contrast (72132) |
$1,300 |
$2,600 |
3.9× |
| CT maxillofacial w contrast (70487) |
$1,300 |
$2,600 |
7.7× |
| CT maxillofacial w/o contrast (70486) |
$1,200 |
$2,400 |
11.9× |
| CT maxillofacial w/wo contrast (70488) |
$1,800 |
$3,600 |
10.7× |
| CT neck soft tissue w contrast (70491) |
$1,300 |
$2,600 |
7.7× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,800 |
$3,600 |
10.7× |
| CT orbits w/o contrast (70480) |
$1,200 |
$2,400 |
11.9× |
| CT pelvis w & w/o contrast (72194) |
$1,800 |
$3,600 |
10.7× |
| CT pelvis w/o contrast (72192) |
$1,200 |
$2,400 |
11.9× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,800 |
$3,600 |
10.7× |
| CT soft tissue neck w/o contrast (70490) |
$1,200 |
$2,400 |
11.9× |
| CT thoracic spine w/contrast (72129) |
$1,300 |
$2,600 |
7.7× |
| CT thoracic spine w/o contrast (72128) |
$1,200 |
$2,400 |
11.9× |
| CT thoracic spine w/wo contrast (72130) |
$1,800 |
$3,600 |
10.7× |
| CT thorax w/o contrast (71250) |
$1,200 |
$2,400 |
11.9× |
| CT upper extremity w/o & w/contrast material (73202) |
$1,800 |
$3,600 |
10.7× |
| CT upper extremity w/o contrast rt (73200) |
$1,200 |
$2,400 |
11.9× |
| CT upper extremity with contrast (73201) |
$1,300 |
$2,600 |
3.9× |
| Foot 2 views (73620) |
$112 |
$224 |
1.3× |
| Forearm 2 views (73090) |
$112 |
$224 |
1.3× |
| Hand 2 views (73120) |
$158 |
$315 |
1.6× |
| Hand 3 views (73130) |
$112 |
$224 |
1.3× |
| Humerus Min 2 Views Left (73060) |
$112 |
$224 |
1.3× |
| Knee 3 views (73562) |
$112 |
$224 |
1.3× |
| MRI abdomen w contrast (74182) |
$1,214 |
$2,427 |
3.6× |
| MRI abdomen w/o & w/contrast material (74183) |
$1,214 |
$2,427 |
3.6× |
| MRI abdomen w/o contrast (74181) |
$1,214 |
$2,427 |
5.3× |
| MRI any jnt lwr ext with con lt (73722) |
$787 |
$1,574 |
1.0× |
| MRI any jt upper extremity w/contrast matrl (73222) |
$750 |
$1,499 |
1.0× |
| MRI bone marrow blood supply (77084) |
$1,018 |
$2,035 |
4.4× |
| MRI c-spine with contrast (72142) |
$1,400 |
$2,800 |
4.2× |
| MRI cardiac w/o contrast (75557) |
$1,018 |
$2,035 |
4.4× |
| MRI cervical spine w/o contrast (72141) |
$1,300 |
$2,600 |
5.7× |
| MRI chest w/o & w/contrast material (71552) |
$1,950 |
$3,900 |
5.8× |
| MRI chest w/o contrast (71550) |
$1,300 |
$2,600 |
5.7× |
| MRI chest with contrast (71551) |
$1,400 |
$2,800 |
1.9× |
| MRI Forearm w/ Contrast Bilateral 73219 (73219) |
$1,018 |
$2,035 |
3.0× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$1,018 |
$2,035 |
3.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,018 |
$2,035 |
4.4× |
| MRI orbit face &/neck w/o contrast (70540) |
$1,300 |
$2,600 |
5.7× |
| MRI orbit/face/neck w&w/o cont (70543) |
$1,950 |
$3,900 |
5.8× |
| MRI orbit/face/neck w/contrast (70542) |
$1,400 |
$2,800 |
4.2× |
| MRI pelvis w contrast (72196) |
$1,018 |
$2,035 |
3.0× |
| MRI pelvis w/o & w/contrast material (72197) |
$1,187 |
$2,373 |
3.5× |
| MRI pelvis w/o contrast (72195) |
$1,018 |
$2,035 |
4.4× |
| MRI scan of arm joint before and after contrast (73223) |
$1,085 |
$2,170 |
3.2× |
| MRI scan of leg joint before and after contrast (73723) |
$1,140 |
$2,279 |
3.4× |
| MRI spectroscopy (76390) |
$1,018 |
$2,035 |
12.2× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$1,950 |
$3,900 |
5.8× |
| MRI spinal canal lumbar w/contrast material (72149) |
$1,400 |
$2,800 |
4.2× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$1,117 |
$2,234 |
3.3× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$1,400 |
$2,800 |
4.2× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$1,950 |
$3,900 |
5.8× |
| MRI thoracic spine w/o contrast (72146) |
$1,300 |
$2,600 |
5.7× |
| MRI tmj (70336) |
$628 |
$1,255 |
2.7× |
| MRI upper ext joint w/o contrast (73221) |
$686 |
$1,372 |
3.0× |
| MRI upper extrem other than jt w/o & w/contras (73220) |
$1,125 |
$2,250 |
3.4× |
| MRI upper extremity oth than jt w/o contr matrl (73218) |
$1,018 |
$2,035 |
4.4× |
| Neck soft tissue (70360) |
$168 |
$336 |
2.0× |
| Pelvis 1 or 2 views (72170) |
$141 |
$281 |
1.4× |
| Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Age Under 21 (78110) |
$2 |
$3 |
0.0× |
| Pr MRI, lower extr, w/o contrast f/u by contrast (73720) |
$1,160 |
$2,319 |
3.5× |
| Pr red cell survival study (78130) |
$2 |
$3 |
0.0× |
| Radex hips bilateral with pelvis 2 views (73521) |
$141 |
$281 |
1.4× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$112 |
$224 |
1.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$141 |
$281 |
1.4× |
| Radiologic Exam Chest 2 Views - Xr Chest 2 Views (71046) |
$168 |
$336 |
2.0× |
| Radiologic Examination Femur Minimum 2 Views - Xr Femur 2+ Vw Lt (73552) |
$112 |
$224 |
1.3× |
| Red Cell Volume Determination Spx 1 Sampling (78120) |
$2 |
$3 |
0.0× |
| Ribs bilateral 3 views (71110) |
$168 |
$336 |
1.7× |
| Sacroiliac Joints < 3 Views (72200) |
$141 |
$281 |
1.4× |
| Scapula complete (73010) |
$141 |
$281 |
1.4× |
| Sialogram (70390) |
$25 |
$50 |
0.1× |
| Spine thoracic 3 views (72072) |
$196 |
$392 |
1.9× |
| Ultrasound, abdomen limited (76705) |
$259 |
$518 |
2.6× |
| Urography (pyelography), intravenous, with or without KUB, with or without tomography (74400) |
$612 |
$1,223 |
3.6× |
| Us pelvic non ob complete (76856) |
$259 |
$518 |
2.6× |
| Us retroperitoneal complete (76770) |
$259 |
$518 |
2.6× |
| Us retroperitoneal limited (76775) |
$259 |
$518 |
2.6× |
| Wrist 2 views (73100) |
$112 |
$224 |
1.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$141 |
$281 |
1.4× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$112 |
$224 |
1.3× |
| X-Ray Ankle 3+ Vw - Xr Ankle 3+ Views Right (73610) |
$112 |
$224 |
1.3× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$112 |
$224 |
1.3× |
| X-ray exam hip uni 1 view (73501) |
$112 |
$224 |
1.3× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$112 |
$224 |
1.3× |
| X-Ray Facial Bones 3+ Vw - Xr Facial Bones 3+ Views (70150) |
$224 |
$448 |
2.2× |
| X-Ray Foot 3+ Vw - Xr Foot 3+ Views Right (73630) |
$112 |
$224 |
1.3× |
| X-Ray Heel - Xr Calcaneus 2 Views Right (73650) |
$112 |
$224 |
1.3× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$112 |
$224 |
1.3× |
| X-Ray Knee 4+ View - Xr Knee 4+ Views Right (73564) |
$224 |
$448 |
2.2× |
| X-Ray Lumbar Spine Flex/Exten - Xr Lumbar Spine 4+ Views W/ Flex Ext (72120) |
$168 |
$336 |
1.7× |
| X-Ray Nasal Bones - Xr Nasal Bones (70160) |
$112 |
$224 |
1.3× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$168 |
$336 |
1.7× |
| X-Ray Pelvis 3+ Vw - Xr Pelvis 3+ Views (72190) |
$141 |
$281 |
1.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$112 |
$224 |
1.3× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$9.50 |
$18 |
0.1× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$112 |
$224 |
1.3× |
| X-Ray Shoulder 2+ Vw - Xr Shoulder 2+ Views Right (73030) |
$168 |
$336 |
2.0× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$112 |
$224 |
1.3× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$224 |
$448 |
2.2× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$196 |
$392 |
1.9× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$112 |
$224 |
1.3× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$112 |
$224 |
1.3× |
| X-Ray Teeth Single - Xr Teeth 1 View (70300) |
$38 |
$75 |
0.5× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$168 |
$336 |
1.7× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$224 |
$448 |
2.2× |
| X-Ray Toe(S) - Xr Toes 2+ Views Right (73660) |
$112 |
$224 |
1.3× |
| X-Ray Wrist 3+ Vw - Xr Wrist 3+ Views Right (73110) |
$112 |
$224 |
1.3× |
| Xr c-spine 6 or more views (72052) |
$168 |
$336 |
1.7× |
| Xr chest 4+ views (71048) |
$224 |
$448 |
2.2× |
| Xr finger(s) 2+ views (73140) |
$112 |
$224 |
1.3× |
| XR Mastoids < 3 Views Bilateral (70120) |
$196 |
$392 |
1.9× |
| Xr shoulder 1 view (73020) |
$112 |
$224 |
1.3× |
| Xr spine cervical 4 or 5 views (72050) |
$168 |
$336 |
1.7× |
| Xr tibia/fibula 2 views (73590) |
$112 |
$224 |
1.3× |
| Xr tmj bilateral (70330) |
$112 |
$224 |
1.3× |
| Xray knee 1 or 2 views rt (73560) |
$112 |
$224 |
1.3× |